Citation Nr: 21032002 Decision Date: 05/25/21 Archive Date: 05/25/21 DOCKET NO. 16-30 443 DATE: May 25, 2021 REMANDED Entitlement to service connection for a jawbone and dental disorder for compensation purposes is remanded. REASONS FOR REMAND The Veteran had active duty service in the U.S. Air Force from October 1986 to April 2000. This matter comes before the Board of Veterans' Appeals (Board) on an appeal of a December 2014 rating decision issued by a Department of Veterans Affairs (VA) Regional Office. In October 2018, the Board remanded the Veteran's claim for further development. Entitlement to service connection for a jawbone and dental disorder for compensation purposes is remanded. The Board previously remanded this claim so a VA examination could be obtained. In September 2019, the Veteran was afforded the requested examination. At that time, the Veteran reported that he broke the number 9 tooth prior to entering the military. The Veteran asserted that poor dentistry during service led to a root canal failure and subsequent dental implants. The examiner diagnosed the Veteran with loss of less than 25 percent of the maxilla, loss of teeth, and anatomical loss or injury of the mouth, lips, or tongue, but opined that the Veteran's condition was less likely than not (less than 50 percent probability) incurred in or caused by the claimed in-service injury, event, or illness. The examiner stated that root canals can often fail, which is an accepted risk of the procedure. The examiner noted that the Veteran had previously suffered from a trauma to his tooth. The examiner explained that she was unable to determine if the Veteran's in-service root canal was performed properly because she did not have access to radiographs or the teeth themselves, because they were extracted. She stated that unless the root canal was evaluated and found to be below the standard of care then she did not feel that the military service caused the current situation. The examiner stated that the failure could have occurred due to the dental work, the previous trauma to the tooth (if it cracked down the root), or lack of care in the years following the root canal. She stated that it is not uncommon for root canals to fail years later. However, the examiner reiterated that there was absolutely no way for her to establish what the cause was, because the teeth were extracted, and she did not have any radiographs to examine. Once the Secretary undertakes the effort to provide an examination when developing a service connection claim, he must provide an adequate one. See Barr v. Nicholson, 21 Vet. App. 303, 311 (2007). Based on the medical opinion provided, it is unclear if the September 2019 examiner evaluated the pre-extraction x-rays that were provided in a May 2014 submission from Bella Smiles Family Dentistry, or if the examiner determined that these copies were inadequate for purposes of assessing the cause of the Veteran's failed root canal treatment. Additionally, although the September 2019 examiner diagnosed the Veteran with loss of teeth, she did not complete the portion of the disability benefits questionnaire indicating whether the loss of teeth was due to loss of substance of the body of the maxilla or trauma or disease (such as osteomyelitis). Finally, the examiner did not provide an opinion on whether there is clear and unmistakable evidence that the Veteran's current dental disorder was not aggravated in service as the Board requested in its October 2018 remand. Thus, another remand is required to address these deficiencies in the prior opinion. In addition, although the Veteran's in-service dental treatment records are associated with the claims file, it appears his in-service dental x-rays are not. An attempt to obtain those x-rays must also be made on remand. The matter is REMANDED for the following action: 1. Obtain any outstanding service treatment records, including the x-rays that are referenced in the Veteran's in-service dental treatment records. 2. After performing the development listed above, forward the expanded record, including this remand, to an endodontist, if available, or another appropriate clinician, to provide an addendum opinion. No examination of the Veteran is necessary unless the clinician deems it necessary. The clinician must review the expanded record and discuss the following: (a.) Whether it is at least as likely as not (50 percent probability or more) that any of the Veteran's currently diagnosed dental disabilities are a result of the Veteran's dental treatment during his service. The VA examiner should identify the Veteran's current dental disabilities and should specifically indicate whether the Veteran has loss of teeth due to bone loss of the body of the maxilla or the mandible due to trauma or disease such as osteomyelitis. (b.) Whether there is clear and unmistakable evidence that the Veteran's current dental disorders were not aggravated in service; i.e., whether there is clear and unmistakable evidence that they did not increase in disability during service beyond that due to the natural progress of the trauma to the number 9 tooth. The VA examiner is reminded that the Veteran conceded that the trauma to the number 9 tooth clearly and unmistakably preexisted service. The VA examiner should specifically address the Veteran's contentions that the in-service root canals caused the Veteran's jawbone infection and subsequent extractions and bone grafts. A complete rationale, with specific reference to the relevant evidence of record, should accompany each opinion provided. L. STEPANICK Acting Veterans Law Judge Board of Veterans' Appeals Attorney for the Board M. Quist Associate Counsel The Board's decision in this case is binding only with respect to the instant matter decided. This decision is not precedential and does not establish VA policies or interpretations of general applicability. 38 C.F.R. § 20.1303.