Citation Nr: 25001850 Decision Date: 02/06/25 Archive Date: 02/06/25 DOCKET NO. 19-10 801 DATE: February 6, 2025 REMANDED The issue of entitlement to service connection for a dental disability for compensation benefits is remanded. REASONS FOR REMAND The Veteran served on active duty from June 1966 to October 1969. In December 2020, the Veteran testified under oath at a virtual hearing before the undersigned Veteran's Law Judge. A transcript of the hearing is of record. In January 2024, the Board remanded the appeal for additional development. For the reasons detailed below, the Board finds that remand is again needed in this matter. Entitlement to service connection for a dental disability for compensation benefits. The Board finds that additional development is needed prior to final adjudication of the issue on appeal. First, the Board finds that there may be outstanding treatment records to obtain and associate with the claim file. For example, the March 2021 VA examination report for Oral and Dental Conditions Including Mouth, Lips, and Tongue (Other Than Temporomandibular Disorder Conditions) (VA Examination Report) states: "2 years ago, he went to the [redacted] for pain and had received antibiotics for it." VA Examination Report, March 2021. The Board does not see these treatment records in the claim file. Accordingly, the Board asks that they be associated with the claim file. In addition, the Board notes that in the January 2024 remand, the Board directed that the Veteran be notified of the status of a records request and be "provided the appropriate VA forms." BVA Remand, January 2024. The Board acknowledges that a VA letter was sent to the Veteran in January 2024, following the remand, with VA Forms 21-4142 and 21-4142a enclosed. However, the Board does not see that a response was received from the Veteran. As the Board is again remanding the appeal, it will afford the Veteran a new opportunity to identify any outstanding records. Finally, the Board asks that the Veteran be scheduled for a new medical examination and that a new medical opinion be obtained. In particular, the Board seeks clarification as to whether the Veteran has a disability for which service connection for compensation may be granted. The March 2021 VA Examination Report states: "Abscesses present on the lower anteriors seen radiographically." VA Examination Report, March 2021. The VA Examination Report also states: "Used to grind his teeth before in his sleep." VA Examination Report, March 2021. The Board seeks clarification of the following: (1) whether these identified abscesses are an infection of the bone that results in tooth loss; (2) whether the Veteran's teeth grinding is a manifestation of the Veteran's service-connected post-traumatic stress disorder (PTSD); and (3) if "yes" as to both, whether it is at least as likely as not that the teeth grinding led to the abscesses. Also, the Board does not see that an individual longitudinal exposure record (ILER) was associated with the claim file. The Board asks that this be completed upon remand, if possible, as well as any development needed to determine if the Veteran participated in a toxic exposure risk activity (TERA). Thereafter, if it is determined that the Veteran participated in a TERA, the Board asks that a medical opinion be obtained in compliance with 38 U.S.C. § 1168. The matter is REMANDED for the following action: 1. After securing any necessary consent forms from the Veteran, obtain any outstanding treatment records, to include any private and/or VA records, to include any relevant records contained in VistA Imaging, pertaining to the issue on appeal. In particular, the Board notes that the March 2021 VA Examination Report states: "2 years ago, he went to the [redacted] for pain and had received antibiotics for it." VA Examination Report, March 2021. The Board does not see these treatment records in the claim file. Accordingly, the Board asks that they be associated with the claim file. In addition, the Board notes that in the January 2024 remand, the Board directed that the Veteran be notified of the status of a records request and be "provided the appropriate VA forms." BVA Remand, January 2024. The Board acknowledges that a VA letter was sent to the Veteran in January 2024, following the remand, with VA Forms 21-4142 and 21-4142a enclosed. However, the Board does not see that a response was received from the Veteran. As the Board is again remanding the appeal, it will afford the Veteran a new opportunity to identify any outstanding records. In addition, the Board does not see that an ILER was associated with the claim file. The Board asks that this be completed upon remand, if possible, as well as any development needed to determine if the Veteran participated in a TERA. Obtain all necessary consent. All efforts should be documented in the claim file. If any records could not be obtained, this should be noted in the claim file. 2. Upon completion of the above, schedule the Veteran for a medical examination in order to clarify the Veteran's diagnosis. Specifically, the Board asks that the Veteran be examined to determine if his claimed dental disability is a disability pursuant to 38 C.F.R. § 4.150. If the Veteran has such a disability, the examiner is asked to obtain the following medical opinions: (a) Is it at least as likely as not (likelihood is at least approximately balanced or nearly equal, if not higher) that the disability is related to service? (b) Is it at least as likely as not (likelihood is at least approximately balanced or nearly equal, if not higher) that the disability is due to or the result of or aggravated (defined as any increase in disability) by the Veteran's service-connected diabetes mellitus, type II. In addition, the examiner is asked to address the following: (c) Is it at least as likely as not (likelihood is at least approximately balanced or nearly equal, if not higher) that the "Abscesses present on the lower anteriors seen radiographically", noted in the March 2021 VA Examination Report, are an infection of the bone that results in tooth loss? VA Examination Report, March 2021. (d) Is it at least as likely as not (likelihood is at least approximately balanced or nearly equal, if not higher) that the Veteran's teeth grinding is a manifestation of the Veteran's service-connected PTSD. (e) If "yes" to (c) and (d), then is it at least as likely as not (likelihood is at least approximately balanced or nearly equal, if not higher) that the infection of the bone that results in tooth loss is due to or the result of or aggravated (defined as any increase in disability) by the Veteran's teeth grinding? In addition, where appropriate, the Veteran should be provided a TERA examination, and a compliant opinion should be obtained. 38 U.S.C. § 1168. Obtain all necessary consent. The examiner should be given access to the claim file. The examiner should state that a review of the claim file was completed. The examiner must provide a comprehensive report including complete rationales for all opinions and conclusions reached, citing the objective medical findings leading to the conclusions. A detailed rationale is requested for all opinions provided. ? 3. If upon completion of the above action the issue is denied, the case should be returned to the Board after compliance with appellate procedures. E. I. VELEZ Veterans Law Judge Board of Veterans' Appeals Attorney for the Board K. Foster, 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.