Citation Nr: 25003705 Decision Date: 03/19/25 Archive Date: 03/19/25 DOCKET NO. 17-63 067 DATE: March 19, 2025 REMANDED Entitlement to a higher initial rating for dysphagia for solids and liquids, rated noncompensable prior to May 7, 2018, and 30 percent thereafter is remanded. REASONS FOR REMAND The Veteran served on active duty from September 1966 to September 1969. He died in August 2022. The appellant has been substituted for the Veteran. This matter comes to the Board of Veterans' Appeals (Board) on appeal from a February 2017 rating decision by a Regional Office (RO) of the Department of Veterans Affairs (VA). This matter was remanded in May 2019, July 2022, and September 2024 further development. 1. Entitlement to a higher initial rating for dysphagia for solids and liquids, rated noncompensable prior to May 7, 2018, and 30 percent thereafter is remanded. While the Board sincerely regrets the additional delay, this case must be remanded to ensure compliance with the prior remand directives. In the May 2019 and July 2022 remands, the Board directed that an examination be held to evaluate all of the Veteran's residuals of his tonsil squamous cell cancer, to specifically include consideration of whether he had paralysis of any of the facial nerves; and whether this paralysis resulted in symptomatology that overlapped with his dysphagia and loss of taste, or whether they had distinct symptoms which would warrant their own, separate rating/s. The Board specifically noted that the April 2017 VA cranial nerves examination report showed diagnoses of bilateral incomplete moderate paralysis of the cranial nerve V (trigeminal), cranial nerve VII (facial), and cranial nerve IX (glossopharyngeal). As indicated in the May 2019 and July 2022 remands, the Veteran attended VA examinations in July 2019 and in December 2021 to evaluate his loss of sense of taste and his dysphagia, but no evaluation or discussion was made of his facial nerve paralysis at either exam. The Veteran died in August 2022 after the July 2022 remand. The Veteran's claims file was therefore sent to a VA examiner for review and response in March 2024. The examiner was to indicate (based on comprehensive review of the claims file) whether the Veteran had had any facial paralysis that manifested in symptoms separate from his loss of taste and dysphagia. In March 2024, a VA examiner completed a disability benefits questionnaire and noted "Veteran is deceased. With this in mind, this DBQ was completed based off of medical records provided by the VA only." Despite reportedly basing the assessment on the medical records provided by the VA, the examiner indicated that the Veteran did not have facial paralysis. The examiner did not attempt to reconcile this assessment with the April 2017 VA cranial nerves examination report which showed diagnosis of bilateral incomplete moderate paralysis of the cranial nerve V (trigeminal), cranial nerve VII (facial), and cranial nerve IX (glossopharyngeal). The failure to reconcile this apparent discrepancy in the record evidence renders the examination report and finding inadequate. Further, in a seemingly contradictory assessment offered in a June 2024 examination report, the examiner stated, "Records show dry mouth, residual edema (swelling), dysphagia, and loss of taste (presumably from treatment and dry mouth). Significant dysphagia as required daily pilocarpine to increase saliva in the mouth. Records do not otherwise indicate severity of facial nerve paralysis." Thus, while the Board sincerely regrets the additional delay, the matter must be returned to the RO to obtain a responsive opinion. See Stegall v. West, 11 Vet. App. 268, 271 (1998). The matter is REMANDED for the following action: Obtain an addendum opinion from an appropriate physician or specialist regarding the Veteran's dysphagia and facial paralysis associated with his tonsil squamous cell carcinoma residuals prior to his death. The examiner is advised that bilateral incomplete moderate paralysis of the Veteran's cranial nerve V (trigeminal), cranial nerve VII (facial), and cranial nerve IX (glossopharyngeal) was identified upon VA cranial nerves examination in April 2017. The examiner is asked to clarify whether the bilateral incomplete moderate paralysis of the Veteran's cranial nerve V (trigeminal), cranial nerve VII (facial), and cranial nerve IX (glossopharyngeal), identified during the April 2017 VA cranial nerves examination resulted in either: a) overlapping symptomatology, including loss of taste or dysphagia; or, b) distinct residuals which would potentially be compensable under an alternate diagnostic code regarding disease of the cranial nerves. The examiner must specifically indicate whether the Veteran had any facial paralysis which manifested in symptoms separate from his loss of taste and dysphagia. If so, those symptoms must be identified. A complete and fully explanatory rationale must be provided. If the examiner determines that the Veteran did not have any facial paralysis involving the cranial nerves, he or she must reconcile this finding with the April 2017 VA cranial nerves examination report, and explain this apparent discrepancy, to the extent possible. If the requested opinion and findings cannot be rendered without resorting to speculation, the examiner must explain why. D. JOHNSON Veterans Law Judge Board of Veterans' Appeals Attorney for the Board M. Prem, 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.