Citation Nr: 18141311 Decision Date: 10/11/18 Archive Date: 10/10/18 DOCKET NO. 13-35 198 DATE: October 11, 2018 ORDER Entitlement to residuals of dental trauma, to include a left maxillary cyst, for compensation purposes is denied. FINDING OF FACT The competent evidence indicates that the Veteran does not have a dental disability for which service connection for compensation may be granted. CONCLUSION OF LAW The criteria for entitlement to residuals of dental trauma, to include a left maxillary cyst, for compensation purposes have not been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.303, 3.381, 4.150. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran had active duty from August 1989 to August 1993. The Board previously remanded this claim as well as the claim for service connection for alcohol abuse, including as secondary to posttraumatic stress disorder (PTSD) in September 2017. In July 2018, the claim for service connection for alcohol abuse was granted as part of the Veteran’s already service connected-posttraumatic stress disorder. That action constituted a full grant of the benefits sought, and the claim for service connection for alcohol abuse is no longer on appeal. Grantham v. Brown, 114 F.3d 1156 (Fed. Cir. 1997). The Veteran asserts that he has residuals of dental trauma resulting from an assault in boot camp in which he sustained nasal trauma, loss of a left upper tooth and a loose rivet from a prior jaw surgery. See April 2008 VA Form 21-4142. Specifically, he states that his current left maxillary cyst is due to the assault in service. He was afforded a VA examination in November 2013; the examiner was unable to provide an opinion without resorting to speculation, but did not provide a rationale for that conclusion. Therefore, the Board remanded this claim for an addendum opinion. Unfortunately, the evidence of record, including the newly obtained February 2018 VA examination and opinion, fails to establish that service connection is warranted for this claim. Initially, the Board observes that service connection is established when the following elements are satisfied: (1) the existence of a current disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the current disability and the disease or injury incurred or aggravated during service. 38 C.F.R. § 3.30(a); Walker v. Shinseki, 708 F.3d 1331(Fed. Cir. 2012); Shedden v. Principi, 381 F.3d 1163 (Fed. Cir. 2004). Dental disorders, however, are treated differently than other medical disorders in the VA benefits system. See 38 U.S.C. § 1712; 38 C.F.R. §§ 3.381, 17.161. As provided by VA regulations, treatable carious teeth, replaceable missing teeth, dental or alveolar abscesses and periodontal disease are not considered disabling conditions, and may be considered service-connected solely for establishing eligibility for VA outpatient dental treatment. See 38 C.F.R. § 3.381(a). Under current VA regulations, compensation is only available for certain types of dental and oral conditions listed under 38 C.F.R. § 4.150. These conditions include various problems of the maxilla, mandible, or temporomandibular articulation, loss of whole or part of the ramus, loss of the condyloid process or coronoid process, loss of the hard palate, or loss of teeth due to loss of substance of the body of the maxilla or mandible due to trauma or disease such as osteomyelitis rather than as a result of periodontal disease. See id. Therefore, in the absence of a claim for any of these disabilities, or evidence that the Veteran has such disabilities, as is the case here, service connection for compensation purposes for a dental disability or condition is not warranted. See id. Here, the Veteran’s service treatment records (STRs) dated August 1989 reflect that prior to his active duty, he had a history of facial trauma status post orthodontic treatment and placement plates in maxillary sinus area. Additionally, a November 1989 STR and emergency room treatment record, reveal that the Veteran was treated for an injury to the nose and mouth during a physical altercation. As a result, he lost tooth number 9 and had acute upper lip bruising. A facial X-ray, however, was negative for nasal or jaw fracture. These records also show that tooth number 9 was replaced with a prosthesis. The February 2018 VA examiner observed that the Veteran was missing tooth number 9. The Veteran reported that he had numbness in his upper lip since the fight in 1989. He also stated that he lost the flipper for tooth number 9 in 2013. In addition, the examiner observed that tooth number 1 had an abscessed, non- restorable root tip and tooth number 31 had an occlusal amalgam that had fallen out. She also indicated that the Veteran had a maxilla dental condition, a history of a nasal cyst and subjective complaints of upper lip numbness. Based on physical examination of the Veteran, his statements and the evidence of record, the examiner opined it was as least as likely as not that the Veteran’s dental condition was due to his active service, specifically, the November 1989 altercation. She, however, clarified that the only dental condition linked to the November 1989 altercation in service was the missing tooth number 9. Otherwise, the examiner stated that there was no objective evidence of any other dental condition stemming from the November 1989 altercation. In reaching this conclusion, the examiner observed that the after the Veteran was punched in the nose and mouth, he sustained injuries, which included loss of tooth number 9 and swelling of the nose. She noted that X-rays of the facial and nasal bones were negative for fractures. Even though the examiner noted that the Veteran had a history of a nasal cyst, which could not be evaluated by dental, she, nevertheless, stated that her current examination of the Veteran, revealed no residual swelling or objective evidence of a chronic condition resulting from the November 1989 altercation. She further commented that there was no objective evidence substantiating the Veteran’s complaint of numbness of the upper lip. Additionally, she observed that the Veteran’s panographic X-ray, conducted in conjunction with the current examination, revealed no evidence of a maxillary cyst, which would require CT scan for validation of a new cyst formation since his maxillary cyst/cyst wall were removed in 2011. Moreover, the examiner opined that there was clear and unmistakable evidence of that the Veteran had a preexisting medical condition. She reiterated that the objective evidence of record failed to substantiate that the Veteran developed a chronic dental condition from the November 1989 altercation besides the lost. She also observed that the Veteran’s treatment records showed that after discharge from service, he was treated and diagnosed with facial trauma/metal plates maxillary sinus condition, which was unrelated to his active duty. The examiner pointed out that the maxillary cyst was associated with a missed placed screw with associated surrounding cyst/inflammation, documented in the Veteran’s VA medical treatment records. The examiner also noted that the anterior plate was intact and within normal levels. Additionally, she stated that there was no evidence of permanent aggravation beyond normal progression identified. Accordingly, the probative evidence of record precludes granting service connection for residuals of a dental condition due to the November 1989 in-service altercation or any events of service. While the Veteran is competent and credible to report the symptoms he observed, any opinion regarding the nature and etiology of any dental condition requires medical expertise that the Veteran has not demonstrated. See Jandreau v. Nicholson, 492 F. 3d. 1372, 1376 (2007). Here, the expert opinion obtained fails to establish the required relationship between the any currently diagnosed dental condition and his military service. Thus, the evidence of record is insufficient to substantiate the claim for service connection for residuals of a dental condition, including a left maxillary cyst. See Madden v. Gober, 125 F.3d 1477, 1480-81 (Fed. Cir. 1997) (explicitly rejecting the argument that “the Board must accept a veteran’s evidence at face value, and reject or discount it only on the basis of rebuttal evidence proffered by the agency” and holding that the Board must determine “the weight and probity of evidence in the light of its own inherent characteristics and its relationship to other items of evidence”). The Board is grateful to the Veteran for his honorable service, and regrets that it cannot render a favorable decision in this matter. The preponderance of the evidence is against the Veteran’s claim. Consequently, the benefit-of-the-doubt rule does not apply, and service connection for residuals of dental trauma, including a maxillary cyst, is denied. See 38 U.S.C. 5107; 38 C.F.R. 3.102; Gilbert v. Derwinski, 1 Vet. App. 49, (1990). DELYVONNE M. WHITEHEAD Acting Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD N. Sangster, Counsel