Citation Nr: 18142769 Decision Date: 10/17/18 Archive Date: 10/16/18 DOCKET NO. 15-16 883 DATE: October 17, 2018 ORDER Entitlement to service connection for a dental disability for compensation purposes is denied. REMANDED Entitlement to a rating more than 20 percent for right lower extremity neuropathy is remanded. Entitlement to a rating more than 10 percent for degenerative disc disease, status-post laminectomy lumbar spine is remanded. Entitlement to a rating more than 30 percent for Crohn’s disease with migrating polyarthralgia is remanded. Entitlement to a rating more than 30 percent for chronic migraine headaches is remanded. Entitlement to an effective date earlier than February 27, 2012, for the assignment of a 20 percent rating for radiculopathy, right lower extremity is remanded. Entitlement to a total disability rating based upon individual unemployability (TDIU) due to service-connected disabilities is remanded. FINDING OF FACT The Veteran does not have a dental disability for which service connection for compensation purposes may be granted. CONCLUSION OF LAW The criteria for entitlement to service connection for a dental disability for VA compensation purposes have not been met. 38 U.S.C. §§ 101(24), 1110, 1712, 5107; 38 C.F.R. §§ 3.6(a), 3.102, 3.303, 4.150. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran had active military service from June 2002 to June 2005. This matter is before the Board of Veterans’ Appeals (Board) on appeal from a rating decision by the Department of Veterans Affairs (VA) Regional Office (RO). Entitlement to service connection for a dental disability Under current legal authority, compensation is only available for certain types of dental and oral conditions, such as impairment of the mandible, loss of a portion of the ramus, and loss of a portion of the maxilla. See 38 C.F.R. § 4.150. Compensation is available for loss of teeth only if such loss is due to loss of substance of the body of the maxilla or mandible during service due to trauma or disease such as osteomyelitis, and not to the loss of the alveolar process because of periodontal disease. 38 C.F.R. § 4.150, Code 9913 (Note). Treatable carious teeth, replaceable missing teeth, dental or alveolar abscesses, and periodontal disease cannot be service-connected for purposes of compensation. 38 C.F.R. § 3.381. In the instant case, although the Veteran is competent to report experiencing symptoms of a tooth disorder because of medications he takes for a service-connected disability, there is no documented evidence of any in-service injuries. Moreover, there is no evidence that the Veteran has a dental disorder for which compensation may be payable. Specifically, as indicated previously, compensation is available for loss of teeth only if such loss is due to loss of substance of the body of the maxilla or mandible during service due to trauma. Service dental records show the Veteran had missing teeth as well as cavities; however, there was no documented dental trauma. In support of the claim, the Veteran submitted internet documents that show possible relationship between the use of the medication Remicade (he currently takes for his service-connected Crohn’s disease) and a tooth disorder. He also submitted a statement from Dr. M.K. that shows the Veteran needed extraction because of possible infection associated with his Crohn’s disease. A different statement from Dr. J.T. documents she believes the Veteran’s dental condition of deep decay and broken teeth could have been affected by the medicines he takes for his Crohn’s disease. During the August 2012 VA dental examination, there was no dental disability shown. The examiner indicated that he reviewed the service dental records and it documents the Veteran had extensive caries (decay) on multiple teeth with poor oral hygiene and heavy plaque. A January 2005 service record shows the Veteran was not brushing daily and was drinking sprite constantly. Current x-rays show the Veteran was missing all maxillary teeth and many mandibular posterior teeth. There were no gross caries or pathology observed on remaining teeth. The examiner noted the Veteran reported that his teeth were extracted by VA in 2011 as there was a finding of gross caries on multiple teeth. He opined that the extractions were not related to side effects of medications for service-connected Crohn’s disease. The examiner found that the extractions relates to the poor oral hygiene and heavy use of soda pop while the Veteran was in the service. Although the Veteran has submitted evidence that shows a possible relationship between his teeth extractions and medication he takes for a service-connected disability, because he does not have a dental disorder for which VA compensation benefits are payable, the claim for service connection for a dental disorder for VA compensation purposes only, must be denied. In reaching this conclusion, the Board has considered the applicability of the benefit-of-the-doubt doctrine. However, as the preponderance of the evidence weighs against this claim, that doctrine is not applicable. See 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102. The Veteran has not presented, and the remaining evidence of record does not otherwise contain, competent evidence showing that he has a dental disability for which service connection for compensation purposes may be granted. Hence, the appeal in this matter must be denied. As a final point, the Board notes that this decision is limited to whether compensation benefits are warranted for the Veteran’s claimed dental condition. If he wishes to claim service connection for dental disability for purposes of potentially receiving dental treatment, he should address this claim to his local VA Medical Center. See, e.g., 38 C.F.R. § 17.161. REASONS FOR REMAND Increased ratings The record shows that the Veteran’s most recent VA examinations to assess the nature and severity of his Crohn’s disease, headaches, lumbar spine, and right lower extremity radiculopathy were over three years ago in January 2015. The evidence associated with the record indicates a possible worsening of those disabilities since that time. In an April 2017 correspondence, the Veteran reports that his disabilities have worsened since the last VA examination. Given the foregoing, the Board finds that more contemporaneous examinations are needed to fully and fairly evaluate the Veteran’s claim for higher ratings. Earlier effective date and TDIU Relevant to the earlier effective date and TDIU claims, the Board notes the issues are “inextricably intertwined” with the resolution of the increased rating claims on appeal here, and therefore, must be fully decided prior to adjudication of the earlier effective date and TDIU claims. See Harris v. Derwinski, 1 Vet. App. 180 (1991) The matters are REMANDED for the following action: 1. The RO should obtain and associate all outstanding treatment records relevant to the Veteran’s Crohn’s disease, headaches, lumbar spine, and right lower extremity radiculopathy disability since January 2015. 2. The Veteran should be afforded appropriate VA examination(s) to evaluate the current severity of his Crohn’s disease, migraine headaches, lumbar spine, and right lower extremity radiculopathy. The electronic file should be made available to the respective examiner(s) for review before the examination(s). All indicated tests and studies should be conducted at the respective examination(s). H.M. WALKER Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD M. McPhaull, Counsel