Citation Nr: 18143559 Decision Date: 10/19/18 Archive Date: 10/19/18 DOCKET NO. 16-30 443 DATE: October 19, 2018 REMANDED Entitlement to service connection for a jaw bone 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 the Department of Veterans Affairs (VA) Regional Office (RO) in Seattle, Washington. Entitlement to service connection for a jaw bone and dental disorder is remanded. The Veteran asserted in a May 2014 statement that his bone infection and loss of the number 9 and 10 teeth was due to his in-service root canals of the number 9 tooth. In this regard, the Board notes that the Veteran acknowledged a pre-service trauma to the number 9 tooth, but asserts that the in-service treatment caused an infection of the jaw bone due to bone decay; the Veteran stated that the root “cracked” which caused the resin filling to leak. The Veteran stated that he required extractions of the number 9 and 10 teeth, followed by a bone graft, implants, and crowns. Service treatment records reflect that the Veteran underwent treatment of the number 9 tooth, in July 1994 and August 1999; a history of trauma to the tooth was noted, and the Veteran underwent a root canal in July 1994. Post-service treatment records from Bella Smiles Family Dentistry confirm that the Veteran underwent extraction of the number 9 and 10 teeth due to extensive bony defect with periapical granuloma and missing facial bone; the Veteran also underwent a bone graft. Under current VA regulations, compensation is only available for certain types of dental and oral conditions listed under 38 C.F.R. § 4.150, such as impairment of the mandible, loss of a portion of the ramus, and loss of a portion of the maxilla. Compensation is available for loss of teeth only if such is due to loss of substance of body of maxilla or mandible due to trauma or disease such as osteomyelitis, but not periodontal disease. Otherwise, a Veteran may be entitled to service connection for dental conditions including treatable carious teeth, replaceable missing teeth, dental or alveolar abscesses, and periodontal disease, for the sole purposes of receiving VA outpatient dental services and treatment, if certain criteria are met. 38 U.S.C. § 1712; 38 C.F.R. §§ 3.381, 17.161; Simington v. West, 11 Vet. App. 41, 44 (noting the distinction between replaceable missing teeth which can be service connected for treatment purposes only and teeth lost “as a result of 'loss of substance of body of maxilla and mandible' which can be assigned ratings anywhere from 0 to 100 % for compensation purposes”). Although the Veteran’s trauma occurred prior to his in-service treatment for the number 9 tooth, and he sought dental treatment for the number 9 tooth in the years since service, it remains unclear whether the Veteran is diagnosed with a dental condition for which disability compensation may be provided; specifically, loss of teeth due to bone loss of the body of the maxilla or the mandible due to trauma or disease such as osteomyelitis, but not periodontal disease. See 38 C.F.R. §§ 4.150, Diagnostic Code 9913; 17.161(a) (2018). Moreover, although the Veteran’s service treatment records clearly reflect dental work, a remand is required so that a VA dental examination can be conducted. VA adjudicators may consider only independent medical evidence to support their findings; they may not rely on their own unsubstantiated medical conclusions. If the medical evidence of record is insufficient, VA is always free to supplement the record by seeking an advisory opinion, or ordering a medical examination to support its ultimate conclusions. See Colvin v. Derwinski, 1 Vet. App. 171 (1991). Therefore, additional clinical assessment and medical opinion is necessary to adequately address the Veteran’s claim of entitlement to service connection. Accordingly, the Board finds that the Veteran should be afforded a VA examination in order to determine nature and etiology of the Veteran’s claimed dental disability. See McClendon v. Nicholson, 20 Vet. App. 79 (2006). The matter is REMANDED for the following action: 1. The RO should request that the Veteran provide sufficient information and authorization to enable it to obtain any additional evidence pertinent to the claim for service connection for loss of all teeth, including, but not limited to all available dental treatment records since April 2000. 2. After any additional records are associated with the claims file, the RO should schedule the Veteran for a VA dental examination. 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. The examiner should also render an opinion, based on the entire medical history, as to whether it is at least as likely as not (50 percent probability or more) that any of the Veteran’s currently diagnosed dental disability is a result of the Veteran’s dental treatment during his service. The VA examiner is reminded that the Veteran conceded that the trauma to the number 9 tooth clearly and unmistakably preexisted service. As such, the VA examiner should only address the following: whether there is clear and unmistakable evidence that the Veteran’s current dental disorder was not aggravated in service, i.e., whether there is clear and unmistakable evidence that it 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 should specifically address the Veteran’s contentions that the in-service root canals caused the Veteran’s jaw bone infection and subsequent extractions and bone grafts. A complete rationale, with specific reference to the relevant evidence of record, should accompany each opinion provided. (Continued on the next page)   3. After completing any additional notification or development deemed necessary, the Veteran’s claim should be readjudicated. If the claim remains denied, the Veteran should be furnished with a supplemental statement of the case and afforded a reasonable opportunity for response. Gayle Strommen Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD Hallie E. Brokowsky, Counsel