Citation Nr: 18143971 Decision Date: 10/22/18 Archive Date: 10/22/18 DOCKET NO. 16-09 019 DATE: October 22, 2018 ORDER 1. Entitlement to service connection for a dental condition for VA compensation purposes is denied. 2. Entitlement to service connection for a dental condition for VA dental treatment purposes is granted. FINDINGS OF FACT 1. The Veteran does not have a current dental disability due to trauma or injury incurred during active service. 2. The Veteran’s teeth #7, #8, and #10 were normal at entry and later had temporary crowns placed after more than 180 days of active service. 3. The Veteran’s tooth #9 was carious but restorable at entry and later had a new caries that developed after more than 180 days of active service and required a temporary crown. 4. The Veteran’s tooth #14 was noted as filled at entry and was later replaced by a crown after more than 180 days of active service. 5. The Veteran’s tooth #18, which was noted at entry under planned treatment for prosthesis, was later found questionably restorable, extracted after 180 days of active service, and treated with stage I and II implant surgery. 6. The Veteran’s tooth #19 was not noted as carious, filled, or non-restorable at entry (though it was noted at entry under planned treatment for prosthesis); it was later treated with a crown after more than 180 days of active service. CONCLUSIONS OF LAW 1. The criteria for service connection for a dental condition for VA compensation purposes have not been met. 38 U.S.C. §§ 1110, 5107 (2012); 38 C.F.R. §§ 3.303, 4.150 (2017). 2. The criteria for entitlement to Class II VA outpatient dental treatment have been met for teeth #7, #8, #9, #10, #14, #18 and #19. 38 U.S.C. § 1712 (2012); 38 C.F.R. §§ 3.381, 4.150, 17.161(b) (2017). REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran had active service from January 2010 to January 2014. 1. Entitlement to service connection for a dental condition for VA compensation purposes. 2. Entitlement to service connection for a dental condition for VA dental treatment purposes. Service connection may be granted for a disability resulting from a disease or injury incurred in or aggravated by active service. To establish a right to compensation for a present disability, a Veteran must show: (1) the existence of a present disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the present disability and the disease or injury incurred or aggravated during service. Dental disorders are treated differently than other medical disorders in the VA benefits system. 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. To warrant compensation for a dental disability, as opposed to treatment only, the evidence must show that a trauma has caused a loss of substance of the body of the maxilla or mandible resulting in a loss of teeth, or that disease (such as osteomyelitis, but not periodontal disease) has caused a loss of substance of the body of the maxilla or mandible resulting in a loss of teeth. Absent a demonstration of dental trauma, service connection may be considered solely for the purpose of determining entitlement to dental examinations or outpatient dental treatment. In that case, treatable carious teeth, replaceable missing teeth, dental or alveolar abscesses, and periodontal disease will be considered service-connected solely for the purpose of establishing eligibility for outpatient dental treatment in accordance with 38 C.F.R. § 17.161 (2017). See 38 C.F.R. § 3.381 (2017). The Veteran submitted his claim for service connection for a dental condition in July 2013 under the Benefits Delivery at Discharge (BDD) program, prior to his January 2014 discharge from active service. He contends generally that his claimed dental problems began during active service when he received dental treatment that was not completed prior to discharge. In March 2015, the Veteran reported that following his discharge in January 2014, he was left with an incomplete dental file, including 4 front teeth that are temporary, a molar implant, and 2 missing molars that dentists broke while doing root canals upon discharge; he further stated that a VA dentist told him that the work would take over a year to complete and that he was denied subsequent treatment. Within his March 2016 VA Form 9 substantive appeal, the Veteran reported that during active service, he was given five temporary crowns and an incomplete molar implant; he stated that within weeks of separation he was told that VA could not complete the dental work and requested that the dental work began during active service be completed. Service treatment records document that upon pre-induction examination in July 2009, the Veteran’s dental health was normal; he also denied severe tooth or gum trouble within a concurrent report of medical history. A January 2010 initial dental examination at enlistment noted the Veteran’s Class 2 dental condition; the exam was noted to be overall within normal limits, with the following documented caries, defective restorations, or fractured teeth: #4, #9, #11, #13, #14, #15, #18, #20, #29, and #31. The Veteran was also noted to be missing the following teeth: #1, #16, #17, #30, and #32; his recommended treatment plan included planned prosthetics for teeth #18, #19, and #31. In March 2010, a dentist noted that tooth #18 had been exposed for years and was questionably restorable. A July 2010 dental examination revealed new caries in teeth #9 and #12, with planned treatment including a crown for tooth #19 and prosthetics for #14, #18, and #31. Thereafter, the Veteran underwent extraction of tooth #18 in May 2011, followed by stage I implant surgery of tooth #18 in August 2011 and stage II implant surgery of tooth #18 in May 2012. A July 2011 dental examination noted a new caries on tooth #9, with pain reported in teeth #7, #8, #9, and #10. A May 2012 periodic health assessment notes the Veteran’s Class 3 dental classification; notably, he was not referred for dental treatment, only for preventive/healthy lifestyle counseling, including dental care, and was found to be fully medically ready with no required follow up. A December 2012 dental examination revealed caries on teeth #3, #5, #7, #8, #9, #13, #15, #28, and #30. The Veteran was noted to have a prosthetic on tooth #18, and crowns on teeth #7, #8, #9, #10, and #19. In August 2013, the Veteran reported that a temporary crown had fallen off; the following month, temporary crowns on teeth #7 and #10 were recemented and he was also referred for crown lengthening of teeth #14 and #19. In October 2013, he underwent surgery and had crowns placed on teeth #14 and #19, and a replacement provisional crown was also placed on tooth #10. Upon subsequent dental examination in November 2013, he was noted to have an implant on tooth #18, and crowns on teeth #7, #8, #9, #10, #14, and #19. Service dental records do not otherwise show any trauma to the mouth or teeth. The Veteran’s DD Form 2014 notes that he was not provided with a complete dental exam and all appropriate dental services and treatment within 90 days prior to separation. The Veteran was afforded a VA dental examination in March 2014. At that time, the VA examiner noted the Veteran’s loss of teeth; in particular, tooth #15 was noted to have decay, #19 had a missing crown, and a number of anterior teeth were noted to have temporary crowns. The Veteran reported cavities, multiple temporary crowns on his front teeth that needed permanent crowns, and large fillings which were prone to break. Significantly, the examiner noted that there was no anatomical loss or bony injury of any teeth (other than that due to the loss of the alveolar process as a result of periodontal disease). The loss of teeth was not due to loss of substance of body of the maxilla or mandible, trauma or disease, and the masticatory surfaces could be restored by suitable prosthesis. The examiner further noted the Veteran’s missing tooth #18, as well as decay and temporary crowns prone to fracture which resulted in impairment of mastication. Diagnostic dental x-rays revealed anterior teeth #7, #8, #9, and #10 with temporary crowns and resulting functional impact due to decay at tooth #15 and aesthetic concerns from the temporary crowns. Based upon the above evidence, including the Veteran’s statements and service dental treatment records, the Board has specifically considered herein the Veteran’s claim regarding teeth #7, #8, #9, #10, #14, #18, and #19. First, the Board finds that the Veteran does not have a compensable dental disorder for VA compensation purposes. There is no probative evidence of record that he has a current dental disability that is due to loss of substance of the body of the maxilla or mandible through trauma or osteomyelitis. Rather, the Veteran’s loss of teeth is related to loss of the alveolar process as a result of periodontal disease, which is explicitly excluded from eligibility for service connection for compensation purposes. There is also no evidence or even allegation of damage to the Veteran’s maxilla (upper jaw bone) or mandible (lower jaw bone) during active service. For these reasons, the Board finds that the evidence weighs against a finding of a current dental disability eligible for service connection for VA compensation purposes. As to outpatient dental treatment, the Board notes there are various categories of eligibility that exist for VA outpatient dental treatment. 38 U.S.C. § 1712 (2012); 38 C.F.R. § 17.161. Class I VA outpatient treatment is available for veterans with an adjudicated compensable service-connected dental condition. In this case, as noted above, the evidence does not show that the Veteran has an adjudicated service-connected compensable dental condition, nor does he allege that his claimed dental condition would warrant a compensable rating; therefore, entitlement to Class I dental treatment is not warranted. Class II eligibility for any treatment reasonably necessary for the one-time correction of a service-connected noncompensable condition is available for veterans discharged under conditions other than dishonorable from active service of 90 days or more in the Persian Gulf War on or after October 1, 1981, provided the veteran made application for such treatment within 180 days after such discharge or release, the veteran’s DD Form 214 does not bear a certification that the veteran was provided, within the 90-day period immediately before such discharge or release, a complete dental examination (including dental X-rays) and all appropriate dental treatment indicated by the examination to be needed, and a VA dental examination was completed within six months after discharge or release, unless delayed through no fault of the veteran. Here, the record reflects that the Veteran served for more than 90 days in the Persian Gulf War, was discharged under honorable conditions after October 1, 1981, applied for dental compensation and treatment prior to his discharge from active service, was not provided with a complete dental exam and all appropriate dental services and treatment within 90 days prior to separation, and was provided with a VA dental examination in March 2014, within six months of his separation in January 2014. As such, the Veteran meets eligibility for Class II dental treatment for any service-connected noncompensable dental conditions. Additionally, the Board finds that the Veteran’s teeth #7, #8, #9, #10, #14, #18, and #19 qualify as service-connected noncompensable dental conditions that warrant Class II dental treatment. As discussed above, service dental records document that upon initial dental examination in January 2010, the Veteran’s teeth #7, #8, and #10 were normal; tooth #9 was noted as carious but restorable; tooth #14 was noted as filled; tooth #18 was noted under planned treatment for prosthesis; and tooth #19 was not noted as carious, filled, or non-restorable (though it was also included under planned treatment for prosthesis). Subsequent service dental records document that teeth #7, #8, and #10 had temporary crowns placed after more than 180 days of active service. See 38 C.F.R. § 3.381(e)(1). Tooth #9 had a new caries that developed after more than 180 days of active service and later required a temporary crown. See 38 C.F.R. § 3.381(e)(3). Tooth #14 was later replaced by a crown after more than 180 days of active service. See 38 C.F.R. § 3.381(e)(2). Tooth #18 was found questionably restorable in March 2010, extracted after 180 days of active service, and later treated with stage I and II implant surgery. See 38 C.F.R. § 3.381(e)(4). Finally, tooth #19 was later treated with a crown after more than 180 days of active service. See 38 C.F.R. § 3.381(e)(1). The Board has also considered whether the Veteran is eligible for any of the additional classes of outpatient VA dental treatment. Veterans having a service-connected noncompensable dental condition determined to be the result of combat wounds or other service trauma will be eligible for VA dental care on a Class II(a) basis. Notably, the term “service trauma” does not include the intended effects of therapy or restorative dental care and treatment provided during a veteran’s military service. 38 C.F.R. § 3.306(b)(1) (2017). To the extent that the Veteran has claimed, including within his March 2015 statement, that in-service treatment providers “broke” his teeth, the Board finds that such statements are not probative, as the Veteran does not possess dental expertise and provided such history in the context of his claim for VA benefits. Moreover, service dental records do not support a finding of in-service trauma; rather, such records document that the Veteran was provided with regular dental care and treatment during active service, which is specifically excluded from the definition of service trauma. As such, the Veteran does not meet eligibility requirements for Class II(a) dental treatment. Class II(b) or (c) eligibility extends to veterans having a service-connected noncompensable dental condition who were detained or interned as prisoners of war. In this case, the Veteran’s personnel records, including his DD Form 214, do not reflect that he was a prisoner of war, and he has not asserted this fact. Thus, he does not meet the criteria for Class II(b) or (c) dental treatment. Other categories of eligibility include those veterans having a dental condition clinically determined to be complicating a medical condition currently being treated by VA, veterans whose service-connected disabilities are rated as totally disabling, and some veterans who are Chapter 31 vocational rehabilitation trainees. However, none of these categories are applicable in this case. In sum, as the Veteran’s service dental records document dental treatment for teeth #7, #8, #9, #10, #14, #18, and #19 which qualifies as service-connected noncompensable dental conditions, the Board finds that the Veteran is entitled to service connection for the purposes of obtaining any treatment indicated as reasonably necessary for the one-time correction of such conditions. See 38 C.F.R. § 17.161(b)(2). A. P. SIMPSON Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD D. Chad Johnson, Counsel