Citation Nr: 18152276 Decision Date: 11/21/18 Archive Date: 11/21/18 DOCKET NO. 12-28 178 DATE: November 21, 2018 ORDER New and material evidence having been submitted, reopening of the claim for service connection for a dental disability is granted. Entitlement to service connection for a dental disability is granted. FINDINGS OF FACT 1. A September 2004 rating decision denied the claim of entitlement to service connection for a dental disability for purposes of compensation; the Veteran did not appeal the decision or submit any pertinent evidence within the appeal period. 2. Evidence received subsequent to the expiration of the appeal period includes evidence that is not cumulative or redundant of the evidence previously of record and relates to unestablished facts necessary to substantiate the claim. 3. The Veteran’s current dental disability is etiologically related to her active duty service. CONCLUSIONS OF LAW 1. New and material evidence has been presented to reopen the claim of entitlement to service connection for a dental disability for purposes of compensation. 38 U.S.C. § 5108 (2012); 38 C.F.R. § 3.156 (2018). 2. The criteria for service connection for a dental disability for compensation purposes have been met. 38 U.S.C. §§ 1110, 5107 (2012); 38 C.F.R. §§ 3.102, 3.303, 3.304 (2018). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS Introduction The Veteran served on active duty from September 1990 to February 1994. With respect to the issue of entitlement to service connection for a dental disability, the Board acknowledges that generally, an unappealed rating decision may not thereafter be reopened and allowed, unless new and material evidence is presented or secured with respect to the disallowed claim. See 38 U.S.C. §§ 5108, 7105 (c) (2012). As will be explained further below, the Board finds the evidence presently of record, which includes an additional private medical opinion and treatment records, is sufficient to establish service connection for a dental disability, and as such, new and material evidence has been presented to reopen the claim. This appeal has been advanced on the Board’s docket pursuant to 38 C.F.R. § 20.900(c) (2018). Legal Criteria Service connection may be granted for disability resulting from disease or injury incurred in or aggravated by active duty. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303. Service connection will be granted for a dental disease or injury of individual teeth and the investing tissue shown by the evidence to have been incurred in or aggravated by active duty. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.381(a). Dental disabilities that may be awarded compensable disability ratings are set forth under 38 C.F.R. § 4.150. These disabilities include chronic osteomyelitis or osteoradionecrosis of the maxilla or mandible, loss of the mandible, nonunion or malunion of the mandible, loss of the maxilla, nonunion or malunion of the maxilla, limited temporomandibular motion, loss of the ramus, loss of the condyloid or coronoid processes, loss of the hard palate, and loss of teeth due to the loss of substance of the body of the maxilla or mandible and where the lost masticatory surface cannot be restored by suitable prosthesis, when the bone loss is a result of trauma or disease but not the result of periodontal disease. 38 C.F.R. § 4.150, Diagnostic Codes 9900-9916. Replaceable missing teeth, treatable carious teeth, dental or alveolar abscesses, and periodontal disease are not disabling, and may be considered service connected solely for the purpose of determining entitlement to a VA dental examination or outpatient dental treatment. 38 C.F.R. § 3.381. The Board notes that 38 C.F.R. § 3.381 was amended during the appeal; however, the amendments did not alter 3.381(b), and are not pertinent in this case. See 77 Fed. Reg. 4496 (January 30, 2012). Burden of Proof Except as otherwise provided by law, a claimant has the responsibility to present and support a claim for benefits under laws administered by the Secretary. The Secretary shall consider all information and lay and medical evidence of record in a case before the Secretary with respect to benefits under laws administered by the Secretary. When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, the Secretary shall give the benefit of the doubt to the claimant. 38 U.S.C. § 5107 (2012); 38 C.F.R. § 3.102 (2018); see also Gilbert v. Derwinski, 1 Vet. App. 49, 53 (1990). To deny a claim on its merits, the evidence must preponderate against the claim. Alemany v. Brown, 9 Vet. App. 518, 519 (1996), citing Gilbert, 1 Vet. App. at 54. Factual Background and Analysis The Veteran’s service treatment records indicate she entered active duty edentulous. Thereafter, the Veteran underwent dental implant surgery, wherein individual implants were surgically placed in order to replace each of her missing teeth with permanently affixed crown moldings. However, the Veteran did not obtain the crown moldings, but rather was provided with a temporary denture. Since that time, the Veteran has experienced a deterioration of the underlying implanted posts, which has resulted in infections, swelling and pain. During a recent November 2016 VA examination, the examiner determined the Veteran’s current dental problems are the result of improperly restored restorations in service. The Board finds the improper restoration of the Veteran’s teeth in service constituted a trauma to her mouth. In addition, the Veteran recently submitted a statement from her private dentist, which indicates that as a result of the above-noted deterioration of the underlying dental posts, the Veteran has experienced inflammation and bone loss. In support of this finding, the clinician provided the results of recently obtained x-rays. The clinician found two new prostheses can be fabricated, which would restore oral function and remedy the Veteran’s currently experienced manifestations of pain and inflammation; however, the Board notes that under 38 C.F.R. § 4.150, Diagnostic Code 9913, even where loss of the masticatory surface can be restored by suitable prosthesis, service connection is nonetheless warranted when bone loss is present. The Board does observe that during the Veteran’s November 2016 VA examination, the examiner found no evidence of anatomical loss or bony injury to the mandible or maxilla, but the examiner also failed to obtain any diagnostic testing such as x-ray, magnetic resonance imaging, or computed tomography in order to confirm these findings. As such, the Board finds the Veteran’s private clinician’s findings as to the presence of bone loss to be more probative. In sum, the evidence indicates the Veteran has experienced a loss of substance of the body of the maxilla or mandible, which is the direct result of improperly restored restorations in service. Therefore, the Board finds service connection for this disability is warranted. T. REYNOLDS Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD G. Fraser, Counsel