Citation Nr: 18159553 Decision Date: 12/20/18 Archive Date: 12/19/18 DOCKET NO. 15-27 631 DATE: December 20, 2018 ORDER Entitlement to service connection for loss of teeth due to loss of body of maxilla or mandible without loss of continuity is denied. FINDING OF FACT 1. The Veteran does not have loss of teeth due to loss of body of maxilla or mandible without loss of continuity. 2. The Veteran did not incur or aggravate a dental disability due to service trauma. CONCLUSION OF LAW 1. Loss of teeth due to loss of body of maxilla or mandible without loss of continuity was not incurred or aggravated during service for compensation purposes. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. §§ 3.303, 3.381. 2. The criteria for Class II(a) eligibility for VA outpatient dental treatment have not been met. 38 U.S.C. § 1712; 38 C.F.R. §§ 3.381, 17.161. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from October 1986 to August 1994. This matter comes before the Board of Veterans’ Appeals (Board) from a May 2013 rating decision issued by a Department of Veterans Affairs (VA) Regional Office (RO). The Veteran was scheduled for a hearing on 15 October 2018, but did not attend. The request is considered withdrawn. 1. Loss of teeth due to loss of body of maxilla or mandible without loss of continuity Generally, to establish service connection 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. Davidson v. Shinseki, 581 F.3d 1313, 1315-16 (Fed. Cir. 2009); Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004). Service connection may also be granted for any disease diagnosed after discharge, when all the evidence, including that pertinent to service, establishes that the disease or injury was incurred in service. 38 C.F.R. § 3.303(d). The dental and oral conditions which may be service-connected for VA compensation purposes are delineated at 38 C.F.R. § 4.150, Diagnostic Codes (DC) 9900-9916, and include loss of teeth due to loss of substance of body of maxilla or mandible without loss of continuity (DC 9913). Compensation is available for loss of teeth but only if such loss is due to loss of substance of body of maxilla or mandible due to trauma or due to disease such as osteomyelitis, but not due to the loss of the alveolar process as a result of periodontal disease. A veteran may be entitled to noncompensable service connection for other dental conditions not listed in section 4.150, 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(a), 17.161. Here, the Veteran’s entry and separation medical examinations report normal mouth and throat, and no severe tooth or gum trouble. However, service dental records show that he received dental treatment immediately at entry. This is consistent with an April 2013 VA examination report stating that the Veteran had lost teeth due to pre-service trauma; the Veteran reported that he had lost a maxillary central incisor due to a pre-service basketball injury. The examiner also reports that a cyst on the left maxillary central incisor was noted at entry. These teeth were replaced with a bridge between the lateral incisors. This is the only statement that the Veteran has provided regarding the cause of his dental disability. There is no evidence of record that demonstrates the Veteran has a dental disorder which would entitle him to service connection for compensation purposes. While the record establishes loss of teeth, the Board places significant weight on the April 2013 VA examination report which documents that the Veteran’s tooth loss is due to pre-service trauma. The report also states that the Veteran has not lost any part of the mandible or mandibular ramus, nor any part of the maxilla, which would be required to award a service connection under DC 9913. 38 C.F.R. § 4.150. Next, the Board turns to whether entitlement to service connection is warranted for a dental disorder solely for the purpose of determining eligibility for outpatient dental treatment. Replaceable missing and fractured teeth may be considered service connected solely for the purposes of determining entitlement to dental examinations or outpatient dental treatment. Simington v. West, 11 Vet. App. 41, 44 (1998). Trauma, as defined for purposes of dental treatment eligibility, connotes damage caused by the application of an external physical force during the service member’s performance of military duties. See Nielson v. Shinseki, 607 F.3d 802 (2010) (holding that “service trauma” in 38 U.S.C. § 1712(a)(1)(C) means an injury or wound produced by an external physical force during the service member’s performance of military duties; this definition excludes the intended result of proper medical treatment and psychological stress not the result of malpractice). While the April 2013 examination cites trauma as the etiology of the Veteran’s lost maxillary central incisors, this trauma was reported by the Veteran as occurring prior to service. Because the Veteran’s teeth were not lost due to combat wounds or service trauma, he is not eligible for Class II(a) dental services. H. N. SCHWARTZ Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD S.W. Strike, Associate Counsel