Citation Nr: 20000072 Decision Date: 01/02/20 Archive Date: 01/02/20 DOCKET NO. 16-11 448A DATE: January 2, 2020 ORDER New and material evidence having been received, the previously denied claim of service connection for a dental condition for compensation purposes is reopened. Service connection for a dental condition for compensation purposes is denied. REFERED CLAIM Service connection for a dental condition for treatment purposes.   FINDINGS OF FACT The Veteran does not have a dental condition for which compensation may be awarded. CONCLUSIONS OF LAW The criteria for service connection for a dental condition for compensation purposes are not met. 38 U.S.C. §§ 1110, 1712, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.381, 4.150, 17.161. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from October 1968 to February 1971. The case is on appeal from a May 2015 rating decision. In July 2019, the Veteran testified at a Board hearing. A claim of service connection for a dental condition for compensation purposes may also be a claim for VA outpatient dental treatment under 38 C.F.R. § 3.381. Mays v. Brown, 5 Vet. App. 302 (1993). In dental claims, the RO adjudicates the service connection claim for compensation purposes, and the VA Medical Center (VAMC) adjudicates the claim for outpatient treatment. As this matter stems from an adverse determination by the RO, the appeal is limited to the issue of service connection for a dental condition for compensation purposes. The claim of service connection for a dental condition for the purpose of obtaining VA outpatient dental treatment is REFERRED to the RO for additional referral to the appropriate VAMC. See 38 C.F.R. § 17.161. The Board has limited the discussion below to the relevant evidence required to support its finding of fact and conclusion of law, as well as to the specific contentions regarding the case as raised directly by the Veteran and those reasonably raised by the record. See Scott v. McDonald, 789 F.3d 1375, 1381 (Fed. Cir. 2015); Robinson v. Peake, 21 Vet. App. 545, 552 (2008). 1. Whether new and material evidence has been received to reopen a previously denied claim of service connection for a dental condition. The Veteran’s claim of service connection for a dental condition (variously characterized as periodontitis, gingivitis and gum disease) has previously been denied multiple times. Most recently, by an April 2012 rating decision, the RO denied reopening the claim for lack of new and material evidence. The Veteran was notified of the decision by letter later that month, which was mailed to the then current mailing address of record. Thereafter, nothing further regarding the claim was received until the present claim to reopen in October 2014. No new evidence or notice of disagreement was received by VA within one year of the issuance of the April 2012 rating decision. As the Veteran did not appeal the decision, that rating decision is final. See 38 U.S.C. § 7105; 38 C.F.R. §§ 20.302, 20.1103. In a letter dated in February 2015, the Veteran’s private dentist, C.T.W., indicated that the Veteran’s exposure to Agent Orange, and other chemicals during his military service in Vietnam, may have contributed to the deterioration of his dentition and supporting structures of the teeth. The Board finds that new and material evidence has been submitted so that the previously denied claim of service connection for a dental or oral disorder is reopened. See 38 U.S.C. § 5108; 38 C.F.R. § 3.156(a). 2. Service connection for a dental condition for compensation purposes. Legal Criteria Service connection may be granted for a disability resulting from a disease or injury incurred in or aggravated by active service. See 38 U.S.C. § 1110; 38 C.F.R. § 3.303. A veteran seeking compensation under these provisions must establish three elements: “(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.” Saunders v. Wilkie, 886 F.3d 1356, 1361 (Fed. Cir. 2018) (quoting Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004)). Under current VA regulations, compensation is only available for certain types of dental and oral conditions listed under 38 C.F.R. § 4.150, Diagnostic Codes (DCs) 9900-9916. The conditions for which service-connected compensation benefits are available are as follows: chronic osteomyelitis or osteoradionecrosis of the maxilla or mandible (DC 9900); loss of the mandible (DCs 9901-9902); nonunion or malunion of the mandible (DCs 9903-9904); limited temporomandibular motion (DC 9905); loss of the ramus (DC 9906-9907); loss of the condyloid or coronoid processes (DCs 9908-9909); loss of the hard palate (DCs 9911-9912); 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 (DC 9913); loss of the maxilla (DCs 9914-9915); and nonunion or malunion of the maxilla (DC 9916). See 38 C.F.R. § 4.150. Thus, for loss of teeth, bone loss through trauma or disease such as osteomyelitis, must be shown for compensable purposes. See DC 9913. The loss of the alveolar process as a result of periodontal disease is not considered disabling. See 38 U.S.C. § 1712; 38 C.F.R. §§ 3.381, DC 9913; and 17.161. Nevertheless, for other types of service-connected dental conditions, the claimant may receive treatment only and not compensation. See 38 U.S.C. § 1712; 38 C.F.R. §§ 3.381, 4.150, 17.161. In particular, under 38 C.F.R. § 3.381, treatable carious teeth, replaceable missing teeth, dental or alveolar abscesses, and periodontal disease are to be considered service-connected solely for the purpose of establishing eligibility for outpatient dental treatment pursuant to 38 C.F.R. § 17.161. As such, the Board has referred a claim for treatment purposes. Analysis In this case, the Veteran is seeking service connection for his oral and dental disorders, which he describes as severe gingivitis, as the condition was first treated while serving in Vietnam. Service treatment records (STRs) confirm the Veteran’s statements as to the in-service event as he was treated for bleeding and ulcerative lesions assessed by Army providers as herpetic gingivostomatitis. See November 4, 1969 progress notes. Post-service treatment records show treatment for dental problems. According to February 2001 and December 2005 letters from dentist P.M., the Veteran has received dental and periodontal treatment since December 1974. He has been seen for severe periodontitis (see February 2001 letter from P.M.) and severe bone loss due to periodontal disease (see March 23, 2011 Aspen Dental progress notes). Additionally, the Veteran’s dentists have linked his dental problems to his time in service, including possibly to environmental hazards and Agent Orange. This claim turns, however, on whether the Veteran’s current dental condition can be permissibly service connected. From an earlier claim, a May 2003 VA dental examination noted the diagnosis of periodontitis. Treatment records continue to show that the Veteran has dental conditions that are similar in nature. They are conditions that are excluded from service connection for compensation purposes. See 38 C.F.R. §§ 3.381, 4.150. As such, the preponderance of the evidence is against the claim and the benefit of the doubt doctrine is not applicable. See 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102. Therefore, service connection for a dental condition for compensation purposes is not warranted. RYAN T. KESSEL Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board William Pagan, Associate Counsel The Board’s decision in this case is binding only with respect to the instant matter decided. This decision is not precedential, and does not establish VA policies or interpretations of general applicability. 38 C.F.R. § 20.1303.