Citation Nr: 20022560 Decision Date: 04/01/20 Archive Date: 04/01/20 DOCKET NO. 16-53 691 DATE: April 1, 2020 ORDER Entitlement to service connection for residuals of an in-service dental injury, incisal edge tooth fracture of #9 (repaired), for compensation purposes is denied. FINDING OF FACT The Veteran does not have a current dental disorder for which VA disability compensation may be paid. CONCLUSION OF LAW The criteria for entitlement to service connection for residuals of an in-service dental injury, incisal edge tooth fracture of #9 (repaired), for compensation purposes have not been met. 38 U.S.C. §§ 1110, 1131, 1712 (2012); 38 C.F.R. §§ 3.381, 4.150, 17.161 (2019). REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from June 1993 to September 2002. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from a March 2015 rating decision. In February 2020, the Veteran testified at a Board hearing before the undersigned Veterans Law Judge at the RO. A copy of the hearing transcript has been associated with the electronic claims file. In an October 2016 letter, the RO informed the Veteran that it had received his request for dental treatment. In order to initiate a determination regarding his eligibility to dental treatment services, the RO instructed that he may visit the enrollment office at his nearest VA healthcare facility or call the VA Health Eligibility and Enrollment line at 1-855-488-8440. In a September 2017 VA Form 8 (Certification of Appeal), it was noted that the Veteran’s dental treatment claim was referred to VHA. As the AOJ referred the Veteran’s claim for VA outpatient dental treatment to VHA, no further action is necessary in this regard. See Mays v. Brown, 5 Vet. App. 302, 306 (1993). The Board notes that this decision is limited to whether compensation benefits are warranted for the Veteran’s claimed dental disorder. If he wishes, he can file a claim seeking medical reimbursement for dental expenses and follow up on his referred claim for service connection for a dental disability for purposes of potentially receiving dental treatment. He should address that claim to his local VA Medical Center under 38 C.F.R. § 17.161. 1. Entitlement to service connection for residuals of an in-service dental injury, incisal edge tooth fracture of #9 (repaired), for compensation purposes In July 2014, the Veteran filed a claim for service connection for upper front tooth injury. In written statements, he has further asserted that the attempts to repair his chipped tooth have been ineffective and that he either wanted a compensable rating or treatment in the form of a crown. During his February 2020 Board hearing testimony, the Veteran indicated that he was simply asking VA to provide care and treatment for a tooth that was injured while he was on active duty. Service connection may generally be established for disability resulting from injury suffered or disease contracted in the line of duty in the active military, naval, or air service. 38 U.S.C. §§ 1110, 1131 (2012); 38 C.F.R. § 3.303 (2019). Dental disorders are an exception to this general rule and are treated differently than other medical disorders in the VA benefits system. The regulations governing dental claims make a fundamental distinction between replaceable missing teeth and teeth lost as a result of loss of substance of body of maxilla or mandible due to trauma or disease such as osteomyelitis, and not loss of the alveolar process as a result of periodontal disease. 38 C.F.R. §§ 3.381, 4.150 (2019); see also Simington v. West, 11 Vet. App. 41, 44 (1998). 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. See Woodson v. Brown, 8 Vet. App. 352, 354 (1995). The rating schedule for dental and oral conditions under 38 C.F.R. § 4.150 was recently amended; however, given the nature of the Veteran’s claim and the other evidence of record, the amendments do not contain changes that affect the outcome of the case. See 82 Fed. Reg. 36083 (Aug. 3, 2017). Service connection for compensation purposes can only be established for certain types of dental and oral conditions listed 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 (2019). Under 38 C.F.R. § 3.381, treatable carious teeth, replaceable missing teeth, dental or alveolar abscesses, and periodontal disease are not compensable disabilities but may be considered service-connected solely for the purpose of establishing eligibility for outpatient dental treatment as provided in 38 C.F.R. § 17.161. 38 U.S.C. § 1712 (2012); 38 C.F.R. § 3.381(a) (as amended at 38 C.F.R. § 3.381(b) with no substantive changes for the purposes of this claim, see 77 Fed. Reg. 4470 (Jan. 30, 2012)). The alveolar process is the portion of the bone in either the maxilla or mandible that surrounds and supports the teeth. See Dorland’s Illustrated Medical Dictionary, 1517 (32nd Ed. 2012). Gingivitis is a form of periodontal disease. See Dorland’s Illustrated Medical Dictionary at 768 (30th Ed. 2003). The Veteran’s DD Form 214 reflected that he was not provided a complete dental examination and all appropriate dental service and treatment within 90 days prior to separation. The March 1993 enlistment examination report showed that the Veteran was marked as being acceptable in the dental section. Additional service treatment records dated from 1994 to 2001 detailed that the Veteran had a class change and was later listed to be Class 2. A January 1995 service treatment note clearly indicated that the Veteran suffered a chipped middle tooth on left upper jaw when working on a vehicle with no noted nerve involvement. He was sent to a dentist for repair. Post-service private dental records detailed that the Veteran had his chipped tooth #9 recemented into place multiple times in 2014. A photograph as submitted that showed the same chipped middle tooth on left upper jaw. Additional private dental records detailed that the Veteran had a crown of that tooth in 2019. In a March 2015 VA examination report, the examiner diagnosed tooth fracture #9 – incisal edge – repaired. There was no 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, loss of teeth due to the loss of substance of the body of the maxilla or mandible, or lost masticatory surface that could not be restored by suitable prosthesis (when the bone loss is a result of trauma or disease but not the result of periodontal disease). The examiner opined that the claimed condition was less likely than not (less than 50 percent probability) incurred in or caused by the claimed in-service injury, event, or illness. In the cited rationale, the examiner noted that the Veteran had a fractured tooth in 1995 that had been repaired in 1995, 2001, and 2014. It was noted that service dental records in the file were limited from 1993 to 1998 and did not indicate any fracture of front teeth but instead showed oral surgery evaluations, cleanings, and gingivitis. In considering the evidence of record under the laws and regulations set forth above, the Board concludes that entitlement to service connection for residuals of an in-service dental injury, incisal edge tooth fracture of #9 (repaired), for compensation purposes is not warranted. Service treatment records clearly reflected that the Veteran chipped his tooth in January 1995. However, evidence of record does not indicate that the Veteran’s in-service dental trauma has resulted in lost masticatory surface that could not be restored by suitable prosthesis. Post-service private treatment records show his chipped tooth was recemented multiple times and eventually fitted for a crown but do not document complaints or treatment for any dental disorder eligible for compensation under 38 C.F.R. § 4.150. In addition, the Board notes that treatable carious teeth, replaceable missing teeth, dental or alveolar abscesses, and periodontal disease are not compensable disabilities and will be service connected solely for the purpose of determining entitlement to outpatient dental treatment, which is not of issue here. The record does not suggest any other basis for awarding service connection for a dental disorder for VA compensation purposes. Thus, the criteria to award entitlement to service connection for residuals of an in-service dental injury, incisal edge tooth fracture of #9 (repaired), for compensation purposes, have not been established, either through medical or probative lay evidence. (Continued on the next page)   In arriving at the decision to deny the claim, the Board has considered the applicability of the benefit-of-the-doubt doctrine. However, as the preponderance of the evidence is against the claim of entitlement to service connection for residuals of an in-service dental injury, incisal edge tooth fracture of #9 (repaired), for compensation purposes, that doctrine is not applicable. 38 U.S.C. § 5107(b) (2012); 38 C.F.R. § 3.102 (2019); Gilbert v. Derwinski, 1 Vet. App. 49, 53-56 (1990). MICHAEL MARTIN Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board J. D. Deane, 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.