Citation Nr: 21002158 Decision Date: 01/12/21 Archive Date: 01/12/21 DOCKET NO. 16-17 166 DATE: January 12, 2021 REMANDED Entitlement to service connection for loss of teeth is remanded. REASONS FOR REMAND The Veteran served on active duty from June 1970 to March 1972. He appeared at a hearing before the undersigned Veterans Law Judge in December 2018. This matter comes before the Board of Veterans’ Appeals (Board) from a September 2015 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO). It was previously before the Board in April 2019 where the claim was denied, and the Veteran subsequently appealed to the United States Court of Appeals for Veterans Claims (Court). In April 2020, the Court granted a Joint Motion for Remand (JMR) in which the parties agreed to vacate the April 2019 decision and remand the matter to the Board. The record reflects that the Veteran had missing teeth during service, some of which he indicates were pulled as a result of a fall and injury to his jaw. A bridge was not placed until years later which, the Veteran states, is no longer feasible. To be considered a disability for VA compensation purposes, teeth must be missing due to service trauma or disease such as osteomyelitis which results in loss of substance of the body of the maxilla or mandible. 38 C.F.R. §§ 3.381, 4.150, Diagnostic Code 9913. Replaceable missing teeth are not compensable disabilities. 38 C.F.R. § 3.381(b). In the Board’s previous denial, it noted that private dental records submitted in March 2019 reflected the Veteran’s bridge as lacking support, with bone loss in the area of the Veteran’s in-service extractions as well as other teeth. It was not clear if this bone loss is to the body of the maxilla or mandible, as opposed to the alveolar process which would not meet the criteria described in Diagnostic Code 9913. It was also noted that dental implants were the only recommended solution because removeable partials would not be well tolerated with the Veteran’s dental issues. As the Board determined the Veteran’s missing teeth could be replaced with dental implants, it found that this was a case where the Veteran has replaceable missing teeth and therefore not a current disability for VA compensation purposes. However, the JMR noted that the Veteran’s service treatment records noted extraction of tooth 18, and the private treatment record noted by the Board makes no reference to this particular tooth. As such, a VA dental examination and medical opinion are necessary that addresses all of the Veteran’s previously-extracted teeth, as well as whether the bone loss noted in his private dental records is to the maxilla or mandible, as opposed to the alveolar process for the purposes of 38 C.F.R. §§ 3.381, 4.150, Diagnostic Code 9913. The matter is therefore REMANDED for the following actions: 1. Ask the Veteran to identify all outstanding treatment records relevant to his claim. All identified VA records should be added to the claims file. All other properly identified records should be obtained if the necessary authorization to obtain the records is provided by the Veteran. If any records are not available, or the Veteran identifies sources of treatment but does not provide authorization to obtain records, appropriate action should be taken (see 38 C.F.R. § 3.159(c)-(e)), to include notifying the Veteran of their unavailability. 2. After records development is completed, schedule the Veteran for a VA dental examination. The examiner is asked to address the following: a) All current dental disorders. b) Whether any missing teeth are due to loss of substance of the body of the maxilla or mandible (as opposed to the alveolar process). If so, whether the loss of substance of the body of the maxilla or mandible is due to trauma or disease such as osteomyelitis (as opposed to periodontal disease). c) Whether any missing teeth are not replaceable. d) Whether any of the current dental disorders, to include missing teeth, are at least as likely as not (50 percent or greater probability) the result of an in-service event, injury, or disease, to include as a result of a fall and injury to his jaw. The in-service tooth extractions should be considered as should the February 2019 private dental treatment record indicating the Veteran’s bridge lacked support, with bone loss in the area of the Veteran’s in-service extractions as well as other teeth, and that dental implants were the recommended solution because removable partials would not be well tolerated with the Veteran’s dental issues. (Continued on the next page.) A rationale for all opinions expressed is requested as adjudicators are precluded from making any medical findings. Nathan Kroes Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board R. Scarduzio, 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.