Citation Nr: 21004316 Decision Date: 01/26/21 Archive Date: 01/26/21 DOCKET NO. 12-19 374 DATE: January 26, 2021 ORDER Entitlement to service connection for compensation purposes for a dental condition, including removal of tooth number nine is denied. Entitlement to service connection for treatment purposes only for missing tooth #9 with bridging is granted. FINDINGS OF FACT 1. Service trauma aggravated the Veteran’s alveolar abscess requiring the removal of tooth #9; the missing tooth is not due to the loss of substance of body of the maxilla or mandible, and is replaceable. 2. The Veteran has a service-connected noncompensable dental condition resulting from service trauma, meeting the requirements for Class II(a) eligibility for dental treatment. CONCLUSIONS OF LAW 1. The criteria for service connection for compensation purposes for a dental condition, including removal of tooth number nine have not been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.304, 3.381, 4.150. 2. Resolving reasonable doubt in the Veteran’s favor, the criteria for eligibility for VA dental treatment for a noncompensable dental condition due to service trauma have been met. 38 U.S.C. §§ 1712, 5107; 38 C.F.R. §§ 3.102, 17.161. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from November 1956 to November 1960 and from October 1962 to November 1962, with additional service in the National Guard. These matters come before the Board of Veterans’ Appeals (Board) on appeal from a May 2011 rating decision issued by a Department of Veterans Affairs (VA) Regional Office (RO). The Veteran testified at an October 2016 video hearing held before the undersigned Veterans Law Judge. A copy of the transcript is of record. In February 2017, the Board reopened service connection for a dental disorder for compensation purposes and remanded the underlying issue on the merits, as well as entitlement to service connection for a noncompensable dental disorder for the purpose of obtaining VA outpatient dental treatment for further development. The remanded issues have since been returned to the Board for further appellate review. 1. Service connection for compensation purposes for a dental condition including removal of tooth #9 is denied. The Veteran seeks service connection for a dental condition resulting from service trauma. Specifically, he reports he developed a toothache, later determined to be due to an alveolar abscess, which required extraction of tooth #9 following flying in an unpressurized airplane. At the Board hearing in October 2016, the Veteran testified that the flight ended in an emergency landing because his face swelled up like a balloon and required hospitalization, and that the doctor at that hospital told him that the unpressurized flight had exacerbated his tooth abscess. Service connection for a dental disorder for compensation purposes can only be established for certain types of dental and oral conditions listed under 38 C.F.R. § 4.150, such as impairment of the mandible, loss of a portion of the ramus, and loss of a portion of the maxilla. Compensation is available for loss of teeth only if due to loss of substance of the body of the maxilla or mandible. See Simington v. West, 11 Vet. App. 41 (1998). For loss of teeth to merit compensation, bone loss through trauma or disease such as osteomyelitis must be shown for purposes of compensability; the loss of the alveolar process as a result of periodontal disease is not considered disabling. See 38 C.F.R. § 4.150, Diagnostic Code 9913, Note. Service treatment records from March 1960 document that the Veteran underwent consultation for an upper anterior bridge, and teeth #8 and #10 were prepared for bridge. An October 1962 dental record notes that tooth #9 had been removed and replaced by bridge. Tooth #9 was present at the enlistment dental examination in December 1956. The Veteran was provided with VA dental examinations in August 2018 and November 2020. Both examination reports note that the Veteran’s loss of teeth is not due to loss of substance of body of maxilla or mandible, but is due to trauma or disease. They also indicate that the masticatory surfaces can be restored by suitable prosthesis. At the November 2020 examination, the Veteran reported that he had no problems with the bridge placed on teeth #8-10 until the late 1990s, at which time the bridge “started to wear down and chip.” He had a new larger bridge placed on #6-11 after having teeth #7, 8, and 10 extracted in 2012 due to periodontal disease. The examiner opined that the original bridge placed during service resolved the Veteran’s #9 tooth loss, and was resolved for the next 35 years. She stated that a typical dental bridge lasts 5-15 years. When considering the evidence of record, it is undisputed that the Veteran underwent extraction and bridging for tooth #9 during service. The Veteran is also competent to report what he experienced during service and what was told to him by his treating physician regarding the exacerbation of his alveolar abscess on the unpressurized flight. While the subsequent in-service hospitalization and specifics regarding the described flight are not noted in the Veteran’s service treatment records, the Board will resolve all reasonable doubt in the Veteran’s favor in finding that his alveolar abscess leading to extraction of tooth #9 was aggravated beyond its natural progression by the service trauma resulting from the unpressurized flight. However, as noted above, compensation is available for loss of teeth only if due to loss of substance of the body of the maxilla or mandible. The evidence of record does not show that the service trauma resulted in loss of substance of the body of the maxilla or mandible. For this reason, the Board finds that the Veteran does not have a dental disability that is eligible for service connection for compensation purposes, and the claim for compenstion must be denied. 2. Entitlement to service connection for treatment purposes only for missing tooth #9 with bridging is granted. While certain dental conditions, such as replaceable missing teeth and alveolar abscesses are not subject to service connection for compensation purposes, they may be subject to service connection for treatment purposes only if the Veteran qualifies for one of the classes of eligibility for dental treatment as set forth in 38 C.F.R. § 17.161. See 38 U.S.C. § 1712. Only Class I and Class II are potentially applicable in this case, and are discussed below. With reference to Class I, those having a service-connected compensable dental disability or condition may be authorized dental treatment as necessary to maintain oral health and masticatory function. As explained in the preceding section, the Veteran does not have a dental disability subject to compensable service connection pursuant to 38 C.F.R. § 4.150 and thus he does not satisfy the Class I criteria. 38 C.F.R. § 17.161(a). (Continued on the next page)   With reference to the Class II criteria and as relevant to the matter at hand, a veteran having a service-connected noncompensable dental condition or disability adjudicated as resulting from combat wounds or service trauma (Class II (a)) may be authorized any treatment indicated as reasonably necessary for the correction of the service-connected noncompensable condition or disability. 38 C.F.R. § 17.161(c). Replaceable missing and broken (fractured) teeth may be considered service-connected solely for the purposes of determining entitlement to dental examination or outpatient dental treatment. Simington v. West, 11 Vet. App. 41 (1998). Service trauma, as defined for purposes of dental treatment eligibility, means damage caused by the application of sudden, external force, brought to bear outside a clinical setting. It does not include the intended effects of therapy or restorative dental care and treatment provided during military service. 38 C.F.R. § 3.306(b)(1); VAOGCPREC 5-97 (1997), 62 Fed. Reg. 15,566 (1997); Nielson v. Shinseki, 607 F.3d 802 (2010) (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). Here, competent and probative evidence is found to be at least evenly balanced so as to allow for resolution of doubt in the Veteran’s favor to find that during service the Veteran experienced the external physical force of an unpressurized airplane flight that aggravated his alveolar abscess, leading to extraction of tooth #9 and placement of a bridge. Such external force was outside of a clinical setting and occurred during the Veteran’s performance of military duties. As such, the Class II(a) criteria are met for VA dental treatment for a noncompensable dental condition that resulted from service trauma. 38 C.F.R. § 17.161(c); see 38 U.S.C. § 1712(a)(1)(C). Based on the forgoing, Class II(a) dental treatment, for any treatment indicated as reasonably necessary for the correction of such service-connected noncompensable condition, is warranted. J. PARKER Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board A. Solomon, 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.