Citation Nr: 21066422 Decision Date: 11/01/21 Archive Date: 11/01/21 DOCKET NO. 16-24 023A DATE: November 1, 2021 ORDER Entitlement to service connection for nonunion of the mandible for compensation purposes is granted. Entitlement to service connection for loss of tooth #24 as a dental disability for compensation purposes is granted. REMANDED Entitlement to service connection for dental disability for compensation purposes is remanded. Entitlement to service connection for dental disability for purposes of obtaining VA outpatient treatment is remanded. INTRODUCTION The Veteran served on active duty from September 2001 to December 2011. These matters come before the Board of Veterans' Affairs (Board) on appeal from a rating decision by a Department of Veterans Affairs (VA) Regional Office (RO). In August 2020, the Veteran and his wife testified at a hearing before the undersigned Veterans Law Judge. A transcript of this hearing has been associated with the claims file. This appeal was remanded by the Board in February 2021. FINDINGS OF FACT 1. The Veteran's nonunion of the mandible had its onset in service. 2. The Veteran's loss of tooth #24 is due to the loss of loss of substance of body of mandible caused by trauma. CONCLUSIONS OF LAW 1. The criteria for service connection for nonunion of the mandible have been met. 38 U.S.C. §§ 1110, 1154, 5107(b); 38 C.F.R. §§ 3.102, 3.303, 3.381, 4.150, 17.161. 2. The criteria for service connection for loss of tooth #24 as a dental disability for compensation purposes have been met. 38 U.S.C. §§ 1110, 1154, 5107(b); 38 C.F.R. §§ 3.102, 3.303, 3.381, 4.150, 17.161. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS In February 2021, the Board granted service connection for "mandible disability" and "residuals of an injury to the mouth," and remanded the claims of entitlement to service connection for dental disability for compensation purposes and dental disability for purposes of obtaining VA outpatient treatment. The RO effectuated the Board's February 2021 grants in an August 2021 rating decision. Therein, the RO assigned a noncompensable rating for incomplete paralysis of the left cranial nerve, a separate noncompensable rating for incomplete paralysis of the right cranial nerve, and a separate noncompensable rating mandibular fracture, each effective December 29, 2011 (the day following the Veteran's separation from service). Thereafter, the RO confirmed and continued the denial of service connection for dental disability for compensation purposes and dental disability for purposes of VA outpatient treatment. After issuing an August 2021 supplemental statement of the case, the RO remitted the appeal to the Board for further appellate review. Although the Board granted service connection for "mandible disability" in February 2021, the scope of the grant effectuated by the RO was erroneously limited to "mandibular fracture," as discussed above. Because the Veteran's claim of entitlement to service connection for dental disability for compensation purposes is still pending before VA and is within the Board's jurisdiction, the Board is granting service connection for additional mandible and dental disability. Specifically, the May 2021 VA examination included a summary of the Veteran's relevant medical history, which is as follows: Surgical procedures [in] Oct[ober] 2010 to correct malpositioned gingiva and [obstructive sleep apnea]. First [the Veteran] underwent genioglossal advancement with subsequent symphysis of the mandible. Then [he] underwent an open reduction [with] rigid internal fixation of mandible [fracture] and reposition osteotomy of [the] chin. Post[-]surgical complications lead to [an] infection which lead to jaw [fracture] leading to wiring. Jaw was wired incorrectly leading to teeth shifting and nonunion of [the] mandible. [Tooth] #24 abscessed and extracted. Numbness/tingling/sharp pain in jaw line. Subsequently, the examiner indicated that the Veteran experiences "locking," "constant and severe pain," as well as "numbness and tingling sensation in his jaw." Under current VA regulations, compensation is only available for certain types of dental and oral conditions, such as impairment of the mandible, loss of a portion of the ramus, and loss of a portion of the maxilla. See 38 C.F.R. § 4.150. Compensation is available for loss of teeth if such is due to loss of substance of body of maxilla or mandible, only if such bone loss is due to trauma or osteomyelitis, and not to the loss of the aveolar process as a result of periodontal disease, as such loss is not considered disabling. Id. at Note. As demonstrated by May 2021 VA examiner's opinion, the oral/dental procedures the Veteran underwent during service ultimately resulted in nonunion of his mandible. Nonunion of the mandible is a disability for which service connection is available for compensation purposes. Consequently, the Board finds that nonunion of the mandible is related to the Veteran's service and, thus, service connection is warranted. With respect to tooth #24, the regulations require two circumstances before compensation is available for loss of teeth: (1) that the tooth loss is due to the loss of substance of body of maxilla or mandible and (2) the loss of substance of the body of maxilla or mandible be caused by trauma or osteomyelitis (not aveolar process/periodontal disease). Under the very unique circumstances of this case, the Board is satisfied that the series of unsuccessful dental/oral procedures the Veteran underwent qualify as service-related trauma. Indeed, in Section I of the May 2021 VA examination report, the examiner indicated that one of the diagnoses is "loss of teeth," which is described as "for reason other than periodontal disease, or other routine dental maladies: this is intended for loss of teeth due to service-related trauma." As such, this aspect of service connection has been established. Concerning the loss of substance of the maxilla or mandible, the May 2021 VA examiner explained that, as a result of surgical complications leading to wiring that was incorrectly administered, tooth #24 shifted, abscessed, and required extraction. Further, in Section III of the May 2021 VA examination report, the examiner indicated that the Veteran experienced "anatomical loss or bony injury" to his mandible and "anatomical loss or bony injury leading to the loss of any teeth." Accordingly, the Board finds that there is reasonable evidentiary basis to conclude that the loss of tooth #24 is due to the loss of substance of the body of the mandible. As such, the Board finds that the criteria for service connection for the loss of #24 for compensation purposes have been met. REASONS FOR REMAND Based on a review of the previous VA examination findings, the Board finds that it remains unclear as to all of the disabilities resulting from the in- and post-service oral/dental procedures. As such, a remand is warranted in order to provide the Veteran another VA examination. With respect to the claim of entitlement to service connection for dental disability for outpatient treatment, this matter was not developed or adjudicated by the RO after the February 2021 remand. As such, a remand is required. The matters are REMANDED for the following action: 1. Develop and adjudicate the claim of entitlement to service connection for dental disability for VA outpatient treatment. 2. Provide the Veteran with VA dental examination. Make the Veteran's electronic claims file available to the examiner and ensure that the examiner specifies in the report that it was contemporaneously reviewed. All pertinent symptomatology and findings must be reported. Any indicated special diagnostic tests that are deemed necessary for an accurate assessment must be conducted. The examiner is asked to clearly identify each disability, dental or otherwise, resulting from the dental/oral procedures stemming from the in-service surgical correction of malpositioned gingiva and obstructive sleep apnea. STEVEN D. REISS Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Sean G. Pflugner, 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.