Citation Nr: 21075376 Decision Date: 12/20/21 Archive Date: 12/20/21 DOCKET NO. 14-27 783 DATE: December 20, 2021 ORDER Service connection for a dental disability, to include loss of teeth is denied. FINDING OF FACT The preponderance of the evidence is against a finding that the current dental disability, to include loss of teeth, began during active service, or is otherwise related to an in-service injury or disease. CONCLUSION OF LAW The criteria for service connection for a dental disability, to include loss of teeth, are not met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty in the United States Navy from January 1977 to April 1983. This matter is before the Board of Veterans' Appeals (Board) on appeal from a July 2013 rating decision that, in pertinent part, denied service connection for a dental condition. The Veteran testified before the undersigned Veteran's Law Judge during an April 2017 videoconference hearing and a copy of the transcript is of record. In February 2020, the Board remanded the claim to the Agency of Original Jurisdiction (AOJ) for further to obtain an adequate opinion on the etiology of the current dental disability, which was obtained. As such, the Board finds that there has been substantial compliance with the development sought as part of the February 2020 remand. Stegall v. West, 11 Vet. App. 268 (1998). 1. Service Connection for Dental Condition. The Veteran contends that service connection is warranted for the residuals of an in-service dental surgery. After review of the evidence, both lay and medical, the Board finds that service connection for a dental disability is not warranted. Service connection may be granted for disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. § 3.303. The three-element test for service connection requires evidence of: (1) a current disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the current disability and the in-service disease or injury. Shedden v. Principi, 381 F.3d 1163, 1166 -67 (Fed. Cir. 2004). The question for the Board is whether the Veteran's current dental disability began during service or is at least as likely as not related to an in-service injury, event, or disease. The Board concludes that, while the Veteran has a current diagnosis of loss of teeth, the preponderance of the evidence weighs against finding that the Veteran's loss of teeth began during service or is otherwise related to an in-service injury, event, or disease. Service treatment records document extensive dental treatment. An abstract of service medical history and clinical record show the Veteran was hospitalized following a maxillary hypoplasia from March 27, 1979 to April 17, 1979. The Veteran's October 1982 separation examination notes an oral surgery during service but includes no additional narrative. The Veteran has submitted private dental records that show extensive treatment including the removal of teeth. VA treatment records show that in March 2018, the Veteran reported having two teeth pulled. There are three VA examinations of record. The Board notes that there is uncertainty around the validity of the September 2019 VA examination. Specifically, while the examiner indicated an in-person examination was conducted, the Veteran has indicated multiple times that he did not undergo this examination. Given the uncertainty with this examination, the Board has not considered its findings in this decision. In October 2020, the Veteran underwent a VA examination. The VA examiner diagnosed the Veteran with peri-implantis and in a November 2020 addendum opined that the Veteran's loss of teeth was less likely than not caused by loss of maxilla or mandible. However, review of the opinion shows the examination did not provide adequate rationale as support and it is therefore inadequate. Specifically, the examiner indicated the tooth loss was more likely due to periodontal disease but provided no rationale for that finding. See Barr v. Nicholson, 21 Vet. App. 303 (2007). In September 2021, a VA Doctor of Dental Science (DDS), reviewed the claims file and opined that the Veteran's tooth loss was less likely than not caused by the in-service surgery and was more likely due to dental decay. The VA doctor further opined that the loss of bone was due to generalized periodontal disease developing over 39 years' time. The rationale provided was that dental decay was noted as the reason for root canal treatment. The VA DDS recounted the Veteran's in-service treatment including the March 1979 surgery and then commented on the October 2016 CT scan. Specifically, the VA doctor indicated that the statement by Dr. JP regarding the October 2016 CT scan appeared to be noting visible surgical trauma and not finding that the Veteran had experienced a traumatic injury. The VA doctor further indicated that no complications were noted following the surgery in 1979 and that there were no conditions related to the developmental deformity, nor were there record of the deformity becoming worse following surgery. Finally, the VA DDS noted that following the removal of the affected teeth, no bone graft was required which indicated the existing bone was adequate for the placement of dental implants. The examiner's opinion is probative, because it is based on an accurate medical history and provides an explanation that contains clear conclusions and supporting data. Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008). (Continued on the next page) In view of foregoing, the Board finds the September 2021 VA opinion regarding service connection both probative and supported by sufficient rationale. The Board notes that the Veteran has indicated through lay reports, including the April 2017 Board hearing, that the loss of teeth resulted from the in-service dental surgery. While the Veteran is competent to report readily observable symptoms, such as loss of teeth, he is not competent to provide a diagnosis in this case or determine that these symptoms were manifestations of the in-service surgery. The issue is medically complex, as it requires knowledge of, multiple systems and their interactions including the musculoskeletal system and dental anatomy and pathology. Jandreau v. Nicholson, 492 F.3d 1372, 1377, 1377 n.4 (Fed. Cir. 2007). Therefore, it is outside the competence of the Veteran in this case because the record does not show that he has the medical training or credentials to make such a determination. Jandreau v. Nicholson, 492 F.3d 1372, 1377 n.4 (Fed. Cir. 2007); see also Kahana v. Shinseki, 24. Vet. App. 428 (2011). Consequently, the Board gives more probative weight to the medical opinions. In sum, review of the extensive record including private and VA treatment records reveals that at no point has any medical professional indicated that the Veteran's current dental disability was incurred during service to include the 1979 dental surgery. Because the preponderance of the evidence is against claim, service connection for the current dental disability, including loss of teeth, must be denied. H. SEESEL Veterans Law Judge Board of Veterans' Appeals Attorney for the Board C. Teague, 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.