Citation Nr: 21012537 Decision Date: 03/04/21 Archive Date: 03/04/21 DOCKET NO. 17-56 380 DATE: March 4, 2021 ORDER Entitlement to service connection for a dental disability, claimed as loss of teeth, is denied. REMANDED Entitlement to an initial compensable disability rating for bilateral hearing loss is remanded. FINDING OF FACT The Veteran’s loss of teeth is not a disability for which service connection for compensation purposes may be granted. CONCLUSION OF LAW The criteria for entitlement to service connection for a dental disability, claimed as loss of teeth, have not been met. 38 U.S.C. §§ 1110, 1132, 1712; 38 C.F.R. §§ 3.303, 3.304, 3.381, 4.150. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from April 1967 to April 1970. This matter comes before the Board of Veterans’ Appeals (Board) on appeal of a March 2015 rating decision by the Department of Veterans Affairs (VA) Regional Office (RO). In February 2021, the Veteran testified during a video conference hearing before the undersigned Veterans Law Judge. A transcript of the hearing is associated with the claims file. Tooth loss The Veteran seeks entitlement to service connection for a dental condition resulting in loss of all his teeth. The Veteran stated he began to have toothaches while serving in Vietnam. Access to dental care was limited due to being in a combat zone. He stated when he asked about treatment it was recommended his teeth be pulled out or he should take pain medication until he could get a root canal. The Veteran’s April 1967 entrance dental examination showed four missing teeth (numbers 10, 16, 30, and 31). The April 1970 separation examination revealed the Veteran was missing five teeth (numbers 10, 13, 16, 30, and 31) when he underwent a Type A and Class 4 dental examination. There is no indication in these dental treatment records that the Veteran experienced loss of teeth due to the loss of substance in the body of the maxilla or mandible as a result of in-service trauma or disease, such as osteomyelitis. At his January 2021 Board hearing the Veteran denied any dental trauma in service. Shortly after separation in 1970, the Veteran reported having all his teeth pulled out at Bay Pines VA Healthcare Center. The Bay Pines VA records were unable to be located. Several statements were submitted on the Veteran’s behalf stating the Veteran’s teeth deteriorated while in Vietnam and all his teeth were pulled at Bay Pines VA after service. Under VA regulations, compensation is available for certain types of dental and oral conditions listed under 38 C.F.R. § 4.150. These conditions include loss of whole or part of the mandible, nonunion or malunion of the mandible, loss of whole or part of the ramus, loss of whole or part of the maxilla, nonunion or malunion of the maxilla, loss of the condyloid or coronoid process, or loss of any part of the hard palate. See 38 C.F.R. § 4.150, Diagnostic Codes 9900-9916. Compensation is also available for loss of teeth only if such is due to loss of substance of body of maxilla (upper jawbone) or mandible (lower jawbone). See Simmington v. West, 11 Vet. App. 41 (1998). For loss of teeth, bone loss through in-service trauma or disease, such as osteomyelitis, must be shown for compensable purposes. 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. In addition, to be compensable, the lost masticatory surface for any tooth cannot be restorable by suitable prosthesis. Id. Thus, in order to establish service connection for VA compensation purposes, it is not enough to show that the teeth were lost due to trauma during active duty service. The evidence must demonstrate that the trauma resulted in loss of substance of the maxilla or mandible, which then resulted in loss of teeth. The Board notes that the term “service trauma” does not include the intended effects of treatment provided during military service such as therapeutic tooth extractions. 38 C.F.R. § 3.381. Treatable carious teeth, replaceable missing teeth, and dental or alveolar abscesses are not considered disabling conditions and are not subject to service connection for VA compensation purposes. See 38 C.F.R. § 3.381 (b). The Veteran has not identified or submitted any dental treatment records showing the current state of his oral or dental health. In the absence of such, there is no evidence that he has experienced any of the oral or dental conditions set forth in 38 C.F.R. § 4.150 and subject to compensable service connection consideration. The Board has also reviewed the Veteran’s available in-service dental treatment records, which show that tooth number 13 was extracted during service. A March 1970 memorandum states the Veteran’s dental records have been lost. However, there is no indication in the available dental treatment records that the Veteran experienced loss of teeth due to the loss of substance in the body of the maxilla or mandible as a result of in-service trauma or disease, such as osteomyelitis. The Board finds that the record does not show, nor does the Veteran contend, that his teeth were lost due to in-service trauma or bone loss. Furthermore, regardless of the cause, the clinical evidence reflects that he does not currently exhibit a compensable dental disability for which service connection may be granted. He currently has dentures and does not contend otherwise, indicating that his missing teeth have been replaced. The applicable legal criteria provide that replaceable missing teeth is not a disabling condition for VA compensation purposes and may be considered service connected solely for the purpose of establishing eligibility for VA outpatient dental treatment. 38 C.F.R. § 3.381(b). The RO has indicated that it was referring the Veteran’s claim for dental treatment to the VA hospital for adjudication, so that will be addressed separately and is not on appeal. Under these circumstances, the Board can find no basis upon which to award service connection for VA compensation purposes for a dental disability claimed as loss of teeth. REASONS FOR REMAND Increased rating--Bilateral hearing loss is remanded The Board finds that further development is necessary before a decision on the merits may be made regarding the issue of entitlement to an initial compensable disability rating for bilateral hearing loss. The Veteran was last provided a VA examination relating to his bilateral hearing loss in 2017, over 3 years ago. During the January 2021 Board hearing the Veteran stated that his hearing loss has worsened since his last hearing examination. In light of the Veteran’s assertions, a new VA examination is required so that the current nature and severity of the Veteran’s service-connected disability may be determined. See 38 U.S.C. § 5103A; 38 C.F.R. § 3.159; see also Green v. Derwinski, 1 Vet. App. 121, 124 (1991) (VA has a duty to provide the veteran with a thorough and contemporaneous medical examination); Weggenmann v. Brown, 5 Vet. App. 281 (1993) (VA has a duty to provide an examination when there is evidence that the disability has worsened since the previous examination). The matter is REMANDED for the following action: 1. Schedule the Veteran for a VA examination to determine the current nature and severity of his service-connected bilateral hearing loss. R. FEINBERG Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board A. St. Laurent, Associate 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.