Citation Nr: 21013198 Decision Date: 03/08/21 Archive Date: 03/08/21 DOCKET NO. 14-18 277 DATE: March 8, 2021 ORDER Entitlement to service connection for compensation purposes for loss of front teeth due to in-service dental trauma is denied. FINDING OF FACT The evidence does not reach equipoise that the Veteran had loss of a front tooth due to loss of substance of body of the maxilla or mandible. CONCLUSION OF LAW The criteria for entitlement to service connection for compensation purposes for loss of front teeth due to in service dental trauma have not been met. 38 U.S.C. §§ 1110, 1712, 5107(b); 38 C.F.R. §§ 3.381, 4.150. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from January 1966 to January 1969. He served honorably in the U.S. Marine Corps, including service in the Republic of Vietnam during the Vietnam era, and is a Purple Heart recipient. Unfortunately, the Veteran died in April 2017, during the pendency of his appeal. The Agency of Original Jurisdiction (AOJ) has recognized his surviving spouse as the substitute claimant for the purposes of processing this claim to completion. The Board previously remanded this case in September 2018 and February 2020 for additional development. The case has now returned to the Board for further appellate review. The Board notes that, following the February 2020 remand, the AOJ sent two requests to treatment provider Dr. S.W. and requested that the appellant send information or evidence with respect to Dr. S.W. Further, a VA opinion was provided as to the onset of the loss of teeth. Accordingly, the Board finds that the AOJ has substantially complied with the remand instructions. Stegall v. West, 11 Vet. App. 268 (1998) A claim of service connection for a dental disability is also considered a claim for VA outpatient dental treatment. Mays v. Brown, 5 Vet. App. 302, 306 (1993). In dental claims, the Regional Office (RO) adjudicates the claim for service connection and the VA Medical Center adjudicates the claim for outpatient treatment. As the current issue of service connection for a dental disability stems from an adverse determination by the RO, the dental issue addressed herein must be limited to service connection for compensation purposes only. The Board notes that the issue of outpatient treatment is moot. Entitlement to service connection for compensation purposes for loss of front teeth due to in-service dental trauma is denied. During his lifetime, the Veteran contended that service connection for loss of front teeth is warranted as he sustained trauma in service when he was blown off of the back of a personnel carrier and landed on his radio. The Board finds that service connection is not warranted. In the VA benefits system, dental disabilities are treated differently than medical disabilities. Disability compensation is only available for certain types of dental and oral conditions listed under 38 C.F.R. § 4.150, including chronic osteomyelitis or osteoradionecrosis of the maxilla or mandible, loss of the mandible, nonunion or malunion of the mandible, limited temporomandibular motion, loss of the ramus, loss of the condyloid or coronoid processes, loss of the hard palate, and loss of teeth due to the loss of substance of the body of the maxilla or mandible and where the lost masticatory surface cannot be restored by suitable prosthesis, when the bone loss is a result of trauma or disease but not the result of periodontal disease. 38 C.F.R. § 4.150. Furthermore, dental conditions such as treatable carious teeth, replaceable missing teeth, dental or alveolar abscesses, and periodontal disease will be considered service-connected solely for the purpose of establishing eligibility for outpatient dental treatment but will not be considered for compensation. 38 U.S.C. § 1712; 38 C.F.R. §§ 3.381, 4.150. It is the responsibility of VA adjudicators to make a determination on questions including whether the Veteran has a compensable or noncompensable service-connected dental condition or disability, and whether the dental condition or disability is a result of combat wounds or service trauma. 38 C.F.R. § 3.381(a). Notably, VA’s General Counsel has held that dental treatment of teeth, even extractions, during service does not constitute dental trauma. See VAOPGCPREC 5-97, 62 Fed. Reg. 15,566 (1997). In this case, however, in-service dental trauma was conceded in the September 2018 Board decision. In a February 1966 entrance dental examination, the Veteran was noted to be missing teeth numbers 1, 4, 5, 16, 18, 19, 20, 29, and 32. A July 1967 note from a dental company in the Republic of Vietnam noted extraction of teeth 9 and 10. In a January 1969 separation examination report, on clinical evaluation the Veteran’s head, face, neck, and scalp and mouth and throat were noted to be normal. It was noted that teeth 9 and 10 had been replaced by dentures. In an August 2002 VA note, physical examination showed the Veteran’s skull and face to be normal. In an October 2002 skull series imaging report, the provider noted that the Veteran’s facial bones were within normal limits. During his lifetime, specifically in a May 2014 VA Form 9 substantive appeal, the Veteran reported that during service he was thrown to the ground when a mortar or artillery round exploded nearby and his teeth broke off at the gums when he landed on his radio. He stated that he was transported to a medical facility where the roots of the teeth were extracted, and he was provided a plastic partial plate. Similarly, in a May 2018 statement, the appellant stated that the Veteran had relayed to her, that in the blast, he sustained a concussion and lacerations to his scalp due to shrapnel and had two teeth broken off a couple of others loosened; the loose teeth regained their stability. In an April 2020 VA opinion, the clinician noted that the Veteran had missing teeth and concluded that the Veteran’s tooth extraction, specifically of teeth 9 and 10, was at least as likely as not related to conceded in-service trauma. However, notably, the April 2020 clinician did not find the Veteran’s tooth extraction was due to a loss of substance of the body of the maxilla or mandible. Even assuming that the Veteran’s extracted teeth were not replaceable missing teeth, the preponderance of the evidence is against finding that the extraction of teeth 9 and 10 was due to the loss of substance of the body of the maxilla or mandible. There is no lay or medical evidence, and neither the Veteran contended, nor the appellant contends, that the loss of the Veteran’s teeth was due to the loss of substance of the body of the maxilla or mandible. While the Veteran reported that his teeth broke off at the gums, he did not claim any injury to other parts of his mouth including the maxilla or mandible. The appellant stated that his other teeth were loosened in the blast but that they regained their stability. Further, in 2002 his skull and face were noted to be normal on physical examination and imaging showed that his facial bones were within normal limits. As the preponderance of the evidence is against finding that tooth loss was due to the loss of substance of the body of the maxilla or mandible and as there is no evidence that the Veteran had any of the compensable oral disorders listed under 38 C.F.R. § 4.150, service connection is not warranted. The Board has considered the doctrine of reasonable doubt, but finds that the record does not provide an approximate balance of negative and positive evidence on the merits. The claim is, therefore, denied. Gilbert v. Derwinski, 1 Vet. App. 49, 55 (1990); 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102. While the Board cannot grant the appellant’s claim, the Board is thankful for the Veteran’s honorable service. M. ESPINOZA Acting Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board M. Vashaw, 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.