Citation Nr: 21014782 Decision Date: 03/15/21 Archive Date: 03/15/21 DOCKET NO. 18-36 189 DATE: March 15, 2021 ORDER Entitlement to service connection for a dental disability for compensation purposes is denied. FINDING OF FACT The preponderance of the evidence is against the finding that the Veteran has tooth loss due to loss of substance of body of maxilla or mandible, or bone loss through trauma or disease, such as osteomyelitis. CONCLUSION OF LAW The criteria for service connection for a dental disability for compensation purposes have not been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.381, 4.150. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty in the United States Army from June 1965 to May 1968, to include service in Vietnam. For his meritorious service, the Veteran was awarded the Defense Meritorious Service Medal, the Bronze Star Medal, and the Army Commendation Medal with V device, among other decorations. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from a rating decision issued in March 2017 by a Department of Veterans Affairs (VA) Regional Office (RO). This matter was previously remanded by the Board in August 2019 and October 2020 for additional development. It is now before the Board for further appellate review. The issues of entitlement to service connection for sleep apnea and chronic renal insufficiency were also remanded by the Board in October 2020. In a February 2021 rating decision, the RO granted these claims; as such, they are no longer before the Board. Entitlement to service connection for a dental disability for compensation purposes. The Veteran asserts that he is entitled to service connection for his tooth loss for compensation purposes. Generally, to establish service connection there must be competent evidence showing: (1) a current disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the present disability and the in-service injury incurred or aggravated during service. 38 U.S.C. § 1110; 38 C.F.R. § 3.303; Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004). Under VA regulations, compensation is available for certain types of dental and oral conditions. The dental conditions for which service-connected compensation benefits are available are set forth under 38 C.F.R. § 4.150, DCs 9900-9916. 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. Compensation is also available for loss of teeth only if such is due to loss of substance of body of maxilla or mandible. See Simmington v. West, 11 Vet. App. 41 (1998). For loss of the teeth, bone loss through 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 compensation purposes, it is not enough to show that the teeth were lost due to trauma. The evidence must demonstrate that the trauma resulted in loss of substance of the maxilla or mandible, which then resulted in the loss of the teeth. 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). When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, the Secretary shall give the benefit of the doubt to the claimant. 38 U.S.C. § 5107; 38 C.F.R. § 3.102; see also Gilbert v. Derwinski, 1 Vet. App. 49, 53 (1990). Review of the Veteran’s service treatment records (STRs) reveals that there were no dental issues documented on the Veteran’s June 1965 entrance examination. The Veteran’s separation examination, however, documents that the Veteran was missing several teeth upon separation from service. The Veteran received a correspondence from the VA in August 1968. The correspondence stated that his noncompensable dental conditions were incurred in or aggravated by military service. An evaluation performed on the Veteran revealed that his functional areas were operating within normal limits. The VA reported to the Veteran that necessary treatment for a service-connected noncompensable dental disability can be furnished on a one-time basis. VA treatment records from February 2019 note that bone loss was hinted at for the Veteran’s number 2 (#2) tooth. The records also stated that the Veteran had a diagnosis of partial loss of teeth, with an unspecified cause. In the previous October 2020 Board remand, the Board determined that the December 2019 VA examination of record was inadequate. Specifically, the examiner did not address whether the Veteran had a loss of bone mass in the mandible or maxilla when medical records documented a suspected bone loss at number 2 (#2) tooth. Thus, a new examination was requested. Pursuant to October 2020 Board remand directives, the Veteran appeared for a new examination for a dental disability in January 2021. During the examination, the Veteran reported that he was involved in a helicopter crash while in service. He reported that during the crash, other service members stepped on his face to exit the helicopter. Imaging studies were performed which revealed that the Veteran had missing teeth as well as fixed partial prostheses. The examiner opined that the Veteran’s current dental disability was less likely than not related to his military service. The examiner explained that although the Veteran experienced trauma to his face as the result of the helicopter crash, there is no specific diagnosis or residual signs of trauma to his maxillary or mandibular bone that reduced his quality of life. Further, the examiner stated that the Veteran’s teeth that are missing can be replaced by implants. As noted, the January 2021 VA examination specifically noted that there was no loss of substance of the maxilla or mandible. The Board finds that the January 2021 VA examiner's opinion is entitled to great probative weight as such considered all of the pertinent evidence of record, to include the statements of the Veteran, and provided a complete rationale, relying on and citing to the records reviewed. Moreover, the examiner offered clear conclusions with supporting data as well as reasoned medical explanations connecting the two. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295 (2008); Stefl v. Nicholson, 21 Vet. App. 120, 124 (2007) (“[A]medical opinion... must support its conclusion with an analysis that the Board can consider and weigh against contrary opinions”). Further, there is no medical opinion to the contrary of record. Although the Veteran suffers from loss of teeth, there is no evidence of record that his tooth loss is due to the loss of substance of body of maxilla or mandible during service. Additionally, the evidence does not support a finding that the Veteran has been diagnosed with any of the dental and oral conditions listed in 38 C.F.R. § 4.150. That is, there is no diagnosis of record for 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, for which service-connected compensation could be granted. See 38 C.F.R. § 4.150, Diagnostic Codes 9900-9916. As such, the Board finds that entitlement to service connection for a dental disability for compensation purposes is not warranted. In reaching such decision, the Board has considered the applicability of the benefit of the doubt doctrine. However, the preponderance of the evidence is against the Veteran's claim for service connection for a dental disability for compensation purposes. As such, that doctrine is not applicable in the instant appeal, and his claim must be denied. 38 U.S.C. § 5107; 38 C.F.R. § 3.102; Gilbert, supra. L. ANDERSEN Acting Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board C. K. Hall, 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.