Citation Nr: 21022189 Decision Date: 04/15/21 Archive Date: 04/15/21 DOCKET NO. 15-31 763 DATE: April 15, 2021 ORDER Entitlement to service connection for loss of teeth, secondary to residuals of treatment for service-connected squamous cell carcinoma of the tonsils, for compensation purposes is denied. REFERRED A claim for service connection for a dental disorder is also a claim for Department of Veterans Affairs (VA) outpatient dental treatment under 38 C.F.R. § 3.381. Mays v. Brown, 5 Vet. App. 302 (1993). In dental claims, the VA Regional Office (RO) adjudicates the claim for service connection and the VA Medical Center adjudicates the claim for outpatient treatment. As this matter stems from an adverse determination by the RO, the appeal is limited to the issue of service connection for a dental disorder for the purpose of compensation. Thus, the claim for service connection for a dental disorder for the purpose of obtaining VA outpatient dental treatment is REFERRED to the Agency of Original Jurisdiction (AOJ) for additional referral to the appropriate VA medical facility, if in order. See 38 C.F.R. § 17.161. FINDING OF FACT The Veteran does not have a dental disability that meets the VA criteria for receipt of disability compensation including loss of teeth. CONCLUSION OF LAW The criteria for service connection for loss of teeth, secondary to residuals of treatment for service-connected squamous cell carcinoma of the tonsils, for compensation purposes are not met. 38 U.S.C. §§ 1131, 1712, 5107(b); 38 C.F.R. §§ 3.303, 3.381(b). REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from May 1968 to March 1970, including service in the Republic of Vietnam. This appeal comes to the Board of Veterans’ Appeals (Board) from a VA AOJ September 2013 rating decision. In December 2016, the Veteran testified at a videoconference hearing before the undersigned Veterans Law Judge. A transcript of that hearing has been reviewed by the Board, and is included in the claims file. In October 2018 the Board remanded the case to the AOJ for additional development. On remand, the AOJ granted service connection for tonsil carcinoma; chronic cough and dry mouth; painful neck scar; and disfiguring scar of the neck. Thus, these matters are no longer on appeal and before the Board. The Board notes further, that a Board remand confers upon the appellant the right to compliance with that order. Stegall v. West, 11 Vet. App. 268, 271 (1998). Substantial compliance, rather than strict compliance, is required. D’Aries v. Peake, 22 Vet. App. 97, 105 (2008). After a review of the evidence added to the record in the time since the October 2018 remand, the Board finds that there has been substantial compliance with the remand directives. 1. Entitlement to service connection for compensation purposes for loss of teeth, secondary to residuals of treatment for service-connected squamous cell carcinoma of the tonsils The Veteran appeals the denial of service connection for the loss of his teeth for compensation purposes. Dental disabilities which may be awarded compensable disability ratings are set forth under 38 C.F.R. § 4.150. These disabilities include 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, 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, Diagnostic Codes 9900-9916. The Rating Schedule provides further that rating activity should consider each defective or missing tooth and each disease of the teeth and periodontal tissues separately to determine whether the condition was incurred or aggravated in line of duty during active service and, when applicable, to determine whether the condition is due to combat or other in-service trauma, or whether the veteran was interned as a prisoner of war. 38 C.F.R. § 3.381 (b). 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. Treatable carious teeth, replaceable missing teeth, dental or alveolar abscesses, and periodontal disease (pyorrhea) are not disabling conditions. See 38 C.F.R. § 3.381. Thus, compensation is only available for loss of teeth where the lost masticatory surface cannot be restored by suitable prosthesis, if such is due to loss of substance of body of maxilla or mandible, but only if such bone loss is due to trauma or osteomyelitis, and not to the loss of the alveolar process as a result of periodontal disease, as such loss is not considered disabling. 38 C.F.R. § 4.150, Diagnostic Code 9913. Absent a demonstration of dental trauma, service connection may be considered solely for the purpose of determining entitlement to dental examinations or outpatient dental treatment. See Woodson v. Brown, 8 Vet. App. 352, 354 (1995). Treatable carious teeth, replaceable missing teeth, dental or alveolar abscesses, and periodontal disease will be considered service connected solely for establishing eligibility for outpatient dental treatment as provided in 38 C.F.R. § 17.161. 38 C.F.R. § 3.381(a). The most recent October 2020 VA examiner’s report does not indicate a loss of the body of either the maxilla or the mandible, and he indicated a radiation-related etiology, not trauma or disease. Furthermore, the Veteran does note assert, nor do his service treatment records (STRs) show, that the Veteran suffered in-service trauma or a disease to his jaw and teeth. There are no statutory or regulatory provisions that might allow the Veteran to establish entitlement to service connection for compensation purposes for his claimed dental conditions, including missing teeth and denture prosthesis. The regulations governing dental claims make a fundamental distinction between “replaceable missing teeth” and teeth lost as a result of loss of substance of body of maxilla or mandible due to trauma or disease such as osteomyelitis. 38 C.F.R. § 4.150. Replaceable missing teeth may be considered service-connected solely for the purpose of establishing eligibility for outpatient dental treatment. As the Veteran does not have loss of substance of the mandible or maxilla, or loss of teeth due to bone loss from trauma or disease, he does not have a dental disability for which VA compensation may be granted. The record additionally does not show nonunion or malunion of the mandible or maxilla, limited temporomandibular motion, loss of the ramus, loss of the condyloid or coronoid processes, or loss of the hard palate. Consequently, as the Veteran does not have tooth loss due to the loss of substance of the body of the maxilla or mandible where the lost masticatory surface cannot be restored by suitable prosthesis and with the bone loss a result of trauma or disease, he does not have a disability for which service connection for a dental disorder for compensation purposes can be granted. There is no doubt to be resolved and his claim must be denied. S. L. Kennedy Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board M. Neville, 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.