Citation Nr: 21024439 Decision Date: 04/22/21 Archive Date: 04/22/21 DOCKET NO. 12-33 681A DATE: April 22, 2021 ORDER Entitlement to service connection for a dental disability for VA 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 (2012); 38 C.F.R. §§ 3.102, 3.303, 3.381, 4.150 (2020).   REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served honorably in the United States Army from June 1965 to May 1968, which included service in the Republic of Vietnam and an award of the Bronze Star Medal. In October 2020, the Board remanded claims for service connection for sleep apnea and chronic renal insufficiency. In February 2021, the agency of original jurisdiction (AOJ) issued a rating decision that granted these service connection claims. Consequently, the claims for service connection for sleep apnea and chronic renal insufficiency are no longer before the Board. Entitlement to service connection for a dental disability for VA compensation purposes is denied. In February 2017, the Veteran submitted a VA Form 21-526EZ. Thereby, the Veteran initiated a claim for service connection for a dental disability for VA compensation purposes. Along with his claim, the Veteran submitted a statement, which identified an in-service helicopter crash that resulted in multiple damaged teeth. 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 38C.F.R. §4.150, Diagnostic Codes (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, DC 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. The Board notes that VA’s General Counsel has instructed 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). In August 1968, VA notified the Veteran that he incurred noncompensable dental conditions during military service. Additionally, VA relayed that any necessary treatment for a noncompensable dental disability could be furnished on a one-time basis. In December 1982 and May 2015, the Veteran’s service treatment records (STRs) were associated with the claims file. The Board notes that dental issues were not reported and/or noted during the Veteran’s enlistment physical in June 1965. The Board also notes that numerous dental issues and damaged teeth were reported in the June 1967 STRs. In September 2011, the AOJ issued a rating decision. At that time, the AOJ relayed that, “(t)he following teeth were injured by trauma in service . . ..” In February 2019, Dental Progress Notes were generated at the Birmingham VA Medical Clinic (VAMC). Important to this analysis, one note relayed a partial loss of teeth, with an unspecified cause. A second note reported that, “bone loss hinted at for #2.” In December 2019, the Veteran underwent a VA examination that considered the nature and etiology of oral and dental conditions. The VA examiner noted a diagnosis for loss of teeth. The VA examiner did not report loss of any portion of the mandible or maxilla, nor did the examiner report malunion or nonunion of the mandible or maxilla. In October 2020, the Board addressed the Veteran’s claim for service connection for a dental disability. At that time, the Board determined that the December 2019 VA examination of record was inadequate. Specifically, the VA 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 the number 2 (#2) tooth. Consequently, the Board concluded that an addendum VA examination report was necessary. In January 2021, the Veteran underwent a VA examination that considered the nature and etiology of any currently endured dental conditions. During the examination, the Veteran reported that he was involved in an in-service helicopter crash. The Veteran reported that his teeth were damaged when other service members stepped on his face to exit the helicopter. The VA examiner reported a diagnosis for loss of teeth. Importantly, the VA examiner did not report a diagnosis for loss of any portion of mandible or maxilla, nor did the examiner report malunion or nonunion of mandible or maxilla. The VA examiner specifically reported that the Veteran’s missing teeth was not result of loss of substance of body of maxilla or mandible. The VA examiner also reported that the masticatory surfaces could be restored with suitable prosthesis. Imaging studies were performed, which revealed that the Veteran had missing teeth as well as fixed partial prostheses. The VA examiner opined that the Veteran’s current dental disability was less likely than not (less than 50 percent probability) related to his military service. The VA examiner relayed that, “(o)utside of the veteran’s medical records reporting that he experienced trauma to the face as the result of a helicopter crash, there are no specific diagnoses in the file, nor are there any residual signs of trauma to his maxillary/mandibular bone/teeth that reduce his quality of life. The teeth that are missing can be replaced by implants, fixed, or removable prostheses.” The Board finds that the January 2021 VA examination report is entitled to significant probative weight as the examiner 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 VA 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”). The Board notes that there is no opposing medical opinion in the Veteran’s claims file. The Board observes that, 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 current diagnosis 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, DCs 9900-9916. Ultimately, the Board finds that entitlement to service connection for a dental disability for VA compensation purposes is not warranted. In reaching this conclusion, 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 VA compensation purposes.   Therefore, the doctrine is not applicable in the instant appeal, and the Veteran’s claim must be denied. 38 U.S.C. § 5107; 38 C.F.R. § 3.102; Gilbert, supra. DAVID L. WIGHT Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board RLBJ, 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.