Citation Nr: 21024812 Decision Date: 04/26/21 Archive Date: 04/26/21 DOCKET NO. 10-38 541 DATE: April 26, 2021 ORDER Entitlement to service connection for a dental disorder for VA treatment purposes only is denied. FINDINGS OF FACT 1. While in service, the Veteran’s teeth numbers 2, 3, 14, 18, 19, and 30 were extracted. 2. In service dental extractions did not constitute negligence or malpractice for the purpose of establishing dental trauma for Class II(a) eligibility for dental treatment. CONCLUSION OF LAW The criteria for service connection for a dental disorder for purposes of receiving VA outpatient dental treatment have not been met. 38 U.S.C. §§ 1712, 5103, 5103A, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.381, 4.150, 17.161. REASONS AND BASES FOR FINDINGS AND CONCLUSION The Veteran served on active duty from August 1970 to August 1972. In July 2012, a hearing was held before the undersigned Veterans Law Judge (VLJ). The Veteran, with the VLJ’s permission, did not attend the hearing due to health issues. The Veteran’s representative provided evidence on the Veteran’s behalf. A transcript of the hearing has been associated with the claims file In February 2013 and January 2015, the Board remanded the claim for further development. In March 2016, the Board denied the Veteran’s claim for entitlement to service connection for jaw disabilities, to include an anterior open bite and temporomandibular joint condition/disorder (“TMJ/TMD”) for the purposes of compensation. The Board also denied entitlement to service connection for dental treatment and services. In October 2017, the United States Court of Appeals for Veterans Claims (Court) issued a Memorandum Decision affirming the Board’s decision denying entitlement to service connection for jaw disabilities for compensation purposes. However, the Court vacated the portion of the Board’s decision that denied entitlement to service connection for dental treatment purposes. The Court found that the Board failed to address the Veteran’s contentions that he has a Class II(a) claim because the Marine Corps extracted his teeth after mistaking him for another servicemember. The Court also noted that VA failed to obtain relevant evidence, i.e., the Veteran’s in-service x-rays, that would have assisted him in demonstrating that the extractions were unnecessary. The Court remanded the claim. In May 2018, and based on the October 2017 Memorandum Decision, the Board remanded the claim for a VA examination to address whether any current dental disorder was incurred or otherwise related to service and to address whether any current disability was due to negligence or malpractice in removing the teeth in service. VA was also instructed to obtain any outstanding service treatment records, to include any records regarding in-service dental x-rays. Based on the 2018 remand, in August 2019, the Veteran was notified by correspondence that it had been determined that the dental x-rays could not be located and therefore are unavailable for review. The letter noted all efforts to obtain the needed information had been exhausted, and based on these facts, it was determined that further attempts to obtain the records would be futile. VA has made sufficient efforts to obtain the Veteran’s in-service dental x-rays. Despite VA efforts, the x-rays are unavailable and further attempts to find such records would be futile. Therefore, the Board finds VA has fulfilled its duty to assist in obtaining the identified and available evidence needed to substantiate the claim adjudicated in this decision. In April 2020, the Board, once again, remanded the claim to determine whether any current disability was due to negligence or malpractice in removing the teeth in service. Entitlement to service connection for a dental disability for treatment purposes only Dental conditions such as treatable carious teeth, replaceable missing teeth, dental or alveolar abscesses, and periodontal disease may 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. In order to qualify for treatment for these conditions, the Veteran must establish eligibility through one of the categories specified by regulation. For Class II(a) eligibility, the record must show that a noncompensable service-connected dental condition was adjudicated as resulting from a combat wound or other service trauma. Under the applicable statute for Class II(a) eligibility, 38 U.S.C. § 1712(a)(1)(C), service trauma is “an injury or wound produced by an external physical force during the performance of military duties,” and “excludes the intended result of proper medical treatment.” Nielson v. Shinseki, 607 F.3d 802, 809 (Fed. Cir. 2010). In Nielson, however, the Federal Circuit indicated that “service trauma” in the context of establishing Class II(a) eligibility could be the “unintended result of medical treatment due to military negligence or malpractice” (i.e., improper treatment). Analysis The Veteran seeks entitlement to service connection for a dental condition for treatment purposes. On the Veteran’s September 1970 Report of Medical History; Enlistment exam, which documents the Veteran’s full name, birth date, race, place of birth, and social security number, the examiner noted that the Veteran had dental caries that were to be repaired. Additionally, the Veteran himself noted that he had had severe tooth or gum trouble. The examiner noted MOD dental caries which were to be repaired. During his initial dental examination, the Veteran’s dental chart, which identified the Veteran by name, social security number, date of birth, and service number, notes that on October 16, 1970, x-rays were taken of the Veteran’s teeth. The examiner placed circles around teeth numbers 1, 16, 17, and 32. Lines were place through teeth numbers 2, 3, 14, 18, 19, 29, and 30, and black dots were place on teeth numbers 4, 5, 7, 12,13, 15, 20, 28, and 31. On October 27, 1970, teeth numbers 14, 18, and 19 were extracted, and in November, tooth number 20 was restored. In January 1971, teeth numbers 2, 3, and 30 were extracted. On February 14, 1972, teeth numbers 29 and 31 were restored, and on February 22, 1972, teeth numbers 7, 10, and 15, were also restored. On the Veteran’s July 1972 separation examination, he was noted to have seven missing teeth and a notation that his dental defects and diseases were “Type 3, Class 1, Qualified.” The Board notes that the Veteran’s STRs document teeth extractions during service. Under the applicable statute for Class II(a) eligibility, 38 U.S.C. § 1712(a)(1)(C), service trauma is “an injury or wound produced by an external physical force during the performance of military duties, and does not include the intended result of proper medical treatment.” Nielson v. Shinseki, 607 F.3d 802, 804 (Fed. Cir. 2010). In Nielson, however, the Federal Circuit also held that “service trauma” in the context of establishing Class II(a) eligibility could be the unintended result of medical treatment due to military negligence or malpractice. Therefore, the question before the Board is whether the Veteran’s dental disability was caused by the unintended result of medical treatment due to military negligence or malpractice. In his October 2008 Correspondence, the Veteran stated that two weeks into boot camp, eight of his teeth were extracted. When he asked why his teeth were taken out, he was told that he was not going to Vietnam “with a mouth full of rotten teeth.” He stated that prior to the extractions, he had no dental pain and no rotten teeth. The Veteran stated that the unnecessary removal of so many teeth severely traumatized him. He was given no further treatment or options. In March 2009, the Veteran was afforded a VA examination to determine the nature and etiology of his dental disorder. The Veteran reported having eight teeth pulled in service. He stated that when he was stationed in Quantico, a dentist told him he should not have had any teeth pulled. He also stated that in 1972, there was another marine who had a similar last name. The Veteran felt that the military dentists may have pulled his teeth instead of the other marine’s teeth. After reviewing the Veteran’s records, the examiner noted that in September 1970, upon entering service, the Veteran’s enlistment physician documented dental caries that were to be repaired. On October 16, 1970, the Veteran underwent a dental exam. The exam revealed dental caries evident on teeth numbers 2, 3, 14, 18, 19, 29, and 30. The Veteran’s dental records showed that on October 27, 1970, teeth numbers 14, 18, and 19 were extracted, and on January 25, 1971, teeth numbers 2, 3, and 30 were extracted. Between January 1971 and February 1972, teeth numbers 7, 10, 15, 20, 29, and 31 were restored. On his separation exam, it was noted that teeth numbers 2, 3,14,18,19, and 30 were missing. The VA examiner diagnosed the Veteran with loss of MODB tooth structure of tooth number 12 (probable missing restoration) and severe periodontal disease associated with tooth number 15 (the tooth was terminal). The examiner noted normal TMJ. The examiner stated that there was no evidence of any dental or joint problem that could be considered to have occurred during military service. In April and May 2009, the Veteran saw a private dentist, Dr. S.D.D. The Veteran complained of muscle spasms, persistent earaches, ringing in ears, dizziness, and, at times, clicking and popping in the joint. The dentist stated that his initial evaluation was that the Veteran had an anterior open bite which may be contributing to many of his symptoms. Dr. S.D.D. further stated that in order to determine whether or not it was the bite and function that was causing the pain and inner ear symptoms, he would recommend a functional application to reproduce an ideal functional bite to see if the Veteran’s symptoms subside. The Veteran inquired as to whether removing eight teeth while in service could have contributed to his bite problems. The examiner stated, in his judgment, it was possible that having had that many teeth removed without concurrent replacement may have contributed to the Veteran’s problems long term. The Veteran had bridges placed later, but they were placed using his existing occlusion. In May 2009, the Veteran submitted an article entitled Neuromuscular Dentistry and TMD; A problem bite can cause TMD. The article stated that there are many causes of TMD/TMJ. But a very common cause is a bad bite. The article further stated that a problem bite often exists when teeth are missing, misaligned, or worn down. Over time, the constant muscle tension leads to muscle fatigue, spasm, and pain. The constant strain on the muscles can also pull the disc that cushions the jaw joint out of position. If this happens, the bones of the jaw joint can rub against each other and the nerves, causing pain and damaging the joint. In May 2009, the Veteran submitted a statement. The Veteran stated that his medical records proved that his teeth should have been repaired in service, and there was no evidence of the condition of his teeth prior to the extractions. He further stated, “yes, it is true that I had moderate dental caries (I had no dental pain) but there is no evidence that my teeth were beyond repair and had to be pulled.” In his July 2009 Notice of Disagreement (NOD), the Veteran stated that while in service, the dental clinic mixed him up with another Marine. Additionally, the dentist failed to install the necessary support bridge/appliance to help support his missing back teeth. In his September 2010 Substantive Appeal, the Veteran stated that there had never been a thorough and extensive TMJ diagnosing exam, either by a VA or civilian professional. In June 2013, the Veteran submitted a statement from his dentist, L.H., D.M.D. The dentist noted an anterior open bite with complete lack of guidance during excursive movements. The Veteran complained of muscle and TMJ soreness which was confirmed through palpation of musculature surrounding the oral cavity. The examiner believed that the open bite was either partially or totally responsible for the TMJ and muscle symptoms. As to the etiology of the dysfunctional occlusion, the examiner stated, “I can’t say for sure. There are many reasons that an open bite can develop, and a complete review of all past dental records would be required to come to a conclusive opinion on the matter.” The examiner further stated, “during my exam with the patient, such a review was not possible. It is, however, entirely possible that the prolonged absence of posterior dentition could have been contributory to his current condition.” In December 2013, the Veteran was afforded a VA examination to determine the nature and etiology of his dental disorder. The Veteran entered the Marine Corps in August 1970 and was discharged August 1972. He did not serve in a combat zone, to include Vietnam, and he suffered no trauma except that he had teeth extracted. The Veteran asserted that small differences in his records indicated that the military dentists extracted his good teeth based on his eminent transfer to Vietnam, and his dental records were switched with another Marine’s records. This other Marine had bad teeth. The Veteran also asserted that the loss of these teeth led to years of TMJ problems. The VA examiner stated that the Veteran self-educated on TMJ and sought multiple opinions, all of which describe some symptoms of mild variety with “possible” diagnosis of TMJ as cause of his anterior open bite, ear problems, and dizziness. The VA examiner noted that on September 28, 1970, the Veteran stated he had a history of severe tooth or gum trouble. In two separate appointments, the military dentist removed teeth numbers 2, 3, 30 and 14, 18, and 19. However, during his VA examination, the Veteran asserted that all of the teeth were taken at the same appointment, and he recalled going back to his dorm room with a “bloody mouth.” The VA examiner noted no record of treatment for dry sockets or any other post extraction sequelae, including no treatment in his medical or dental records for excessive bleeding. The Veteran also stated that another military dentist subsequently disputed the need for those six extractions. However, the VA examiner noted no statement in the records to confirm that this occurred. During service, the Veteran also had restorations on teeth numbers 7, 9, 15, 20, 29, and 31. In the early 1990s, a civilian dentist placed four bridges on the Veteran’s teeth. The VA examiner, D.C.T., Chief, Dental Services, stated that the Veteran did not now have or had ever had a TMJ condition. The examiner stated that the radiograph performed on the day of the exam showed a TMJ cartilage space that appeared normal. There was no history of trauma while in military service. While in the Marine Corps, the Veteran’s teeth were extracted. The examiner stated that the radiographs from that time period are missing, so, he could not fully determine the condition of the teeth that were extracted. The examiner further stated that he could not find any correlation between loss of the Veteran’s teeth and his reported TMJ symptoms, i.e., the examiner noted no deviation on opening, no pain on palpation, and no audible clicking, or popping even though the Veteran stated that he could hear these sounds, including hearing his neck vertebrae when he turned his head. Additionally, there was no grinding or clenching reported and no morning muscle soreness all of which the examiner stated are indicative of potential TMJ parafunctional habits. The examiner further stated that after posturing during the exam, i.e., rubbing the jaw, the Veteran was still able to open on request, multiple times, without the secondary reaction of rubbing his jaw muscles and face. The examination revealed mild-moderate perio. The examiner stated that the Veteran’s description of extreme ear problems, dizziness, etc., did not affect his driving as he left the clinic in the driver’s seat. Additionally, the written documentation did show the six teeth as non-restorable, and there is no evidence to refute that the caries were so extensive as to render them non-restorable. During his in-service physical, the Veteran himself stated that he had “severe tooth and gum problems.” The VA examiner stated that the Veteran’s claim of TMJ related to military service is not caused by or a result of his in-service extractions. The examiner further stated that the Veteran had sufficient dentition remaining after extractions to preclude any significant change in his jaw relationship. In his September 2014 Correspondence, the Veteran stated that his military dental records had been altered and are invalid. He stated that his name did not appeal anywhere on the forms. Additionally, his 1970 examiner noted that he had moderate dental carries that were to be repaired. The Veteran stated that as a medical doctor, the doctor would be competent to know by observation the condition of a person’s teeth. He further stated that the 1970 examiner’s diagnosis refutes the VA examiners’ evidence that his teeth were irreparable. In June 2016, the Veteran submitted a statement from a dentist. After reviewing the Veteran’s military and subsequent dental record, the dentist opine that it is as likely as not that the Veteran’s current dental condition is due to his time in active service. In November 2019, the Veteran was afforded another VA examination to determine the nature and etiology of his dental disorder. The Veteran stated that his condition began in 1970 when his teeth were unnecessarily pulled. When his condition began, he was in a lot of pain which made it hard for him to chew. His jaw was misaligned which caused popping of his jaw, and he has experienced grinding pain and headaches. He stated that VA did not provide treatment, and he himself paid for four bridges that helped temporarily with his chewing. The examiner, A.M.L., D.M.D., diagnosed the Veteran with TMJD and periodontal disease. The examiner opined that the claimed condition is less likely than not (less than 50 percent probability) incurred in or caused by the claimed in service injury, event, or illness. The examiner noted the Veteran’s claim, i.e., that perfectly good teeth were extracted. The examiner stated that the in-service event occurred almost 50 years prior to the VA exam, and there is no way of knowing if good teeth were pull as it is all hearsay. The examiner further stated that if healthy teeth were removed, it is very likely that the TMD symptoms could have begun from an unbalanced occlusion, but there is no evidence to suggest this other than the Veteran’s word. The examiner stated that the Veteran’s range of motion (ROM) was normal, and in his opinion, there was no way to determine whether the Veteran’s current symptoms are from active service. The examiner also stated that even if the symptoms began in service, a majority of TMJ disorders present themselves around that age. After reviewing the available medical records, the examiner did not see a correlation between the Veteran’s symptoms and his time in service. The examiner stated that the Veteran’s current dental situation revealed severe neglect over the last several years. Therefore, the Veteran’s current dental conditions are less likely than not incurred in or caused by military service. On September 17, 2020, VA obtained an opinion to determine whether it is at least as likely as not that the Veteran’s TMJ disease is due to the October 1970 and January 1971 in service extractions. The examiner, W.G.L., D.D.S., confirmed the Veteran’s TMD diagnosis. The examiner opined that it is as least likely as not that the Veteran’s TMJ disease was due to the October 1970 and January 1971 in service extractions. The examiner stated that the March 2009 VA dental exam indicated no finding of any limitation of ROM with the interincisal opening of 41mm, protrusive movement of 8mm, right lateral movement of 8mm, and left lateral movement of 11mm with no joint sounds. The Veteran’s indicated TMJs were within normal limits. The examiner stated that the records dated prior to the date of the exam did not list any positive findings of TMJ disorder. Additionally, there were no entries found in any military dental service records from 1970 to 1972 that indicated any type of TMJ disorder existed at that time. The VA examiner acknowledged the letters from the Veteran’s private dentists opining that the Veteran’s condition is related to treatment in service. The VA examiner noted that no specific examples were cited supporting those opinions. The examiner also opined that it is at least as likely as not that the Veteran’s periodontal disease is due to the October 1970 and January 1971 extractions. The examiner stated that the October 16, 1970 dental charting indicated (with vertical lines drawn through teeth 2, 3, 14, 18, 19, 29, 30, and 31) that those teeth were non-restorable and would most likely need to be extracted. Medical records of the enlistment physical indicated severe tooth and gum problems. Therefore, the Veteran’s periodontal or gum issues existed prior to the removal of the six teeth. Additionally, the examiner opined that it is ats least as likely as not that there was carelessness, negligence, lack of proper skill, error in judgement, or similar instance of fault on the part of the military in extracting the six teeth. The examiner stated that the induction physical indicated severe tooth and gum problems. At the time of the induction exam, the physician’s note stated dental caries to be repaired and moderate dental caries. The VA examiner stated that the October 16, 1970 dental charting image showed a method where two to three vertical lines are drawn on a tooth in the chart. Traditionally, this meant that that tooth will most likely need to be extracted. On that chart, vertical lines were drawn on teeth numbers 2, 3, 14, 18, 19, 29, 30, and 31. All but number 29 were extracted on October 27, 1970 and January 25, 1971. Medical record entries showed that tooth number 29 had a root canal. The examiner stated that looking at that chart, a circle around a tooth meant it was not completely erupted, and an X over a tooth meant it was not present. The VA examiner stated that in his opinion, this indicated that the teeth extracted were initially thought to be non-restorable and would most likely need to be removed of which only one could be saved. After reviewing all of the information in the file, the examiner stated that it was clearly evident that the military dentist had initially planned for the extractions of those teeth and clearly did so in October 1979 and January 1971. On September 30, 2020, VA noted that the September 2020 VA examiner provided positive opinions; however, the rationale conflicted with the medical opinions. VA requested clarifying addendum opinions. In October 2020, the Veteran was afforded another VA examination to determine the nature and etiology of his dental disorder. The examiner, A.M.L. D.M.D., confirmed the Veteran’s TMJ diagnosis and also noted the beginnings of arthritis. The examiner stated that the Veteran was experiencing TMD in some degree, but the degree of the Veteran’s comfort was purely subjective. The examiner was not willing to speculate whether the Veteran’s condition happened as a result of an in-service incident. The Veteran alleged that teeth that did not have any issues were removed. The examiner stated that there is no way to know if this is true because there are no records to verify this. Additionally, the examiner was unable to state whether the extractions started the Veteran’s problem. The examiner did not feel like the Veteran was consistent with his dental maintenance over the years, and this played a role in his dental issues. But, the examiner was able to say whether this occurred in service or not. The examiner clarified that he was performing the exam as the Veteran stood at the time of the exam. The examiner was not willing to read pages of old records to decide when it started, and if it was something that occurred while in-service. The examiner stated that based on the exam, the Veteran did not have functional loss. In December 2020, another examiner, W.G.L. D.D.S., opined that it is less likely than not that the Veteran’s periodontal disease is due to his October 1970 and January 1971 in service extractions. The examiner also opined that it is less likely as not that there was carelessness, negligence, lack of proper skill, error in judgement, or similar instance of fault on the part of the military in extracting the six teeth. The examiner stated firstly, the induction physical indicated severe tooth and gum problems, and the physicians note stated dental caries to be repaired and moderate dental caries. Secondly, the dental charting image dated October 16, 1970 used a method where two to three vertical lines are drawn on a tooth in the chart. The examiner stated that, traditionally, this meant that that tooth will most likely need to be extracted. On that chart, vertical lines were drawn on teeth numbers 2, 3, 14, 18, 19, 29, 30, and 31, and all but tooth number 29 were extracted in October 1970 and January 1971. Additionally, a circle around a tooth meant it was not completely erupted, and an X over a tooth meant it was not present. The examiner explained that this was an older charting style, and, in his opinion, indicated that those teeth extracted were initially thought to be non-restorable and would most likely need to be removed. The examiner stated, in his opinion, it is clearly evident that after reviewing all the information in the file that the military dentist had initially planned for the extractions of those teeth and clearly did so in October 1979 and January 1971. The examiner stated that no other information supported that the Veteran’s TMJ issues as found by A.M.L. D.M.D. were related or caused by any treatment received while in service. There is no negligence, lack of skill there was carelessness, etc., due to extracting the six teeth or cause of periodontal disease. The examiner opined that it is less likely than not that the Veteran’s disability became worse as a result of carelessness, negligence, lack of skill, or similar incidence of fault on the part of the attending VA personnel and less likely than not resulted from an event that could not have reasonably been foreseen by a reasonable healthcare provider, and/or failure on the part of VA to timely diagnose and/or properly treat the claimed disease or disability allowed the disease or disability to continue to progress as standard precautions and care was rendered. In January 2021, the December 2020 examiner, W.G.L., D.D.S., opined that it is less likely that the Veteran’s periodontal disease is due to extracting the six teeth in October 1970 and January 1971. Additionally, it is less likely as not that there was carelessness, negligence, lack of proper skill, error in judgement, or similar instance of fault on the part of the military in extracting the six teeth. The examiner stated that the induction physical indicated severe tooth and gum problems. Additionally, the Veteran’s periodontal disease was not caused by the October 1970 and January 1971 extractions because upon entering service, the Veteran had pre-existing tooth and gum issues. The examiner stated that it is a well-known fact via medical knowledge and expertise, that tooth extraction does not cause periodontal disease but is a treatment option for teeth which are hopelessly periodontally involved. The 1970 physician’s note stated dental caries to be repaired and moderate dental caries. The examiner reiterated his December 2020 statements about the dental charting. He stated that no other information supported that the TMJ issues as found by A.M.L. D.M.D. were related or caused by any treatment received by the Veteran while in service. There is no negligence, lack of skill, or carelessness, etc. due to extracting the six teeth or cause of periodontal disease nor that the claimed disability of dental disability for treatment purposes was caused by or became worse as a result of the VA treatment at issue. Periodontal disease could not have resulted from carelessness, negligence, lack of skill, or similar incidence of fault on the part of the attending VA personnel. Lastly, it is less likely than not that these issues resulted from an event that could not have reasonably been foreseen by a reasonable healthcare provider, and/or failure on the part of VA to timely diagnose and/or properly treat the claimed disease or disability allowed the disease or disability to continue to progress as standard precautions and care was rendered. The Board notes that in 2009, the Veteran’s private dentist, Dr. S.D.D., D.D.S., P.S., stated, in his judgment, it is possible that having had that many teeth removed without concurrent replacement may have contributed to the Veteran’s problems long term. In June 2013, the Veteran submitted another statement from another private dentist, L.H., D.M.D. The dentist stated, as to the etiology of the dysfunctional occlusion, “I can’t say for sure. There are many reasons that an open bite can develop, and a complete review of all past dental records would be required to come to a conclusive opinion on the matter.” The examiner stated, “during my exam with the patient, such a review was not possible. It is, however, entirely possible that the prolonged absence of posterior dentition could have been contributory to his current condition.” Both dentists stated that it was possible that many teeth removed without concurrent replacement may/could have contributed to the Veteran’s problems. However, the Board notes that attesting that something is “possible” is too speculative upon which to base an award. See Bostain v. West, 11 Vet. App. 124, 127-28, quoting Obert v. Brown, 5 Vet. App. 30, 33 (1993) (a medical opinion expressed in terms of “may” also implies “may or may not” and is too speculative to establish a causal relationship). Essentially, it is possible that many things may occur, but “possible” does not mean statistically likely or even as likely as not. Additionally, L.H., D.M.D. stated that in order to determine the etiology of the dysfunctional occlusion, a complete review of all past dental records would be required to come to a conclusive opinion on the matter. However, such a review was not possible. Therefore, the Board finds these opinions to be of little probative value. In May 2009 and in support of his claim, the Veteran submitted an article entitled Neuromuscular Dentistry and TMD; A problem bite can cause TMD. The Board notes that although the article provided information on the causes of TMJ, it does not specifically address the Veteran’s situation. As such, the article is also of little probative value. The Board notes that the Veteran admitted to having, at the time of his entrance exam, at least moderate dental carries. The Board also notes that six of the Veteran’s teeth were removed during service. However, after reviewing the Veteran’s records, to include service dental records, the Board finds that service connection for a dental disorder for treatment purposes is not warranted and does not otherwise show that dental treatment in service, to include the Veteran’s extractions, constituted negligence or malpractice is not warranted. During his March 2009 examination, the examiner diagnosed the Veteran with MODB tooth structure of number 12 and severe periodontal disease associated with number 15. The Veteran had normal TMJ. The examiner stated that there was no evidence of any dental or joint problem that could be considered to have occurred during military service. During his December 2013 examination, the examiner stated that the Veteran did not now have or had ever had a TMJ condition. The examiner stated that the radiograph performed on the day of the exam showed a TMJ cartilage space that appeared normal. The examiner could not find any correlation between the in-service teeth extractions and the reported TMJ symptoms. The examiner further stated that the Veteran had sufficient dentition remaining after extractions to preclude any significant change in his jaw relationship. In November 2019, A.M.L., D.M.D., diagnosed the Veteran with TMJD and periodontal disease. The examiner stated that if healthy teeth were removed, it is very likely that the TMD symptoms could have begun from an unbalanced occlusion, but, there was no evidence to suggest this other than the Veteran’s word. The examiner stated that, in his opinion, there is no way to determine whether the Veteran’s current symptoms are from the in-service teeth removal. After reviewing the available medical records, the examiner did not see a correlation between the Veteran’s symptoms and his time in service. Additionally, the examiner stated that the Veteran’s current dental situation revealed years of severe neglect. Therefore, his current dental conditions are less likely than not incurred or caused by military service. The Board notes that during his September 2020 VA examination, the VA examiner noted that the Veteran’s disorder was at least as likely as not. However, in the addendum opinion, the examiner amended his opinion to reflect the opinion “it is less likely than not.” Regarding whether the Veteran’s TMJ disease was due to the extraction of the six teeth in October1970 and January 1971, the examiner stated that the March 2009 VA dental exam indicated no findings of any limitation of ROM with the interincisal opening of 41mm, protrusive movement of 8mm, right lateral movement of 8mm, and left lateral movement of 11mm with no joint sounds. The Veteran’s indicated TMJs were within normal limits. The examiner stated that the records dated prior to the date of the exam did not list any positive findings of TMJ disorder. Additionally, there were no entries found in any military dental service records from 1970 to 1972 that indicated any type of TMJ disorder existed at that time. The VA examiner acknowledged the letters from the Veteran’s private dentists opining that the Veteran’s condition is related to treatment in service. The VA examiner noted that no specific examples were cited supporting those opinions. Regarding whether the Veteran’s periodontal disease is due to the extraction of six teeth in October 1970 and January 1971, the examiner stated that the October 16, 1970 dental charting indicated (with vertical lines drawn through teeth 2, 3, 14, 18, 19, 29, 30, and 31) that those teeth were non-restorable and would most likely need to be extracted. Medical records of the enlistment physical indicated severe tooth and gum problems. Therefore, the Veteran’s periodontal or gum issues existed prior to the removal of the six teeth. Additionally, regarding whether carelessness, negligence, lack of proper skill, error in judgement, or similar instance of fault on the part of the military in extracting the six teeth, the VA examiner stated that all of the induction physical indicated severe tooth and gum problems. In January 2021, the September 2020 VA examiner opined that it is less likely that the Veteran’s periodontal disease is due to extracting the six teeth. The examiner also opined that it is less likely than not that there was carelessness, negligence, lack of proper skill, error in judgement, or similar instance of fault on the part of the military in extracting the six teeth. The examiner stated that the induction physical indicated severe tooth and gum problems. Because the Veteran’s entrance exam noted pre-existing tooth and gum issues, the Veteran’s periodontal disease was not caused by the October 1970 and January 1971 extractions. The examiner stated that it is a well-known fact via medical knowledge and expertise, that tooth extraction does not cause periodontal disease but is a treatment option for teeth which are hopelessly periodontally involved. The examiner stated that no other information supported that the TMJ issues as found by A.M.L. D.M.D. were related or caused by any treatment received by the Veteran while in service. The examiner stated that there was no negligence, lack of skill, or carelessness due to extracting the six teeth or cause of periodontal disease nor that the claimed disability of dental disability for treatment purposes was caused by or became worse as a result of the VA treatment at issue. Periodontal disease could not have resulted from carelessness, negligence, lack of skill, or similar incidence of fault on the part of the attending VA personnel. Lastly, it is less likely than not that these issues resulted from an event that could not have reasonably been foreseen by a reasonable healthcare provider, and/or failure on the part of VA to timely diagnose and/or properly treat the claimed disease or disability allowed the disease or disability to continue to progress as standard precautions and care was rendered. The Board notes that the Veteran submitted many statements stating that his teeth were removed without just cause and/or his medical records were mixed up with another marine with a similar name. The Veteran stated that the doctor performing his medical exam noted moderate dental caries. As noted above, the Veteran’s identifying information, to include, his name, date of birth, and social security number are all listed on the first page of his dental records. Additionally, prior to the start of his dental work, the Veteran was seen at the dental clinic where x-rays were taken. The Board notes that the examiner who performed the Veteran’s entrance exam observed moderate dental caries. But, without further exam to include x-rays, the examiner would have been unaware of the extent of the Veteran’s dental caries. So, the Board finds that although the Veteran and the examiner who performed the Veteran’s entrance exam are competent to report moderate cavities, determining the extent of the Veteran’s dental condition is medically complex, as it required more extensive examination and knowledge of dental pathology. See Jandreau v. Nicholson, 492 F.3d 1372, 1377 n.4 (Fed. Cir. 2007); see also Kahana v. Shinseki, 24. Vet. App. 428 (2011). Regarding the alleged mistaken extractions, the Board notes that almost two weeks after the initial dental appointment, the Veteran’s teeth numbers 14, 18, and 19 were extracted. In January 1971, two and a half months after the first extractions, teeth numbers 2, 3, and 30 were extracted. The Board also notes that in November 1971, prior to the second set of extractions, the Veteran was seen at the dental facility and tooth number 20 was restored. Therefore, the Board finds that if the Veteran’s records were switched with another Marine’s records, the mistake would most likely have been caught prior to teeth numbers 2, 3, and 30 being extracted. The Board also finds that although the Veteran believes his dental disability is related to in-service malpractice or negligence, his STRs are more reliable evidence and have more probative value than the Veteran’s more recent lay statements. See Curry v. Brown, 7 Vet. App. 59, 68 (1994) (contemporaneous evidence has greater probative value than history as reported by the claimant). Though the Veteran was noted to have had dental extractions and restorable teeth during service, these are not disabling, and may not be considered service connected solely for the purpose of establishing eligibility for VA outpatient dental treatment. 38 C.F.R. § 3.381(a). Additionally, the evidence does not show anything that can be considered “service trauma” resulting from his in-service dental care, and the criteria for Class II(a) eligibility for VA dental treatment under 38 U.S.C. § 1712 and 38 C.F.R. § 17.161 have not been met. In reaching this conclusion, the Board has considered the applicability of the benefit-of-the-doubt doctrine. However, as the preponderance of the evidence is against the claim, that doctrine is not applicable. See 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102. MICHAEL LANE Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board T. Moore 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.