Citation Nr: 21026905 Decision Date: 05/04/21 Archive Date: 05/04/21 DOCKET NO. 09-43 294 DATE: May 4, 2021 ORDER Entitlement to service connection for dental trauma is denied. REMANDED Entitlement to service connection for bilateral hearing loss is remanded. FINDING OF FACT The Veteran's records indicate that a July 1978 injury resulted in the loss of two teeth, but it did not result in bone loss of the maxilla or mandible, or residuals or other dental disabilities that may be subject to service connection for compensation purposes. CONCLUSION OF LAW The criteria for service connection for dental trauma have not been met. 38 U.S.C. §§ 1101, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.381, 4.150. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran had active duty service from January 1978 to September 1983. These matters are before the Board of Veterans' Appeals (Board) on appeal from March 2010 and July 2012 rating decisions by a Department of Veterans Affairs (VA) Regional Office (RO). In the March 2010 rating decision, the RO, in relevant part, denied service connection for dental trauma. In the July 2012 rating decision, the RO denied service connection for bilateral hearing loss. These matters were previously before the Board in February 2013 and September 2017. The issues of service connection for bilateral hearing loss and dental trauma were remanded in a February 2013 Board decision because the RO did not issue a statement of the case (SOC) for either claim in response to notices of disagreement (NODs) filed by the Veteran. They were again remanded in a September 2017 Board decision because the Veteran requested hearings for both issues and no hearing had been held at the time of the decision. The Veteran testified regarding the issues of bilateral hearing loss and dental trauma before the undersigned Veterans Law Judge (VLJ) in an April 2019 hearing. A copy of the hearing transcript has been reviewed and associated with the claims file. The Board notes that another hearing was conducted in November 2012, by a VLJ other than the undersigned, regarding the issues of service connection for posttraumatic stress disorder (PTSD), residuals of a head injury, seizures, headaches, and hepatitis C. While the Veteran appeared at two Board hearings before two different VLJs, the hearings covered separate issues with no overlap and single-judge disposition is appropriate for each appeal. See Arneson v. Shinseki, 24 Vet. App. 379 (2011); 38 C.F.R. § 20.604 (stating that the VLJ who conducts a hearing shall participate in making the final determination of the claim). The Board notes that the September 2017 decision also remanded the issue of service connection for residuals of a head injury other than seizures and headaches, finding the issue to be inextricably intertwined with the Veteran's claim for bilateral hearing loss. The claim for residuals of a head injury other than seizures and headaches was discussed at the November 2012 hearing before a different VLJ. Thus, that issue will be covered in a separate Board decision by the VLJ who conducted that hearing. Entitlement to service connection for dental trauma Under the current legal authority, compensation is only available for certain limited types of dental and oral conditions, such as impairment of the mandible, loss of a portion of the ramus, and loss of a portion of the maxilla. See 38 C.F.R. § 4.150. Treatable carious teeth, replaceable missing teeth, dental or alveolar abscesses, and periodontal disease are not disabilities for compensation purposes, but may be considered service-connected solely for the purpose of establishing eligibility for outpatient dental treatment. 38 U.S.C. § 1712; 38 C.F.R. §§ 3.381, 4.150. The Veteran is claiming service connection for a dental disability. Namely, he contends that he is eligible for disability compensation for the loss of two of his teeth after they were knocked out during an in-service injury. The Board notes that VA granted service connection for his dental trauma for treatment purposes only in April 1984. The Veteran's service treatment records indicate that he suffered a head injury while in service in July 1978, which resulted in the loss of his two front upper teeth. At the time of the injury, his treatment records state that there was no radiographic evidence of a problem except for small bone spicules. A non-VA treatment note dated in July 1985 indicated that his mandible appeared intact, with no evidence of fracture or other osseous abnormalities. In November 2015, the Veteran reported that he had no sequelae of his in-service head injury other than headaches. A VA examination was conducted in March 2010. The examiner indicated that the Veteran's two front upper teeth were missing but that no balancing or working interferences were present and the Veteran reported no jaw problems. She noted no crepitus, clicking, trismus, or discomfort on external or internal palpation. She did note generalized extensive decay and poor oral hygiene but stated that the Veteran's anterior bridge replacing his missing front teeth was in good condition with no apparent decay. The examiner opined that the Veteran's current dental problems appeared to be connected to neglect. At the April 2019 hearing, the Veteran and his attorney indicated that they would submit dental records from Dr. J.D. D.D.S., the Veteran's private dentist, showing that he has bone loss. The Veteran's attorney submitted dental records from Dr. D.'s practice in August 2019. However, The Board has reviewed these records and finds no notation reflecting bone loss. The statutory and regulatory provisions are very clear and very strict where the issue of service connection for dental disabilities is concerned. Unlike other disabilities, where the presence of a condition in service is affirmative evidence with respect to a service connection claim, dental disabilities are governed by specific requirements. What must be shown is either dental trauma in service resulting in impairment of the mandible, loss of a portion of the ramus, or loss of a portion of the maxilla. Replaceable missing teeth are not a disability for VA compensation purposes. In this instance, the Veteran is not shown to have a loss of substance of the maxilla, ramus, or mandible. Accordingly, as there is no evidence that the Veteran has a dental disability listed in 38 C.F.R. § 4.150, the preponderance of the evidence is against the claim, and there is no basis for service connection for compensation purposes. REASONS FOR REMAND Entitlement to service connection for bilateral hearing loss is remanded. The Veteran contends that he has hearing loss related to service. A VA audiological examination was conducted in February 2012, in which the examiner found that the Veteran did not have a current disability because his hearing was clinically normal and had not worsened to the level of disability for VA purposes. In a March 2015 addendum, the examiner indicated that the Veteran's military occupational specialty as a multichannel communications equipment operator would have caused a moderate level of military noise exposure. The examiner also noted that the training involved in achieving his qualification as a Sharpshooter for M16s and grenades would have also caused noise exposure, even if ear protection was worn. A VA examination was conducted in November 2015, in conjunction with the Veteran's claim for residuals from a head injury, in which the examiner indicated hearing loss as a residual from the July 1978 head injury. The claims file contains audiogram tests performed in January 1978, May 1978, March 1980, July 1983, and as part of the February 2012 VA examination. Additionally, a December 2011 VA treatment note discusses the results of another audiogram, indicating that the Veteran's hearing was clinically normal but demonstrated a 10-decibel loss compared to the January 1978 audiogram performed as part of his entrance examination. However, the treatment note does not actually include a copy of the 2011 audiogram results. During the April 2019 hearing, the Veteran testified that he frequently participated in artillery exercises and wore no ear protection during them, and that he first noticed hearing problems during service. He also testified that his hearing had worsened since his last hearing test in February 2012. Due to the time that has passed since the previous VA examination and the Veteran's testimony that his hearing has worsened, a new VA examination should be afforded here. The matter is REMANDED for the following actions: 1. Obtain and associate with the claims file the Veteran's updated VA treatment records, from November 2020 to the present. 2. Obtain and associate with the claims file the results of the audiogram test discussed in the VA treatment record dated in December 2011. 3. After completion of #1 and #2, schedule the Veteran for a VA audiology examination to determine the nature and etiology of any current hearing loss disability. The entire claims file must be made available for review by the examiner, and such review should be noted in the examination report. The examiner should provide an opinion as to whether it is at least likely as not (a 50 percent or greater possibility) that any current hearing loss disability arose during service or is otherwise related to service, to include, but not limited to, his in-service head injury and/or military noise exposure. The examiner should elicit a full history from the Veteran and consider the lay statements of record, to include the April 2019 hearing testimony regarding in-service noise exposure and his head injury, and his testimony that he first noticed hearing problems while in service. If there is a medical basis to support or doubt the history provided by the Veteran, the examiner should provide a fully reasoned explanation. The examiner must provide a comprehensive rationale for the proffered medical opinion. The examiner is advised that the Veteran is competent to attest to his symptoms and factual matters of which he has firsthand knowledge. If any opinion cannot be given without resorting to speculation, the examiner should explain why and state whether the need to speculate is due to a deficiency in the state of general medical knowledge (no one could respond given medical science and the known facts), the record (additional facts are required), or the examiner does not have the knowledge or training. As appropriate, the AOJ should conduct additional development or supplement the record. 4. After completion of #1 through #3, readjudicate the issue of service connection for bilateral hearing loss, to include consideration of the additional VA examination reports and treatment records since the last supplemental statement of the case (SSOC) in December 2016. If the benefits sought on appeal are not granted in full, issue the Veteran and his representative another SSOC and provide the Veteran an opportunity to respond. Eric S. Leboff Veterans Law Judge Board of Veterans' Appeals Attorney for the Board A. Pratt 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.