Citation Nr: 21027413 Decision Date: 05/05/21 Archive Date: 05/05/21 DOCKET NO. 08-07 813 DATE: May 5, 2021 ORDER Entitlement to service connection for compensation purposes for loss of teeth, claimed as residual injury to the face with dental trauma, is denied. FINDING OF FACT Although the Veteran has documented in-service dental trauma, the evidence does not show that the Veteran lost any teeth due to bone loss of the body of the maxilla or the mandible as a result of trauma or disease during service. CONCLUSION OF LAW The criteria for entitlement to service connection, for compensation purposes, for a dental condition, to include loss of teeth, have not been met. 38 U.S.C. § 1110; 38 C.F.R. §§ 3.303, 3.381, 4.150. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from November 1963 to March 1967. This matter comes to the Board of Veterans' Appeals (Board) on appeal from an April 2006 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO) in Cleveland, Ohio. The Veteran's claims file is currently under the jurisdiction of the VA RO in Houston, Texas. In December 2012, the Board remanded the issues for further development. In particular, the Board remanded the claim of entitlement to service connection for type II diabetes mellitus for the RO to issue a statement of the case. In January 2017, the RO issued a statement of the case. The Veteran did not submit a VA Form 9 until April 2017. That VA Form 9 is untimely because it was received more than 60 days after the January 2017 statement of the case and over a year after the April 2006 rating decision. 38 C.F.R. § 20.302. Therefore, the issue of entitlement to service connection for type II diabetes mellitus is not in appellate status. In September 2017, the Board remanded the appeal in order to schedule the Veteran for a hearing. In January 2018, the Veteran appeared at a hearing before the undersigned Veterans Law Judge. A transcript of the hearing has been associated with the record. In November 2018, the Board remanded the appeal to the RO to obtain records and to schedule the Veteran for VA examinations for his claimed conditions. These actions have been completed. In May 2019, the Board remanded the appeal to the RO to obtain an addendum opinion with a complete rationale for the etiology of the Veteran's claimed dental conditions. The Board remanded this appeal again in October 2020. 1. Entitlement to service connection for loss of teeth, claimed as residual injury to the face with dental trauma. The Veteran seeks entitlement to service connection for a dental condition resulting in loss of teeth. Under VA regulations, compensation is available for certain types of dental and oral conditions listed under 38 C.F.R. § 4.150. 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. See 38 C.F.R. § 4.150, Diagnostic Codes 9900-9916. Compensation is also available for loss of teeth only if such is due to loss of substance of body of maxilla (upper jawbone) or mandible (lower jawbone). See Simmington v. West, 11 Vet. App. 41 (1998). For loss of teeth, bone loss through in-service 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 VA compensation purposes, it is not enough to show that the teeth were lost due to trauma during active duty service. The evidence must demonstrate that the trauma resulted in loss of substance of the maxilla or mandible, which then resulted in loss of 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). Treatable carious teeth, replaceable missing teeth, and dental or alveolar abscesses are not considered disabling conditions and are not subject to service connection for VA 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 record reflects the Veteran sustained in-service dental trauma. The Veteran's November 1965 service dental records show that the Veteran was treated for trauma to teeth 9, 10,11, and 18, which were extracted. However, there is no indication in the record that the Veteran had suffered bone loss, defined by the regulations as loss of substance of body maxilla or mandible. In a November 2018 opine, the opining dentist stated that Extraction of teeth #9 and 10 were documented and extracted while vet was on active duty in Newfoundland on November 14, 1965. It was also documented that his upper lip was sutured on this date. The vet reported to me an incident with a tow bar that hit him in the face and caused injury to upper lip and teeth. This incident was not documented in claims file. #11 was extracted on November 16, 1966 according to documents and was potentially traumatized from reported incident. #19 and #18 were extracted while on active duty on November 12, 1963 and November 24, 1965, respectively. The reason for extraction was not documented. The examining dentist opined that the Veteran's loss of teeth were not due to loss of substance of body of maxilla or mandible without loss of continuity. On January 2019 VA dental examination, the Veteran reported trauma to his mouth from an accident during service in 1965. Specifically, the examiner noted that The Veteran reported in 1965 four teeth were knocked out by a tow bar during active duty with the navy. Veteran reported it hit him in the mouth, four teeth were immediately knocked out and one was broken at gum line and was extracted by dentist on the ship. The Veteran has faint scar on upper left lip from trauma with towbar. In 1966, (the) Veteran had upper partial delivered to him in Vietnam. Through the years the patient lost upper teeth. In 1996, (the) Veteran had remaining upper dentition removed and denture delivered. In 2002, (the) Veteran had lower dentition removed and lower denture placed along with new upper (denture). The examiner noted that, after service, the Veteran had all of his teeth removed and received dentures. The Veteran also claims that the use of prosthesis led to the loss of his remaining teeth. On examination, injury in service that led to loss of teeth was noted, but the tooth loss was not due to loss of substance of the body of the maxilla or mandible. It was also noted that masticatory surfaces could be restored by suitable prosthesis. The examiner noted that panographic/intraoral imaging to demonstrate loss of teeth, mandible or maxilla were taken in November 2018. The panographic x-ray determined no abnormalities of mandible or maxilla. In this case, there was no evidence of bone loss of the teeth on X-rays in the service treatment records. Moreover, several VA examinations explicitly found there was no evidence of a dental disorder for which compensation may be paid. No competent medical evidence is of record which refutes the VA examination findings on this matter. Absent a finding that the Veteran suffered bone loss or some other impairment of the mandible or maxilla, the Board must deny the claim as the disability claimed does not meet the definition of a dental or oral disability for compensation purposes. Applying the relevant regulatory provisions to the facts of this case, the Board concludes that service connection for a dental disability for VA compensation purposes is not warranted. As the Veteran does not have the type of dental condition for which compensation is payable, his claim must be denied. Clearly, the service dental records do not show, and the Veteran does not claim, that he lost any teeth due to bone loss of the body of the maxilla or the mandible as a result of trauma or disease. He sustained trauma to teeth #s 9, 10, 11, and 18, which resulted in their extraction, during service, but no evidence that these extractions, or the subsequent extractions of his remaining teeth, were due to bone loss of the body of the maxilla or mandible. On VA dental examinations and dental opinions, several examiners opined that the Veteran's loss of teeth #s 9, 10, 11, and 18 was due to an accident during service, but that the reason for the loss of the remaining teeth was unclear. However, even acknowledging a loss of the teeth due to trauma during service, service because there is no evidence to show that the loss of such teeth was due to bone loss of the maxilla or mandible, the loss of teeth is not compensable under the provisions in 38 C.F.R. § 4.150. There is no evidence to show that the loss of his teeth, either in service or following service, was due to bone loss of the maxilla or mandible. Accordingly, the preponderance of the evidence is against the claim of service connection of loss of teeth for VA compensation purposes, and the appeal in this matter must be denied. Here, the Board notes that the Veteran's claimed condition may nevertheless be service connected solely for the purpose of establishing eligibility for outpatient dental treatment under 38 C.F.R. § 17.161. However, the Veteran should understand that this decision does not adjudicate the issue of entitlement to service-connection for dental disability for treatment purposes only, or the factual issues relating to the claim. A claim of entitlement to service-connection for a dental disability for treatment purposes only is separate and distinct from a claim of entitlement to service-connection for a dental disability for compensation purposes. As of the time of this decision, there is no indication that the Veteran has ever been denied service connection of his dental condition for treatment purposes, indeed, the statement of the case in this matter makes that fact clear. Should he wish to seek dental treatment through VA, he is welcome to apply for the benefit, and such entitlement will be determined. As the Veteran seeks service connection for a disability which can only be considered service connected for the purposes of establishing eligibility for outpatient dental treatment, and not for compensation purposes, the claim for service connection for a dental disability, for compensation purposes, must be denied. Sabonis v. Brown, 6 Vet. App. 426, 430 (1994) (where the law and not the evidence is dispositive, the claim must be terminated or denied as without legal merit). T. MAINELLI Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Michael J. O'Connor 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.