Citation Nr: 21029915 Decision Date: 05/17/21 Archive Date: 05/17/21 DOCKET NO. 15-22 935A DATE: May 17, 2021 ORDER Entitlement to service connection for bone loss of the jaw, to include as secondary to exposure to contaminated water at Camp Lejeune and/or Camp Pendleton, is denied. (The issues of entitlement to higher (compensable) ratings for bilateral inguinal hernias, hemorrhoids, and irritable bowel syndrome will be the subject of a separate Board decision.) FINDING OF FACT The weight of the evidence of record is against a finding that gingival recession, and mild to localized moderate horizontal bone loss had onset in active service or is otherwise due to active service, to include as secondary to exposure to contaminated water at Camp Lejeune and/or Camp Pendleton. CONCLUSION OF LAW The criteria for entitlement to service connection for bone loss of the jaw, to include as secondary to exposure to contaminated water at Camp Lejeune and/or Camp Pendleton, have not been met. 38 U.S.C. §§ 1131, 1137, 5107; 38 C.F.R. §§ 3.303, 3.307, 3.309(f). REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran had active military service from April 1978 to November 1981 and from May 1982 to May 1984. The Veteran perfected this appeal from a July 2013 rating decision. On last review of this case the Board remanded it to the Agency of Original Jurisdiction (AOJ) for additional development. See 11/12/2020 BVA Decision. As discussed further below, the Board finds substantial compliance with the remand directives. See Stegall v. West, 11 Vet. App. 268, 271 (1998). The Board remand also included the issues of service connection for chronic obstructive pulmonary disease and post-operative residuals of a gall bladder disability. While the case was on remand the AOJ granted those claims. There is no indication in the claims file that the Veteran appealed either the assigned effective date of initial rating. Hence, those issues will not be addressed in the decision below. See Grantham v. Brown, 114 F.3d 1156, 1158-59 (Fed. Cir. 1997). Pursuant to the Veteran's written request, the Board granted a 30-day extension, dated from January 2021. See 01/07/2021 Correspondence; 03/05/2021 Extension. The Board notes the Veteran's reference to a Higher-Level Review in his January 2021 correspondence. The Board finds, however, that a sympathetic reading of the four corners of the Veteran's lay request does not indicate that he intended to opt out of his Legacy Appeal and opt-in to the Appeals Modernization Act (AMA) for his dental claim. This is underscored by the fact that the increased rating claims noted earlier are under the AMA, and that the Veteran's representative has not interposed any objection to continuing the dental claim under the Legacy Appeal procedures. See 03/15/2021 Appellate Brief. Entitlement to service connection for bone loss of the jaw, to include as secondary to exposure to contaminated water at Camp Lejeune and/or Camp Pendleton, is denied. General Legal Requirements Generally, to establish a right to compensation for a present disability, a veteran must show: (1) a present disability; (2) an in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the present disability and the disease or injury incurred or aggravated during service, the so-called "nexus" requirement. Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004); 38 C.F.R. § 3.303. Service connection may be granted for any disease diagnosed after discharge when all the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d). Certain chronic diseases will be presumed related to service, absent an intercurrent cause, if they were shown as chronic in service; or, if they manifested to a compensable degree within a presumptive period following separation from service; or, if they were noted in service (or within an applicable presumptive period) with continuity of symptomatology since service that is attributable to the chronic disease. 38 U.S.C. §§ 1101, 1137; 38 C.F.R. §§ 3.303, 3.307, 3.309; Walker v. Shinseki, 708 F.3d 1331, 1338 (Fed. Cir. 2013). Effective March 14, 2017, VA amended its adjudication regulations regarding presumptive service connection, adding certain diseases associated with contaminants present in the base water supply at U.S. Marine Corps Base Camp Lejeune, North Carolina from August 1, 1953, to December 31, 1987. The final rule establishes that Veterans who served at Camp Lejeune for no less than 30 days during this period, and who have been diagnosed with any of eight associated diseases (adult leukemia, aplastic anemia and other myelodysplastic syndromes, bladder cancer, liver cancer, multiple myeloma, Non-Hodgkin's lymphoma, and Parkinson's disease) are presumed to have incurred or aggravated the disease in service for purposes of entitlement to VA benefits. See 38 C.F.R. § 3.309(f). The Veteran's claimed disability, bone loss of the jaw, is not currently on the presumptive disability list. This does not, however, preclude him from establishing service connection for the claimed disorder on a direct basis, to include as due to Camp Lejeune water contamination. See Combee v. Brown, 34 F.3d 1039 (Fed. Cir. 1994). In relevant part, 38 U.S.C. § 1154(a) requires that VA give "due consideration" to "all pertinent medical and lay evidence" in evaluating a claim for disability or death benefits. Davidson v. Shinseki, 581 F.3d 1313, 1316 (Fed. Cir. 2009). 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(b); Gilbert v. Derwinski, 1 Vet. App. 49, 57-58 (1990); see also 38 C.F.R. § 3.102. In the current case, VA has conceded exposure to Camp Lejeune water contamination, since the Veteran was based there from September 1978 to January 1980. See 01/13/1999 Military Personnel Records (MPR), P. 3. Discussion Dental disabilities that may be awarded service-connected compensation 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, loss of the maxilla, nonunion or malunion of the maxilla, limited temporomandibular motion, loss of the ramus, loss of the condyloid or coronoid processes, loss of the hard palate, and 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. Replaceable missing teeth, treatable carious teeth, dental or alveolar abscesses, and periodontal disease are not disabling, and may be considered service connected solely for the purpose of determining entitlement to a VA dental examination or outpatient dental treatment. 38 C.F.R. § 3.381. The Veteran's Certificate of Release from his second tour of active service notes that he completed a complete dental examination and received all appropriate dental services and treatment prior to his separation. See 02/11/2014 Military Personnel Records, P. 4. There is no indication that dental disease existed at the time of his separation from active service. See 05/22/2019 STR-Medical, P. 19-21. The AOJ did not afford the Veteran a dental examination as part of the initial adjudication of the claim in 2013. On initial review in 2018, the Board remanded the case for an examination. See McLendon v. Nicholson, 20 Vet. App. 79, 83 (2006). The AOJ arranged a dental examination of the Veteran as directed. A dental examiner determined that the Veteran presented with missing teeth Number 1, 16, 17, 18, 19, 32, gingival recession, mild to localized moderate horizontal bone loss, and fair oral hygiene. The examiner opined that it is not at least as likely as not that the noted conditions had onset in active service or are otherwise causally connected to the Veteran's active service. See 09/05/2019 C&P Exam, 3rd Entry, P. 3. The examiner did not provide any rationale in support of his conclusions. Thus, the Board remanded again in 2020 for an addendum. In the addendum (12/18/2020 CAPRI, P. 2-3), the dental clinician opined that it was not at least as likely as not that the Veteran's current dental condition, horizontal bone loss, is causally connected to his active service, because the etiology of periodontitis (bone loss) is bacterial plaque. The clinician noted that the accumulation of bacterial plaque leads to gingivitis that can progress to periodontitis due to the lack of adequate oral homecare. In essence, the dental clinician opined that the etiology of the Veteran's currently diagnosed dental condition is poor dental hygiene. If teeth are not properly cleaned, bacterial plaque accumulates, leading to caries, bone loss, and tooth loss. Id. The Board finds that the dental clinician reviewed the claims file, examined the Veteran, and provided a clear rationale for the findings and opinion provided. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295 (2008); Stefl v. Nicholson, 21 Vet. App. 120, 124 (2007). Hence, the Board finds it highly probative and affords it significant weight. As noted earlier, dental disease is not among the diseases deemed associated with the contaminated water at Camp Lejeune. The Veteran has not provided or cited the Board to any evidence that it should be or that dental disease is in any way causally connected to the contaminated water. Hence, the Board finds that the preponderance of the evidence is against the claim. 38 C.F.R. §§ 3.303, 3.307, 3.309(f). Finally, the Board acknowledges that a claim of service connection for a dental disorder also raises a claim for service connection for outpatient dental treatment purposes. Mays v. Brown, 5 Vet. App. 302 (1993). In this regard, replaceable missing teeth, treatable carious teeth, dental or alveolar abscesses, and periodontal disease are not disabling, and may be considered service connected solely for the purpose of determining entitlement to a VA dental examination or outpatient dental treatment. 38 C.F.R. § 3.381. In any event, the claimed bone loss is not among these conditions, precluding service connection for treatment purposes only. Since the preponderance of the evidence is against the claim, there is no reasonable doubt to resolve. Gilbert, 1 Vet. App. 49, 57-58; see also 38 C.F.R. § 3.102. Eric S. Leboff Veterans Law Judge Board of Veterans' Appeals Attorney for the Board W. T. Snyder 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.