Citation Nr: 21042145 Decision Date: 07/12/21 Archive Date: 07/12/21 DOCKET NO. 16-18 520 DATE: July 12, 2021 ORDER Service connection for a dental disorder for compensation purposes is denied. REFERRED The issue of entitlement to service connection for a dental disability for treatment purposes only has previously been referred in April 2013, but this issue does not appear to have been adjudicated; therefore, the Board does not have jurisdiction over it, and it is referred to the Agency of Original Jurisdiction (AOJ) for appropriate action. 38 C.F.R. § 19.9(b). Specifically, the AOJ should refer the claim for dental treatment again to the appropriate VA Medical Center. FINDINGS OF FACT 1. The Veteran received routine dental treatment during service. 2. The Veteran did not suffer any dental trauma during service. 3. The Veteran does not have a current dental disorder for VA compensation purposes. CONCLUSION OF LAW The criteria for establishing service connection for a dental disorder for compensation purposes have not been met. 38 U.S.C. §§ 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.381, 4.150, 17.161. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran, who is the appellant, had active service from August 1969 to February 1973 and from October 1984 to August 1989. This matter is on appeal from a November 2013 rating decision. In this case, the duties to notify and assist have been satisfied. Neither the Veteran nor the evidence has raised any specific contentions regarding the duties to notify or assist. In August 2020, the Board reopened the previously denied claim for service connection for a dental disorder and remanded the appeal for VA treatment records pertaining to dental treatment on or after October 3, 2015, any relevant private dental treatment that may be identified by the Veteran, and a VA examination with a medical opinion on the etiology of the current dental disability, including loss of teeth. To comply with the remand directives, updated VA treatment records were obtained in August 2020, and the AOJ asked the Veteran to identify and provide authorization for any private dental treatment records by way of August 2020 correspondence with a negative August 2020 response received from the Veteran regarding knowledge of any additional medical records to support the appeal. Also, a VA dental examination with an adequately supported medical opinion was obtained in March 2021. For these reasons, the Board finds that there was compliance with the prior remand directives. In this case, the duties to notify and assist have been satisfied. Neither the Veteran nor the record has raised any specific contentions regarding the duties to notify or assist. Service Connection for Dental Disorder Analysis Compensation is only available for certain types of dental and oral conditions listed under 38 C.F.R. § 4.150, such as impairment of the mandible, loss of a portion of the ramus, and loss of a portion of the maxilla. The regulations governing dental claims make a fundamental distinction between "replaceable missing teeth" (see 38 C.F.R. § 3.381(b)), and teeth lost as a result of loss of substance of body of maxilla or mandible due to trauma or disease such as osteomyelitis, and not loss of the alveolar process as a result of periodontal disease. See 38 C.F.R. § 4.150; Simington v. West, 11 Vet. App. 41, 44 (1998). Absent a demonstration of dental trauma, service connection may be considered solely for the purpose of determining entitlement to dental examinations or outpatient dental treatment. See also Woodson v. Brown, 8 Vet. App. 352, 354 (1995). The United States Court of Appeals for Veterans Claims (Court) has specifically held that a claim for service connection for a dental disorder is also a claim for VA outpatient dental treatment. See Mays v. Brown, 5 Vet. App. 302 (1993). Treatable carious teeth, replaceable missing teeth, dental or alveolar abscesses, and periodontal disease will be considered service connected solely for the purpose of establishing eligibility for outpatient dental treatment as provided in 38 C.F.R. § 17.161. 38 C.F.R. § 3.381(a). After review of the lay and medical evidence of record, the Board finds that the weight of the evidence is against finding that the Veteran has a dental disorder subject to VA compensation. The service treatment and dental records, which are complete, are absent of any complaint of, diagnosis of, or treatment for dental trauma during service. During the two periods of active service, the Veteran was treated for periodontal disease, dental caries, and abscess. In January 1981, Tooth 1, Tooth 2, Tooth 15, Tooth 16, Tooth 17, Tooth 18, Tooth 19, and Tooth 32 were extracted due to severe periodontitis. In April 1981, Tooth 13 was extracted due to periodontal disease. In January 1973, Tooth 31 was extracted due to an abscess. The Veteran's extracted teeth do not constitute an injury for which compensation may be granted. See 38 C.F.R. § 3.381 (replaceable missing teeth and periodontal disease are not disabilities for compensation purposes). "Congress specifically limits entitlement to service-connected disease or injury where such cases have resulted in a disability . . . in the absence of a proof of present disability there can be no claim." Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992). The evidence does not show loss of teeth due to loss of substance of the body of the maxilla or mandible, where the lost masticatory surface cannot be restored by suitable prosthesis, or due to disease other than periodontal disease or caries, thus, the evidence does not show a dental disorder subject to compensation under the laws and regulations administered by VA. The competent medical opinion evidence weighs against the appeal. After review of the record and interview and examination of the Veteran, the March 2021 VA examiner opined that the Veteran's periodontitis during service was less likely than not incurred or caused by the loss of substance of body of the maxilla or mandible due to trauma or due to disease such as osteomyelitis, and not due to the loss of the alveolar process as a result of periodontal disease. The March 2021 VA examiner explained that the Veteran's loss of teeth was due to the periodontitis that he had during service, and that the Veteran's dental history is consistent with having entered service with a relatively uncommon type of periodontitis that is caused by a bacterial infection in childhood called Localized Juvenile Periodontitis (LJP). The VA examiner noted that the problem was first recorded during a dental evaluation in December 1970 where it was noted that he had advanced periodontitis even though the Veteran had not reached age 21; the only disease that presents in this manner is LJP. Furthermore, the VA examiner explained that it was clear that the Veteran received adequate dental care, the diagnosis of periodontitis recorded in his records was correct, and there was no indication that he lost his posterior teeth due to any cause other than periodontitis. The March 2021 VA examiner wrote that it was also clear that the Veteran, despite knowing that he had this disease, has not sought treatment to slow the progress of the disease, which has led to additional bone and tooth loss. The March 2021 VA examiner noted that it was less likely than not that there were unintended results of medical treatment due to military negligence or malpractice that might constitute service trauma. Based on the forgoing, the Board finds that the weight of the evidence shows that the Veteran did not suffer tooth loss in service resulting from the loss of substance of the body of the maxilla or mandible caused by in service dental trauma or disease, other than periodontal disease. See 38 C.F.R. § 4.150. As there is no diagnosis of a dental disorder for which service connection may be granted, the appeal must be denied. E. CHOI Acting Veterans Law Judge Board of Veterans' Appeals Attorney for the Board C. Palmer, 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.