Citation Nr: 21049256 Decision Date: 08/11/21 Archive Date: 08/11/21 DOCKET NO. 15-17 969 DATE: August 11, 2021 ORDER Entitlement to service connection for a dental disability for the purpose of VA outpatient dental treatment, is granted. FINDINGS OF FACT 1. Prior to his active duty service, the Veteran was fitted with a permanent dental bridge to replace tooth #7 (spanning teeth #6 to #8). 2. During active duty service, the Veteran sustained dental trauma which resulted in destruction of the (pre-service) permanent bridge. 3. Prior to separation from service, the Veteran was fitted with a temporary bridge; a permanent replacement bridge was not provided. CONCLUSION OF LAW The criteria for Class II(a) eligibility for VA outpatient dental treatment have been met. 38 U.S.C. § 1712; 38 C.F.R. §§ 3.381, 17.161. REASONS AND BASES FOR FINDINGS AND CONCLUSION The appellant is a Veteran who served on active duty from March 1976 to May 1977. This case is before the Board of Veterans' Appeals (Board) on appeal from a January 2015 Department of Veterans Affairs (VA) rating decision. In January 2019, a videoconference hearing was held before the undersigned; a transcript is associated with the record. In June 2019, the Board reopened and remanded a claim of service connection for a back disability, denied service connection for a dental disability for the purpose of VA compensation, and remanded entitlement to service connection for a dental disability for the purpose of outpatient dental treatment by VA. [An interim (September 2020) rating decision granted service connection for lumbosacral strain with degenerative arthritis (and for left lower extremity radiculopathy); accordingly, that matter is no longer before the Board.] In November 2020, this claim was remanded for additional development and to cure a due process defect. Service connection for a dental disability for purposes of dental outpatient treatment is granted. Legal Criteria Service connection for purposes of outpatient dental treatment may be granted for a dental condition of any tooth and/or and periodontal tissue shown by the evidence to have been incurred in or aggravated by service, so long as the veteran falls under one of a number of specific classifications: Class I - Those having a service-connected compensable dental disability or condition; Class II - Those having a service-connected noncompensable dental condition or disability shown to have been in existence at time of discharge or release from active service, which took place after September 30, 1981, with at least 90 days of service during the Persian Gulf War or 180 days of other active service, and who applied for treatment within 180 days after release from active duty, or prior to September 30, 1981 with at least 180 days of service and who applied for treatment within a year of release from active duty; Class II(a) - Those having a service-connected noncompensable dental condition or disability adjudicated as resulting from combat wounds or service trauma; Class II(b) - Homeless and other enrolled veterans eligible for a one-time course of dental care under 38 U.S.C. § 2062 ; Class II(c) - Those who were prisoners of war, as determined by the concerned military service department; Class III - Those having a dental condition professionally determined to be aggravating disability from an associated service-connected condition or disability may be authorized dental treatment for only those dental conditions which, in sound professional judgment, are having a direct and material detrimental effect upon the associated basic condition or disability; Class IV - Those whose service-connected disabilities are rated at 100% by schedular evaluation or who are entitled to the 100% rate by reason of individual unemployability; and Class V - Those participating in a rehabilitation program under 38 U.S.C. chapter 31, and dental services as are professionally determined necessary for any of the reasons enumerated in § 17.47(g). 38 U.S.C. § 1712; 38 C.F.R. § 17.161. Factual Background The Veteran seeks service connection for a dental disability for purposes of dental outpatient treatment. As noted above, a June 2019 Board decision denied service connection for a dental disability for VA compensation purposes. Service treatment records (STRs) show that a dental condition was not noted on January 1976 enlistment examination. An undated photograph appears to show a two-winged Maryland bonded bridge across teeth #6-8. On February 20, 1977, the Veteran reported that he fell earlier that morning, resulting in a laceration near his right eye and the loss of "2 front false teeth." He was referred for dental treatment. A February 24, 1977 dental treatment record notes fracture to prosthesis teeth #6-9; Veteran reported such was lost; maxilla and mandible impressions were taken. The next day, he was fitted with a temporary prosthesis over teeth #6-9. In March 1977, dental multiple x-rays were taken. An April 27, 1977 record notes a consult for teeth #6-8 and "insufficient time to fabricate replacement due to...Base closure & phase down. [Veteran] also seperating" (sic). On May 1977 separation from service examination, tooth #7 was noted as missing. Historically, in May 1984 the Veteran initially filed a claim for "dental bridge." The Los Angeles RO in February 1986 sought his dental records from the Los Angeles VA outpatient clinic, but it is not clear whether there was any response (or if VA then adjudicated the claim). [At the Board hearing, the Veteran stated that when he filed his claim in 1984, he went to the VA medical center in Long Beach, California.] He then relocated, and in April 2001, filed another claim for "dental/bridge." A January 2002 rating decision notes that the issue was referred to a VA dental clinic, but it is not clear what happened thereafter. His current claim for "dental injury" was received in September 2014. At the January 2019 Board hearing, the Veteran testified that he had a permanent bridge emplaced before service at the age of 12 or 13 due to a prior dental injury, and that during service his bridge was inadvertently "bashed" out when he fell down a stairwell in the barracks on colliding with another serviceman. He stated that he went to [a service] dentist who provided a temporary bridge, and that before he could receive a permanent bridge, he was discharged. He confirmed that his claim essentially concerned a pre-service prosthesis that was broken during service and not fully (permanently) repaired. His attorney argued that the loss (destruction) of the prosthetic device in service was the "functional equivalent of [the Veteran's] tooth" and therefore could be service-connected as due to trauma. Analysis Initially, the Board notes that the Veteran is competent to report the observable manifestations of his claimed disability. He has consistently reported, including in sworn testimony, that a permanent dental bridge (placed before service entrance) was knocked out during service and replaced with (only) a temporary prosthesis prior to his separation from service. The Board finds no reason to question the credibility of his accounts. His STRs confirm he was treated in service for a fractured dental prosthesis, and confirm he separated from service before a permanent replacement was fabricated. The Board also finds that the loss of the Veteran's permanent dental bridge was due to trauma. Trauma, as defined for purposes of dental treatment eligibility, connotes damage caused by the application of sudden, external force, brought to bear outside a clinical setting sustained as sudden trauma; for these purposes, the term "service trauma" does not include the intended effects of therapy or restorative dental care and treatment provided during a Veteran's military service. 38 C.F.R. § 3.306(b)(1); Nielson v. Shinseki, 607 F.3d 802, 808-09 (2010). The Veteran has reported that his permanent dental bridge was knocked out when he collided with another person in a barrack vestibule. Again, the Board has no reason to question the credibility of his accounts. The relevant regulations do not address the unique circumstances of this case, namely that the Veteran lost a permanent (pre-service) dental bridge/prosthesis and not a natural tooth, due to trauma in service. The Board has reviewed Nielson, VAOPGCPREC 5-97, and 63 Fed. Reg. 15,556 (1997) (including the associated comments) but finds no guidance regarding incidences akin to the specific facts of this claim seeking service connection for treatment purposes. The Veteran's representative contends that the destruction due to trauma of a permanent prosthetic device emplaced prior to service was the "functional equivalent of [the Veteran's loss of ] tooth [due to trauma]." The Board notes that a dental bridge can restore the look and function of teeth. See https://my.clevelandclinic.org/health/treatments/10921-dental-bridges (last accessed on August 10, 2021). Although such may not be true in every case, the Board finds that here (considering the Veteran's STRs (including photographs and dental treatment records), his lay reports, and his representative's argument) the Veteran's pre-service dental bridge functioned as the equivalent of a natural tooth (tooth #7). Considering the foregoing, and resolving reasonable doubt in the Veteran's favor, the Board finds that service connection for treatment purposes is warranted. The record includes competent and credible evidence that the Veteran sustained trauma in service to a permanent dental bridge (prosthesis) that replaced tooth #7 and spanned teeth #6 to 8. That damaged bridge was replaced by only a temporary (not permanent) prosthesis prior to the Veteran's separation from service (as described above). Based on the foregoing, the Board finds that the Veteran meets the requirements for entitlement to Class II(a) VA outpatient dental treatment. 38 C.F.R. § 17.161(c). Service connection solely for the purpose of establishing eligibility for outpatient dental treatment is therefore warranted. GEORGE R. SENYK Veterans Law Judge Board of Veterans' Appeals Attorney for the Board J. Dupont, 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.