Citation Nr: 22015565 Decision Date: 03/18/22 Archive Date: 03/18/22 DOCKET NO. 18-42 211 DATE: March 18, 2022 REMANDED Entitlement to service connection for missing teeth, to include for compensation and treatment purposes, is remanded. Entitlement to service connection for jaw problems (claimed as jaw locking), to include as secondary to missing teeth, is remanded. REASONS FOR REMAND The Veteran served on active duty in the United States Army from January 1971 to January 1973. These matters come before the Board of Veterans' Appeals (Board) on appeal from November 2017 and February 2018 rating decisions by the Department of Veterans Affairs (VA) Regional Office (RO). The Veteran testified before the undersigned Veterans Law Judge in September 2021. A copy of the transcript is of record. As a procedural matter, the Board notes that the November 2017 rating decision denied service connection for missing teeth. A February 2018 rating decision again denied service connection for missing teeth and also denied service connection for jaw problems (claimed as jaw locking). The March 2018 rating decision continued to deny service connection for both missing teeth and jaw problems. As the Veteran submitted new evidence within a year of the November 2017 and February 2018 rating decisions, this evidence tolled the rating decisions from becoming final. See 38 C.F.R. § 3.156(b) (providing that if new and material evidence is received within one year after the date of mailing of an RO decision, it will be "considered as having been filed in connection with the claim which was pending at the beginning of the appeal period"); Young v. Shinseki, 22 Vet. App. 461, 466 (2009) (holding that new and material evidence received within one year of a RO decision prevents that decision from becoming final). 1. Entitlement to service connection for missing teeth, to include for compensation and treatment purposes, is remanded. 2. Entitlement to service connection for jaw problems (claimed as jaw locking), to include as secondary to missing teeth, is remanded. The Veteran seeks service connection for missing teeth, particularly numbers 17, 19, 20, and 30. He contends that he sustained injuries in service following parachute jump exercises that resulted in multiple teeth that were knocked out of his mouth. He also contends that he developed jaw pain and was recently informed that his jaw pain was caused by his missing teeth. See February 2018 Correspondence. Compensation is only available for certain 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. 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. To establish entitlement to service connection for loss of a tooth, the Veteran must have sustained a combat wound or other in-service trauma. 38 U.S.C. § 1712; 38 C.F.R. § 3.381 (b). The significance of finding that a dental condition is due to in-service trauma is that a veteran will be eligible for VA outpatient dental treatment, without being subject to the usual restrictions of a timely application and one-time treatment. 38 C.F.R. § 17.161 (c). Service treatment records (STRs) are silent for any dental related trauma as a result of parachute jumping. The Veteran's January 1971 dental records demonstrate normal x-rays. Service dental records in August 1972 demonstrate teeth numbers 17, 18, and 20 were extracted. An undated health record found in STRs shows treatment at Fort Bragg, NC (Bn Aid Station) in June 1971; however, those records are unavailable. The Veteran's DD-214 confirms the Veteran is in receipt of the parachute badge. A November 2017 VA oral examination did not demonstrate any clinical dental diagnosis but did evidence anatomical loss or bony injury of teeth due to trauma. A mandible or maxilla condition was not noted. The examination also demonstrated teeth numbers, 17,19, 20, and 30 were missing; and documented the Veteran's reports for a locked jaw since his service-related injury. The examiner concluded the Veteran's teeth were damaged due to stressful nocturnal bruxing and was 100 percent incurred during service. A January 2018 statement from private physician Dr. D.D. reports that the Veteran's mandibular left second molar, mandibular left second bicuspid, and mandibular right first molar were lost by injury following a parachute jump in service. In January 2018, the Veteran expressed dissatisfaction with the November 2017 VA examiner based on lack of a thorough medical examination. In particular, he noted the examiner failed to take x-rays or examine the inside of his mouth and therefore did not make a valid assessment. Private treatment records in 2018 evidence complaints and treatment for jaw pain and a diagnosis for temporomandibular joint disorder (TMJ). In March 2018 correspondence, the Veteran detailed instances of parachute jumping exercises in 1971 and subsequent treatment at a base hospital in Fort Bragg, NC. In November 2020 correspondence, the Veteran identified outstanding dental records at Blowe Family Dentistry in Mount Holly, NC where he received treatments in the area of his mouth affected by the claimed conditions. During his September 2021 Board hearing, the Veteran continued to report that his missing teeth and jaw pain were attributable to injuries sustained following parachute jumping exercises in 1971. He reported persistent jaw pain following service, and that the severity of his jaw pain required an additional extraction of an adjacent tooth. He also indicated that he did not seek immediate treatment for his oral condition in service because his sergeant told him to get back to work. The Board finds that a decision cannot yet be rendered in this matter as there appears to be outstanding medical and dental records that could help substantiate the Veteran's claims and/or identify any trauma related injuries during service. Particularly, the Veteran identified treatments at Blowe Family Dentistry and at a base hospital in Fort Bragg, NC around 1971. Additionally, the Board finds the November 2017 VA examination findings are inconsistent as the examiner identified anatomical loss or bony injury of teeth due to trauma but concluded "teeth damaged due to stressful nocturnal bruxing is 100 percent incurred during service." The Board also assigns the January 2018 private opinion little probative value because it only concluded that the Veteran's missing teeth were due to parachute jumping during service but failed to provide a basis for coming to such conclusion. Given the recent diagnosis for TMJ, a new examination is warranted to better determine whether the Veteran has an oral condition that constitutes a disability manifested by loss of a portion of the ramus or loss of a portion of the maxilla, for which service connection may then potentially be established under 38 C.F.R. § 4.150. Additionally, the theory of secondary service connection was raised by the Veteran as he reported that his jaw problems were caused by his missing teeth. The matters are REMANDED for the following actions: 1. With any necessary assistance from the Veteran, obtain any outstanding VA records, to include the June 1971 hospitalization record at Bn Aid Station at Fort Bragg, NC, and/or private treatment records from Blowe Family Dentistry in Mount Holly, NC. All efforts to obtain such records should be documented in the claims file. 2. Following the above development, schedule the Veteran for an examination by an appropriate clinician to determine the nature and etiology of any dental/oral disability associated with any impairment of the mandible, loss of a portion of the ramus, or loss of a portion of the maxilla. The electronic claims file must be reviewed for the examination, and the examination report should indicate that it has been reviewed. A complete history should be elicited from the Veteran. The examiner should specifically address whether bone loss as identified by the November 2017 VA examination for missing teeth numbers 17,19, 20, and 30 were associated with any impairment of the mandible, loss of a portion of the ramus, or loss of a portion of the maxilla. If so, the examiner must explicitly state which of these is present and their extent, and if not, the examiner must explicitly state that none of these are present. The examiner must determine the following: (a) Whether missing teeth are at least as likely as not (approximately 50 percent or greater probability) causally related to service, to include parachute jumping exercises. (b) If missing teeth are found to be related to service, the examiner must determine whether it is at least as likely as not (approximately 50 percent probability or more) that the Veteran's jaw problems, to include TMJ, are proximately due to or aggravated by the missing teeth. (c) Whether any jaw problems, to include TMJ, are at least as likely as not (approximately 50 percent or greater probability) causally related to service, to include parachute jumping exercises. The examiner is advised that secondary service connection does not require "permanent" worsening of the condition being claimed by the service-connected disability and requires considering whether there has been any worsening, no matter how incremental, so even if not above and beyond the condition's natural progression. See Ward v. Wilkie, 31 Vet. App. 233 (2019). The clinician must provide separate findings and rationales relating to causation and aggravation. Atencio v. O'Rourke, 30 Vet. App. 74 (2018). The examiner should consider the Veteran's lay statements regarding his history of symptoms and treatment. The examiner should also consider the January 2018 statement from private physician Dr. D.D. relating the Veteran's mandibular left second molar, mandibular left second bicuspid, and mandibular right first molar to parachute jumping exercises in service. The examiner must provide a rationale in support of all opinions provided. If any opinion cannot be provided without resorting to speculation, the examiner must explain why this is so. 3. Then, readjudicate the Veteran's claims on appeal. If the benefits sought on appeal remain denied, the Veteran and his representative should be provided a supplemental statement of the case. L. CHU Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Y. Asfaw, Associate 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.