Citation Nr: 22019205 Decision Date: 03/31/22 Archive Date: 03/31/22 DOCKET NO. 18-18 797 DATE: March 31, 2022 ORDER Entitlement to service connection, to include on a secondary basis, for loss of teeth is denied. FINDING OF FACT The evidence does not show a compensable dental disability that was the result of loss of substance of the body of the maxilla or mandible due to in-service dental trauma or bone disease. CONCLUSION OF LAW The criteria for service connection for loss of teeth have not been met. 38 U.S.C. §§ 101, 1110, 5107; 38 C.F.R. §§ 3.6, 3.303, 3.381, 4.150, 17.161. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from January 2004 to December 2004. This matter is before the Board of Veterans' Appeals (Board) on appeal from an April 2016 rating decision by a Department of Veterans Affairs Regional Office (RO). In November 2021, the Veteran testified at a hearing before the undersigned. A copy of the transcript of that hearing has been associated with the claims file. The Board held the record open for 60 days for the Veteran to submit additional relevant evidence. Entitlement to service connection for a dental disability The Veteran seeks entitlement to service connection for loss of teeth. Specifically, she asserts that as a result of a sexual assault and sexual harassment, she separated from service due to her PTSD prior to being able to receive follow-up dental care. A claim for service connection for a dental disability is also considered a claim for outpatient dental treatment. Mays v. Brown, 5 Vet. App. 302, 306 (1993). In dental claims, the Regional Office (RO) adjudicates the claim for service connection and the VA Medical Center (VAMC) adjudicates the claim for outpatient treatment. Because the current issue of entitlement to service connection for a dental disability stems from an adverse determination by the RO, the dental issue addressed herein must be limited to service connection for compensation purposes. Therefore, the issue of entitlement to outpatient dental treatment is referred to the Agency of Original Jurisdiction (AOJ) for further referral to the appropriate VAMC for adjudication. See 38 C.F.R. § 17.161. As a general matter, service connection for a disability requires evidence of: (1) the existence of a current disability; (2) the existence of the disease or injury in service; and, (3) a relationship or nexus between the current disability and any injury or disease during service. Shedden v. Principi, 381 F.3d 1163 (Fed. Cir. 2004); see also Hickson v. West, 12 Vet. App. 247, 253 (1999), citing Caluza v. Brown, 7 Vet. App. 498, 506 (1995), aff'd, 78 F.3d 604 (Fed. Cir. 1996). Service connection may also be established on a secondary basis for a disability which is proximately due to or the result of a service-connected disease or injury. 38 C.F.R. § 3.310(a). To prevail on the issue of entitlement to secondary service connection, there must be: (1) evidence of a current disability; (2) evidence of a service-connected disability; and (3) nexus evidence establishing a connection between the service-connected disability and the current disability. Allen v. Brown, 7 Vet. App. 439, 448 (1995). However, under current VA regulations, 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. Compensation is available for loss of teeth only if due to loss of substance of body of maxilla or mandible due to trauma or disease such as osteomyelitis, but not periodontal disease. Treatable carious teeth, replaceable missing teeth, dental or alveolar abscesses, and periodontal disease are not considered disabling conditions and may be considered service-connected solely for establishing eligibility for outpatient dental treatment. See 38 C.F.R. § 3.381(a). The Veteran asserts that her teeth were extracted during service and asks VA to help in restoring those teeth as they caused resorbtion of the alveolar bone. Specifically, she asks VA for dental treatment including dental implants. The evidence of record includes service treatment records (STRs) showing that within a week of the Veteran's enlistment, she underwent an initial dental evaluation that noted missing teeth numbers 4, 15, 16, 17 and 31. Teeth number 2 and 3 were noted as non-restorable. Cavities, defective restorations and fractured teeth were found to involve teeth numbers 6-7, 10-14, 18, 20, 29 and 30. Later that month, teeth numbers 2 and 3 were extracted. In March 2004, tooth number 1 was extracted, and teeth number 12 and 13 underwent a crown lengthening procedure. Tooth number 19 was extracted in September 2004. Accordingly, the STRs evidence that 3 teeth were extracted during service. Thereafter, a June 2014 VA medical record shows the Veteran underwent a recent tooth extraction. See VA Medical Records Received February 2018. In a November 2015 letter, the Veteran stated that she was never told she could have used programs to get her teeth fixed. She requested to have VA fix 8 missing teeth. In this regard, she stated that it had been 11 years since she was discharged from service, and had she known what missing teeth would mean to her overall health, she would have asked for assistance earlier. In a December 2015 letter, she stated that she had two teeth removed during boot camp by a dentist. She further stated that during service, her dentist told her that the removed teeth would be replaced by dental implants. In addition, she stated that she later had additional problems with her teeth resulting in the extraction of several more teeth. Thereafter, due to sexual harassment during service, she stated that she requested to be separated, that her request was approved, and after a short medical and dental examination she was discharged. She asserted that she was never told she could have used programs to get her teeth fixed. Due to learning about effects on health caused by missing teeth, including mental health and loss of alveolar bone structure, she requested VA to replace 8 missing teeth with implants. She underwent a VA examination in February 2016. That examination report shows that she is missing teeth numbers 1 to 4, 13 to 16, 17 to 19, 31 to 32. The Veteran reported that she lost teeth during service due to tooth decay, and that she was told she would receive implants. She stated that she left service following a sexual assault, and that she would like VA to provide her with dental implants to replace the teeth she had lost during service. The examination report shows that her dental condition did not involve anatomical loss or bony injury of the mandible or maxilla. Her lost teeth were not due to loss of substance of body of maxilla or mandible or due to trauma. She additionally had never been diagnosed with osteomyelitis or osteoradionecrosis of the mandible. The examiner opined that the missing teeth were "less likely than not (less than 50 percent probability) proximately due to or the result of" the service-connected PTSD. In support of this opinion, the examiner noted that PTSD did not cause loss of teeth, and, therefore, "PTSD itself was in no way related to her dental issue." At a November 2021 Board hearing, the Veteran testified that she did not have any issues with her teeth prior to service. During service, she testified that she had approximately 3 to 4 teeth extracted. In addition, she stated that at the time her teeth were extracted, a treatment plan was not in place, and that there had been no mention of dental implants. She denied any problems with her mandible. She further stated that it was her belief that she should have received further dental treatment prior to her discharge from service. The Veteran submitted a letter from her dentist in December 2021. The dentist stated that implants were needed to replace teeth numbers 3, 4, 13, 14 and 19. In addition, the dentist stated that when her teeth were extracted, a bone graft should have been placed in order to preserve the alveolar bone, and that not doing so without a plan to replace those teeth at such a young age was negligent. As a result, it was asserted that the alveolar bone had resorbed. After a review of the evidence or record, the Board finds that service connection for a dental disorder for compensation purposes is not warranted in this case. Specifically, the Board finds that the evidence does not show a compensable dental disability that was the result of loss of substance of the body of the maxilla or mandible due to in-service dental trauma or bone disease. The Board further finds the December 2021 letter from her dentist of little probative value. It additionally appears that the dentist had not reviewed the claims file. In this regard, the dentist referred to several teeth which were identified as having been extracted during service without a treatment plan. However, of these teeth, only two were extracted during service (teeth numbers 3 and 19). Tooth number 4 had been extracted prior to service. Tooth number 13 had been treated with a crown extension during service, and tooth number 14 was noted as a problem tooth at entry to service (as was tooth number 3), but the records do not show that either tooth was extracted during service. In any event, there is no evidence, including any lay statements or medical records, showing that any loss of teeth during service was due to loss of substance of body of maxilla or mandible or due to trauma. The Federal Circuit Court defines "service trauma" as "an injury or wound produced by an external physical force during the service member's performance of military duties." Nielson v. Shinseki, 23 Vet. App. 56, 60 (2009); see also VAOPGCPREC 5-97. VA's General Counsel held that dental treatment of teeth, even extractions, during service do not constitute dental trauma. See VAOPGCPREC 5-97. The Board finds the Veteran losing teeth due to having them extracted during service does not amount to dental trauma. Accordingly, as there is no competent evidence suggesting that the Veteran's dental disability is due to loss of substance of body of maxilla or mandible due to in-service trauma or disease, service connection for loss of teeth is not established under 38 C.F.R. § 4.150 on either a direct or secondary basis. In making this determination, the Board notes that the decision is limited to whether service connection is warranted for compensation purposes. As noted above, the issue of entitlement to service connection for dental treatment is referred for appropriate action. S. HENEKS Veterans Law Judge Board of Veterans' Appeals Attorney for the Board C. Lamb, 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.