Citation Nr: 25003909 Decision Date: 03/21/25 Archive Date: 03/21/25 DOCKET NO. 19-17 765 DATE: March 21, 2025 ORDER Entitlement to service connection for a dental condition for compensation purposes is denied. FINDING OF FACT The Veteran's loss of teeth does is not due to loss of substance of body of the maxilla or mandible without loss of continuity (as a result of trauma) or disease. CONCLUSION OF LAW The criteria for entitlement to service connection for a dental condition 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. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served honorably on active duty from October 1957 to March 1961. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a January 2018 rating decision of a Regional Office (RO) of the Department of Veterans Affairs (VA). By way of history, this claim was previously before the Board in August 2019 when the Board denied the Veteran's claim for entitlement to service connection for a dental condition for compensation purposes. The Veteran subsequently appealed this denial to the United States Court of Veterans Claims (Court). Before the Court, the Veteran and VA filed a Joint Motion for Remand (JMR), arguing that the Board provided an inadequate statement of reasons or bases as to whether the duty to assist was satisfied for this claim. The Court granted the JMR in a December 2020 order. As a result, the Veteran's claim was sent back to the Board, which again remanded the claim in September 2021, and September 2023, for further evidentiary development. Following completion of such development, the appeal has been presently returned to the Board for adjudication. Entitlement to service connection for a dental condition for compensation purposes is denied. In his August 2017 Statement in Support of Claim (VA Form 21-4138), the Veteran stated the following: "When I was in basic training, I got into a fight with [an] Airmen. We got into an argument, and he swung at me, hitting me in the face. The other Airmen broke it up. When I was stationed in [omitted], I again got into a fight. This time I was working in the barracks, until I was assigned to the wood shop. We had to clear the barracks, and one Airmen took my supplies. I went after him, and we got into a fight, he swung at me, and hit me in the face. At [omitted] Air Force Base, I had some more fights, three altogether, needless to say I got hit in the face again. The last fight is when I got hit with a claw hammer... I saw an Airmen coming at me with the claw hammer, just as he was coming down with it I turned my head and he still got me from jaw to the front of my mouth. Six months to a year later, I had to have a root canal done. I asked the dentist what caused that, he told me that came from getting hit in the face, and after that I did start having a problem with my teeth. I lost all my teeth except for two of my teeth." To establish service connection, there must exist medical or, in certain circumstances, lay evidence of (1) a current disability; (2) an in-service incurrence or aggravation of a disease or injury; and (3) a nexus between the claimed in-service disease or injury and the present disability. Romanowsky v. Shinseki, 26 Vet. App. 289, 293 (2013); 38 C.F.R. § 3.303(a). Under VA law, compensation is only available for certain types of dental and oral conditions, which are rated under 38 C.F.R. § 4.150, Diagnostic Codes (DCs) 99009916. DC 9913 applies to dental service connection claims involving teeth. Compensation is only paid for loss of teeth due to loss of substance of body of the maxilla or mandible without loss of continuity (as a result of trauma) or disease such as osteomyelitis. Compensation is not available for loss of the alveolar process (the ridge on the surfaces of the upper (maxilla) and lower (mandible) jaws containing the tooth sockets) as a result of periodontal disease, since such loss is not considered disabling. See Note, 38 C.F.R. § 4.150, DC 9913. VA regulations distinguish between "replaceable missing teeth", or periodontal disease and teeth lost as a result of "loss of substance of body of maxilla or mandible." Simington v. West, 11 Vet. App. 41, 44 (1998); 38 C.F.R. § 3.381. Replaceable missing teeth may be considered as service connected solely for the purpose of determining entitlement to dental examinations or outpatient dental treatment, but only the loss of teeth involving the loss of substance of body of either the maxilla or mandible (as described in 38 C.F.R. § 3.381) is considered compensable and may be rated under the appropriate diagnostic codes. Thus, to warrant compensation for a dental disability, as opposed to outpatient dental treatment solely, the evidence must show not only that there was dental trauma or disease (such as osteomyelitis), but that such trauma or disease caused a loss of substance of body of the maxilla or mandible resulting in a loss of teeth. In rendering a decision on appeal, the Board must analyze the competency, credibility, and probative value of the evidence, account for the evidence that it finds to be persuasive or unpersuasive and provide the reasons for its rejection of any material evidence favorable to the claimant. Buchanan v. Nicholson, 451 F.3d 1331, 133537 (Fed. Cir. 2006). When all the evidence is assembled, VA is responsible for determining whether the evidence supports the claim or if there is an approximate balance of positive and negative evidence, with the appellant prevailing in either event, or whether the evidence persuasively weighs against a claim, in which case, the claim is denied. Lynch v. McDonough, 21 F.4th 776, 781 (Fed. Cir. 2021). Turning to the evidence of record, VA treatment records from 2016 reflect that the Veteran obtained maxillary full denture as well as had already had a partial mandibular denture due to loss of teeth. The Veteran underwent a VA dental and oral conditions examination in August 2022. The examiner noted that the Veteran had a history of tooth trauma to teeth #8 and #9, as well as restored edentulism both maxillary and mandibular. During the examination, the Veteran reported that while in service he got involved in a fight while playing football, as well as additional activities thereafter of being hit in the face during fights and altercations. The Veteran reported experiencing mild discomfort after the incidents but did not seek emergent care initially. The Veteran recalls most vividly that during one fight, he was hit with a hammer in the front teeth and around six months later, multiple teeth had abscessed. The Veteran reported that he was placed on antibiotics and had multiple procedures to later restore and fill teeth. After the restorative treatment was completed, the Veteran indicates that everything was file "for a while." However, the Veteran reported that over the course of several years following, he had multiple teeth treated and some extracted. In 2012, the Veteran reported he had his dental treatment transferred to the VA, and had more teeth extracted, as well as placement of upper and lower denture prosthesis. The Veteran reports during the examination that the prostheses assisted function and oral health, but they periodically require refabrication due to wear. In November 2021, the Veteran had maxillary denture refabricated, along with lower partial denture. Presently, the Veteran indicates he has a complete upper denture and partial lower denture, which is functional with no issues. The VA examiner noted no mandible or maxilla conditions. The examiner noted that physical examination revealed that the Veteran has in place fully clinically functional/stable maxillary complete denture and clinically functional/stable lower partial denture (#22, 27 surveyed crowns) with no complications. The VA examiner noted that the oral environment was within normal limits. Regarding etiology, the VA examiner noted that "Veteran service treatment records (STRs) indicate history of restorable dental anomalies upon discharge. Veteran statement indicates correlating history of trauma to a previously restorable tooth/teeth (#8, 9). VA Rating decision (29 Feb 2012) was made for service connection for dental treatment purposes is granted for tooth #8 and #9 due to trauma." An addendum opinion was obtained in November 2022, and the VA examiner was asked to address whether it was at least as likely as not that that the Veteran's history of trauma to teeth #8 and #9 led to additional dental disabilities, which necessitated the restored edentulism to the maxilla and partial to the mandible. The VA examiner stated, "It is opined that it is less likely than not the Veteran's history of trauma to teeth #8 and #9 lead to additional dental disabilities, which necessitated the restored edentulism (maxilla) and the partial (mandible). STRs indicate in-service linked trauma precipitated restorative needs/complications to #8 and #9 specifically. Etiological factors associated with health of remaining dentition are profuse with other causal elements to include but not limited to home care, oral hygiene, persistent dental care, non-occupational/service activity risks, diet and professional maintenance frequency. Previous trauma may be contributory to subsequent complications to #8 and #9, however findings are insufficient to assert direct causal (50% or greater) linkage to maxillary edentulism and mandibular partial edentulism." In June 2023, the Veteran submitted several articles from medical journals entitled "Dental abscess: A potential cause of death and morbidity", "Apical infection spreading to adjacent teeth: a case report", "The microbiology of acute dental abscess", "Blunt carotid artery trauma associated with maxillofacial injuries: a report of three cases", and "Maxillofacial fractures in children[.]" Notably, the Veteran only submitted the abstract for some of the articles cited. Further, neither the Veteran nor his representative presented any argument as to how these articles are applicable to the Veteran's claim. The Veteran underwent an additional VA oral and dental conditions examination in October 2023. The examiner noted that the Veteran has been diagnosed with loss of teeth (for reasons other than periodontal disease, or other routine dental maladies); however, the examiner did not find that the Veteran exhibited criteria for diagnoses of loss of any portion of the mandible or loss of any portion of the maxilla. The VA examiner also noted that the Veteran had sensitive teeth. During the examination, the Veteran reported that he had trauma to teeth #8 and teeth #9 when he was 13 years old, and then had a lot of dental issues while he was on active duty. The Veteran reported that he had all of his teeth extracted, except for two #22 and #27. The Veteran has upper complete dentures and lower partial dentures which were made at a VA dental clinic. The VA examiner noted that the loss of teeth is not due to the loss of substance of body of the maxilla or mandible without loss of continuity. The VA examiner indicated that the loss of teeth is due to trauma, specifying "loss of teeth due to trauma as a teenager, lack of dental care while he was in service, and poor oral hygiene." The examiner noted that the masticatory surfaces are restored by suitable prosthesis as the Veteran has a complete upper denture and partial lower denture. For disability compensation purposes, the Veteran does not have a qualifying dental condition. As noted above, only loss of teeth due to loss of substance of body of the maxilla or mandible without loss of continuity (as a result of trauma) or disease is eligible for disability compensation. Without such a condition, the Veteran has not satisfied the first element of service connection for his dental claim, and the Board need go no further with its analysis. See Romanowsky, 26 Vet. App. at 293; Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992) (holding that, where the evidence does not support a finding of current disability upon which to predicate a grant of service connection, there can be no valid claim for that benefit); 38 C.F.R. §§ 3.303(a), 3.381, 4.150. Accordingly, the Veteran's claim for entitlement to service connection for a dental condition for compensation purposes is denied. As an ancillary matter, in addition to compensation, VA law provides for various categories of eligibility for VA outpatient dental treatment. VA medical center records document the continued care and treatment of the Veteran for various conditions, including dental treatment. The Board notes that the claims file reflects that the Veteran already is in receipt of dental services from VA. Bethany L. Buck Veterans Law Judge Board of Veterans' Appeals Attorney for the Board R. M. Lowman, 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.