Citation Nr: 9815130	
Decision Date: 05/15/98    Archive Date: 05/29/98

DOCKET NO.  95-37 428	)	DATE
	)
	)

On appeal from the
Department of Veterans Affairs Regional Office in Seattle, 
Washington


THE ISSUE

Entitlement to service connection for residuals of wisdom 
teeth extractions.


REPRESENTATION

Appellant represented by:	AMVETS


ATTORNEY FOR THE BOARD

Alice A. Booher, Counsel



INTRODUCTION

The veteran had active service from June 1986 to June 1994.

This appeal to the Board of Veterans’ Appeals (the Board) is 
from rating action taken by the Department of Veterans 
Affairs (VA) Regional Office (RO) in Seattle.

Service connection is in effect for: bilateral foot 
condition, pes planus with plantar fasciitis, rated as 10 
percent disabling; aseptic meningitis, rated as 10 percent 
disabling; and for bilateral ankle sprains, 
pseudofolliculitis of the back and face, residuals of a left 
knee condition, residuals of fracture of the ring finger of 
the left hand and status post removal, spermatocele of the 
right testicle, each evaluated as noncompensably disabling.

The issue of entitlement to an increased rating for ankle 
sprain(s) was initially part of the current appeal. However, 
in his Substantive Appeal, a VA Form 9, received in October 
1995, the veteran specifically indicated that he was 
satisfied with the rating assigned for the ankle disability.  
The Board has therefore limited its appellate review to the 
issue reported on the title page.


CONTENTIONS OF APPELLANT ON APPEAL

In substance, the veteran argues that the removal of his 
wisdom teeth in service precipitated additional problems with 
his jaw, now recurrently manifested by swelling and some 
discomfort, and particular difficulty in masticating.


DECISION OF THE BOARD

The Board, in accordance with the provisions of 38 U.S.C.A. 
§ 7104 (West 1991 & Supp. 1997), has reviewed and considered 
all of the evidence and material of record in the veteran's 
claims file.  

Based on its review of the relevant evidence in this matter, 
and for the following reasons and bases, it is the decision 
of the Board that a preponderance of the evidence is in favor 
of the veteran’s claim for service connection for residuals 
of wisdom teeth extraction.


FINDINGS OF FACT

1.  In service the veteran had removal of wisdom teeth and 
later required surgery to remove a residual bony protrusion.

2.  Evidence and recent dental opinion establish that there 
has been possible aggravation of periodontal problems by the 
healing area of the wisdom teeth removal.


CONCLUSION OF LAW

The veteran has additional disability as a result of 
residuals of wisdom tooth extraction incurred in service.  38 
U.S.C.A. §§ 1110, 1131, 5107 (West 1991); 38 C.F.R. §§ 3.303, 
3.310 (1997).


REASONS AND BASES FOR FINDINGS AND CONCLUSION


Criteria

Service connection may be established for a disability 
incurred in or aggravated by active service.  38 U.S.C.A. 
§§ 1110, 1131 (West 1991).  Under other regulations, service 
connection may also be granted for certain disabilities which 
are present to a compensable degree within a given period 
after service.  

Service connection may be granted for any disease diagnosed 
after discharge, when all the evidence, including that 
pertinent to service, establishes that the disease was 
incurred in service.  38 C.F.R. § 3.303(d) (1997).  

Service connection may be granted for disability resulting 
from service-connected disease or injury.  38 C.F.R. § 3.310 
(1997).  The United States Court of Veterans Appeals (Court) 
has identified certain other circumstances in which there may 
well be secondary impact of such a disability must also be 
considered.  See Allen v. Brown, 7 Vet. App. 439 (1995).  

The Court has clearly indicated that this is not intended to 
limit a grant of service connection to those disabilities 
which were present in service or within a year thereafter, 
but also contemplates a chronic disability for which there is 
a credible medical opinion that there is a link between 
current disability and the in-service injury or disease.  
See, i.e., Caluza v. Brown, op. cit..  The Court further 
concluded that “satisfactory” evidence meant “credible” 
evidence as characterized in Caluza, supra, aff’d, 78 F.3d 
604 (Fed.Cir. 1996); see also Collette v. Brown, 82 F.3d 389 
(Fed.Cir. 1996).

A determination of service connection requires a finding of 
the existence of a current disability and a determination of 
a relationship between that disability and an injury or 
disease incurred in service.  Watson v. Brown, 4 Vet. 
App. 309, 314 (1993).

The Court has also held that a determination with regard to 
entitlement to service connection must be made upon a review 
of the entire evidentiary record including thorough and 
comprehensive examinations that are representative of the 
entire clinical picture.  Brown v. Brown, 5 Vet. App. 413 
(1993).  

In this, and in other cases, only independent medical 
evidence may be considered to support Board findings.  If the 
medical evidence of record is insufficient, or, in the 
opinion of the Board, of doubtful weight or credibility, the 
Board is always free to supplement the record by seeking an 
advisory opinion, ordering a medical 

examination or citing recognized medical treatises in its 
decisions that clearly support its ultimate conclusions.  
However, it is not free to substitute its own judgment for 
that of such an expert.  See Colvin v. Derwinski, 1 Vet. 
App. 171, 175 (1991).

Moreover, it remains the duty of the Board as the fact finder 
to determine credibility of the testimony and other lay 
evidence.  See Culver v. Derwinski, 3 Vet. App. 292, 297 
(1992).  

Factual Background

Service dental records show that the veteran had removal of 
several teeth including wisdom teeth in service.  He then 
required some follow-up care including for a retained bony 
fragment or protrusion.

On VA examination in 1994, the veteran stated that he had 
developed a left lower jaw problem after a wisdom tooth was 
removed in service, and then a second surgical procedure was 
required to remove a bony protrusion.  He said that since 
then, he had developed periodic swelling and discomfort in 
that area and when that happened, he had problems chewing on 
the left side.  The examiner palpated around the area of the 
wisdom tooth removal and found no irregularity, abnormality 
or swelling.

On VA examination in February 1996 by a dentist, the veteran 
was noted to have similar complaints.  Specifically, the 
veteran said that he had had extraction of teeth ##17 and 32 
in service; that since then, there had been periodic episodes 
of swelling particularly in the tooth #17 area at anywhere 
from 6 to 12 month intervals.  The last episode had been in 
September 1995 which had been treated by a dentist at Fort 
Lewis with a distal wedge, #18, scraping of the bone and 
irrigation.


The dentist described the veteran’s generalized gingivitis 
with sub-gingival calculus throughout his mouth secondary to 
poor oral hygiene.  He also had some subgingival calculus 
distal to certain teeth in which areas probing resulted in 
bleeding.  The rest of the mouth had some mild hemorrhage on 
probing as well, but no pocket depth exceeding 3 mm.  His 
oral hygiene was said to be generally inadequate with plaque 
accumulation throughout the mouth interproximally and at the 
gingival margin, particularly poor distal to teeth ## 18 and 
31.  The veteran said that he had not been flossing these 
areas because he did not know how to do so.  X-rays were 
normal.  The dentist noted that if the poor hygiene 
continues, he would continue to suffer swelling episodes or 
infection in these areas to include possible other areas of 
the mouth. 

He further diagnosed and opined that 

“Generalized gingivitis with an 
incipient periodontal disease distal to 
teeth numbers 18 and 31 secondary to 
inadequate oral hygiene and secondary to 
an insufficient frequency of professional 
care to include of remaining teeth.  This 
condition of the lower left and lower 
right has been perhaps aggravated by the 
healing response when the third molars 
were removed in 1987.  However, that 
healing is within normal limits and the 
architecture of the periodontia distal to 
the remaining second molars is within 
normal limits.”  [Emphasis added].

Analysis

Based on the evidence of record, and given the nature of the 
veteran’s complaints when compared to current clinical 
findings and dental opinion, and notwithstanding the 
concurrent presence of poor dental hygiene and absence of 
regular professional care, etc., the Board has no alternative 
but to find that residuals of the veteran’s wisdom teeth 
removal in service had a direct impact on his generalized 
periodontal condition, with resultant swelling and discomfort 
in chewing when the condition is in exacerbation, and that 
service connection is accordingly in order.


ORDER

Service connection for residuals of wisdom teeth extraction 
is granted.



		
	RONALD R. BOSCH
	Member, Board of Veterans' Appeals

NOTICE OF APPELLATE RIGHTS:  Under 38 U.S.C.A. § 7266 (West 
1991 &  Supp. 1997), a decision of the Board of Veterans' 
Appeals granting less than the complete benefit, or benefits, 
sought on appeal is appealable to the United States Court of 
Veterans Appeals within 120 days from the date of mailing of 
notice of the decision, provided that a Notice of 
Disagreement concerning an issue which was before the Board 
was filed with the agency of original jurisdiction on or 
after November 18, 1988.  Veterans' Judicial Review Act, 
Pub. L. No. 100-687, § 402, 102 Stat. 4105, 4122 (1988).  The 
date which appears on the face of this decision constitutes 
the date of mailing and the copy of this decision which you 
have received is your notice of the action taken on your 
appeal by the Board of Veterans' Appeals.
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