Source: https://va-claim.com/2018/12/21/entitlement-to-service-connection-for-a-dental-disability-for-compensation-purposes-including-tooth-8-remanded-citation-nr-18132299/
Timestamp: 2019-04-18 22:51:42+00:00

Document:
Entitlement to service connection for a dental disability for compensation purposes, including tooth #8, is remanded.
The Veteran served on active duty in the United States Air Force from October 1959 to October 1979.
This matter is before the Board of Veterans’ Appeals (Board) on appeal from a January 2016 rating decision by a Department of Veterans Affair (VA) Regional Office (RO).
The Board notes that a claim for service connection for a dental condition is also considered a claim for VA outpatient dental treatment.  Mays v. Brown, 5 Vet. App. 302, 306 (1993).  However, in dental claims, the RO adjudicates the claim of service connection and the VA Medical Center adjudicates the claim for outpatient treatment.  As this matter stems from an adverse RO determination, the appeal is limited to the issue of entitlement to service connection for a dental trauma for compensation purposes.  Moreover, the record indicates that entitlement to dental treatment was already established by an August 1989 rating action.
The Veteran provided testimony at a hearing before the undersigned in July 2018.  A transcript of that hearing is of record.
1. Entitlement to service connection for a dental disability for compensation purposes, including tooth #8, is remanded.
Service connection may be awarded for missing teeth due to dental trauma or bone loss in service.  The law and regulations also provide that treatable carious teeth, replaceable missing teeth, dental or alveolar abscesses, and periodontal disease are considered non-disabling conditions and may be considered service-connected solely for the purpose of determining entitlement to VA dental examination or outpatient dental treatment.  See 38 U.S.C. § 1712; 38 C.F.R. §§ 3.381, 17.161; see also Woodson v. Brown, 8 Vet. App. 352, 354 (1995).
The Veteran has contended, to include at his July 2018 hearing, that he sustained in-service dental trauma and provided details thereof.  In pertinent part, he testified that he was hit in the mouth, which damaged tooth #8, and had treatment for that injury.
The Veteran’s service treatment records confirm he had in-service dental treatment, to include for root fracture of tooth #8 in August 1960.  Although these records do not document the exact circumstances of that fracture, the Veteran is competent, as a lay person, to describe the type of in-service trauma he contends occurred during service.  His service treatment records also document facial injuries that were “accidentally incurred” in a bar fight in May 1968.  Moreover, the August 1989 rating action indicate that he was found to have service trauma, particularly in regard to tooth # 8.
Despite the foregoing, the Board also notes that service connection for compensation purposes is only warranted for certain dental conditions.  Specifically, dental disabilities that may be awarded compensable disability ratings are set forth under 38 C.F.R. § 4.150.  These disabilities include chronic osteomyelitis or osteoradionecrosis of the maxilla or mandible, loss of the mandible, nonunion or malunion of the mandible, limited temporomandibular motion, loss of the ramus, loss of the condyloid or coronoid processes, loss of the hard palate, loss of teeth due to the loss of substance of the body of the maxilla or mandible and where the lost masticatory surface cannot be restored by suitable prosthesis, when the bone loss is a result of trauma or disease but not the result of periodontal disease.  38 C.F.R. § 4.150, Diagnostic Codes 9900-9916.
In this case, it is not clear whether the Veteran currently has a dental disability for which compensation may be paid, and, if so, whether it is due to in-service dental trauma.  Therefore, the Board finds that a competent medical evidence is required to resolve this matter.  As such, a remand is required to accord the Veteran such an examination and opinion.  See McLendon v. Nicholson, 20 Vet. App. 79 (2006); Colvin v. Derwinski, 1 Vet. App. 171, 175 (1991).
1. Obtain all outstanding VA treatment records which cover the period from April 2016 to the present.
2. Request the Veteran identify the names and addresses of all private health care providers for whom he has received dental treatment from April 2016 to the present.  After obtaining any necessary release, request those records not on file.
3. Notify the Veteran that he may submit lay statements from himself and from other individuals who have first-hand knowledge, and/or were contemporaneously informed of his in-service and post-service dental symptomatology.  The Veteran should be provided an appropriate amount of time to submit this lay evidence.
4. The Veteran should be scheduled for a dental examination by an appropriately qualified clinician.  The examiner should clarify the nature of any current dental disability found to be present.  Further, the examiner should express an opinion whether it is at least as likely as not such dental disability was caused by in-service dental trauma, to include whether there was dental malpractice.  Such an opinion should reflect consideration of the Veteran’s account of in-service dental trauma, as well as the documented in-service dental treatment to include the fracture of tooth # 8 root in August 1960.  A complete rationale for any opinion expressed should be provided, to include if the examiner determines an opinion cannot be provided without resort to speculation.

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