Citation Nr: 0000190 Decision Date: 01/05/00 Archive Date: 12/28/01 DOCKET NO. 98-05 885 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in Manchester, New Hampshire THE ISSUE Entitlement to service connection for gum disease, to include as due to an undiagnosed illness. REPRESENTATION Appellant represented by: Disabled American Veterans WITNESS AT HEARING ON APPEAL The veteran ATTORNEY FOR THE BOARD A. C. Mackenzie, Associate Counsel INTRODUCTION The veteran had verified active service from August 1985 to July 1989 and from November 1990 to May 1991. He participated in Operation Desert Shield/Desert Storm during his second period of verified service. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a February 1997 rating decision issued by the Department of Veterans Affairs (VA) Regional Office (RO) in Philadelphia, Pennsylvania. This case has since been transferred to the Manchester, New Hampshire VARO. The veteran also appealed the Philadelphia VARO's denials of service connection for inflammatory acne and rhus dermatitis; muscle and joint aches; chronic fatigue; a generalized anxiety disorder; and gastroesophageal reflux disease, with irritable bowel syndrome. However, in a December 1998 rating decision, the Manchester VARO granted service connection for a disorder encompassing anxiety, fatigue, muscle and joint aches, and gastrointestinal symptoms, all to include as due to an undiagnosed illness. The RO also granted service connection for rhus dermatitis and inflammatory acne separately. FINDINGS OF FACT 1. All relevant evidence necessary for an equitable disposition of this appeal has been obtained by the RO. 2. There is competent medical evidence showing an etiological relationship between the veteran's current gum disease and service. CONCLUSION OF LAW Gum disease was incurred as a result of service. 38 U.S.C.A. §§ 1110, 1131, 5107 (West 1991); 38 C.F.R. §§ 3.303, 3.307 (1999). REASONS AND BASES FOR FINDINGS AND CONCLUSION As a preliminary matter, the Board finds that the veteran's claim is well grounded within the meaning of 38 U.S.C.A. § 5107(a) (West 1991). That is, the veteran is found to have presented a claim which is not inherently implausible. Furthermore, after examining the record, the Board is satisfied that all relevant facts have been properly developed in regard to the veteran's claim, and no further assistance is required in order to comply with the VA's duty to assist him with the development of facts pertinent to his claim, as mandated by 38 U.S.C.A. § 5107(a). Service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by service. 38 U.S.C.A. §§ 1110, 1131 (West 1991); 38 C.F.R. § 3.303(a) (1999). For the showing of chronic disease in service, there is required a combination of manifestations sufficient to identify the disease entity and sufficient observation to establish chronicity at the time. If chronicity in service is not established, a showing of continuity of symptoms after discharge is required to support the claim. 38 C.F.R. § 3.303(b) (1999). Service connection may also be granted for any disease diagnosed after discharge when all of the evidence establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d) (1999). Service connection may also be established for a chronic disability resulting from an undiagnosed illness which became manifest either during active service in the Southwest Asia theater of operations during the Persian Gulf War or to a degree of 10 percent or more not later than December 31, 2001. 38 C.F.R. § 3.317(a)(1)(i) (1999). Consideration of a veteran's claim under this regulation does not preclude consideration of entitlement to service connection on a direct basis. Objective indications of a chronic disability include both "signs," in the medical sense of objective evidence perceptible to an examining physician, and other, non-medical indicators that are capable of independent verification. Disabilities that have existed for six months or more and disabilities that exhibit intermittent episodes of improvement and worsening over a six-month period will be considered chronic. The six-month period of chronicity will be measured from the earliest date on which the pertinent evidence establishes that the signs or symptoms of the disability first became manifest. A chronic disability resulting from an undiagnosed illness referred to in this section shall be rated using evaluation criteria from the VA's Schedule for Rating Disabilities for a disease or injury in which the functions affected, anatomical localization, or symptomatology are similar. A disability referred to in this section shall be considered service-connected for the purposes of all laws in the United States. 38 C.F.R. § 3.317(a)(2-5) (1999). Signs or symptoms which may be manifestations of an undiagnosed illness include, but are not limited to, fatigue, signs or symptoms involving the skin, headaches, muscle pain, joint pain, neurologic signs or symptoms, neuropsychological signs or symptoms, signs or symptoms involving the respiratory system (upper or lower), sleep disturbances, gastrointestinal signs or symptoms, cardiovascular signs or symptoms, abnormal weight loss, or menstrual disorders. 38 C.F.R. § 3.317(b) (1999). The veteran's service medical records indicate dental treatment at various intervals between April 1986 and July 1989. These records do not suggest any specific disease processes, and no dental disorders were noted in the veteran's April 1991 separation examination report. The first post-service evidence of dental treatment of record is an unidentified consultation note from March 1994, which indicates a history of a lower interior abscess. In November 1995, the veteran underwent a VA general medical examination, during which he reported gum disease resulting in the extraction of four anterior incisors and the insertion of a partial removable bridge. He also complained of bleeding gums. No specific dental symptomatology was noted, and the examiner rendered a diagnosis of gingivitis of unknown etiology. Also, in November 1995, the veteran underwent a VA dental examination. In the report of the examination, the examiner noted the veteran's history of dental problems. The examiner also considered the veteran's radiographs, both intraoral and extraoral, and observed severe, advanced, and continuing deterioration of supporting oral structures, with continual loss of alveolar bone in both the maxilla and mandible. Moreover, the examiner noted that "[d]ramatic changes have occurred radiographically in the bone level from 2 February 1988 to 19 August 1993" and that, from August 1993 to July 1995, there was a complete loss of support for the lower anterior teeth from #23 to #26 and continuing loss in the other areas, especially in the maxillary anterior. Bone loss in the posterior maxilla and mandible was less dramatic, except at selected sites. The examiner found that these changes resulted in a reduction in the veteran's ability to masticate food, given the loss of the lower front teeth. The diagnosis was "[s]tatus post unknown exposure in the Gulf War theater with significant morbidity to the oral structures and masticatory function through extensive loss of bone." In this case, the post-service diagnoses of record suggest some difference of opinion between the veteran's examiners as to the exact nature of his dental disability. The November 1995 VA general medical examination report contains a diagnosis of gingivitis, while the report of the November 1995 VA dental examination indicates that the veteran had a diagnosis of "[s]tatus post unknown exposure in the Gulf War theater with significant morbidity to the oral structures and masticatory function through extensive loss of bone." Even assuming that the veteran does suffer from a specifically diagnosed disorder instead of a disability resulting from an undiagnosed illness, thus rendering the criteria of 38 C.F.R. § 3.317 (1999) inapplicable, the Board finds sufficient evidence linking the veteran's current gum disease to service on a direct basis. In this case, the examiner who conducted the November 1995 VA dental examination reviewed the veteran's radiographs and found "dramatic changes" between February 1988 and August 1993, a period of time overlapping with both of the veteran's periods of verified active service. As a result, the examiner rendered the diagnosis noted above, which reflects an etiological relationship between the veteran's dental problems and service. In view of this diagnosis, which supports the veteran's contentions, the Board concludes that the evidence of record supports his claim for service connection for gum disease. ORDER Entitlement to service connection for gum disease is granted. WARREN W. RICE, JR. Member, Board of Veterans' Appeals