Citation Nr: 0007187 Decision Date: 05/04/00 Archive Date: 09/08/00 DOCKET NO. 98-15 951A DATE MAY 04, 2000 On appeal from the Department of Veterans Affairs Regional Office in Chicago, Illinois ORDER The following corrections are made in a decision issued by the Board in this case on March 16, 2000: On line 2, page 3, "are met" is corrected to read "are not met." GEORGE R. SENYK Member, Board of Veterans' Appeals Citation Nr: 0007187 Decision Date: 03/16/00 Archive Date: 03/23/00 DOCKET NO. 98-15 951A) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in Chicago, Illinois THE ISSUE Entitlement to service connection for the residuals of dental trauma. WITNESS AT HEARING ON APPEAL Appellant ATTORNEY FOR THE BOARD K. J. Kunz, Counsel INTRODUCTION The veteran served on active duty from September 1965 to November 1968. This appeal comes before the Board of Veterans' Appeals (Board) from a September 1997 rating decision of the Chicago, Illinois, Regional Office (RO) of the United States Department of Veterans Affairs (VA). In that decision, the RO denied service connection for dental trauma. A Travel Board hearing was held at the RO in December 1999 before the undersigned Member of the Board. The veteran was assisted at the hearing by a Veterans' Service Representative. FINDINGS OF FACT 1. The RO has obtained all relevant evidence necessary for an equitable disposition of the veteran's appeal. 2. Teeth numbers 1, 2, and 32 were extracted in service as a result of trauma during service. 3. Teeth numbers 29, 30, or 31 were not injured or damaged due to trauma during service, and no disorder of teeth numbers 29 or 30 was found during service. 4. Decay of tooth number 31 was incurred in service; however, application for treatment of tooth number 31 was not received within one year after the veteran's separation from service. CONCLUSIONS OF LAW 1. Service connection for teeth numbers 1, 2, and 32 for the purpose of obtaining VA outpatient treatment is warranted. 38 U.S.C.A. §§ 1110, 1712, 5107 (West 1991 & Supp. 1999); 38 C.F.R. §§ 3.381, 17.161 (1999). 2. The criteria for establishing service connection for teeth numbers 29 and 30 for the purpose of obtaining VA outpatient treatment are met. 38 U.S.C.A. §§ 1110, 1712, 5107 (West 1991 & Supp. 1999); 38 C.F.R. §§ 3.381, 17.161 (1999). 3. The criteria for establishing service connection for tooth number 31 are met; but criteria for establishing eligibility for outpatient treatment of that tooth are not. 38 U.S.C.A. §§ 1110, 1712, 5107 (West 1991 & Supp. 1999); 38 C.F.R. §§ 3.381, 17.161 (1999). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The veteran is seeking service connection for teeth in the right side of his mouth that he contends were injured in an automobile accident during service. The veteran's service medical records document that he was in an automobile accident in April 1967, and that he sustained injury to the right side of his head. VA has established service connection for disabilities related to head injury resulting from the 1967 accident. The veteran essentially contends that service connection is warranted for teeth numbers 1, 2, 29, 30, 31, and 32. The veteran has reported, and his service dental records show, that teeth numbers 1, 2, and 32 were extracted during service. He reports that VA has provided root canal treatment and crowns for teeth numbers 29, 30, and 31. He has indicated that he is currently seeking treatment assistance for teeth numbers 29, 30, and 31. Service connection for dental disability may be granted for each missing or defective tooth, and each disease of the investing tissues, that is shown to have been incurred in or aggravated by service. 38 U.S.C.A. § 1712; 38 C.F.R. § 3.381(b). VA provides treatment and compensation for certain specified types of service-connected dental disorders, but provides outpatient treatment only for other specified types of dental disorders. 38 U.S.C.A. § 1712; 38 C.F.R. §§ 3.381, 4.150, 17.161. Applicable law provides several classes of eligibility for outpatient treatment, depending upon various factors, including whether or not the disorder resulted from trauma during service. 38 U.S.C.A. § 1712; 38 C.F.R. §§ 3.381, 17.161. The report of a service dental examination of the veteran in September 1965, at the time of his entry into service, does not indicate that he had any missing teeth at that time. His service medical records reflect that he was hospitalized in April 1967 after being involved in an automobile accident. He was unconscious when he was admitted, and he had a laceration of the scalp and multiple body abrasions. It was thought that he had a cerebral contusion. X-rays of the skull showed some density in the area of the right mastoid, and the possibility of exudate or blood within the mastoid was considered. Service dental records indicate that tooth number 1 was treated for caries in February 1967. Teeth numbers 2, 30, and 31 were x-rayed in June 1967. Teeth numbers 1 and 2 were extracted in July 1967. A gingivectomy at teeth numbers 31 and 32 was performed in August 1967. Tooth number 31 was treated for caries in September 1967. Tooth number 32 was extracted in November 1967. Teeth numbers 18 and 19 were treated for caries in August 1968. The veteran's November 1968 examination for separation from service indicated that teeth numbers 1, 2, 5, 24, and 32 were missing. In May 1978, the veteran wrote that during service he had lost his right upper and lower wisdom teeth, and the molar next to the right upper wisdom tooth. The veteran reported that x-rays taken in the months after his April 1967 automobile accident had shown that the right upper wisdom tooth and the molar next to it were severely cracked. He reported that in June 1967 a service dentist pulled the right upper wisdom tooth and molar because they were cracked, and pulled the right lower wisdom tooth because there would be no tooth opposing it. In September 1996, the veteran wrote that he had recently begun to experience pain in his right lower jaw. He reported that a dentist had told him that the pain was due to nerve damage in teeth that were damaged by a previous injury. The veteran reported that he had previously received root canal treatment of one tooth and caps on three teeth through VA. He indicated that the two teeth that were capped but did not have root canals were causing trouble, and that he concluded that those teeth were previously damaged and had deteriorated. In statements submitted in November 1997 and June 1998, the veteran asserted that problems in the teeth on the right side of his mouth were attributable to his automobile accident during service, in April 1967. He noted that in the accident the right side of his head was smashed into the windshield of his car, and that he sustained a serious head injury and required several weeks of hospitalization. He remained unconscious for approximately two weeks after the accident, and in a state of delirium for approximately four additional weeks after regaining consciousness. During the hospitalization, while he was still delirious, he discovered part of a broken tooth in his mouth, and disposed of it without informing hospital personnel. After he returned from the hospital to duty, he saw a dentist, who extracted teeth numbers 1 and 2. He reported that after service VA paid for root canal work on tooth number 30 and crowns on teeth numbers 29, 30, and 31. He asserted that additional work currently needed on teeth numbers 29, 30, and 31 was due to deterioration of the teeth attributable to the automobile accident in April 1967. He believed that all the teeth on the right side of his mouth were injured in the accident. At the Travel Board hearing in December 1999, the veteran reported that he had found and disposed of a tooth which came loose while he was in the hospital following the automobile accident in 1967. He indicated that he received dental treatment in service after he returned to duty following the hospitalization. He asserted that damage from the accident necessitated extractions of teeth numbers 1, 2, and 32during service. In December 1999, Vincent L. Conforti, D.D.S., wrote that the veteran was his patient, and that he had reviewed the veteran's dental history. Dr. Conforti stated the opinion that the need to extract teeth numbers 1, 2, and 32 was very likely the result of the trauma that the veteran sustained in the automobile accident in April 1967. Dr. Conforti wrote that he could not relate further dental problems to that trauma. A person who submits a claim for veteran's benefits has the burden of submitting evidence sufficient to justify a belief by a fair and impartial individual that the claim is well grounded. 38 U.S.C.A. § 5107(a). The United States Court of Appeals for Veterans Claims (known as the United States Court of Veterans Appeals prior to March 1, 1999) (hereinafter, "the Court") has defined a well grounded claim as a plausible claim; one which is meritorious on its own or capable of substantiation. Murphy v. Derwinski, 1 Vet. App. 78, 81 (1990). The veteran's claim for service connection for residuals of dental trauma is supported by medical evidence of trauma to the right side of the head during service, medical evidence that three teeth from the right side of the mouth were extracted during service, lay evidence that injured teeth were discovered shortly after the head injury, and a dentist's opinion that specified teeth required extraction because of the trauma during service. Such evidence is sufficient to create a well grounded claim for service connection for residuals of dental trauma. When a veteran has presented a well grounded claim within the meaning of 38 U.S.C.A. § 5107(a), VA has a duty to assist the veteran in the development of his claim. 38 U.S.C.A. § 5107(a). Here, the Board finds that the facts relevant to the veteran's claim have been properly developed, and that VA has satisfied its statutory obligation to assist him in the development of his claim for service connection for residuals of dental trauma. The veteran's service medical records indicate that his teeth numbers 1, 2, and 32 were extracted during service. As those extractions were incurred in service, they are service- connected. Treatable carious teeth, replaceable missing teeth, dental or alveolar abscesses, and periodontal disease will be considered service-connected solely for the purpose of establishing eligibility for outpatient dental treatment. 38 C.F.R. § 3.381(a). As the teeth for which the veteran has claimed service-connection are not affected by compensable disorders, service-connection of any of those teeth would be for the purpose of eligibility for treatment. Medical and dental records reflect that the veteran sustained injury to the right side of his head in April 1967, and that teeth numbers 1, 2, and 32 were extracted later in 1967. Taking into account Dr. Conforti's opinion supporting a link between the extraction of teeth numbers 1, 2, and 32 and the 1967 automobile accident, the Board concludes that the evidence supports a finding that teeth numbers 1, 2, and 32 were extracted as a result of trauma during service. The service- connected extractions of teeth numbers 1, 2, and 32 qualify for Class II(a) eligibility for outpatient treatment. Under Class II(a) eligibility, a service-connected noncompensable dental disability resulting from service trauma may be authorized for any treatment indicated as reasonably necessary for the correction of such disability. 38 C.F.R. § 17.161(c). In addition to teeth numbers 1, 2, and 32, the veteran is also seeking service connection for teeth numbers 29, 30, and 31. He contends that those teeth were also injured by trauma in the April 1967 automobile accident. While medical records indicate that the veteran had trauma to the right side of his head, the claims file contains no medical evidence that teeth numbers 29, 30, and 31 sustained injuries due to the head trauma. A lay person's opinion is not competent evidence as to issues of medical causation. See Grottveit v. Brown, 5 Vet. App. 91, 92 (1993). The Board finds that the preponderance of the evidence is against a finding that the automobile accident resulted in injury to the veteran's teeth numbers 29, 30, and 31. Service dental records do not show any treatment of tooth number 29. The records indicate that tooth number 30 was x- rayed during service, but there is no indication that any disorder of that tooth was found. In the absence of dental evidence of a disorder of teeth numbers 29 and 30 during service, the Board finds that the preponderance of the evidence is against service connection for those teeth. Tooth number 31 was x-rayed during service and, later in service, treated for caries, or decay. As decay of that tooth was first noted during service, the Board finds that it is reasonably shown that the decay was incurred in service. Therefore, the decay is service-connected. The service- connected noncompensable condition of decay of tooth number 31 has not been found to be related to trauma during service. Under VA regulations, the decay of tooth number 31 would be eligible for treatment for one-time correction under Class II eligibility. 38 C.F.R. § 17.161. To receive one-time treatment under Class II eligibility, however, application for treatment must be made within one year after separation from service. 38 C.F.R. § 17.161(b)(2)(i)(B). Thus, while decay of tooth number 31 is service-connected, the veteran is not eligible for VA treatment of that condition because any application for treatment was more than a year after his separation from service. ORDER Service connection of teeth numbers 1, 2, and 32 for the purpose of obtaining VA outpatient dental treatment is granted. Service connection for teeth numbers 29 and 30 is denied. Service connection for tooth number 31 is granted; however, eligibility for outpatient treatment of that tooth is denied. GEORGE R. SENYK Member, Board of Veterans' Appeals