BVA9500263 
DOCKET NO.  93-00 150     )       DATE
          )
          )

On appeal from the decision of the
Department of Veterans Affairs Medical Center in Milwaukee,
Wisconsin

THE ISSUE

1.  Entitlement to service connection for residuals of dental
trauma, including loss of the upper front teeth and
temporomandibular joint (TMJ) syndrome.

2.   Entitlement to treatment for TMJ syndrome at VA expense.

REPRESENTATION

Appellant represented by: Disabled American Veterans

ATTORNEY FOR THE BOARD

Richard F. Williams

INTRODUCTION

The veteran served on active duty from March 1964 to March 1967
and from November 1990 to May 1991.  It is also apparent that he
had numerous periods of inactive duty training between 1967 and
1990.

This matter comes to the Board of Veterans' Appeals (Board) on
appeal from a November 1991 decision of the Department of
Veterans Affairs (VA) Medical Center (VAMC) in Milwaukee,
Wisconsin, which denied entitlement to treatment for TMJ syndrome
at VA expense.

REMAND

The veteran contends that he sustained an injury to his mouth
during his first period of service, which resulted in the loss of
his front upper teeth.  He further asserts that his residuals of
that injury were aggravated during his second period of active
duty and resulted in pain and infection of his temporomandibular
joints, which has  necessitating dental treatment.  He points out
that he requested dental treatment within ninety (90) days from
his release from his second period of service.  As noted above,
he appealed the VAMC denial of treatment for TMJ disease at VA
expense.  In an October 1992 decision, the VA Milwaukee,
Wisconsin, Regional Office (RO) denied service connection for
TMJ.  For the reasons set forth below, the Board finds that
further development is warranted.

If it is established that the veteran has a service-connected
compensable dental disability or condition, he may be authorized
any dental treatment indicated as reasonably necessary to
maintain oral health and masticatory function.  There is no time
limit for making application for treatment and no restriction as
to the number of repeat episodes of treatment.  38 C.F.R.
§ 17.123(a) (1993) ("Class I" entitlement).  (Also see 38 C.F.R.
§  4.150, Code 9905:  TMJ productive of any definite limitation
of motion, interfering with mastication or speech, warrants a
10 percent rating.)  In addition, a veteran having a service-
connected noncompensable dental condition or disability
adjudicated as resulting from combat wounds or service trauma may
be authorized any treatment indicated as reasonably necessary to
correct the condition.  38 C.F.R. § 17.123(c) ("Class II(a)"
entitlement).  Under these circumstances, I find that his claim
for service connection for TMJ disease is "inextricably
intertwined" with his claim for treatment for TMJ disease at VA
expense, within the meaning of Harris v. Derwinski,
1 Vet.App. 180 (1991).  Since the intertwined issue has not been
developed for appellate consideration, the case must be returned
to the RO for that development.  Since allowance of the veteran's
claim for service-connected disability compensation for a dental
condition might entitle him to treatment under the provisions of
38 C.F.R. § 17.123(a) or (c), there is an obligation to consider
his request for VA outpatient dental treatment as a claim for
Class I and II(a) benefits pursuant to that regulation.  Mays v.
Brown, 5 Vet.App. 302, 306 (1993).

In view of the foregoing, this case is REMANDED to the RO for the
following action:

1.  The veteran should be given a VA dental
examination to determine whether he has a
TMJ disability, and, if so, whether the TMJ
disability was first manifested by the
"crackling sound" in the right jaw joint
reported in the service medical records
(January 6, 1967).

2.  The RO should review the veteran's
claims for service connection for TMJ
syndrome and missing teeth due to trauma.
If either claim is granted, the case should
be referred to the VAMC for readjudication
of the issue of entitlement to treatment
for TMJ syndrome at VA expense.  If the
claim is denied, the RO should issue a
statement of the case to the veteran and
his representative, which includes all of
the pertinent law and regulations
pertaining to the issue of service
connection for TMJ syndrome and missing
teeth due to dental trauma, and they should
be given an opportunity to respond.

Thereafter, if indicated, the case should be returned to the
Board.  No action is required of the veteran until he is further
notified.

          J. E. DAY
          Member, Board of Veterans' Appeals

The Board of Veterans' Appeals Administrative Procedures
Improvement Act, Pub. L. No. 103-271, § 6, 108 Stat. 740, ___
(1994), permits a proceeding instituted before the Board to be
assigned to an individual member of the Board for a
determination.  This proceeding has been assigned to an
individual member of the Board.

Under 38 U.S.C.A. § 7252 (West 1991), only a decision of the
Board of Veterans' Appeals is appealable to the United States
Court of Veterans Appeals.  This remand is in the nature of a
preliminary order and does not constitute a decision of the Board
on the merits of your appeal.  38 C.F.R. § 20.1100(b) (1993).