Citation Nr: 0003393 Decision Date: 02/10/00 Archive Date: 02/15/00 DOCKET NO. 95-11 973 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in Denver, Colorado THE ISSUES 1. Entitlement to service connection for missing teeth numbered 3, 4, 5 and 30. 2. Entitlement to service connection for carious teeth numbered 7, 12, 29 and 31. 3. Entitlement to a compensable rating for tooth number 2. REPRESENTATION Appellant represented by: Paralyzed Veterans of America, Inc. ATTORNEY FOR THE BOARD Vito A. Clementi, Counsel INTRODUCTION The appellant served on active duty from March 1967 to June 1969. Service in Vietnam is indicated by the evidence of record. The veteran was awarded the Purple Heart Medal. This matter was last before the Board of Veterans' Appeals (Board) in March 1997, on appeal from a March 1994 rating decision of the Department of Veterans Affairs (VA) Regional Office in Denver, Colorado, (the RO). On its last review, the Board in part noted that the appellant's correspondence appeared to suggest that he was seeking service connection relative to his teeth for both compensation and treatment purposes. The Board therefore directed that upon remand, the RO was to contact the appellant and obtain clarification as to which benefit the appellant sought. Further, the Board in part noted that the appellant may have been seeking service connection for a dental condition due to "service trauma" as set forth in 38 C.F.R. §§ 3.381(e) and 17.161(c). By letter dated in April 1997, the RO requested that the appellant specify whether he was seeking service connection for the teeth in question for the purposes of compensation, or for treatment. The appellant did not respond to this inquiry. The Board notes that the appellant's claim of entitlement to service connection for missing teeth numbers 14 and 19, and carious teeth numbers 10, 13, 15, 18, 20, and 21 was certified for review. An August 1998 rating decision granted service connection for treatment purposes for the teeth at issue based upon the finding that their surrounding tissue had been noted to have embedded shrapnel residuals. In this regard, because the benefit sought on appeal has been granted, service connection for teeth numbers 13, 14, 15, 18, 19, 20, and 21 is no longer at issue. See 38 C.F.R. § 19.35 (1999) [certification is for administrative purposes and does not serve to either confer or deprive the Board of jurisdiction of an issue]. Remaining is the issue of the appellant's entitlement to service connection for compensation purposes for these and the remaining teeth (3, 4, 5 and 30), as was certified to the Board. The latter issue is discussed below. Additional issues The Board further notes that in January 2000, the appellant argued through his representative that the issue of service connection for wounds of the trapezius muscle had never been adjudicated. See Informal Brief of Appellant, page 3. The appellant's VA claims folder reveals that in March 1971, the appellant filed an initial claim for VA benefits (VA Form 21- 526) in which he referred to wounds of the neck and jaw. The veteran further stated that "as a result of the bullet wound to the neck have lost some mobility and strength from my right arm and shoulder." In July 1971, service connection was granted for the residuals of a gunshot wound to the right side of the neck as well as residuals of a fracture of the mandible. The issue of entitlement to service connection for wounds of the trapezius muscle, which appears to have been raised as such for the first time in the January 2000 communication from the appellant's representative, is referred to the RO for appropriate action. In the January 2000 informal brief, the appellant's representative raised the issue of entitlement to service connection for bruxism, indicating that such may be secondary to the appellant's service-connected post-traumatic stress disorder. The issue of service connection for bruxism is also referred to the RO for appropriate action. Through his representative, the appellant also contends that in effect the RO has severed service connection for compensation purposes for tooth number 2. As will be more fully discussed below, the issue of severance of service connection has not been adjudicated by the RO. This contention is therefore referred to the RO for appropriate action. FINDINGS OF FACT 1. The appellant's number 3, 4, 5, 14, 19, and 30 teeth were missing prior to entry onto active duty. 2. The appellant's number 7 and 12 teeth were not treated during active duty. 3. The appellant's number 29 and 31 teeth were lost due to an in-service trauma to the mandible. 4. Medical evidence has not been obtained indicating that the appellant has lost all upper anterior teeth, all lower anterior teeth, or all upper and lower teeth on one side due to any incident of his military service. CONCLUSIONS OF LAW 1. The appellant has not submitted a well-grounded claim of entitlement to service connection for treatment purposes of teeth numbers 3, 4, 5, and 30. 38 U.S.C.A. § 5107(a) (West 1991). 2. The appellant is not entitled to service connection for treatment purposes of teeth numbers 7 and 12. 38 U.S.C.A. §§ 1110, 1712 (a) (West 1991 & Supp. 1998); 38 C.F.R. §§ 3.381, 17.161 (1999). 3. The appellant is entitled to service connection for treatment purposes of teeth numbers 29 and 31. 38 U.S.C.A. §§ 1110, 1712 (a) (West 1991 & Supp. 1998); 38 C.F.R. §§ 3.381, 17.161 (1999). 4. The appellant is not entitled to service connection for compensation purposes for a dental condition due to trauma. 38 U.S.C.A. § 1110, 5107(a) (West 1991); 38 C.F.R. §§ 4.149, 4.150, Diagnostic Code 9913, Note (1999). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The appellant contends that a grant of service connection is warranted for all of the teeth at issue. His argument with regard to teeth numbers 3, 4, 5 and 20, is construed as implying that the teeth in question were lost at some point during, or as a result of some incident during his military service. With regard to teeth numbers 7, 12, 29 and 31, the appellant argues that service connection should be granted for these teeth, which were noted to be carious upon his entry onto active duty. The appellant further contends that a compensable disability rating is warranted for tooth number 2. He posits that the November 1996 rating decision, which denied a compensable rating for tooth number 2, was in error in its observation that the original March 1994 rating granting service connection for the tooth in question was for treatment only, and not for compensation purposes. By law, the Board's statement of reasons and bases for its findings and conclusions on all material facts and law presented on the record must be sufficient to enable the claimant to understand the precise basis for the Board's decision, as well as to facilitate review of the decision by courts of competent appellate jurisdiction. See Vargas-Gonzalez v. West, 12 Vet. App. 321, 328 (1999); Gilbert v. Derwinski, 1 Vet. App. 49, 56-57 (1990); 38 U.S.C.A. § 7104(d)(1) (West 1991). For the sake of clarity, the Board will first review the law applicable to claims for service connection, dental disabilities and for rating claims. A discussion of the factual background will follow. The Board will then analyze each of the appellant's claims in turn. Service Connection In general, service connection may be granted for disability or injury incurred in or aggravated by active military service. 38 U.S.C.A. §§ 1110, 1131 (West 1991). The resolution of this issue must be considered on the basis of the places, types and circumstances of his service as shown by service records, the official history of each organization in which the claimant served, his medical records and all pertinent medical and lay evidence. Determinations relative to service connection will be based on review of the entire evidence of record. 38 C.F.R. § 3.303(a) (1999). Service Connection for Dental Disorders Service connection will be granted for a disease or injury of the individual teeth and investing tissues, shown by the evidence to have been incurred in or aggravated by service. As to each noncompensable service-connected dental condition, a determination will be made as to whether it is due to a combat wound or other service trauma. 38 C.F.R. § 3.381(b) (1999); compare 38 C.F.R. § 3.381 (a) (1998). 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 as otherwise provided by applicable regulation. 38 C.F.R. § 3.381(a) (1999). In determining service connection, the condition of teeth and periodontal tissues at the time of entry into active duty will be considered. Treatment during service, including filling or extraction of a tooth, or placement of a prosthesis, will not be considered evidence of aggravation of a condition that was noted at entry, unless additional pathology developed after 180 days or more of active service. 38 C.F.R. § 3.381(c) (1999). The significance of a finding that a dental condition is due to in-service trauma is that the veteran may be authorized to receive any VA dental care indicated as reasonably necessary for the correction of such service-connected noncompensable condition or disability. 38 C.F.R. § 17.161(c) (formerly § 17.123(c), commonly referred to as Class II(a) eligibility. For the purposes of determining whether a veteran has Class II(a) eligibility for dental care under 38 C.F.R. § 17.161(c), the term "service trauma" does not include the intended effects of treatment provided during the veteran's military service, including tooth extraction. See VAOPGCPREC 5-97, 62 Fed. Reg. 15566 (1997). The Board is bound by this opinion. 38 U.S.C.A. § 7104(c). The statutory presumption of soundness of condition at the time of entrance into active service will not be applicable in cases of dental conditions not disabling to a compensable degree. Each missing or defective tooth and each disease of the investing tissues will be considered separately in determining service connection. 38 C.F.R. § 3.381. A separate rating is required for dental trauma, even if service connection has been granted for numerous teeth. 38 C.F.R. § 3.381(e). A veteran is entitled to outpatient dental services and treatment, and related dental appliances, as often as may be found necessary, and regardless of when his application was filed, if his service-connected dental condition is due to combat wounds or other service trauma, known as "Class II(a)" VA dental benefits. 38 U.S.C.A. § 1712; 38 C.F.R. § 17.161(c). Rating Disabilities The law generally provides that disability evaluations are determined by the application of a schedule of ratings which is based on the average impairment of earning capacity. 38 U.S.C.A. § 1155; 38 C.F.R. § 3.321(a), Part 4. Separate diagnostic codes identify the various disabilities. Regulations generally require that the disability be viewed in relation to its whole history but the present level of disability is of primary concern. Francisco v. Brown, 7 Vet. App. 55, 58 (1994). In resolving the factual issues as to the severity of the appellant's disorder, the Board may only consider the specific factors as are enumerated in the applicable rating criteria. See Massey v. Brown, 7 Vet. App. 204, 208 (1994); Pernorio v. Derwinski, 2 Vet. App. 625, 628 (1992). Francisco v. Brown, 7 Vet. App. 55, 57-58 (1994); see Solomon v. Brown, 6 Vet. App. 396, 402 (1994). Well-Groundedness of Claims Under the law, a person who submits a claim for benefits shall have 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); Tirpak v. Derwinski, 2 Vet. App. 609 (1992). If a claim is not well grounded, the application for service connection must fail, and there is no further duty to assist in the claim's development. 38 U.S.C.A. § 5107; Murphy v. Derwinski, 1 Vet. App. 78 (1990). A well-grounded claim is "one which is meritorious on its own or capable of substantiation. Such a claim need not be conclusive but only possible" in order meet the burden established in the statute. Kandik v. Brown, 9 Vet. App. 434, 439 (1996); Tirpak, 2 Vet. App. at 611. In order for the appellant's claim to be well grounded, there must have been presented competent evidence of a current disability; a disease or injury which was incurred in service, and a nexus between the disease or injury and the current disability. Caluza v. Brown, 7 Vet. App. 498, 506 (1995), aff'd per curiam, 78 F.3d 604 (Fed.Cir. 1996)(table); see Watai v. Brown, 9 Vet. App. 441, 443 (1996). The burden to submit evidence sufficient to establish a "well-grounded" claim is the claimant's alone. Epps v. Gober, 126 F.3d 1464, 1469 (Fed.Cir. 1997). Where the determinative issue involves either medical etiology or diagnosis, competent medical evidence is necessary to fulfill the well-grounded claim requirement. Where the determinative issue does not require medical diagnosis or etiology, lay testimony by itself may suffice to meet the statutory burden. Caluza, 7 Vet. App. at 504; Grottveit v. Brown, 5 Vet. App. 91, 93 (1993). The truthfulness of evidence is presumed in determining whether a claim is well grounded. Meyer v. Brown, 9 Vet. App. 425, 429 (1996); King v. Brown, 5 Vet. App. 19, 21 (1993). Factual Background The appellant's service medical records reflect that when he entered the U.S. Marine Corps in March 1967, a contemporaneous dental examination found that his teeth numbers 3, 4, 5, 14, 19 and 30 were missing. Teeth numbers 2, 7, 10, 12, 13, 15, 18, 20, 21, 29 and 31 were noted to be carious. The service medical records further show that while the appellant was serving in Vietnam in January 1968, he sustained a gunshot wound to the right neck and mandible. Following evacuation to a Naval Hospital in Oakland, California, the appellant underwent a period of hospitalization and physical therapy from February to May 1968. Contemporaneous radiographic examination the following month detected metallic densities over the right side of the mandible. In May 1968, following a period of convalescent leave, tooth number 2 was extracted due to a vertical fracture. The appellant was then returned to duty. By VA rating decision dated in March 1971, service connection was granted for missing tooth number 2, and for teeth numbers 13 to 29. The "dental rating sheet" implementing the decision reflects that the "basis for [the] rating" was "for out-patient treatment only." It was noted that the appellant had sustained "[d]ental trauma" in 1968. In June 1971, the appellant underwent a VA dental examination, prepatory to repair by restoration and prophylaxis of numbered teeth, in particular numbers 7 and 10. It was noted that the appellant also was to have emplaced partial replacements of missing teeth. In particular, tooth number 2 was to received a maxillary partial replacement, and a mandibular partial denture was to be emplaced on teeth numbers 28 through 31. The report of dental examination further reflects that a residual shell fragment wound of the right mandible with profuse residuals metallic foreign bodies was noted, and was further described as being well-healed with well-functioning mandibular fractures. In June 1992, the appellant submitted an application for VA compensation or pension, in which he in part stated that he desired to have "some teeth repaired." He alluded to injuries sustained when he received a gunshot wound to the neck and mandible while in service. He stated that he was unable to chew food, as his previous dental repairs were "falling apart." In a January 1993 statement, the appellant related that after he was shot in Vietnam, medical care providers placed priority of treatment on his gunshot wound and fractured jaw, and that little attention was paid to his teeth which were chipped and broken. He stated that the only attention that was given to his teeth was when an abcess developed on a tooth that had a fractured root, and that tooth was pulled. The appellant stated that his teeth were in their present condition due to the trauma sustained by the gunshot wound and hand grenade fragments by which he was wounded in service. The appellant reiterated these contentions in a letter received in May 1993. By rating decision dated in March 1994, service connection was denied for missing teeth numbers 3, 4, 5, 14, 19 and 30. Service connection was also denied for carious teeth numbers 7, 10, 12, 13, 15, 18, 20, 21, 29, and 31. Following receipt of his Notice of Disagreement, the appellant underwent a VA physical examination in May 1995. He reported that he had some pain on the right side of the mandible during cold weather, and occasional sporadic pain that went to his right ear. Upon clinical examination, there was no tenderness to the mandible upon palpation. Some clicking of the temporomandibular joints bilaterally was noted on opening and closing of the mouth. Thee was no limitation to movement opening and closing the mouth. The appellant was noted to have a well-healed, nontender scar below the mandible on the right side. He wore a mustache, and both the mandible and the chin were covered with hair. There were no deformities, loss of soft tissue, or bone noted on either side of the appellant's face. There was no numbness or speech difficulties noted. Radiographic examination revealed multiple grenade fragments, predominantly on the right, and to a lesser extent on the left hemimandible. Although the clinical history included a bilateral fracture of the mandible, no distinct fracture lines were observed. The appellant was diagnosed to have a history of a fractured bilateral mandible, secondary to the explosion of a grenade. The residuals were noted to be "treated surgically and well healed, with the residuals of well healed scars as described, retained metallic fragments and post surgical changes," with no limitation of motion. By rating decision dated in July 1995, the evaluation of the appellant's service-connected residuals of the bilateral mandible fracture was continued as zero percent disabling. Following the Board's March 1997 remand, VA dental records were received reflecting in part that in August 1993, visible shrapnel was detected in the tissues of teeth numbers 2 and 13 through 29. The appellant was afforded a VA dental examination in August 1997. The examiner noted that x-ray testing revealed the presence of shell or bullet fragments in the right mandible. The examiner opined that teeth numbers 29, 30, 31 were in part probably lost due to the in-service gunshot wound, and that teeth numbers 10, 27, 28, and 32 required treatment. The examiner stated that the etiology of the tooth condition was multifactorial, but appeared to be related, in part, to the service-connected shell fragment wound to the mandible. By rating decision dated in August 1998, service connection for treatment purposes was granted for teeth numbers 10, 13 through 27, 28, and 32. It was noted that the appellant's tooth number 30 had been noted upon service entry to be missing. Analysis Entitlement to service connection for missing teeth numbered 3, 4, 5 and 30 The appellant argues that a grant of service connection is warranted for the numbered teeth at issue. Having carefully examined all of the evidence of record and the appellant's contentions, the Board finds that the appellant has not submitted a well-grounded claim of entitlement to service connection for treatment purposes of teeth 3, 4, 5 and 30. Specifically, the appellant's claim fails because there has been produced no evidence that suggests a linkage between the loss of the teeth at issue and any incident of the appellant's military service. The appellant's service medical records plainly reveal that upon entrance onto active service, teeth numbers 3, 4, 5, and 30 (as well as 14 and 19 ) were missing, and there has been obtained no evidence to refute this competent and contemporaneous medical evidence. As is noted above, a VA examiner opined in August 1997 that the appellant's loss of tooth number 30 was probably caused, at least in part, to the gunshot wound he sustained while in military service. However, the examiner's opinion, rendered 30 years after the tooth in question was noted to be missing prior to service entry, is plainly contradicted by the medical evidence of record that was generated contemporaneous with the appellant's service entry. See Samuels v. West, 11 Vet. App. 433 (1998); Godfrey v. Brown, 7 Vet. App. 398 (1995). Through his representative, the appellant has not raised any specific contentions with regard to the issue of service connection for teeth numbers 3, 4, 5, and 30. The Board notes that in its November 1996 and August 1998 rating decisions, the RO found that service connection for compensation was not warranted with regard to the teeth at issue. The Board has carefully scrutinized the appellant's contentions and the evidence record in light of the applicable law relative to service connection for compensation, in particular that found in 38 C.F.R. § 4.150 (1999). Having done so, the Board has not located a basis upon which service connection for compensation may be granted. In particular, loss, nonunion, malunion, of the maxilla or mandible; limited motion of the temporomandibular joint; impairment of the ramus or the condyloid process or loss of the palate has not been noted. See 38 C.F.R. § 4.150, Diagnostic Codes 9900 to 9912; 9914 to 9916 (1999). Furthermore, under Diagnostic Code 9913 for loss of teeth, its individual ratings apply only to bone loss through trauma. See 38 C.F.R. § 4.150, Diagnostic Code 9913, Note. In this regard, because teeth numbers 3, 4, 5, 14, 19 and 30 were clearly missing prior to the appellant's entry onto active military service, they are not for consideration ab initio as to the issue of whether their loss would result in service connection for compensation purposes. See also 38 C.F.R. § 3.381(d)(6) (1999) [teeth noted as missing at entry will not be service connected, regardless of treatment during service]. Under these circumstances, the appellant's claim of entitlement to service connection for missing teeth numbers 3, 4, 5 and 30 for treatment purposes is clearly not well grounded. The benefit sought is therefore denied. Entitlement to service connection for treatment purposes for teeth numbered 7, 12, 29 and 31 The appellant argues that a grant of service connection is warranted for the numbered teeth at issue. As to service connection for treatment purposes of teeth numbers 7, 12, 29 and 31, the Board observes that upon the appellant's March 1967 enlistment, they were clearly noted to be carious. The appellant's service medical records do not reflect that the appellant thereafter had treatment for the teeth in question. In light of these factors, and with due application of the provisions of 38 C.F.R. § 3.381(b) and (c) as those provisions are set forth supra, service connection for treatment purposes of teeth numbers 7 and 12 is clearly not warranted. In this regard, the Board has carefully considered the appellant's contention that a remand of this matter is warranted to ascertain whether there exists inpatient treatment records generated during the course of the appellant's convalescence following his in-service injury. The appellant argues that because his in-service post-injury treatment included his jaw being wired shut, his pre-existing dental condition was per se aggravated. He further contends that a complete copy of his in-service dental records has not been obtained. See Appellant's informal brief, page 3. To the extent that the appellant argues that his in-service treatment has aggravated the condition of teeth numbers 7 and 12, the Board notes that the record is devoid of any competent medical opinion suggesting such aggravation in the manner suggested by the appellant. Because the appellant and his representative are laypersons, they are not qualified to render medical opinions regarding medical matters, and his opinion is entitled to no weight. Cromley v. Brown, 7 Vet. App. 376, 379 (1995); Boeck v. Brown, 6 Vet. App. 14, 16 (1993); Grivois v. Brown, 6 Vet. App. 136, 140 (1994); Espiritu v. Derwinski, 2 Vet. App. 492, 495 (1992). In this regard, the appellant's claim is not well grounded. Although the appellant correctly notes the presence of an in- service treatment note reflecting that he was to be followed on a daily basis by the military dental services provider, the record does not suggest the nature of the treatment then rendered to him. The Board notes that the service medical records reflect that from the time of his return to the continental United States from Vietnam, the appellant was under continuous treatment for the residuals of a fractured jaw, to include the ultimate extraction of tooth number 2 (as is discussed below). In particular, the record of hospitalization from February 17 to May 3, 1968 reflects that the appellant was transferred to a Ward "to be followed by the Dental Service," and that the treatment thereafter was for maintenance of the jaw wiring. There is no evidence that the appellant was treated during this period for any other dental disorder other than a fractured jaw. Although not in reliance upon the disposition of this issue, the Board observes that the medical records obtained appear to be supportive of the appellant's January 1993 contention that the only tooth treated during the course of his post- injury hospitalization was number 2. In support of his argument for remand, the appellant has cited the decision of the Federal Circuit Court of Appeals in Hayre v. West, 188 F. 3d 1327 (1999). The Hayre decision does not avail the appellant. First, the Board notes that in this matter, unlike Hayre, VA has made two attempts to retrieve all of the relevant service medical records. In response to the latter request, the National Personnel Records Center specifically reported that no further medical records beyond those forwarded existed. Thus, an additional remand for yet another attempt to locate such records would be fruitless. Moreover, unlike the veteran in Hayre, the appellant in this matter cannot relate the substance of the allegedly missing dental records, beyond the information that is presently of record. Having found that the issue of the appellant's entitlement to service connection for treatment purposes is not well- grounded with regard to teeth numbers 7 and 12 for the fundamental reason that there exists no medical evidence in support of the claim, the Board observes that the same cannot be said with respect to found for teeth numbers 29 and 31. As was noted above, in an August 1997 report, a VA dental examiner opined that the teeth in question were probably lost, at least in part, due to the gunshot wound to the mandible. Although teeth numbers 29 and 31 were clearly carious upon the appellant's entry, the examiner's opinion expressing the causality of the ultimate loss due to the trauma of the gunshot wound with regard to these teeth is sufficient to both well ground the claim and , ultimately, to warrant the granting of service connection for treatment purposes. Accordingly, service connection is granted for treatment purposes for teeth numbers 29 and 31. Service connection for compensation purposes for teeth numbered 7, 10, 12, 13, 15, 18, 20, 21, 29, and 31. The Board now turns to the issue of whether a grant of service connection for compensation may be appropriate with regard to the numbered teeth 7, 10, 12, 13, 15, 18, 20, 21, 29, and 31. As was noted above, loss, nonunion, malunion, of the maxilla or mandible; limited motion of the temporomandibular joint; impairment of the ramus or the condyloid process or loss of the palate has not been noted. See 38 C.F.R. § 4.150, Diagnostic Codes 9900 to 9912; 9914 to 9916 (1999). The Board must therefore consider whether application of 38 C.F.R. § 4.150, Diagnostic Code 9913 for loss of teeth is appropriate. Under that provision, where the loss of the masticatory surface cannot be restored by suitable prosthesis, ratings from 10 to 40 percent are assignable based upon the loss of substance of the body of the maxilla or mandible without loss of continuity, based upon the number and location of the missing teeth. A loss of teeth due to the loss of substance of the body of the maxilla or the mandible when there is no loss of continuity, but where the lost masticatory surface cannot be restored by a suitable prosthesis, warrants a 10 percent evaluation when all upper and lower teeth on one side are missing, all lower anterior teeth are missing, or all upper anterior teeth are missing. Where the loss of masticatory surface can be restored by suitable prosthesis, a zero percent rating is warranted. 38 C.F.R. § 4.150, Diagnostic Code 9913. In this case, the medical evidence does not show that the appellant has a service-connected loss of all upper and lower teeth on one side, loss of all lower anterior teeth or loss of all upper anterior teeth. Hence, the appellant's dental condition does not meet the criteria specified for a compensable rating 38 C.F.R. § 4.150, Diagnostic Code 9913. The Board has also considered whether the assignment of a zero percent disability rating be would warranted under 38 C.F.R. § 4.150, Diagnostic Code 9913, for the loss of masticatory surface restored by suitable prosthesis. In this regard, and as is noted above, the examiner conducting the August 1997 VA examination reported in part that consideration should be given to emplacing a denture to restore the masticatory function in the area of teeth numbers 29 to 32. However, the Board observes that the provision applicable to the assignment for a zero percent disability rating contemplates the loss of the masticatory surface of service-connected teeth restored by suitable prosthesis. In other words, a zero percent disability is for application where, but for the prosthesis, a compensable rating would be assigned. In the appellant's case, the appellant's teeth do not meet any of the combinations that are requisite for the assignment of a compensable rating, irrespective of the suitability of a prosthesis, (i.e., loss of all upper and lower teeth on one side, loss of all lower anterior teeth or loss of all upper anterior teeth.). Entitlement to a compensable rating for tooth number 2 The generally applicable law pertaining to rating disabilities is set forth above. The appellant's primary contention relative to missing tooth number 2 is that the RO "severed" service connection for compensation benefits that had been awarded in March 1994, without following the procedures as outlined by applicable regulation, 38 C.F.R. § 3.105. The appellant argues that the issue of a compensable disability rating for tooth number 2 is "inextricably intertwined" with the issue, as propounded by the appellant, of severance of service connection for compensation. See Informal Brief of Appellant, page 3. As to whether his tooth number 2 warrants a compensable disability rating, the appellant has offered no contentions. The record reflects that following receipt of the appellant's April 1995 notice of disagreement, the Statement of the Case informed the appellant that a 10 percent evaluation was not assignable, "as all [of the] upper and lower teeth on one side are not missing." In due course of appellate proceedings, the RO found in confirmed rating decisions of August 1996, November 1996, and August 1998 that a compensable evaluation for the number 2 tooth was not warranted. The record thus reveals that while a compensable disability rating for the number 2 tooth has been consistently denied, service connection for compensation purposes has not been. The Board observes that a compensable disability rating has been consistently denied because the provisions of 38 C.F.R. § 4.150, Diagnostic Code 9913 pertaining to the evaluation of dental disabilities, has not been met. The issue certified to the Board in this matter is whether the appellant is entitled to an increased (compensable) disability rating for the number 2 tooth. Plainly, he does not meet the criteria as established by regulation for a compensable rating. As a matter of law, the claim for an increased rating must be denied. See Sabonis v. Brown, 6 Vet. App. 426 (1994). The appellant's contention relative to the issue of an increased rating being "inextricably intertwined" with that of severance for service connection is without merit. A claim is inextricably intertwined only if the RO would have to reexamine the merits of any other claim that has been denied by the Board, or the appellate courts, which is pending on appeal pursuant to the same action. See Harris v. Derwinski, 1 Vet. App. 180, 183 (1991). The prohibition against the adjudication of claims that are inextricably intertwined is based upon the recognition that claims related to each other in the prescribed degree should not be subject to piecemeal decision-making or appellate litigation. See generally Parker v. Brown, 7 Vet. App. 116 (1994); Babchak v. Principi, 3 Vet. App. 466 (1992) (For the proposition as cited). In this matter, the record clearly reveals that the appellant is not entitled to a compensable disability rating. As was noted in the introduction to this decision, the appellant's claim that the RO severed service connection for compensation purposes for tooth number 2 has not been the subject of an RO decision. The Board can plainly decide the merits of the appellant's claim for an increased disability rating for tooth number 2, irrespective at this point of whether service connection for compensation purposes should be severed. For the reasons and bases expressed above, the Board concludes that a compensable disability rating for tooth number 2 is denied. ORDER A well-grounded claim not having been submitted, service connection of teeth numbers 3, 4, 5, and 30 for the purposes of VA dental treatment is denied. Service connection for teeth numbers 7 and 12 for the purposes of VA dental treatment is denied. Service connection for teeth numbers 29 and 31 for the purposes of VA dental treatment is granted. Service connection for teeth numbers 7, 10, 12, 13, 15, 18, 20, 21, 29, and 31 for the purposes of VA compensation is denied. An increased rating for tooth number 2 is denied. Barry F. Bohan Member, Board of Veterans' Appeals In various correspondence and pleadings, the appellant has reported that he obtained dental treatment for the teeth in question. As is noted above, the appellant's service medical records reflect that his tooth number 2 was extracted during service. The Board notes that in an August 1998 rating decision, service connection was granted for treatment purposes for teeth numbers 14 and 19, upon the finding that competent medical evidence had detected the presence of shrapnel in the investing tissue of the teeth in question. Although the issue of service connection for treatment of these two teeth was certified to the Board for review, the grant of service connection for treatment purposes renders moot the issue of the appellant's entitlement to service connection for treatment purpose of these two teeth. The Board notes that in its August 1998 rating decision, the RO granted service connection for treatment purposes for teeth numbers 13 through 27 [upon the finding that competent medical evidence had detected the presence of shrapnel in the investing tissue surrounding the teeth in question] and for tooth number 10, [upon the basis that the etiology of its condition was in part traceable to the service-connected gunshot wound]. Although the issue of service connection for treatment of teeth numbers 10, 13, 15, 18, 20 and 21 was certified to the Board for review, the grant of service connection for treatment purposes renders moot the issue as was certified. Remaining is the issue of the appellant's entitlement to service connection for treatment purposes for the remaining teeth, (7, 12, 29 and 31) and service connection for compensation purposes for all of the teeth. The examiner also opined that tooth number 30 was included in those that were probably lost in part due to the gunshot wound. As is noted above, tooth number 30 was already missing upon the appellant's entry onto active military service. The Board observes that the general principles of application as are set forth in 38 C.F.R. § 3.381(d)(1) through (5) (1999) are not applicable to teeth numbers 29 and 31 as the regulation's provisions in the section only apply to "dental conditions noted at entry and treated during service." As is noted above, the appellant's teeth numbers 29 and 31 were not treated during the course of his military service. In his informal brief, the appellant argues that in observing the appellant to have manifested "bruxism" during the course of a VA medical examination, the RO "attempted to raise the issue," and "inappropriately attempts to disassociate bruxism" from symptoms attributable to the appellant's service-connected disorders. See Appellant's Informal Brief, page 4. Examination of the RO's decision does not support the appellant's interpretation. Instead, the RO appears to have merely noted the medical evidence of record, as it was obligated to do under the law. See Vargas- Gonzalez v. West, 12 Vet. App. 321, 328 (1999); As is noted above, service connection for treatment purposes is in effect for tooth number 2, which has been determined to be replaceable, under 38 C.F.R. § 3.381(a).