Part XIII, Subpart i, Chapter 4, Section AOverview of Classes of Eligibility for Dental Treatment

Revised May 26, 2009

XIII.i.4.A.1.a#Eligibility and Level of Treatment for Class I Dental Conditions

The table below describes the eligibility requirement and level of treatment available to Veterans with Class I dental conditions.

Note: A rating determination is required to establish SC compensable dental conditions.

XIII.i.4.A.1.b#Restrictions on Class I Dental Treatment

For Class I dental treatment, there is no restriction on

• the time limit for making application for treatment, or
• the number of repeated treatments.

2Class II: SC Dental Conditions for Treatment Purposes

This topic contains information on Class II SC dental conditions for treatment purposes, including

• availability of Class II dental treatment
• eligibility for Class II dental treatment
• level of treatment for Class II dental conditions
• restrictions on Class II dental treatment
• exception to the 180-day application limitation
  • for Veterans
    • discharged after August 12, 1981, and
    • with a corrected discharge, and
  • based on notification of eligibility criteria at separation, and
• determination of eligibility for Class II dental treatment without rating action.

Revised April 23, 2015

XIII.i.4.A.2.a#Availability of Class II Dental Treatment

Class II dental treatment is available to a Veteran if the dental condition is determined to be SC. The condition must have existed at the time of discharge or release from active service. Note: Listed below are some of the distinctions between Class I and Class II SC dental conditions.

• Class I dental conditions are evaluated as greater than 0 percent and qualify for payment of compensation.
  • Class I SC dental conditions are evaluated under 38 CFR 4.150.
• Class II dental conditions do not warrant payment of compensation.
  • Class II conditions may be SC noncompensable (0 percent) conditions evaluated under 38 CFR 4.150, or
  • Class II conditions may be SC for treatment purposes only under 38 CFR 3.381.

Reference: For more information on handling dental conditions noted at entry on active duty, see M21-1, Part XIII, Subpart i, 4.C. Authority: For information on the authority for treatment of Class II SC dental conditions, see 38 CFR 3.381 and 38 CFR 17.161. Important: Refer claims for treatment of the following dental conditions to the Department of Veterans Affairs (VA) medical center (VAMC) eligibility clerk

• treatable carious teeth
• replaceable missing teeth
• dental or alveolar abscesses, and
• periodontal disease.

XIII.i.4.A.2.b#Eligibility for Class II Dental Treatment

A Veteran may be entitled to one-time correction of certain SC dental conditions if he/she meets the following requirements for Class II dental disabilities

• the Veteran was discharged or released
  • from active service after September 30, 1981, and
  • under conditions other than dishonorable
• the Veteran served on active military, naval, or air service for
  • 90 days or more during the Gulf War period (beginning August 2, 1990), or
  • 180 days or more during any other period
• the certificate of discharge or release does not certify that the Veteran had a complete dental examination (including x-rays) and all appropriate dental treatment indicated by examination, within 90 days immediately prior to discharge or release
• the application for dental treatment is made within 180 days after discharge or release, and
• the VA dental examination is completed within six months after discharge or release, unless delayed through no fault of the Veteran.

Reference: For cases in which discharge was prior to October 1, 1981, see 38 CFR 17.161(b)(2)(i).

XIII.i.4.A.2.c#Level of Treatment for Class II Dental Conditions

Any treatment indicated as reasonably necessary may be authorized for the one-time correction of a Class II dental condition.

XIII.i.4.A.2.d#Restrictions on Class II Dental Treatment

Treatment may be authorized for Class II dental conditions with the following restrictions

• application for treatment must be made within 180 days after discharge or release, and
• a VA dental examination must be completed within 6 months after discharge or release, unless delayed through no fault of the Veteran.

XIII.i.4.A.2.e#Exception to the 180-Day Application Limitation for Veterans Discharged After August 12, 1981

Veterans discharged from their final period of service after August 12, 1981, who reentered active military service within 90 days after the date of discharge or were released from a prior period of active military service, may apply for treatment of Class II SC dental conditions relating to any such periods of service within 180 days from the date of their final discharge or release.

XIII.i.4.A.2.f#Exception to the 180-Day Application Limitation for Veterans With a Corrected Discharge

If a competent authority has corrected a disqualifying discharge or release, then an application for Class II dental treatment may be made within 180 days after the date of correction. Reference: For more information on correction of military records, see 38 CFR 3.12(e).

XIII.i.4.A.2.g#Exception to the 180-Day Application Limitation Based on Notification of Eligibility Criteria at Separation

If the Veteran’s certificate of discharge fails to indicate whether the Veteran was provided dental services as required by 38 U.S.C. 1712(a)(1)(B)(iv), then develop for the Veteran’s service records as necessary and follow the steps in the table below.

XIII.i.4.A.2.h#Determination of Eligibility for Class II Dental Treatment Without Rating Action

Per 38 CFR 17.162, if a Veteran submits a timely application for treatment of an SC Class II dental condition, he/she may be deemed eligible and dental treatment authorized by the VAMC on a one-time completion basis without referral to the Veterans Service Center (VSC) for rating action if all of the criteria listed below are met.

• The Veteran was examined to determine the need for dental treatment within six months after date of discharge or release (unless delayed through no fault of the Veteran).
• Sound dental judgment warrants the conclusion that the condition originated in, or was aggravated during, service, and the condition existed when the Veteran was discharged or released from active service.
• Treatment does not involve replacement of a missing tooth noted at the time of VA examination, except
  • in conjunction with an authorized extraction replacement, or
  • if a determination can be made on the basis of sound professional judgment that a tooth was extracted or lost on active duty.

Notes:

• Individuals whose entire tour of duty consisted of active or inactive duty for training are not eligible.
• Normally, the VAMC can determine eligibility for dental treatment unless the Veteran claims service connection (SC). The VSC rating activity determines SC for dental conditions.

3Classes II(a) and II(c) Dental Outpatient Service

This topic contains information on Classes II(a) and II(c) dental outpatient service, including

• eligibility and levels of outpatient service for Class II(a) and II(c) dental conditions, and
• automatic eligibility for Class II(c) dental treatment.

Revised May 26, 2009

XIII.i.4.A.3.a#Eligibility and Levels of Outpatient Service for Class II(a) and II(c) Dental Conditions

The table below describes the eligibility requirements and levels of outpatient dental service available to Veterans meeting the criteria for Classes II(a) and II(c), as well as rating activity requirements.

Note: Claims folders may exist with references to Class II(b) eligibility. Class II(b) restricted dental treatment for Veterans who were FPOWs for less than 90 days. That category is now obsolete and claims from Veterans with any length of FPOW service are included in category II(c).

XIII.i.4.A.3.b#Automatic Eligibility for Class II(c) Dental Treatment

A Veteran may be deemed eligible for dental treatment by the VAMC without referral to the VSC for a decision if the

• Veteran has applied for Class II(c) benefits, and
• Veteran’s name appears on the Health Eligibility Center’s FPOW Registry File.

Note: This treatment is authorized under 38 U.S.C. 1712(a)(1)(F).

4Classes III, IV, V, and VI Dental Outpatient Service

Revised May 26, 2009

XIII.i.4.A.4.a#Eligibility and Levels of Treatment for Class III, IV, V, and VI Dental Service

The table below provides information on the eligibility requirements and the levels of treatment for Class III, IV, V, and VI dental outpatient service.

Note: A rating determination is generally not required for Class III, IV, V, and VI dental service.