Part XIII, Subpart i, Chapter 4, Section CRatings for Dental Treatment Purposes

Revised October 10, 2019

XIII.i.4.C.1.a#VHA and VBA Roles in Dental Treatment Eligibility Determinations

Authorization of dental treatment under 38 CFR 17.161 is normally handled by the Business Office at the Veterans Health Administration (VHA) facility nearest the Veteran’s residence or the VHA Health Eligibility Center without referral to the Veterans Service Center (VSC) and the rating activity.The Veterans Benefits Administration's (VBA’s) role is to make determinations as required by VHA in order for them to determine entitlement to treatment. VHA may complete VA Form 10-7131, Exchange of Beneficiary Information and Request for Administrative and Adjudicative Action , to request information or a rating from VBA for use in its determination of eligibility to treatment under Class I, II, II(a), II(c), or Class IV. Important : As noted in M21-1, Part XIII, Subpart i, 4.C.1.d, VBA must only render determinations on service connection (SC) for dental treatment purposes when requested to do so by VHA. References: For more information on

• the classes of dental treatment eligibility, see
  • M21-1, Part XIII, Subpart 1, 4.C.1.b, and
  • M21-1, Part XIII, Subpart i, 4.A
• determinations VBA may make for dental treatment purposes, see M21-1, Part XIII, Subpart i, 4.C.1.c
• processing dental treatment requests, see M21-1, Part XIII, Subpart i, 4.B, and
• rating dental and oral conditions for compensation purposes, see M21-1, Part V, Subpart iii, 14.

XIII.i.4.C.1.b#Outpatient Dental Treatment Classifications by VHA

The table below describes the most common dental treatment classifications used by VHA and provides a reference for more information on each classification. For the purpose of this topic, the focus will be on Classes II(a) and II.

Important:SC non-compensable (as used in Class II and IIa) means either

• dental disabilities that are SC for compensation purposes but only assigned a 0-percent evaluation, or
• 38 CFR 3.381(b) conditions that can only be SC for treatment purposes and, therefore, are not entitled to any compensation payments.

XIII.i.4.C.1.c#Determinations VBA Makes for Dental Treatment Purposes

Per 38 CFR 3.381(a), VHA may request determinations from VBA including, but not limited to, whether a

• dental condition or disability is a result of
  • combat wounds, or
  • service trauma
• Veteran has a
  • non-compensable SC dental condition or disability, or
  • compensable SC disability
• Veteran is totally disabled due to an SC disability, or
• Veteran has former FPOW status.

Note: This does not mean a formal rating determination is always required. In many cases, eligibility for outpatient dental treatment can be decided by VHA without VBA rating action based on information of record such as

• one-time dental treatment for Veterans who apply within 180 days after military discharge (Class II)
• FPOW status (Class II(c)), and
• total disability (Class IV).

In lieu of a dental treatment rating decision, annotate VA Form 10-7131 that the Veteran is totally disabled. References: For more information on

• conditions that can be SC only for treatment purposes, see M21-1, Part XIII, Subpart i, 4.C.1.f, and
• verification of FPOW status for dental eligibility, see M21-1, Part XIII, Subpart i, 4.B.4.

XIII.i.4.C.1.d#When to Prepare a Rating for Dental Treatment Purposes

As specified in 38 CFR 3.381(a), VBA will develop and prepare a decision for a claim for SC for dental treatment purposes only after VHA

• determines that a Veteran meets the basic eligibility requirements of 38 CFR 17.161, and
• requests that VBA make a determination (by providing required information or issuing a rating decision).

Important: Provide only** the determination requested.

XIII.i.4.C.1.e#Service Trauma for Dental Treatment Purposes

Veterans who have a non-compensable dental condition (including tooth disorders for which SC for compensation purposes cannot be awarded) resulting from combat wounds or service trauma may receive any reasonably necessary treatment for the SC dental condition under Class II(a). If VHA provides a VA Form 10-7131 requesting a dental trauma rating, prepare a rating decision identifying the specific tooth number(s) that were injured and identify the service trauma.Note:Service trauma means an injury or wound produced by an external physical force, for example, striking the mouth on a vehicle, striking the mouth when falling, and biting down on a cherry pit. Proper in-service tooth extraction does not constitute service trauma as indicated in Nielson v. Shinseki, 607 F.3d 802 (Fed. Cir, 2010). References: For more information on

• service dental trauma, see VAOPGCPREC 5-1997
• conditions that can be SC only for treatment purposes, see M21-1, Part XIII, Subpart i, 4.C.1.f, and
• tooth numbering systems, see M21-1, Part XIII, Subpart i, 4.C.1.m.

XIII.i.4.C.1.f#Conditions SC Only for Dental Treatment Purposes

Per 38 CFR 3.381(b), the following conditions may not be considered compensable dental disabilities. They may be SC non-compensable dental conditions solely for the purpose of determining entitlement to Class II or Class II(a) dental treatment under 38 CFR 17.161.

• treatable carious teeth
• chronic periodontal disease (pyorrhea)
• replaceable missing teeth, and
• dental or alveolar abscesses.

Note : This list is not exclusive and other dental conditions may qualify.Important: Periodontal disease is not treatable except for Class II purposes, even if secondary to an SC disability. Reference: For more information on rating dental and oral conditions for compensation purposes, see M21-1, Part V, Subpart iii, 14.

XIII.i.4.C.1.g#Dental Conditions Not Considered SC Even for Treatment Purposes

Under 38 CFR 3.381(f), the following must not be considered SC even for treatment purposes:

• calculus
• acute periodontal disease
• third molars, unless disease or pathology of the tooth
  • developed after 180 days or more of active service, or
  • was due to combat or in-service trauma, and
• impacted or malposed teeth, and other developmental defects, unless disease or pathology of these teeth developed after 180 days or more of active service.

Notes:

• Third molars injured by combat or other in-service trauma may be considered for Class II(a) purposes upon VHA request for a service trauma determination.
• 180 days is the requisite service specified for Class II eligibility under 38 CFR 17.161(b)(1)(i)(A) and 38 CFR 17.161(b)(1)(ii).

XIII.i.4.C.1.h#Separate Consideration of Each Condition for Dental Treatment Purposes

38 CFR 3.381(c) specifies that the rating activity must consider each defective or missing tooth, each disease of the teeth, and each periodontal tissue separately to determine whether the condition was incurred or aggravated in the line of duty for the purpose of Class II(a) or II treatment eligibility.Note: This includes determinations of whether there was combat-related or other service trauma.

XIII.i.4.C.1.i#Dental Conditions on Service Entry and Aggravation for Treatment Purposes

Under 38 CFR 3.381(d), the condition of teeth and periodontal tissues at the time of entry into active duty must be considered. Treatment during service, including filling or extraction of a tooth, or placement of a prosthesis, must not be considered evidence of aggravation of a condition that was noted at entry for treatment purposes, unless additional pathology developed after 180 days or more of active service.

XIII.i.4.C.1.j#SC for Dental Treatment - Noted at Entry and Treated During Service

Use the table below to determine the proper action to take based on 38 CFR 3.381(e) guidance regarding SC for treatment purposes of dental conditions noted at entry and treated during service.

Note: If service dental records are incomplete, consider the doctrine of reasonable doubt under 38 CFR 3.102.

XIII.i.4.C.1.k#SC for Dental Treatment – Extracted Teeth from Chronic Periodontal Disease

38 CFR 3.381(g) states that teeth extracted because of chronic periodontal disease may be SC for treatment purposes if they were extracted after 180 days or more of active service, per 38 U.S.C. 1712.

XIII.i.4.C.1.l#Processing Dental Treatment Claims Involving Multiple Periods of Service

If a Veteran has two periods of service and, during the second period of service, incurs a new condition in the same tooth or aggravates a dental condition that was already SC based on the first period of service, show the incurrence of the new condition or the aggravation of the pre-existing condition in the second period of service. This is done to ensure the Veteran’s entitlement to treatment based on the subsequent service.

XIII.i.4.C.1.m#Tooth Numbering Systems

Tooth numbering by the Department of Veterans Affairs (VA) and service departments has been the same since 1953, but differed previously. The table below shows the numbering systems for the service departments prior to 1953 and the VA numbering system. — Upper

Note : The Coast Guard and Public Health Service have the same tooth numbering system as VA.

XIII.i.4.C.1.n#Use of Navy Dental Records in Determinations of SC

Copies of dental records have not always been usable for rating purposes because, prior to 1953, different colored markings on the original Naval records represented either disease or fillings and these markings could not be distinguished on photocopies.Accept the record of subsequent dental operations on the bottom of Navy Form H-4, Navy Dental Records (Examination) , as sufficient to authorize SC, even though the reverse side of that form may not record the insertion of fillings.

XIII.i.4.C.1.o#Use of Army Dental Records to Determine Defective or Missing Teeth at Enlistment

Army regulations require that every individual entering active service for more than 60 days has an initial dental examination within 60 days of entry on active service. In the absence of a suitable enlistment examination, for example, if the only examination notation was indefinite, such as “ acceptable ,” “ non-disqualifying ,” or “ not examined ,” accept the first examination within a reasonable period after entrance on active duty as recording the missing or defective teeth at enlistment.Note: Facts in individual cases, such as when a first examination report is more than 90 days after enlistment, may warrant an exception to this general rule.

XIII.i.4.C.1.p#Dental Examinations in Treatment Claims

Generally, a claim for dental treatment may be rated on service records without a dental examination. However, a dental examination may be required to identify teeth or chronic periodontal disease for which SC for treatment or examination purposes may be in order under 38 CFR 17.160.