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A Quick Dental Question


Ricky

Question

Just wanted to know if anyone can help me. I am SC 40% for DMII (non-AO claim). My dentist told me today that my DMII has caused me to have severe peridontal disease. He stated that I would have to undergo treatment to try and save my teeth because the peridontal disease would more than likely not allow me to effectively wear dentures. The DMII is aggrevating the peridontal disease and the peridontal disease is aggravating the DMII. Since the peridontal is secondary to my DMII can/should I submit a claim for it. If I do submit a claim what do you think my chances are? I know they normally do not provide dental unless you are 100% PT which I am not. Thanks for any replies.

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  • HadIt.com Elder

[Code of Federal Regulations]

[Title 38, Volume 1]

[Revised as of July 1, 2002]

From the U.S. Government Printing Office via GPO Access

[CITE: 38CFR17.161]

[Page 654-655]

TITLE 38--PENSIONS, BONUSES, AND VETERANS' RELIEF

CHAPTER I--DEPARTMENT OF VETERANS AFFAIRS

PART 17--MEDICAL--Table of Contents

Sec. 17.161 Authorization of outpatient dental treatment.

Outpatient dental treatment may be authorized by the Chief, Dental

Service, for beneficiaries defined in 38 U.S.C. 1712(b) and 38 CFR 17.93

to the extent prescribed and in accordance with the applicable

classification and provisions set forth in this section.

(a) Class I. Those having a service-connected compensable dental

disability or condition, may be authorized any dental treatment

indicated as reasonably necessary to maintain oral health and

masticatory function. There is no time limitation for making application

for treatment and no restriction as to the number of repeat episodes of

treatment.

(b) Class II. (1)(i) Those having a service-connected noncompensable

dental condition or disability shown to have been in existence at time

of discharge or release from active service, which took place after

September 30, 1981, may be authorized any treatment indicated as

reasonably necessary for the one-time correction of the service-

connected noncompensable condition, but only if:

(A) They served on active duty during the Persian Gulf War and were

discharged or released, under conditions other than dishonorable, from a

period of active military, naval, or air service of not less than 90

days, or they were discharged or released under conditions other than

dishonorable, from any other period of active military, naval, or air

service of not less than 180 days;

(B) Application for treatment is made within 90 days after such

discharge or release.

© The certificate of discharge or release does not bear a

certification that the veteran was provided, within the 90-day period

immediately before such discharge or release, a complete dental

examination (including dental X-rays) and all appropriate dental

treatment indicated by the examination to be needed, and

(D) Department of Veterans Affairs dental examination is completed

within six months after discharge or release, unless delayed through no

fault of the veteran.

(ii) Those veterans discharged from their final period of service

after August 12, 1981, who had reentered active military service within

90 days after the date of a discharge or release from a prior period of

active military service, may apply for treatment of service-connected

noncompensable dental conditions relating to any such periods of service

within 90 days from the date of their final discharge or release.

(iii) If a disqualifying discharge or release has been corrected by

competent authority, application may be made within 90 days after the

date of correction.

(2)(i) Those having a service-connected noncompensable dental

condition or disability shown to have been in existence at time of

discharge or release from active service, which took place before

October 1, 1981, may be authorized any treatment indicated as reasonably

necessary for the one-time correction of the service-connected

noncompensable condition, but only if:

(A) They were discharged or released, under conditions other than

dishonorable, from a period of active military, naval or air service of

not less than 180 days.

(B) Application for treatment is made within one year after such

discharge or release.

© Department of Veterans Affairs dental examination is completed

within 14 months after discharge or release, unless delayed through no

fault of the veteran.

(ii) Those veterans discharged from their final period of service

before August 13, 1981, who had reentered active military service within

one year from the date of a prior discharge or release, may apply for

treatment of service-connected noncompensable dental conditions relating

to any such prior periods of service within one year of their final

discharge or release.

(iii) If a disqualifying discharge or release has been corrected by

competent authority, application may be made

[[Page 655]]

within one year after the date of correction.

(Authority: 38 U.S.C. 1712)

© Class II (a). Those 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 for the correction of such service-connected

noncompensable condition or disability.

(d) Class II(b). Those having a service-connected noncompensable

dental condition or disability and who had been detained or interned as

prisoners of war for a period of less than 90 days may be authorized any

treatment as reasonably necessary for the correction of such service-

connected dental condition or disability.

(Authority: Pub. L. 100-322; 38 U.S.C. 1712(b)(l)(F))

(e) Class II©. Those who were prisoners of war for 90 days or

more, as determined by the concerned military service department, may be

authorized any needed dental treatment.

(Authority: Pub. L. 100-322, 38 U.S.C. 1712(b)(1)(F))

(f) Class IIR (Retroactive). Any veteran who had made prior

application for and received dental treatment from the Department of

Veterans Affairs for noncompensable dental conditions, but was denied

replacement of missing teeth which were lost during any period of

service prior to his/her last period of service may be authorized such

previously denied benefits under the following conditions:

(1) Application for such retroactive benefits is made within one

year of April 5, 1983.

(2) Existing Department of Veterans Affairs records reflect the

prior denial of the claim.

All Class IIR (Retroactive) treatment authorized will be completed on a

fee basis status.

(Authority: 38 U.S.C. 1712)

(g) Class III. Those having a dental condition professionally

determined to be aggravating disability from an associated service-

connected condition or disability may be authorized dental treatment for

only those dental conditions which, in sound professional judgment, are

having a direct and material detrimental effect upon the associated

basic condition or disability.

(h) Class IV. Those whose service-connected disabilities are rated

at 100% by schedular evaluation or who are entitled to the 100% rate by

reason of individual unemployability may be authorized any needed dental

treatment.

(Authority: 38 U.S.C. 1712)

(i) Class V. A veteran who is participating in a rehabilitation

program under 38 U.S.C. chapter 31 may be authorized such dental

services as are professionally determined necessary for any of the

reasons enumerated in Sec. 17.47(g).

(Authority: 38 U.S.C. 1712(b); chapter 31)

(j) Class VI. Any veterans scheduled for admission or otherwise

receiving care and services under chapter 17 of 38 U.S.C. may receive

outpatient dental care which is medically necessary, i.e., is for dental

condition clinically determined to be complicating a medical condition

currently under treatment.

(Authority: 38 U.S.C. 1712)

[20 FR 9505, Dec. 20, 1955, as amended at 26 FR 11214, Nov. 28, 1961; 27

FR 11424, Nov. 20, 1962; 29 FR 18219, Dec. 23, 1964; 32 FR 13817, Oct.

4, 1967; 33 FR 5300, Apr. 3, 1968; 45 FR 47680, July 16, 1980; 48 FR

16681, Apr. 19, 1983; 49 FR 5617, Feb. 14, 1984; 54 FR 25449, June 15,

1989; 57 FR 4367, Feb. 5, 1992; 57 FR 41701, Sept. 11, 1992.

Redesignated and amended at 61 FR 21965, 21968, May 13, 1996]

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  • HadIt.com Elder

Dear Veteran, I posted the VA regulation which clearly supports your claim. Also, you should do a search on the BVA to find some supportive case law. If your current Dentist can write a strong argument for "aggravation", I think you should push hard for your claim (take names!). I have been in treatment for periodontal disease over the past 2 years at the VA with deep cleaning every 6 months and my periodontal disease is in total remission! I have lost no teeth to the disease yet, and when I finally do, I am going to ask the VA for this program (from the VA): VALPLAST http://www1.va.gov/ntxcdl/page.cfm?pg=18

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  • HadIt.com Elder

Ricky:

I suggest rather than get in a protracted fight to get the care you deserve that you go to the VA Dentist at your VAMC and sign in as an emergency. You can simply tell them that you have pain. Once you see the Dentist ask for help and you may be able to bypass a fight.

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They wouldn't approve me for mutual aggravatiopn of DM/perio because the c&p dentist claimed that my perio wasn't severe enough. The first question she asked me was whether I was on insulin (no), tthen whether I had active severe infections in my mouth (mostly just inflammation, no pus). If you are on insulin and have active infection, you should be approved. She also said that if I were using a less busy clinic they might treat me at my level of severity. If you do have active infection, your VA primary care doc should be able to refer you to dental for emergency care, since if the infection is that bad, it would definitely aggrave your blood sugar level. Welcome home and good luck.

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