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Access To Dental Care For Medically Compelling Conditions

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July 14, 2008

1. Purpose. This Information Letter solicits the assistance of each facility Director in providing
appropriate care for veteran patients having a medical condition negatively impacted by poor
oral health, and provides information that may assist facilities in providing a consistent standard
of dental care throughout the Veterans Health Administration (VHA).

3. Evaluation
a. Veterans with a medically compelling need for dental care may be treated as either a
Classification III or VI, depending upon whether the medical condition is service connected.
b. The following conditions may infer a presumptive need for examination and appropriate
treatment, as indicated. While this list is not meant to be all inclusive, other conditions need to
be supported by contemporary clinical literature.


4. Treatment
a. Classification III and VI patient groups need to receive care limited to the treatment of
those dental conditions that are professionally determined by the examining or treating dentist to
be aggravating or compromising a medical condition. The goal of care is improvement of the
oral conditions that directly impact the medical condition. In general, this is meant to be the
presurgical or pretreatment elimination of oral foci of infection. This generally includes dental
caries, active periodontal disease, or acute and chronic dentoalveolar abscess. Restoration of
function with prosthetic care is a desirable goal, but is resource driven. Comprehensive dental
treatment is not routinely provided.
b. Dental treatment is generally limited to supportive periodontal therapy, non-cast
restorative dentistry, oral surgical procedures, and endodontics; if dental care results in
edentulation or significant compromise to speech or aesthetics, prosthetic rehabilitation may be
authorized. Subsequent prosthetic care following the episode of care when the prosthesis is
provided is the responsibility of the patient. With the exception of patients who have received
radiation therapy to the maxilla or mandible, eligibility for each episode of care must be
predicated on referral and application followed by a new evaluation.
5. Inquiries. Questions regarding this Information Letter may be directed to the Office of
Dentistry in Patient Care Services at 202-461-6951.


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when i went through meps at 17 my wisdom teeth had not came through so, the docs just filled some cavs.

anyway, i go on the 28th to my vamc to have oral surgery to have my wisdom teeth removed. why couldnt my wisdom teeth have came in at 17 lol.

thanks for the info. most vets don't this. if you have an emergent dental issue they'll take care of it.

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Great post Carlie...& Memory235, that one's definitely a keeper!


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what do you mean? lol. at any rate im shocked the va is going to put me to sleep to cut these things out. i should also add on my dd214 it is noted i didnt have dental 90 days prior. plus, i have had recurring infections in my teeth. i was also in hudvash in miami florida. they pulled two teeth in my mouth. i shoulda done it back then im just petrified of anesthesia... idk why.

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Just had my teeth out today. Got some kind of loopy drugs i was all messed up then the doc said im giving you the sleeping drugs. went out then woke up and numb as h*ll for about 8 hours ended up having 8 teeth removed.

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    • Peggy toll free 1000 last week, told me that, my claim or case BVA Granted is at the RO waiting on someone to sign off ,She said your in step 5 going into step 6 . That's good, right.?
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    • I took a look at your documents and am trying to interpret what happened. A summary of what happened would have helped, but I hope I am interpreting your intentions correctly:

      2003 asthma denied because they said you didn't have 'chronic' asthma diagnosis

      2018 Asthma/COPD granted 30% effective Feb 2015 based on FEV-1 of 60% and inhalational anti-inflamatory medication.

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      First, check the date of your 2018 award letter. If it is WITHIN one year, file a notice of disagreement about the effective date. 

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      It might be possible for you to CUE the effective date back to 2003 or earlier. You'll need to familiarize yourself with the restrictions of CUE. It has to be based on the evidence in the record and laws in effect at the time the decision was made. Avoid trying to argue on how they weighed a decision, but instead focus on the evidence/laws to prove they were not followed or the evidence was never considered. It's an uphill fight. I would start by recommending you look carefully at your service treatment records and locate every instance where you reported breathing issues, asthma diagnosis, or respiratory treatment (albuterol, steroids, etc...). CUE is not easy and it helps to do your homework before you file.

      Another option would be to file for an increased rating, but to do that you would need to meet the criteria for 60%. If you don't meet criteria for a 60% rating, just ensure you still meet the criteria for 30% (using daily inhaled steroid inhalers is adequate) because they are likely to deny your request for increase. You could attempt to request an earlier effective date that way.


      Does this help?
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    • Tinnitus comes in two forms: subjective and objective. In subjective tinnitus, only the sufferer will hear the ringing in their own ears. In objective tinnitus, the sound can be heard by a doctor who is examining the ear canals. Objective tinnitus is extremely rare, while subjective tinnitus is by far the most common form of the disorder.

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    • Precedent Setting CAVC cases cited in the M21-1
      A couple months back before I received my decision I started preparing for the appeal I knew I would be filing.  That is how little faith I had in the VA caring about we the veteran. 

      One of the things I did is I went through the entire M21-1 and documented every CAVC precedent case that the VA cited. I did this because I wanted to see what the rater was seeing.  I could not understand for the life of me why so many obviously bad decisions were being handed down.  I think the bottom line is that the wrong type of people are hired as raters.  I think raters should have some kind of legal background.  They do not need to be lawyers but I think paralegals would be a good idea.

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      The document I created has about 200 or so decisions cited in the M21-1.   Considering the fact that there are more than 3500 precedent cases out there I think it is safe to assume the VA purposely left out decisions that would make it almost impossible to deny veteran claims.  Case in point. I know of 14 precedent setting decisions that state the VA cannot ignore or give no weight to outside doctors without providing valid medical reasons as to why.  Most of these decision are not cited by the M21.

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      M21-1 Precedent setting decisions .docx
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