TEETH LOSS OF

Summary

The veteran, who served in the United States Army from April 1968 to March 1971, appeals the denial of compensation under 38 U.S.C. § 1151 for the loss of three teeth (numbers 4, 12, and 13). The claim stems from side effects experienced after being prescribed anticholinergic medications by the VA in November 2016 to treat an overactive bladder. The veteran reported severe dry mouth, which he later linked to tooth cracking and subsequent extractions. A private dental opinion from Dr. E.M. stated that the VA-prescribed medications were significant contributory factors to the tooth loss. A VA examination in April 2025, conducted by Dr. A.M., determined that the loss of teeth numbers 4, 12, and 13 resulted from an event not reasonably foreseeable by a healthcare provider, acknowledging that the anticholinergic medications could contribute to dry mouth and accelerate tooth decay. While Dr. A.M. also noted other potential contributing factors, the Board found that the combination of severe dry mouth from VA-prescribed medications and the subsequent tooth loss constituted an event not reasonably foreseeable. Resolving reasonable doubt in the veteran's favor, the Board granted entitlement to compensation under 38 U.S.C. § 1151 for the loss of teeth numbers 4, 12, and 13.

Rationale

VA prescribed anticholinergic medications for overactive bladder; Medications caused severe dry mouth; Dry mouth contributed to tooth decay, fractures, and extractions; Event not reasonably foreseeable by healthcare provider

Full Decision Text

Citation Nr: A26014622
Decision Date: 02/18/26	Archive Date: 02/18/26

DOCKET NO. 251105-614788
DATE: February 18, 2026

ORDER

Entitlement to compensation under 38 U.S.C. § 1151 for loss of teeth (number 4, 12, and 13) is granted.

FINDINGS OF FACT

Resolving reasonable doubt in favor of the Veteran, the fracture/decay and resulting extractions of teeth number 4, 12, and 13, was caused by dry mouth due to medication/treatment prescribed by the Department of Veterans Affairs, which was an event that was not reasonably foreseeable.   

CONCLUSION OF LAW

The criteria for entitlement to compensation under the provisions of 38 U.S.C. § 1151 for the loss of teeth number 4, 12, and 13 have been met.  38 U.S.C. §§ 1151, 5107; 38 C.F.R. §§ 3.102, 3.361.

REASONS AND BASES FOR FINDINGS AND CONCLUSION

The Veteran served on active duty in the United States Army from April 1968 to March 1971.

This matter comes before the Board of Veterans' Appeals (Board) on appeal from a May 2025 decision issued by the Department of Veterans Affairs (VA) Regional Office (RO).

In the November 2025 VA Form 10182, Decision Review Request: Board Appeal (Notice of Disagreement), the Veteran elected the Direct Review docket.  Therefore, the Board may only consider the evidence of record at the time of the May 2025 agency of original jurisdiction (AOJ) decision on appeal.  38 C.F.R. § 20.301.  Any evidence submitted after the AOJ decision on appeal cannot be considered by the Board.  38 C.F.R. §§ 20.300, 20.301, 20.801. 

If the Veteran would like VA to consider any evidence that was submitted that the Board could not consider, the Veteran may file a Supplemental Claim (VA Form 20-0995) and submit or identify this evidence.  38 C.F.R. § 3.2501.  If the evidence is new and relevant, VA will issue another decision on the claim[s], considering the new evidence in addition to the evidence previously considered.  Id.  Specific instructions for filing a Supplemental Claim are included with this decision. 

The Board recognizes that the denial of due process may include issuing a Board decision prior to the expiration of the one-year period for a claimant to request a docket change.  See Williams v. McDonough, 37 Vet. App. 305 (2024).  In this case, the Board is granting the Veteran's appeal.  Accordingly, the Veteran's due process rights are not adversely affected by not waiting until the end of the one-year period in which to request a docket change following the May 2025 decision.

Compensation Under 38 U.S.C. § 1151

Pursuant to 38 U.S.C. § 1151, disability compensation may be paid for a qualifying additional disability caused by hospital care, medical or surgical treatment, or examination furnished the veteran under any law administered by VA.  To determine whether a veteran has an additional disability, VA compares the veteran's condition immediately before the beginning of the medical treatment upon which the claim is based to his or her condition after such treatment has stopped.  38 C.F.R. § 3.361(b).  To establish that VA treatment caused additional disability, the evidence must show that the medical treatment resulted in the additional disability.  Merely showing that a veteran received care, treatment, or examination and that the veteran has an additional disability or dies does not establish cause.  38 C.F.R. § 3.361(c)(1).  Proximate cause "is the action or event that directly caused the disability or death, as distinguished from a remote contributing cause."  38 C.F.R. § 3.361(d).

The proximate or direct cause of the additional disability must be "carelessness, negligence, lack of proper skill, error in judgment, or similar instance of fault on the part of VA in furnishing the hospital care, medical or surgical treatment, or examination," or, as applicable to this appeal, "an event which was not reasonably foreseeable."  38 U.S.C. § 1151; 38 C.F.R. § 3.361.  Whether the proximate cause of a veteran's additional disability was an event not reasonably foreseeable is in each claim to be determined based on what a reasonable health care provider would have foreseen.  The
 contributing cause."  38 C.F.R. § 3.361(d).

The proximate or direct cause of the additional disability must be "carelessness, negligence, lack of proper skill, error in judgment, or similar instance of fault on the part of VA in furnishing the hospital care, medical or surgical treatment, or examination," or, as applicable to this appeal, "an event which was not reasonably foreseeable."  38 U.S.C. § 1151; 38 C.F.R. § 3.361.  Whether the proximate cause of a veteran's additional disability was an event not reasonably foreseeable is in each claim to be determined based on what a reasonable health care provider would have foreseen.  The event need not be completely unforeseeable or unimaginable but must be one that a reasonable health care provider would not have considered to be an ordinary risk of the treatment provided.  In determining whether an event was reasonably foreseeable, VA will consider whether the risk of that event was the type of risk that a reasonable health care provider would have disclosed in connection with the informed consent procedures of 38 C.F.R. § 17.32.  38 C.F.R. § 3.361(d)(2).

The general requirements for informed consent include an explanation from the practitioner regarding the nature of the proposed procedure or treatment; expected risks; reasonably foreseeable associated risks, complications, or side effects; reasonable and available alternatives; and anticipated results if nothing is done.  38 C.F.R. § 17.32(c)(2).

Turning to the relevant evidence during the period under review, the Veteran underwent a VA genitourinary consult in November 2016.  He reported symptoms of nocturia, urgency, frequency, and incomplete emptying of the bladder.  The VA provider noted that the Veteran likely had overactive bladder.  The Veteran indicated that he wished to trial anticholinergic medication, which was prescribed by the VA provider beginning in November 2016 to treat his overactive bladder.  In December 2016, the Veteran sought treatment at a VA emergency department for severe dry mouth, dry throat, difficulty breathing, and dysphagia.  VA treatment records indicate that the Veteran failed several anticholinergic medications prescribed by VA due to side effects, including severe dry mouth.  In an April 2017 VA note, the provider indicated that he discussed with the Veteran that he was likely to have similar side effects with all overactive bladder medications.

In August 2017, the Veteran sought VA treatment for pain and discomfort with tooth number 12.  The provider reported that tooth number 12 was fractured at the gingival crest and non-restorable, which resulted in extraction of the tooth.  In a November 2017 VA note, the provider stated that the Veteran presented with caries on tooth number 4 requiring extraction.  In a December 2017 VA note, the provider indicated that tooth number 13 had a broken cusp with decay, but that the Veteran was not eligible for extraction through VA unless the tooth was acutely infected.  The Veteran's fractured tooth number 13 was extracted by VA in October 2019 after he reported acute pain for the previous two weeks that was getting worse. 

In January 2023 correspondence, a Doctor of Dental Surgery stated that he reviewed the Veteran's dental treatment and medication history.  In relevant part, Dr. E.M. opined that medications prescribed to the Veteran were significant contributory factors to the loss of his teeth.

In March 2023 correspondence, the Veteran reported that VA had prescribed several medications to treat his overactive bladder, and that three of his teeth cracked and required extractions subsequent to taking the prescribed overactive bladder medications.  The Veteran stated that, after his three teeth had been extracted, he learned that dry mouth can cause teeth to crack.  The Veteran noted that he began using glycerin mouth wash for dry mouth after his teeth had been extracted.  See also November 2024 correspondence (Veteran reported that he had not experienced any teeth cracking after initiating glycerin mouth wash).  He reported that Dr. E.M. reviewed the condition of his teeth prior to VA treatment for his overactive bladder, and Dr. E.M. determined that urology prescriptions were a cause of his teeth cracking and resulting extractions.

A medical opinion was obtained by VA in April 2025.  Here, the VA examination determined that the Veteran has an additional disability, in the form of the loss of teeth number 4, 12, and 13, which occurred after the Veteran was trialed for overactive bladder medications by VA in December 2016.  Dr. A.M. described other existing and equally important factors that he stated may have contributed the Veteran's increased rate of tooth decay, which could have also led to weakening of dental structures and subsequent
.M. reviewed the condition of his teeth prior to VA treatment for his overactive bladder, and Dr. E.M. determined that urology prescriptions were a cause of his teeth cracking and resulting extractions.

A medical opinion was obtained by VA in April 2025.  Here, the VA examination determined that the Veteran has an additional disability, in the form of the loss of teeth number 4, 12, and 13, which occurred after the Veteran was trialed for overactive bladder medications by VA in December 2016.  Dr. A.M. described other existing and equally important factors that he stated may have contributed the Veteran's increased rate of tooth decay, which could have also led to weakening of dental structures and subsequent fractures of teeth number 4, 12, and 13.  Nevertheless, Dr. A.M. acknowledged that overactive bladder medications prescribed by VA may contribute to dry mouth as a risk factor for acceleration of tooth decay.  Dr. A.M. stated that the Veteran's additional disability (loss of teeth number 4, 12, and 13) resulted from an event that could not have reasonably been foreseen by a reasonable healthcare provider.  

As discussed in detail above, beginning in November 2016, VA trialed the Veteran for several anticholinergic medications to treat his overactive bladder, which were noted to result in the Veteran experiencing severe dry mouth.  Additionally, VA treatment records document that three of the Veteran's teeth (number 4, 12, and 13) cracked and required extractions subsequent to taking the VA prescribed overactive bladder medications.  See also November 2024 correspondence (following the extraction of teeth number 4, 12, and 13, the Veteran reported that he had not experienced any teeth crack after initiating glycerin mouth wash for his dry mouth). 

The Board recognizes that Dr. A.M. determined the Veteran had other existing and equally important factors which may have contributed to the Veteran's increased rate of tooth decay leading to the subsequent fractures and extraction of teeth number 4, 12, and 13.  However, Dr. A.M. acknowledged that overactive bladder medications prescribed by VA may contribute to dry mouth as a risk factor for acceleration of tooth decay.  The private medical opinion from Dr. E.M. further supports a finding that medications prescribed to the Veteran for overactive bladder were a significant contributory factor to the loss of his teeth.  In this case, it appears that there is no single proximate cause that directly resulted in the Veteran's loss of teeth number 4, 12, and 13.  Rather, it appears from the medical opinions provided by Dr. E.M. and Dr. A.M. that the Veteran's loss of teeth number 4, 12, and 13, may have been due to several significant contributing factors, to specifically include severe dry mouth due to anticholinergic medications prescribed by VA to treat the Veteran's overactive bladder.  

In light of the above, the Board resolves reasonable doubt in favor of the Veteran in finding that a proximate cause of the fracture/decay and resulting extractions of teeth number 4, 12, and 13, was dry mouth due to medication/treatment prescribed by VA, which was an event that was not reasonably foreseeable.  Accordingly, the appeal is granted. 

 

M. C. WILSON

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board	B. Mask, Counsel

The Board's decision in this case is binding only with respect to the instant matter decided. This decision is not precedential and does not establish VA policies or interpretations of general applicability. 38 C.F.R. § 20.1303.