M21-1 Manual / Part XIII, Subpart i, Chapter 4, Section A

Overview of Classes of Eligibility for Dental Treatment

M21-1, Part XIII, Subpart i, Chapter 4, Section A

Overview

In This Section

This section contains the following topics:

Topic	Topic Name
1	Class I: Compensable Dental Disabilities
2	Class II: Service-Connected (SC) Dental Conditions for Treatment Purposes
3	Classes II(a) and II(c) Dental Outpatient Service
4	Classes III, IV, V, and VI Dental Outpatient Service

1. Class I: Compensable Dental Disabilities

Introduction

This topic contains information on Class I compensable dental disabilities, including

eligibility and level of treatment for Class I dental conditions, and
restrictions on Class I dental treatment.

Change Date

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.

Class	Eligibility Requirement	Level of Dental Treatment
I	Class I dental treatment is available to Veterans with service-connected (SC), compensable dental disabilities or conditions. *Reference: Procedures for rating dental claims are discussed in M21-1, Part XIII, Subpart i, 4.C. Note: A dental disability is rated under the 9900 diagnostic code series in the Schedule for Rating Disabilities,* 38 CFR 4.150.	The Veteran is eligible for any dental treatment indicated as necessary for SC compensable dental conditions to maintain oral health and chewing function.

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.

2. Class II: SC Dental Conditions for Treatment Purposes

Introduction

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.

Change Date

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.

If the service records indicate ...

Then ...

an explanation was not provided concerning available dental services

consider the Veteran’s application for treatment as if he/she had filed within 180 days after release from service.

an explanation was provided concerning available dental services

the Veteran is not eligible for treatment if the application is not received within 180 days of discharge. Note: Notate in the response on VA Form 10-7131, Exchange of Beneficiary Information and Request for Administrative and Adjudicative Action, whether or not the Veteran’s service records indicate an explanation was provided at the time of separation from service about available dental services.

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.

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

Introduction

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.

Change Date

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.

Class	Eligibility Requirements	Level of Dental Treatment	Rating Activity Requirement
II(a)	Veterans with an SC noncompensable dental condition or disability adjudicated as resulting from combat wounds or service trauma.	Any treatment necessary for the correction of the SC noncompensable dental condition or disability.	Rating determination required to establish SC noncompensable dental conditions.
II(c)	Veterans who were former prisoners of war (FPOWs), regardless of the length of captivity.	Any necessary dental treatment.	Rating determination only required to establish SC for any noncompensable dental conditions based on FPOW status.

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).

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

Change Date

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.

Class	Eligibility Requirements	Level of Dental Treatment
III	Veterans with a dental disability professionally determined by VA to be currently aggravating an SC medical condition.	Treatment to satisfactorily resolve the problem. *Note*: This treatment is authorized under 38 U.S.C. 1712 (a)(1)(D).
IV	Veterans who are rated at a schedular 100 percent, or receive the 100-percent rate by reason of individual unemployability.	Any necessary dental treatment. *Note*: This treatment is authorized under 38 U.S.C. 1712 (a)(1)(G).
V	Veterans who have SC disabilities, or have been approved by VA for vocational rehabilitation training under 38 U.S.C. Chapter 31, and have selected an objective, or are already pursuing vocational rehabilitation training.	Treatment to the extent professionally determined necessary to meet *one* of the following requirements make it possible to enter training prevent interruption of the training hasten the Veteran’s return to training which was interrupted because of a dental condition, or overcome significant adverse aesthetic or speech problems impeding achievement of specific goals of rehabilitation (including employability). Note: This treatment is authorized under 38 CFR 17.47(i).
VI	Veterans who are scheduled for admission or receiving care under 38 U.S.C. 1710.	Treatment for a dental condition clinically determined to be complicating a medical condition currently under treatment. *Note*: This treatment is authorized under 38 U.S.C. 1712 (a)(1)(H).

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

Source: VA M21-1 Adjudication Procedures Manual, M21-1, Part XIII, Subpart i, Chapter 4, Section A (U.S. government work, reproduced for reference). Browse all sections →