Topics – VAT exemption – whether Aligners are dental prostheses
HMRC v Align Technology Switzerland GmbH and Anor
The Upper Tribunal (UT) has released its decision in this case concerning the VAT liability of supplies of Invisalign clear aligners (the Aligners) made by Align Technology Switzerland GmbH (Align GmbH) and Align Technology BV (Align BV).
Aligners are removable orthodontic appliances used by dentists to reposition a patient’s teeth to correct misaligned teeth thereby improving the functionality of the patient’s bite. Each Aligner is bespoke and is specially designed by Align for an individual patient, based on a scan of the patient’s mouth and in accordance with the treatment plan prescribed by the patient’s dentist. Treatment plans may last six months or longer. Although the Aligners are removable, patients are typically advised to wear them for between 20 and 22 hours a day and only to remove them for eating and physical activity.
Align treated the supplies of the Aligners as exempt supplies of dental prostheses pursuant to items 2 and 2A, Group 7 of Schedule 9, VATA94. HMRC argued that the supplies were chargeable to VAT at the standard rate.
Section 31(2), VATA94 provides that the goods or services of a description being specified in Schedule 9 are exempt. Group 7 of Schedule 9 provides that the following are exempt from VAT:
- Item 2 – The supply of any services consisting in the provision of medical care, or the supply of dental prostheses, by: (a) a person registered in the dentists’ register; (b) a person registered in the dental care professionals register established under section 36B of the Dentists Act 1984.
- Item 2A – The supply of any services or dental prostheses by a dental technician.
Items 2 and 2A of Group 7 of Schedule 9 VATA94 implemented Article 132(1)(e) of the VAT Directive – the supply of services by dental technicians in their professional capacity and the supply of dental prostheses by dentists and dental technicians.
The legislation requires the dental prostheses to be supplied by a person registered in the dentists’ register or the dental care professionals register or by a dental technician. Align are not dentists or dental technicians but they do employ dental professionals registered in the UK.
The First-tier Tribunal (FTT) focused on whether Aligners qualify as 'prostheses' per the exemption for VAT. Although 'dental prostheses' lacks a formal definition in VAT legislation, the FTT interpreted it based on common language and the exemption's purpose, which is to ensure health-related products remain affordable. The FTT concluded that Aligners fit the definition of dental prostheses, as they are health-related products supplied during dental treatment.
HMRC's interpretation, which excluded orthodontic appliances from the exemption, was deemed overly restrictive and contrary to the exemption's intent. The FTT also noted that guidance from the EU VAT Committee, which suggested braces do not qualify as prostheses, was not definitive and should not dictate the tribunal's interpretation.
Ultimately, the FTT allowed the appeal, determining that Aligners are indeed dental prostheses eligible for VAT exemption, reinforcing the principle that health-related products should not be made more expensive by the addition of VAT.
HMRC appealed the decision of the FTT on a single ground, namely the FTT erred in its interpretation of the phrase ‘dental prostheses’ and thereby misapplied VATA94 to the Aligners. HMRC’s reasons given in the Notice of Appeal included that a ‘prosthesis’ is an artificial replacement for part of the body and a ‘dental prosthesis’ is an artificial item used to replace missing or damaged teeth – the Aligners are orthodontic appliances used to reposition teeth and, accordingly, are not ‘dental prostheses’.
The UT considered how the VAT exemption for ‘dental prostheses’ should be interpreted where neither EU nor UK VAT legislation provides a definition of that term. Relying on established UK and CJEU authorities, the UT noted that an undefined term must be interpreted according to its ordinary meaning in everyday language, while also taking account of the context in which it appears and the objectives of the legislation. Although VAT exemptions must be construed strictly because they are exceptions to the general rule that VAT is chargeable, strict interpretation must not deprive an exemption of its intended effect, and it must remain consistent with the principle of fiscal neutrality.
The UT recalled that the purpose of the exemption is to prevent health-related products from becoming less accessible due to increased costs arising from VAT. The UT accepted that Aligners are health-related products but emphasised that the purpose of an exemption cannot override or expand its wording. The exemption applies only to the supplies specifically described by the legislation, and not to all products that may serve a health-related purpose. Neither the objectives of the exemption nor fiscal neutrality can justify extending an exemption beyond its clear statutory language. The task is not to construe exemptions as narrowly as possible, but to give the exempting words a meaning they can fairly and properly bear in their legislative context. Accordingly, the question is whether Aligners fall within the specific meaning of ‘dental prostheses’ when interpreted by reference to its ordinary meaning, context and legislative purpose.
Dictionary definitions
The UT noted that while dictionaries are recognised as a legitimate aid to construction, case law emphasises that they cannot determine meaning on their own. Words must be interpreted in light of their context and the purpose of the legislative provision in which they appear. The UT rejected the argument that the purpose of the VAT exemption alone can justify a broad interpretation, noting that an item cannot fall within the exemption simply because it serves a health-related purpose.
The UT recalled that the parties disagreed on whether ‘dental prostheses’ should be interpreted as a single composite phrase or by first determining the meaning of ‘prosthesis’ and then considering the effect of the word ‘dental’. Although legal authorities recognise that composite expressions may have a meaning different from the sum of their parts, the UT concluded that, in the immediate case, it was appropriate first to consider the meaning of ‘prosthesis’, since dictionary definitions commonly define ‘dental prosthesis’ as a subset of that broader concept.
The UT reviewed a range of dictionary definitions. Most describe a prosthesis as an artificial replacement for a missing or malfunctioning body part, while some also refer to devices that assist bodily functions. Having considered the definitions collectively, the UT concluded that the ordinary meaning of a prosthesis is something that replaces, or acts in place of, a missing or malfunctioning body part and enables or assists the relevant bodily function. It was not persuaded that the term generally includes external devices that merely provide support or operate as part of a temporary course of corrective treatment.
Case law – the meaning of a prosthesis
The UT considered whether UK case law outside the VAT context provides useful guidance on the meaning of ‘prosthesis’. Although the cases reviewed arose in social security and employment law and are therefore not binding, the UT examined them to determine whether they shed light on the ordinary meaning of the term.
The UT concluded that the case law is persuasive and supports the distinction between a prosthesis, which replaces a missing or malfunctioning body part or function, and medical aids or devices that merely support, assist or improve bodily functioning.
The meaning of ‘dental prostheses’
Given its conclusions on the meaning of prosthesis, The UT considered that it is not easy to see why the addition of the word ‘dental’ should have the effect of widening this meaning. The addition of the word dental appears, at least at first sight, simply to mean that the prostheses which are referred to in the Exemption are those which operate in relation to teeth.
The UT reviewed several medical and dental dictionary definitions, noting that most define dental prostheses as artificial replacements for missing teeth or associated structures. While some dictionaries include orthodontic appliances or retainers as examples of dental prostheses, the UT considered this support limited and not sufficiently persuasive to alter the ordinary meaning of the term.
The UT therefore returned to its earlier conclusion that a prosthesis is something that replaces a missing or malfunctioning body part and performs its function. It found that adding the word ‘dental’ merely identifies the part of the body concerned and does not broaden the meaning of prosthesis. Accordingly, a dental prosthesis is a device that replaces or supplements missing or damaged teeth and performs the function of those teeth.
The UT also rejected the argument that the purpose of the VAT exemption should justify a wider interpretation. Although Aligners are health-related products and may be manufactured by the same technicians who produce items such as crowns or dentures, the exemption applies only to the specific supplies identified in the legislation. Applying its interpretation to the facts found by the FTT, the UT concluded that Aligners are not dental prostheses because they do not replace missing or broken teeth.
EU VAT Committee Guidelines and Working Paper
The UT went on to consider the relevance of EU VAT Committee Guidelines and a related Commission Working Paper in interpreting the meaning of ‘dental prostheses’ for VAT purposes.
The UT examined whether these documents could be used as aids to interpretation. While accepting that the Guidelines are not legally binding and contain little reasoning, it concluded that they remain relevant interpretative materials.
The UT rejected Align’s argument that the Working Paper could not be used as an aid to interpretation, holding that once admitted as evidence it was legitimate to consider its contents and determine the weight to be given to them.
Although the UT attached only limited weight to the Guidelines and Working Paper because they represent the views of an advisory committee rather than a judicial body, it found them supportive of its own analysis. In particular, they reinforced the distinction between dental prostheses and orthodontic devices such as braces or Aligners, supporting the conclusion that Aligners fall outside the exemption because they are dental devices rather than prostheses.
In conclusion, the UT found that ‘dental prostheses’ as used in the Exemption, means artificial items which replace missing or damaged teeth. They do not include the Aligners.
The UT held that the FTT made a material error of law in its interpretation of the VAT exemption and therefore set aside the FTT’s decision. It then considered whether the case should be remitted to the FTT or re-made by the UT itself.
HMRC argued that the decision should be re-made, while Align submitted that remission might be necessary if further factual findings were required. However, Align accepted that no further factual issues arose if HMRC’s interpretation of the exemption was correct.
The UT held that all necessary facts had already been established by the FTT and that no further evidence or fact-finding was required. As a result, there was no need to remit the case. Applying its own interpretation of the exemption, the UT re-made the decision and concluded that the term ‘dental prostheses’ does not include Aligners.
The UT therefore upheld HMRC’s view that Aligners do not qualify for VAT exemption for dental prostheses and are instead subject to VAT.
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