Nexus letter for dental/jaw condition

[Andyman73]

Here is a letter written by my dentist.  I'd like some feedback from all you big brains out there in Hadit land. 

To whom it may Concern:

I am Dr. Kevin L. Hicks. I am general dentist with 20 years' of clinical experience, including treatment of bruxism and TM disorder. I have been asked to write a statement in support of the aforementioned veterans claim.

Mr. XX X   is a patient under my care since March 2013. His diagnosis is dental bruxism with associated muscle enlargement and tenderness as well significant wear in patient's dentition.

I am familiar with his history and have examined Mr. XXX often while he has been under my care. Radiographs on 3/25/2013, 09/15/2014, 10/30/2015, and on 2/12/2016 Cone beam computed tomography (CBCT) show signs of flattened and worn teeth. Also on clinical exam on 2/12/2016 patient shows signs of hypertrophied masseter muscles, tenderness to palpation with limited jaw opening (30 mm), as well pain on contralateral Temporal mandibular area in excursive movements.

After reviewing clinical records of Mr. XXX  visits to dental and medical practitioners during his military service, a visit 7 February 1997, Mr. XXX  presented to branch medical clinical for jaw muscle pain which had been a problem for 1week. The note states that the pain, has been reoccurring since four years ago. Diagnosis at that visit was Jaw pain secondary to bruxism. Patient was seen again 11February 1997 for same issue and again 12 March 1997.

                 Mr. XXX   has no other known risk factors that may have precipitated his current condition.

 

After a review of the pertinent records it is my professional opinion that it is at least as likely as not that Mr. XXX  condition is related to his service.

In my personal experience, stress as well as obstructive sleep apnea have a high degree of causation in bruxism and associated muscular pain.

 

 Ok, is there anything that should be added or removed from the nexus letter?  I didn't think of it at the time, but certainly pain would be a cause of clenching and grinding teeth. 

 

[flores97]

Andyman 73, i am not an expert but that looks like a winner to me!! He gave rationale, has very good credentials, and quoted your strs. I think you have a winner!! And of course, he included the statement at least as likely as not. Well done, in my opinion!

[Vync]

Hey Andyman,
It looks ok.

Seeing that you reported this occurring for four years prior to Feb 1997, were you in the service in Feb 1993? If not, then the VA might try to say something else caused it and consider it a pre-existing condition.

If you were in the service in Feb 1993 and if the VA denies your claim, try to go back to that time and try to find any STRs with something a bit more solid as a root cause of the bruxism/pain such as trauma, training accidents, car wrecks, falls, girlfriend's jealous ex-boyfriend, etc...

If you win, then they will rate is under DC 9905. 30 mm is the upper limit for a 20% rating.

[Andyman73]

Vync,

I delayed entry in Feb of 92, shipped out in Nov of 92.  I grew up as an Army Brat, so had regular dental care care of US Army dental types.

Hmmmm....causative events....possibly falling down the stairs on November 21st, 1992, aka day 5 of boot camp, where I injured my back and knees, and other parts too.  February of 1993, may have been when I fell out of the top rack and bruised one of my heels. 

But keep this in mind, at my MH C&P back in November, the examiner disregarded my extensive med history in regards to chronic pain, and opined that he couldn't see the link between a minor leg injury and my MDD.

Also, do you think that I should have the DDS rewrite the nexus letter to make reference to the chronic pain issues as cause for clenching and grinding?

Thanks.

[Vync]

Andyman,
Wow, it sounds like you could be my long lost brother. I'm also an Army brat, but joined in 1990 and had a fall right after joining boot camp.

Some MH C&P docs have no relation to what we go through in the military. I'd like to see all of them go through a few months of boot camp before they are allowed to work as C&P examiners in the VA.

It might be worth it to dig out copies of the STRs, but check out this BVA win for bruxism. It's very brief on details, but you might find it promising.

http://www.va.gov/vetapp14/Files6/1448321.txt

[flores97]

Andyman, I would submit it just like that. It really does look well written, he even stated that you have "no other known risk factors that may have precipitated this condition". Are you submitting secondary to sleep apnea?

[Andyman73]

Vync,

Maybe you could be my other "twin" brother. 

Yes, my MH examiner had no concept of Military service and the demands put on us, whether combat was present of not.  I mean, come on, what point is it to teach a Marine how to shoot to kill with an open iron sight at 500 meters?  What point is it to teach same said Marine basic fighting skills via pugil sticks to simulate hand to hand with rifles and same with fixed bayonets?  Or hand to hand with and w/o K-Bar???  To make me a better aircraft maintenance type???? No sir, every Marine is a basic rifleman first, then what ever his/her MOS is comes second.

So, yeah....I sure ain't no Chesty Puller, but still...

Thanks for sharing that link, I did look at it, and it does bring a glimmer of hope.

flores97,

No, my SA isn't SC yet.  My MH examiner stated sleep issues, but I am struggling to get past the outer markers to begin my approach to land a SC for it.

Okay, thanks, I was starting to wonder if that letter would be enough...since I've already had a claim full of evidence denied, I don't know how that would be enough to stand up against the wall of claim denial.