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Commander Bob

Ptsd & Teeth Damage

Question

A 2001 VA funded study finds that PTSD patients damage teeth through involuntary grinding, clenching. http://www.sdm.buffalo.edu/news/20010308_ptsd.html " As if persons with posttraumatic stress disorder didn't have enough to worry about,..."

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A 2001 VA funded study finds that PTSD patients damage teeth through involuntary grinding, clenching. http://www.sdm.buffalo.edu/news/20010308_ptsd.html " As if persons with posttraumatic stress disorder didn't have enough to worry about,..."

Just went to the VA dentist. I also have damaged teeth from my PTSD. I am wearing off the tooth enamel to the point were I have indentation marks from my teeth grinding and clenching. I even wear a night guard. I am putting so much pressure on one tooth, that the gum line is receding because the tooth cannot take that kind of pressure. The VA has to graft gum tissue from the roof of my mouth to my tooth in order to fix the receding gum line. (its going to hurt!!!) They are giving me special fluoride toothpaste and rinse to slow down the damage of decay due to clenching and grinding. After I had my C&P for PTSD, I was so worked up that I was clenching my jaws so much that I broke one of my molars with a filling in it right in half. Now I need a crown. Like stated before "as if we don't have enough to worry about." ;)

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Clenching the jaw will also cause TMJ over time. I have that and I broke a few crowns from pressure. Now I have stainless steel crowns. Call me jaws.

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Glad to hear that the VA is passing out night guards. If they did that 30 or 40 years ago, it would have saved a lot of teeth and money. The MD's and the DDS's need to get together on this issue. Is there a protocol in the dental clinic to address PTSD vets? I have never heard of one.

Edited by Commander Bob 92-93

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I am 70% rated for PTSD. I snore and grind my teeth excessively. I know it is not "lady like" :rolleyes: But it happens to the best of us. So I did some research and found this on another site. I don't know if it is accurate, but it might help some of you with Bruxism (grinding teeth). It has caused quite a bit of damage to my once perfect teeth.

Bruxism can be secondary to PTSD, Basically like case law, once it has been approved for one, it should be approved for all. I hope it helps. :

http://vets.yuku.com/reply/292659/t/Re-Grinding-teeth-.html

Proof: Here is an actual BVA decision that granted PTSD and Bruxism ( Grinding of Teeth)

Citation Nr: 0307941

Decision Date: 04/25/03 Archive Date: 04/30/03

DOCKET NO. 00-05 446 ) DATE

)

)

On appeal from the

Department of Veterans Affairs Regional Office in Boston,

Massachusetts

THE ISSUE

Entitlement to service connection for bruxism, as secondary

to service-connected post-traumatic stress disorder (PTSD).

REPRESENTATION

Appellant represented by: Disabled American Veterans

ATTORNEY FOR THE BOARD

E. Ward, Associate Counsel

INTRODUCTION

The veteran served on active duty from August 1965 to June

1967, including service in the Republic of Vietnam from April

1966 to May 1967.

This matter comes before the Board of Veterans' Appeals

(Board) on appeal from a July 1999 rating decision of the

Department of Veterans Affairs (VA) Regional Office (RO) in

Boston, Massachusetts, which denied the veteran's claim of

entitlement to service connection for PTSD and bruxism. The

veteran perfected a timely appeal of this determination to

the Board.

When this matter was previously before the Board in May 2001,

it was remanded for further development and adjudication. On

return to the Board in October 2002, the Board granted

service connection for PTSD and requested further development

on the issue of bruxism. That development has been

completed, and the case is ready for adjudication.

FINDINGS OF FACT

1. All relevant evidence necessary for disposition of the

veteran's appeal has been obtained and associated with the

claims file.

2. The veteran is service connected for PTSD, effective from

January 11, 1999.

3. The veteran currently has a diagnosis of bruxism.

4. The record contains medical evidence and opinion

indicating that the veteran's bruxism is probably

proximately due to his service-connected PTSD.

CONCLUSION OF LAW

Bruxism is proximately due to or the result of the service-

connected PTSD. 38 U.S.C.A. §§ 1101, 1131, 5107 (West 2002);

38 C.F.R. §§ 3.303, 3.310(a) (2002).

REASONS AND BASES FOR FINDINGS AND CONCLUSION

Duty to Assist and Notify

On November 9, 2000, the President signed into law the

Veterans Claims Assistance Act of 2000 (VCAA), 38 U.S.C.A. §§

5100, 5102, 5103, 5103A, 5106, 5107, 5126 (West Supp. 2001),

66 Fed. Reg. 45,620 (Aug. 29, 2001) (to be codified as

amended at 38 C.F.R. §§ 3.102, 3.156(a), 3.159 and 3.326(a)).

Among other things, the VCAA redefines the obligations of VA

with respect to the duties to notify and assist. This change

in the law is applicable to all claims filed on or after the

date of enactment of the VCAA or filed before the date of

enactment and not yet final as of that date. 38 U.S.C.A. §§

5102, 5103, 5103A, 5107.

The Board is satisfied that all relevant facts have been

sufficiently developed, and no further assistance to the

veteran is required to comply with VA's duties to notify and

assist the veteran with his claim as mandated by the VCAA.

In this regard, the record shows that by the rating

decisions, as well as in the statement of the case,

supplemental statements of the case, and various

correspondence including the Board's remand of May 2001, and

remand and development request dated in October 2002, VA

informed the veteran of the evidence needed to support his

claim. The veteran was notified of the need to supply

competent medical evidence to support his claim, and informed

of efforts VA would make to secure outstanding medical

records. Additionally, the RO requested and obtained all

outstanding relevant treatment records, and the veteran has

not referenced any outstanding evidence that might aid in his

claim. A medical opinion was solicited pertaining to his

claim, there is no identified evidence that has not been

accounted for, and the veteran and his representative have

been given the opportunity to submit written argument.

Under the circumstances, the Board finds that the veteran has

been provided with adequate notice of the evidence needed to

successfully prove his claim, and that there is no prejudice

to him by appellate consideration of the claim at this time

without another remand of the case to the RO for providing

additional assistance to the veteran in the development of

his claim as required by the VCAA or to give him another

opportunity to present additional evidence and/or argument.

Bernard v. Brown, 4 Vet. App. 384 (1993). See also Karnas v.

Derwinski, 1 Vet. App. 308 (1991). The record on appeal

demonstrates the futility of any further evidentiary

development and that there is no reasonable possibility that

further assistance would aid him in substantiating his claim.

Hence, no further notice or assistance to the veteran is

required to fulfill VA's duty to assist her in the

development of the claim. Smith v. Gober, 14 Vet. App. 227

(2000); Dela Cruz v. Principi, 15 Vet. App. 143 (2001).

Background and Analysis

Service connection may be established for disability

resulting from personal injury suffered or disease contracted

in line of duty, or for aggravation of a pre-existing injury

suffered or disease contracted in line of duty. 38 U.S.C.A. §

1110; 38 C.F.R. § 3.303. The law also provides that service

connection may be granted for any disease diagnosed after

discharge when all the evidence, including that pertinent to

service, establishes that the disease was incurred in

service. 38 C.F.R. § 3.303(d). In determining whether

service connection is warranted for a disability, VA is

responsible for determining whether the evidence supports the

claim or is in relative equipoise, with the veteran

prevailing in either event, or whether a preponderance of the

evidence is against the claim, in which case the claim is

denied. 38 U.S.C.A. § 5107; Gilbert v. Derwinski, 1 Vet. App.

49 (1990).

Disability which is proximately due to or the result of a

service-connected disease or injury shall be service

connected. When service connection is established for a

secondary condition, the secondary condition shall be

considered a part of the original condition. 38 C.F.R.

3.310(a). Additional disability resulting from the

aggravation of a non-service-connected condition by a

service-connected disability is also compensable under 38

C.F.R. § 3.310(a). See Allen v. Brown, 7 Vet. App. 439, 448

(1995) (en banc).

The critical issue in this case is whether the veteran has

bruxism secondary to the service-connected PTSD. The record

reflects that the veteran served in Vietnam from April 1966

to May 1967. In numerous statements in support of his claim

of service connection for PTSD, as well as lay statements

from his sisters, the veteran reported that after his return

from Vietnam, he experienced nightmares and other PTSD

symptomatology which resulted in the grinding of this teeth

which resulted in the current diagnosis of bruxism.

In October 2002, the Board requested further development of

the veteran's claims of bruxism as secondary to his service-

connected PTSD. Evidence submitted includes a January 2003

letter from the VA staff psychiatrist which indicates that

the veteran has been under his care for chronic PTSD. The

psychiatrist notes that the veteran "continues to have

bruxism secondary to his PTSD, (specifically due to his

traumatic nightmares), and bruxism has caused his teeth great

harm. The psychiatrist opined that "n my opinion

treatment for his bruxism and subsequent dental injuries is

simply an extension of his treatment for PTSD."

The veteran underwent VA dental examination in April 2003.

He gave a medical history of PTSD and oral pain associated

with severely abraded maxillary teeth. Physical examination

showed no functional impairment due to loss of motion,

however, maxillary function was severely compromised due to

maxillary tooth destruction. The dental diagnosis was severe

bruxism, probably associated with service trauma and

secondary to PTSD and chronic major depressive disorder.

Upon consideration of the overall evidence, the Board finds

that the record contains credible supporting evidence that

the veteran's bruxism is proximately due to the service-

connected PTSD. Accordingly, service connection is

warranted.

ORDER

Entitlement to service connection for bruxism, as secondary

to service-connected PTSD, is granted.

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