ptsd Va Medical Coverage For Service Connection

[Roger Louis]

First my intent with this posting is to ask a question concerning medical or dental care so if I started the topic in the wrong place please tell me how to start in the correct place. Today I received a letter from the VA Regional Office that said they decided that I have a service connection of 0% for Temporomandibular Disorder (Claimed As bruxism) which is associated with post traumatic stress disorder (PTSD) . My rating remained at 40% where it was prior to this claim and the decision. Of course I will submit a Notice of Disagreement for the entire claim. However the goal of my claim was not to increase the percentage it was to attempt to gain dental care from the VA.

I am not sure that this decision provides for that care so if anyone has any suggestion I would welcome hearing them. This was a two part claim the first as mention was for Bruxism and the second was for Meniere's disease associated with sensorineural hearing loss. While I am rated at 0% for hearing loss and the VA has provided hearing aids the denied this portion of the claim stating the was not in my record to support the claim.

I did receive a C&P examination for Bruxism however a decision was made concerning the claim for Meniere's disease base on a review of my file apparently since I did not receive a C&P. Both issues show up in the Ebenefits report of the review by the examiner even though I did not receive a C&P examination for Meniere's. One point of interest is the during the examination and in the written report if was evident that the dentist did not think that Bruxism would result from PTSD. Apparently the Regional VA office thought otherwise to some degree.

I want to thank everyone for their service and support to this web site.

[carlie]

Welcome - I will send a shout out to a member and they might reply.

[Vync]

Hi Roger,

Carlie asked me to try to help you out. I'm 30% SC TMJ for 20 years and have bruxism and lots of problems because of it. Let's look at this from a few angles.

TMJ

The VA does not have a dedicated rating for bruxism, so they rate it as dental 9905 TMJ. In order to get 10%, you must show limited motion of the jaw either vertically or horizontally, per the rating criteria shown below. For example, if your inter-incisal range (vertical) range of motion was measured at 36 mm, your rating would be 10%. If it was 41mm or greater, your rating would be 0%.

§4.150 Schedule of ratings - Dental and oral conditions

9905 Temporomandibular articulation, limited motion of:

Inter-incisal range:

0 to 10 mm 40

11 to 20 mm 30

21 to 30 mm 20

31 to 40 mm 10

Range of lateral excursion:

0 to 4 mm 10

Note: Ratings for limited inter-incisal movement shall not be combined with

ratings for limited lateral excursion.

Check your dental C&P exam notes and compare the inter-incisal and lateral excursion against the chart. The 'note' at the bottom of the (above) chart just means you can be rated for either/or, but not both.

VA Dental Treatment

I found a couple of links getting about VA dental treatment eligibility. The tables didn't carry over here very well, so I simplified them:

This is an 'easy to read' PDF file. It breaks things down in plain English.

http://www.va.gov/healthbenefits/resources/publications/IB-10-442_Dental_Benefits_for_Veterans_4_13.pdf

Class II(a): Have a service-connected noncompensable dental condition or disability resulting from combat wounds or service trauma.

Treatment: Any dental care necessary to provide and maintain a functioning dentition. A Dental Trauma Rating (VA Form 10-564-D) or VA Regional Office Rating Decision letter (VA Form 10-7131) identifies the tooth/teeth that are trauma rated.

Class III: Have a dental condition clinically determined by VA to be associated with and aggravating a service-connected medical condition.

Treatment: Dental care to treat the oral conditions that are determined by a VA dental professional to have a direct and material detrimental effect to your service connected medical condition.

This is legal mumbo jumbo (i.e. "the real rules", "the law") from M21-1MR, Part III, Subpart v, Chapter 7, Section B:

https://www.google.com/url?sa=t&rct=j&q=&esrc=s&source=web&cd=2&cad=rja&ved=0CDAQFjAB&url=http%3A%2F%2Fwww.benefits.va.gov%2Fwarms%2Fdocs%2Fadmin21%2Fm21_1%2Fmr%2Fpart3%2Fsubptv%2Fch07%2Fch07_secb.doc&ei=2PgDU5XKHJCvkAed64CACQ&usg=AFQjCNE-6rEWkPli4dd1UzcNZOkKCC6GRA&sig2=hq1ooPeH6fcYv8Ufp6xg_A&bvm=bv.61535280,d.eW0

Class II(a): Veterans with an SC non-compensable dental condition or disability adjudicated as resulting from combat wounds or service trauma.

Treatment: Any treatment necessary for the correction of the SC non-compensable dental condition or disability.

Class III: Veterans with a dental disability professionally determined by VA to be currently aggravating an SC medical condition.

Treatment: Care to satisfactorily resolve the problem. Reference: This care is authorized under 38 U.S.C. 1712 (a)(1)(D)

Class II(A)

It sounds to me like you have a SC non-compensable dental condition because a rating must be 10% to be compensable. You are SC. It's 0%. So, it must be SC non-compensable. I'm not too clear on what they mean by "service trauma", but PTSD definitely is a form of trauma.

Class III

This one is a bit weird, but your bruxism is SC linked like this: PTSD ==> bruxism. The way class III reads sounds like bruxism ==> PTSD. Either way, they are definitely related and impact each other.

Bruxism vs. PTSD

I assume based on the wording in your initial post that you are SC for PTSD and was awarded 0% SC for bruxism, secondary to your PTSD. If the VA granted SC, the evidence was sufficient to warrant SC. Usually it's the other way around, where the RO disregards what the docs write. Getting SC is one thing, getting a rating increase/correction is something different.

Bruxism side effects, secondary conditions, etc...

Side effects can include worn/cracked/chipped teeth, biting/gnawing on your inner cheek or tongue, jaw pain, headaches/migraines, sleep problems, and even cervical spine issues. The side effects of meds used to treat bruxism can also cause their own side effects. They may be unique for each person. I'm not sure if you can file for something as secondary to a SC 0% rating, but if it is causing you major problems it might be worth considering.

Treatment goal

Think about the specific type of treatment you want the VA to provide, because it could be wide and varied, if any. In my case, I got a custom acrylic bite guard to wear at night, some pain meds and muscle relaxers. They also installed three crowns on molars that were almost destroyed by grinding. Also talk with them about what to eat, possibly to see the VA nutritionist if you are to the point where you are making meals in a blender.

If they offer to surgically 'correct' the problem, you might want to get a second or third opinion. A lot of the younger 'quick draw' oral surgeons just want to work on you for the experience.

My Advice

Here's what I recommend. Get with the VAMC eligibility office and/or the VA dental office. Go over the copy of your award letter and the dental eligibility documents. Explain that the bruxism and PTSD are related. The PTSD caused your bruxism and the bruxism triggers your PTSD, kinda like a self-fulfilling problem. If they still do not approve treatment, follow up with your PTSD psychologist/psychiatrist - not a social worker because their opinion might not carry as much weight. They might be able to contact eligibility or dental directly to help justify treatment.

Let me know if this helps. Good luck!

Edited February 19, 2014 by Vync

[Berta]

“One point of interest is the during the examination and in the written report if was evident that the dentist did not think that Bruxism would result from PTSD. Apparently the Regional VA office thought otherwise to some degree. “

Meaning, because they gave you a SC rating?

VA has SCed bruxism to PTSD before.

“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.”
http://www.index.va.gov/search/va/view.jsp?FV=http://www.va.gov/vetapp03/Files/0307941.txt

Bruxism can cause not only severe mandible problems, but severe dental issues as well as headaches.

If you go to the VA SCRD here (Schedule of Ratings, you can determine if the VA gave you the correct diagnostic code and if your medical evidence should have warranted a better rating.

“However the goal of my claim was not to increase the percentage it was to attempt to gain dental care from the VA. “

Did you get a Dental exam C & P?

Did you specifically claim the dental problems?

Have you formally requested a dental appointment?

Since you have a SC rating, even at “0”,I certainly believe the VA would provide you with dental care.

Gee I just noticed the excellent reply Vync gave you.....

It is more on the mark then mine is....

My husband got VA dental care but I think that was because he was in Voc Rehab at the time.

He had minor dental problems and VA made s few appointments for him as ,he didnt request them.

Over almost 2 decades later those brief dental records helped me prove he had DMII.

I am interested in why the VA denied the Meneries claim.”since I did not receive a C&P “

Can you tell us their complete Reasons and Bases for that and why they didnt give you a C & P?

Can you scan and attach the entire denial here (cover personal info first)

Menieres is often due to audio problems. If VA gave you hearing aids, doesn't that mean you ave a hearing loss???

[john999]

When and if you go to the dentist or get a dental exam be sure to complain that due to grinding and TMJ your teeth hurt. The way to get quick treatment for dental problems at the VA is to say you are in severe pain. I would not let the VA or anyone else do surgery on my jaw for TMJ. It can really go wrong. Unless you jaw just locks up and it requires dental intervention to get it to close stay away from surgery. After years of TMJ, myself, what happens is the ligaments that hold the jaw in place just get sort of worn out and your jaw stops popping and clicking. The only problem is your jaw can then slip and you can bite the hell out of your jaw flesh. I use the night guard. The VA should make one for you.

I had TMJ in the service but the crafty dentist never entered that in my records. The jerk told me there was no treatment and to just get used to it. I was on orders to Vietnam, so I did not have time to dispute it.

If the military pulls any of your teeth or does oral surgery do you have any sort of SC status? I hate my VA dentist anyway, but the Army did make a mess of a couple of extractions they did that were probably not necessary. My Army dentist tried to do a tooth transplant by pulling one of my wisdom teeth and trying to implant it in the spot where he extracted a molar. My mouth bled for days and swelled up like a baseball.

John

[Roger Louis]

You all have provided some excellent responses to my original post. There is a lot of information to consider and I have been ask to put a copy of comments from VA online. Time permitting that will be posted later today or in the morning. I called the VA clinic that I normally go to for care and the dentist office could not provide me with an answer and referred me to the eligibility office, of course the person in that office was off today so a message was left. My goal is to get my dental work done but my comfort level with the VA dentist that conducted the C&P is not good. The civilian dentist is good however the cost for the work to be done is significant. Upon calling Delta Dental they said I was eligible for the new dental plan for Veterans however they only pay a limited amount. Additionaly there is the catch that they do not pay for anything that is service connected. As far as TMJ is concerned in my opinion the VA and the C&P examiner missed the point and that is that Bruxism is the concern and not TMJ. Additionally a NOD is in order and will be accomplished later this week. Thanks for the outstanding comments and if anything additional comes to mind let me know as that will contribute to my research.

[Vync]

Roger,

Glad to help. I had a feeling the dental clinic would steer you towards eligibility.

John999,

I checked §4.150 Schedule of ratings - Dental and oral conditions. There are ratings for mandible nonunion, mandible loss, hard palate loss, ramus loss, basically loss of the underlying bone. This is the section about tooth loss:

9913Teeth, loss of, due to loss of substance of body of maxilla or mandible without loss of continuity: Where the lost masticatory surface cannot be restored by suitable prosthesis: Loss of all teeth 40 Loss of all upper teeth 30 Loss of all lower teeth 30 All upper and lower posterior teeth missing 20 All upper and lower anterior teeth missing 20 All upper anterior teeth missing 10 All lower anterior teeth missing 10 All upper and lower teeth on one side missing 10 Where the loss of masticatory surface can be restored by suitable prosthesis 0 Note—These ratings apply only to bone loss through trauma or disease such as osteomyelitis, and not to the loss of the alveolar process as a result of periodontal disease, since such loss is not considered disabling

All of my third molars were extracted at once. The VA denied it initially by stating it was an "elective procedure", but did not have any documentation to prove it. A very clever oral surgeon referred me for an arthrogram of both TMJ sides which found both sides were permanently dislocated. When they remove wisdom teeth, it sometimes can do a number on your jaw. The pressure ofnmy jaw during extractions caused the dislocation, which healed that way and has got worse over time.

This is why John999 hates his dentist: