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.

[Roger Louis]

I have tried 3 times to upload a copy of my award letter from the VA and have not been able to accomplish that. I am in the process of deterring what to say in the NOD and would like opinions based on the letter. Is there specific procedure for cutting an pasting or attaching a file to the forum. I have received a lot of excellent information from the forum and would like to find out the best way to quote the various laws and regulations based on everthing.

[Vync]

Roger,

I typically scan the document with my printer into a PDF. My printer does OCR, which allows the PDF to include readable text that can be copied/pasted. If you try to attach an entire document, be sure that you redact any personal info like name, SSN, DOB, etc... before you scan the document in. I personally prefer the previous method because you can get to the meat of the details.

Regarding quoting and assembling documents, check the FAQ on the main Hadit page. Also, the below links can help you out too.

Here on Hadit, there is a self help guide:

http://www.hadit.com/veterans_self_help_guide.html

Another Hadit contributor, FanaticBooks, has a great site dedicated to assembling claims.
http://www.howtoassemblevaclaims.com

There is a wealth of great information here. The search feature is great.

[john999]

Vync

I had the "Toothache Blues" after the Army dentist got done with me. There is an old Lonnie Johnson blues number called "Toothache Blues" and it is so dirty I don't know how it ever made it onto a record back in the old days. Lonnie Johnson is singing the part of the dentist and Victoria Spivey is in the chair. "Now baby, I told you I was going to have to grind." "Doctor, Doctor grind a little slower" heh, heh.

[VADDS]

Class IIa does not apply to bruxism. Service Trauma is defined as a line of duty related injury to teeth by an external force. Combat or training injury, getting hit by a tool, even a car accident while on AD all qualify. Bruxism, or just biting on something hard are not considered service trauma.

It would be a mistake if VBA rated the OP for bruxism. The VBA classifies bruxism as a neuromuscular symptom of stress, not a separate disease. Bruxism has no disease diagnosis code, no rating criteria. Contrary to what the dentist told the OP, it is now widely accepted that PTSD may cause or worsen bruxism. Most likely, during the course of completing the TMJ DBQ, there was evidence of a disorder in the joint. Since bruxism may cause a TMJ disorder, the OP was granted TMJ secondary to the PTSD, at 0%, based on the ROM measurements.

Class III and VI eligibility rules are clear: The dental treatment must have an evidenced based, direct impact on the medical condition. Examples include removing infected teeth before joint surgery or heart valve replacement. There is substantial evidence in the medical literature that a dental abscess can seed a prosthesis with bacteria, having potentially catastrophic consequences. Providing dental to a PTSD patient may improve overall health, but the same can be said about providing needed dental care to anyone with any disease.

it seems logical and fair that the VA provide dental care to correct problems caused by a service connected disease or its management. But, that is going to take a change in the CFRs, which means complaining to your elected representative, not VA Eligibility or the dental clinic. Besides bruxism, a whole lot of damage to teeth is caused by the dry mouth people get from many different drugs. For the VA to absorb this potentially huge new workload, it is going to take more dentists, more clinics, more money. Again, all of this has to happen in Congress.

There is absolutely nothing in the VADIP programs that exclude service connected conditions from coverage. The OP was given bad info. By the way, I think Metlife has a better program, since its high option has a $3000 yearly cap.

[Roger Louis]

The following quote from the Veterans Affairs participation Guidelines for (VADip), Nov 1, 2013 "The VA Dental Insurance program (VADip) will offer veterans who are not eligible for VA Dental Care....." suggest that the insurance does no cover service connected issues. While 3K coverage for MetLife is a significant amount it will not begin to address the issues that Bruxism over a period of time can cause. The award was for Temporomandibular disorder (claimed as bruxism) at 0% which is not compensable. The dentist during the C&P said that I did not qualify for TMJ and that he did not think that I had a service connected dental condition or disability resulting from combat wounds or service trauma. Apparently based on recent VA guidance or the US Court of Veterans Appeals recent decisions which there are some the VA regional office disagreed with the Dentist and his staff or possible they thought that the condition further aggravated a medical condition. Not sure what an OP is but I am sure that I will learn, however I realize my limits as a layman. Depending on who interprets the CFR for the VA, and others. When the intent is to care for the veteran in my opinion the law is sufficient to allow the VA to cover as I understand has happen in the past veterans with many issues. In any even I want to again thank everyone for all of the excellent information posted which I am sure make my NOD and subsequent appear stronger.

[VADDS]

OP = Original Poster

No need to convince me. But, you should know what you up against. I wrote exactly what I would tell you if we were meeting to discuss your dental eligibility.

VADIP came about primarily to provide an option for Veterans not eligible for VA out-patient dental care. However, any Veteran, dental eligible or not, can enroll. Same premium, same benefits.

It is going to take a strong grass-roots push for elected officials to vote to extend dental eligibility to cover all Veterans for dental problems secondary to service connected diseases. Senator Bernie Sanders, has introduced a bill that would provide dental care to all Veterans. People should write their Senator and request they support the bill. At this point, it has no chance of passing.