Depression and TMJ (Temporal Mandibular Joint Dysfunction)

[68mustang]

I was diagnosed with TMJ back in 1986 on the outside, not by the VA. I am now being being compensated 50% depression-anxiety and 10% tinnutis by the VA. My TMJ has gotten worse and I am having problem with my jaw on both sides. I recently found out through reading that TMJ can be aggravated by depression and anxiety. I have been thinking of filing a secondary claim for the aggravation of my TMJ due to the depression and anxiety. Anyone out have any input on my filing a secondary claim for the condition I mentioned? And has anyone ever filed a claim for TMJ and a secondary claim for aggravation of it? Thanks for any input you all may have. 

[Berta]

Yes, we have had a few vets here file for the TMJ as secondary to ,or aggravated by their MH issues.

If you go to the BVA web site, and to their decicions, and swearch for TMJ and anxiety depression or PTSD you will find how the BVA awarded for the TMJ or why they denied the claim.

Also if you use our hadit search feature discussions on TMJ will pop up.

[Vync]

TMJ can cause depression (i.e. due to chronic pain) or the anxiety/depression can cause TMJ due to bruxism (grinding upper/lower teeth together). A decent night guard/split and NSAID's can help give you relief from the pain, but does not reverse any damage to your teeth or TMJ joints.

My recommendation is to get your doctor or dentist to do an exam, fill out a DBQ, and write a nexus letter connecting the conditions.

I filed initially for TMJ (Army oral surgeon botched wisdom teeth removal). The VA did the normal panorex x-ray, but it showed nothing. When I appealed, the VA did an arthrogram study. The radiologist injects contrast into both TMJ joints and observes movement via flouroscope. The evidence was obvious and the C&P oral surgeon opined in my favor, so I won SC.

Later, I filed for depression as secondary to my SC TMJ. I had a lengthy medical treatment history of acute and chronic pain involving my TMJ. I was granted 10% for anxiety/depression, but got it bumped up to 30% via NOD.

My initial TMJ rating was 10%, then I got it increased to 20%, and later to 30%. From what I have heard, it is one of those conditions that does not tend to improve over time. I qualify for 40% now, but am weighing filing for it because I'm already 100% P&T anyway.

 

My example showed TMJ as primary with MH as secondary, but it can be SC via MH as primary and TMJ as secondary.

If you are not able to get SC via secondary, go through your service treatment and dental records to see if there were any events or injuries which might help provide for direct SC. Examples to look for include head injury, motor vehicle, oral surgery, etc...

 

 

Here's a link to the rating criteria plus the TMJ critera per 9905.

§4.150   Schedule of ratings—dental and oral conditions

Quote

§4.150   Schedule of ratings—dental and oral conditions.

	Rating
Note (1): For VA compensation purposes, diagnostic imaging studies include, but are not limited to, conventional radiography (X-ray), computed tomography (CT), magnetic resonance imaging (MRI), positron emission tomography (PET), radionuclide bone scanning, or ultrasonography
Note (2): Separately evaluate loss of vocal articulation, loss of smell, loss of taste, neurological impairment, respiratory dysfunction, and other impairments under the appropriate diagnostic code and combine under §4.25 for each separately rated condition

9905   Temporomandibular disorder (TMD):
Interincisal range:
0 to 10 millimeters (mm) of maximum unassisted vertical opening.
With dietary restrictions to all mechanically altered foods	50
Without dietary restrictions to mechanically altered foods	40
11 to 20 mm of maximum unassisted vertical opening.
With dietary restrictions to all mechanically altered foods	40
Without dietary restrictions to mechanically altered foods	30
21 to 29 mm of maximum unassisted vertical opening.
With dietary restrictions to full liquid and pureed foods	40
With dietary restrictions to soft and semi-solid foods	30
Without dietary restrictions to mechanically altered foods	20
30 to 34 mm of maximum unassisted vertical opening.
With dietary restrictions to full liquid and pureed foods	30
With dietary restrictions to soft and semi-solid foods	20
Without dietary restrictions to mechanically altered foods	10
Lateral excursion range of motion:
0 to 4 mm	10
Note (1): Ratings for limited interincisal movement shall not be combined with ratings for limited lateral excursion
Note (2): For VA compensation purposes, the normal maximum unassisted range of vertical jaw opening is from 35 to 50 mm
Note (3): For VA compensation purposes, mechanically altered foods are defined as altered by blending, chopping, grinding or mashing so that they are easy to chew and swallow. There are four levels of mechanically altered foods: full liquid, puree, soft, and semisolid foods. To warrant elevation based on mechanically altered foods, the use of texture-modified diets must be recorded or verified by a physician

 

 

 

 

[broncovet]

I humbly suggest you get and read your medical file, and you can answer this question yourself.  

Before you get SC for this, you will need 2 things  (3 if its a new SC, only 2 if its secondary):

1.  Current diagnosis of TMJ.

2.  Nexus, or docs opinion that its "at least as likely as not" that your TMJ is related to your (sc) depression.  

You see, the VA will insist you have a nexus to YOUR depression, not just a general one that depression causes TMJ.  However, it sounds like its likely that a doc would give you a nexus, if you dont already have one.   That is, you will need and IMO/IME if you are lacking your nexus.  

 

[68mustang]

On 4/2/2018 at 5:14 PM, broncovet said:

I humbly suggest you get and read your medical file, and you can answer this question yourself.  

Before you get SC for this, you will need 2 things  (3 if its a new SC, only 2 if its secondary):

1.  Current diagnosis of TMJ.

2.  Nexus, or docs opinion that its "at least as likely as not" that your TMJ is related to your (sc) depression.  

You see, the VA will insist you have a nexus to YOUR depression, not just a general one that depression causes TMJ.  However, it sounds like its likely that a doc would give you a nexus, if you dont already have one.   That is, you will need and IMO/IME if you are lacking your nexus.  

 

Broncovet, Berta, and Vync Thank you all for your helpful response and will take your advice.

[Ddsr]

I just put in for Bruxism/TMJ. I have been going to VA Dental for 3 years now. They are aware of the severe teeth grinding and Jaw pain. I was given a new Mouthpiece which will help with grinding but still have pain in jaw. I am TDIU and since depression is my major SC I have now put in for Bruxism secondary to depression. I also put in for Secondary ED from my Anti Depressants and was awarded that last month. Wondering if anyone else has put in for Bruxism secondary to depression? I see most of the Bruxism claims are for secondary to PTSD which I was not awarded but sure the hell should be, but oh well I am TDIU anyways with no future exams. They must have really seen my history of job after job.