Bruxism and Tics secondary to PTSD

[grayling12]

I'm developing a claim for Bruxism and Tics secondary to PTSD.

My Dentist told me I have Bruxism and said I probably have TMJ as well because of my symptoms. He hasn't put that in my treatment notes yet, and I'm going to talk to him about making a formal diagnosis and putting it in my treatment notes.

I have also talked to my VA Psychiatrist in the past about tics that I have in relation to my PTSD to include grinding and clenching my teeth among others. He agrees that he's noticed the tics but hasn't pursued the issue with meds or wrote anything  in my treatment notes acknowledging them yet.  I am going to ask him to put his opinion on the connection between the Bruxism and Tics in my treatment notes. I've approached him in the past to write nexus letters for me on other claims and he always refused, saying it was a conflict of interest.   

My questions are:
1. Who's diagnosis will hold most weight? My Dentist who believes there's a link between my PTSD and Bruxism or my VA Psychiatrist who has acknowledged that theirs a link?
2. Will I be ok with just their opinions on treatment notes or should I seek out formal letters with their rationale for linking the two conditions?
3. Would I be ok with taking my shrinks notes to another Dr. level Psychologist that's treated me off and on over the years and have him do the Nexus letter?

I've learned from past claims to cross my t's and dot my i's when dealing with the VA. Any advice would be appreciated. Thanks.

[GBArmy]

Garyling12  Oversimplification: if you are developing a disability claim, the more medical evidence that supports your claim the better. Get whatever you can. As to taking your notes to your other doc for a nexus letter, why wouldn't it be ok? They are your own notes. Do it. Good luck.

[brokensoldier244th]

Why wouldn’t you want your doctor wrong the letter/rationale rather than having yet another doctor who’s never seen you or treated you reinvent the wheel? 
 

as for whose evidence to submit, just send both.  I just saw one of there yesterday. They had psych and dentistry notes of their own and then a c and p. They were given favorable findings by the c and p doctor. 

[Buck52]

Brokensolider244th  makes some good point 

you ask?

My questions are:
1. Who's diagnosis will hold most weight? My Dentist who believes there's a link between my PTSD and Bruxism or my VA Psychiatrist who has acknowledged that theirs a link?   both the Dentist and your Psychiatrist

2. Will I be ok with just their opinions on treatment notes or should I seek out formal letters with their rationale for linking the two conditions?  Like GB Army mention above the more evidence the better but these two Dr's Should be ok  as brokensolider 244th mention above

3. Would I be ok with taking my shrinks notes to another Dr. level Psychologist that's treated me off and on over the years and have him do the Nexus letter?  on this you need to be careful that is under minded another Dr and Dr's don't like that (jmo)      so if you ask this Dr just be honest with him'er let this Dr know  your wanting to  know if this diagnosed can be link or related to to your military days because your going to file a claim for it...the Dr either will or he won't, you know your Dr's better than anyone.

I'd use the two Dr's that you mention...if your claim comes back denied then seek out this other Dr, but you may not need to...

look up your symptom's and see what the criteria( in Regs) is for these symptom's compare this with what your Dr 's have mention in your notes  add that in your claim

be as short but to the point  raters do not like to read long drawn out statements and then  come to your point your trying to make just the facts sir  (jmo)

Just be sure you can Back-up what you say in your claim  you do this with medical records and Notes.

use Notes nods in your claim  like see Dr *** your Dentist on page 4   see Dr Psy on page 5/6

ect,,,ect,,, these Dr are ok  but be prepared for your C&P Dr  he/she is the deciding factor  so make sure you take your evidence to the C&P Exam   some times the VA don't send all the information they need.     so .if that happens you will have the evidence to prove it.

And bring it to the examiners attention!

Edited December 3, 2020 by Buck52

[brokensoldier244th]

Keep in mind that an opinion letter with rationale needs to be more than "I, Dr. X, think that A is a result or indirect result of B, because I think so." The letter best needs to be separate from the notes- not just typed into them (makes it easier to find), clearly labeled when you send it in, and it will help if your doctor can refer to someone/something besides his/her/they own opinion of why the two are tied together. Make sense? 

 

"I, Dr. X, think that A is a result or indirect result of B, because I think so." - Not so strong

"I, Dr. X, think that A is a result or indirect result of B, because I think so, and because the Journal of Orthodontia on P 40X, Volume 20, Dated Yadda Yadda shows a clear relationship demonstrated between bruxism and PTSD in patients diagnosed with long term PTSD and other severe recurring mental conditions. (they can do into some more detail here from the article, whatever) ." - Much Stronger

 

Same with your Psych. Keep in mind that if you have a doctor that prolifically updates/adds to your notes, if they slip an opinion in there its just as valid, just harder to find. Its much easier for us if they at least lift out that part and whatever else is relevant and do it up separate, or you make a reference to it on your app or a 4138, highlight it (w/LIGHT highlighter, please) or underline it or something.  It doesn't have to be a book. 1 pg, well written, dbl spaced 12pt font is fine- we don't need entire copies of medical journals and stuff attached.

Excerpts are fine, or even references/cites to. Me, as a VSR, and RVSRs cant easily read 100 pages of a medical journal for 1 article (I see this- really- the veteran sends in the whole scanned issue), and if YOU are sending in journal excerpts make sure they A. apply to you/your condition more than just a vague passing mention, and B. that your doctor at least puts in your notes that you brought it in once and discussed it with them. That way its not just you downloading WEB MD and sending it with your claim (Ive seen this, too). 

 

Edited December 3, 2020 by brokensoldier244th

[Berta]

The BVA has decided 129 Bruxism claims, in 2019 and 2020:

https://www.index.va.gov/search/va/bva_search.jsp?QT=Bruxism&EW=PTSD&AT=&ET=&RPP=10&DB=2020&DB=2019

Many are granted I would think , at the VARO level with the right evidence.

Some above were granted and others denied.

This vet had many claims remanded but won the bruxism claim:

https://www.va.gov/vetapp20/files6/20042612.txt

I got angry when I read it- the VA examiner's statement fully awarded this claim.

"The Board finds that the favorable medical opinion provided by the March 2020 VA examiner in the second April 2020 addendum opinion, indicating that the Veteran’s bruxism is proximately due to his service-connected PTSD, TBI residuals, and bilateral chronic myogenic TMJ disorder, is supported by an adequate rationale for the conclusion reached, as this rationale took into account the pertinent medical evidence of record.  Therefore, the Board affords the opinion substantial weight of probative value.

In light of the foregoing, and after resolving all doubt in the Veteran’s favor, the Board concludes that service connection for bruxism is warranted on a secondary basis.  38 U.S.C. §§ 1110, 5107(b); 38 C.F.R. §§ 3.303(a), 3.310(a)."

I really think literacy is not a factor in being employed by ROs to properly assess evidence sometimes.

In this case

BVA said 

"As the above definition suggests, bruxism is a manifestation of a psychiatric disorder.  In other words, bruxism is not a disability in and of itself.  Bruxism, however, could result in a dental disability, such as TMJ disorder or possibly an infection of the bone that results in tooth loss.  Such additional dental disability, if present, could warrant a separate grant of service connection."

https://www.va.gov/vetapp20/files3/20016533.txt

In this next case:

"1. Entitlement to service connection for bruxism.

The Veteran, during active service, in February 2008, presented for treatment for sleep apnea.  He reported that he grinds his teeth at night and has a dental guard; he was diagnosed with bruxism.  It is not clear the precise date upon which he was prescribed a dental guard for bruxism or the date upon which he was first diagnosed with bruxism; however, the Veteran’s January 1986 service entrance examination and history reports are silent for such.  There is thus no indication that the Veteran’s bruxism was diagnosed prior to service; in essence, there is no indication that the Veteran was not diagnosed with bruxism during his active service.   

On VA examination in March 2011, conducted while the Veteran was still in active service, for the purpose of adjudicating his service connection claims, he reported the onset of his bruxism as two or three years prior and the examiner noted his in-service treatment with a dental device for grinding.  The Veteran denied current treatment and reported that his bruxism had improved since its onset; he was diagnosed with bruxism.

While the Department of Veterans Affairs (VA) Regional Office (RO), in its May 2012 rating decision that denied entitlement to service connection for bruxism, determined that there was no evidence of an event, disease, or injury during service, it does not appear that the RO considered the Veteran’s February 2008 in-service bruxism.  The analysis may thus be stated simply, the Veteran has a current disability, bruxism, that was incurred in active service.  38 U.S.C. §§ 1110, 1131; 38 C.F.R.  § 3.303 (a).  The Board thus finds that service connection for bruxism is warranted."

https://www.va.gov/vetapp19/files8/19161358.txt

One more case whereby the RO could not read.

And this crap is why 38 CFR 4.6 is a Powerful weapon!!!!!!!As well as 38 CFR 3.156 et al.

We claimants have to do Their work (at the RO level)  for them! WE have to know their regulations, when they don't even apply them.

It is a National disgrace!