TMJ w/severe Bruxism

[Wooderson]

I will try to keep this from getting too confusing. 
 

I claimed and was denied back in 2013 for TMJ and Bruxism. I had NO idea what I was doing and didn’t have any evidence (or even an official diagnosis for that matter). Fast forward to now and I do have a diagnosis for TMJ and severe Bruxism. I have PTSD and cervical spine service connected at 20%.  I never even got a C&P exam back in 2013.
 

When I was still on active duty in 2009 after leaving Iraq I saw a military dentist who stated in my SMR “severe Bruxism”. I was then seen by a VA dentist a few months later who prescribed a night guard for the Bruxism. I was never diagnosed with TMJ on active duty. 
 

Here is the issue. I know I will have to do a supplemental to reopen the previous denials. I have done a ton of research and have numerous medical studies that link Bruxism to TMJ (as both a cause and symptom). Also that the PTSD stress/anxiety can lead to Bruxism which can then cause TMJ. And finally cervical spine issues can cause TMJ (which in turn causes the Bruxism) due to all the muscles and ligaments being connected at the neck and head. My teeth are trashed and flattened down to almost nothing. I’m going to be at probably $8-10,000 out of pocket trying to at least prolong keeping my teeth. 

Will the supplement be just a request (with new and relevant information) to reopen? Or will I request to reopen and at the same time submit my evidence and ask for service connection??

Any suggestions would be appreciated. Thanks. 

[brokensoldier244th]

It’s the same thing. The 0995 requests to reopen the claim, and you submit what you have, and we look to see if there is anything Vamc related and pull that too. If you were denied service connection the first time it’s assumed that you are asking for it in the appeal

[Berta]

Can you scan and attach here  the oldest denial?

We need to see the evidence list and their rationale for denial.

Did you get the PTSD rating after those denials?

Did any denial after the PTSD rating occurred? If so can you also attach that one too?

They might hold basis for CUE.

Please cover your C file #, name, address prior to scanning them.

 

[Wooderson]

I will get a copy and post here. Thanks.  

[Wooderson]

I'm still trying to find my denial, but i will also be trying to re-open the tinnitus denial. I know that I advised that I had symptoms while on active duty, just nothing in my records. It states that the Post Deployment health assessment shows that I denied ringing in the ears. That is not true. I actually failed to answer any of the 14 questions in the entire section...i didn't answer yes or no, i guess i overlooked the section when i filled it out and didn't answer anything. I am also going to attempt to secondary link the tinnitus to the bruxism, which is documented in records.

tinnitus.pdf

[Berta]

 

I believe you will need a confirmed diagnosis of the TMJ and a strong IMO/IME to support claims for any secondarys to include the Bruxism.

This very recent August 2020  BVA decision involves Bruxism:

https://www.va.gov/vetapp20/files8/20053843.txt
"The January 2013 rating decision on appeal granted service connection for bruxism as secondary to the Veteran’s service-connected posttraumatic stress disorder (PTSD) and assigned an effective date of September 2012. The Veteran has continuously appealed the rating for bruxism since then."
"During the pendency of this appeal, a final rule prohibiting bruxism as a stand-alone disability was enacted in August 2017. See 82 Fed. Reg. 36080-36086 (Aug. 3, 2017). The Final Rule against bruxism as a stand-alone disability became effective on September 10, 2017."

In the April 2020 rating decision, the AOJ cited that rule as the basis for finding CUE in the initial grant. 
 
"In this case, the appeal of the initial rating for the already service-connected bruxism was pending prior to the September 10, 2017 effective date of the regulation change, so the new regulatory bar against bruxism does not apply to this Veteran’s claim. More important for the CUE analysis, that changed regulation was not in effect at the time of the January 2013 rating decision.  

The Board also notes that in the Final Rule, VA acknowledged that bruxism may be contemplated as a symptom of craniomandibular disorders, of which temporomandibular disorders under 38 C.F.R. § § 4.150, Diagnostic Code (DC) 9905, are a subset, and that other symptoms of craniomandibular disorders include anxiety, stress, and other mental disorders. The Final Rule further noted that VA has determined that secondary service connection for treatment purposes only is warranted for bruxism, both because bruxism is only a secondary condition, not a primary condition, and because its symptoms are already contemplated by the underlying condition. 36081.  However, here, service connection for bruxism was granted as secondary to PTSD.  And the symptoms of bruxism are not contemplated by the rating criteria for PTSD and thus, are not already contemplated by the rating assigned for the PTSD. See 38 C.F.R. § 4.130, Diagnostic Code 9411. The April 2020 rating decision did not address the correct facts; CUE in the April 2020 rating decision is established. 

The Board finds that the April 2020 rating decision itself was CUE."

The VA might have held to the prior regulation for bruxism in your older denials-and the past denials might  reveal that.

I believe you will need a  medical diagnosis of TMJ as the cause of you bruxism and also a medical rationale that your PTSD caused it.

This will take a strong independent medical opinion.

Your dentist might be willing to prepare the opinion for you- he/she will need to follow the IMOIME criteria here in our IMO forum.

The tinnitus claim mentions there is no hearing loss, as one reason why they denied that claim.

The veteran above probably had an IMO/IME for his original claim.

The claim was remanded for a dental exam.

 

 

 

[Wooderson]

So claim is in and I had a C&P examination. I submitted all of the medical studies that showed a connection between TMJ-Bruxism-and PTSD. The C&P was very fast and I was concerned I didn't get a favorable/quality exam.

Waited a few weeks and get a denial for service connection on TMJ with severe bruxism.

Once again I thought I didn't get a favorable opinion from examiner and had VSO get copy of exam. It stated claimant has severe bruxism and it started in Iraq. So I would rationalize that it is more likely than not...The etiology of bruxism is unknown, however stress and anxiety can be contributing factors. The fact the claimants bruxism started in Iraq would coincide with service related anxiety and stress. 

On the decision it showed for positive evidence: TMJ with severe bruxism diagnosis, didn't list anything else I submitted (other doctors reports, buddy letter, etc.). 

My VSO was very surprised that they came back denied and we have submitted for a higher level review. 

Where do you think I lacked/messed up. I really thought this was going to be a no-brainer for the VA, but I sure was wrong.