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. 

[Berta]

It is the new game the VA is playing-

They are denying claims with probative evidence, hoping the claimant wont file a Supplemental claim, or HLR ,because , in many cases the vet has to AGAIN send them the evidence they already had for the original claim and might just accept their lazy- assed denial.

I bet the Evidence list is so Generic you cannot even determine what they actually read-if any of it-and this crap will be seen here more and more , as initial claims assessors somehow have the power to deny claims without being literate.

 

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

That was a good move. There might have been a CUE in the decision, hat the HLR will catch - hopefully- 

also have you searched for the qualifications of the C &P examiner?

They ( the C & P examiner)  probably have no expertise in dental issues that are caused by PTSD. If so you can use that info in the appeal.

You quoted the examiner aid :

" It stated claimant has severe bruxism and it started in Iraq."

Was that in your SMRs or what you told the examiner?

In event event , you can succeed with this claim and I hope you don't need a costly IME to do that.

 

 

 

 

 

[Buck52]

Wooderson

I don't think you messed up you sent what you think you needed  and it all sounds ok to me  its just that who ever denied your claim   just didn't read enough...I hope the HLR DRO can read and see your evidence. If not head straight to the BVA.

In my opinion the problem with the HLR They do not take any new evidence and is just a review of the SCL 

But as Ms Berta mention the DRO may see a CUE Here and approve your claim   just need to wait now and see?

Good Luck

[Vync]

@Wooderson I think the VA may have overlooked the relative equipoise factor (i.e. reasonable doubt)...

Quote

§ 3.102 Reasonable doubt.

It is the defined and consistently applied policy of the Department of Veterans Affairs to administer the law under a broad interpretation, consistent, however, with the facts shown in every case. When, after careful consideration of all procurable and assembled data, a reasonable doubt arises regarding service origin, the degree of disability, or any other point, such doubt will be resolved in favor of the claimant. By reasonable doubt is meant one which exists because of an approximate balance of positive and negative evidence which does not satisfactorily prove or disprove the claim. It is a substantial doubt and one within the range of probability as distinguished from pure speculation or remote possibility. It is not a means of reconciling actual conflict or a contradiction in the evidence. Mere suspicion or doubt as to the truth of any statements submitted, as distinguished from impeachment or contradiction by evidence or known facts, is not justifiable basis for denying the application of the reasonable doubt doctrine if the entire, complete record otherwise warrants invoking this doctrine. The reasonable doubt doctrine is also applicable even in the absence of official records, particularly if the basic incident allegedly arose under combat, or similarly strenuous conditions, and is consistent with the probable results of such known hardships.

(Authority: 38 U.S.C. 501)

[50 FR 34458, Aug. 26, 1985, as amended at 66 FR 45630, Aug. 29, 2001]

Using the above, you can ask the HLR senior reviewer questions like:

1. Did the VA broadly interpret the law with the facts of your case?

2. Did a reasonable doubt arise regarding service origin, degree of disability, or any other point?

3. Is the VA considering both positive and negative evidence? Your lay statements are considered positive evidence and cannot be ignored.

Etc... Just read each sentence and consider how it might apply to your case, your evidence, and the VA decision letter's evidence and reasons and bases.

 

On top of that, consider tossing in the BVA decision that @Berta linked: https://www.va.gov/vetapp20/files8/20053843.txt

Although it is true that the veteran's PTSD/TMJ/bruxism may have a direct relationship to your circumstances, it however has relevance. In light of the very recent Federal Circuit court ruling Euzebio v. McDonough in March 2021, the VA has possession and knowledge of that BVA decision and the relevance of it may be able to be considered in your claim. It's worth a shot.

 

I would recommend you draft up what you want to discuss before the HLR. Be prepared. Lay out all the points and facts when your meeting occurs.