Citation Nr: 0307941 Decision Date: 04/25/03 Archive Date: 04/30/03 DOCKET NO. 00-05 446 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in Boston, Massachusetts THE ISSUE Entitlement to service connection for bruxism, as secondary to service-connected post-traumatic stress disorder (PTSD). REPRESENTATION Appellant represented by: Disabled American Veterans ATTORNEY FOR THE BOARD E. Ward, Associate Counsel INTRODUCTION The veteran served on active duty from August 1965 to June 1967, including service in the Republic of Vietnam from April 1966 to May 1967. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a July 1999 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO) in Boston, Massachusetts, which denied the veteran's claim of entitlement to service connection for PTSD and bruxism. The veteran perfected a timely appeal of this determination to the Board. When this matter was previously before the Board in May 2001, it was remanded for further development and adjudication. On return to the Board in October 2002, the Board granted service connection for PTSD and requested further development on the issue of bruxism. That development has been completed, and the case is ready for adjudication. FINDINGS OF FACT 1. All relevant evidence necessary for disposition of the veteran's appeal has been obtained and associated with the claims file. 2. The veteran is service connected for PTSD, effective from January 11, 1999. 3. The veteran currently has a diagnosis of bruxism. 4. The record contains medical evidence and opinion indicating that the veteran's bruxism is probably proximately due to his service-connected PTSD. CONCLUSION OF LAW Bruxism is proximately due to or the result of the service- connected PTSD. 38 U.S.C.A. §§ 1101, 1131, 5107 (West 2002); 38 C.F.R. §§ 3.303, 3.310(a) (2002). REASONS AND BASES FOR FINDINGS AND CONCLUSION Duty to Assist and Notify On November 9, 2000, the President signed into law the Veterans Claims Assistance Act of 2000 (VCAA), 38 U.S.C.A. §§ 5100, 5102, 5103, 5103A, 5106, 5107, 5126 (West Supp. 2001), 66 Fed. Reg. 45,620 (Aug. 29, 2001) (to be codified as amended at 38 C.F.R. §§ 3.102, 3.156(a), 3.159 and 3.326(a)). Among other things, the VCAA redefines the obligations of VA with respect to the duties to notify and assist. This change in the law is applicable to all claims filed on or after the date of enactment of the VCAA or filed before the date of enactment and not yet final as of that date. 38 U.S.C.A. §§ 5102, 5103, 5103A, 5107. The Board is satisfied that all relevant facts have been sufficiently developed, and no further assistance to the veteran is required to comply with VA's duties to notify and assist the veteran with his claim as mandated by the VCAA. In this regard, the record shows that by the rating decisions, as well as in the statement of the case, supplemental statements of the case, and various correspondence including the Board's remand of May 2001, and remand and development request dated in October 2002, VA informed the veteran of the evidence needed to support his claim. The veteran was notified of the need to supply competent medical evidence to support his claim, and informed of efforts VA would make to secure outstanding medical records. Additionally, the RO requested and obtained all outstanding relevant treatment records, and the veteran has not referenced any outstanding evidence that might aid in his claim. A medical opinion was solicited pertaining to his claim, there is no identified evidence that has not been accounted for, and the veteran and his representative have been given the opportunity to submit written argument. Under the circumstances, the Board finds that the veteran has been provided with adequate notice of the evidence needed to successfully prove his claim, and that there is no prejudice to him by appellate consideration of the claim at this time without another remand of the case to the RO for providing additional assistance to the veteran in the development of his claim as required by the VCAA or to give him another opportunity to present additional evidence and/or argument. Bernard v. Brown, 4 Vet. App. 384 (1993). See also Karnas v. Derwinski, 1 Vet. App. 308 (1991). The record on appeal demonstrates the futility of any further evidentiary development and that there is no reasonable possibility that further assistance would aid him in substantiating his claim. Hence, no further notice or assistance to the veteran is required to fulfill VA's duty to assist her in the development of the claim. Smith v. Gober, 14 Vet. App. 227 (2000); Dela Cruz v. Principi, 15 Vet. App. 143 (2001). Background and Analysis Service connection may be established for disability resulting from personal injury suffered or disease contracted in line of duty, or for aggravation of a pre-existing injury suffered or disease contracted in line of duty. 38 U.S.C.A. § 1110; 38 C.F.R. § 3.303. The law also provides that service connection may be granted for any disease diagnosed after discharge when all the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d). In determining whether service connection is warranted for a disability, VA is responsible for determining whether the evidence supports the claim or is in relative equipoise, with the veteran prevailing in either event, or whether a preponderance of the evidence is against the claim, in which case the claim is denied. 38 U.S.C.A. § 5107; Gilbert v. Derwinski, 1 Vet. App. 49 (1990). Disability which is proximately due to or the result of a service-connected disease or injury shall be service connected. When service connection is established for a secondary condition, the secondary condition shall be considered a part of the original condition. 38 C.F.R. 3.310(a). Additional disability resulting from the aggravation of a non-service-connected condition by a service-connected disability is also compensable under 38 C.F.R. § 3.310(a). See Allen v. Brown, 7 Vet. App. 439, 448 (1995) (en banc). The critical issue in this case is whether the veteran has bruxism secondary to the service-connected PTSD. The record reflects that the veteran served in Vietnam from April 1966 to May 1967. In numerous statements in support of his claim of service connection for PTSD, as well as lay statements from his sisters, the veteran reported that after his return from Vietnam, he experienced nightmares and other PTSD symptomatology which resulted in the grinding of this teeth which resulted in the current diagnosis of bruxism. In October 2002, the Board requested further development of the veteran's claims of bruxism as secondary to his service- connected PTSD. Evidence submitted includes a January 2003 letter from the VA staff psychiatrist which indicates that the veteran has been under his care for chronic PTSD. The psychiatrist notes that the veteran "continues to have bruxism secondary to his PTSD, (specifically due to his traumatic nightmares), and bruxism has caused his teeth great harm. The psychiatrist opined that "[i]n my opinion treatment for his bruxism and subsequent dental injuries is simply an extension of his treatment for PTSD." The veteran underwent VA dental examination in April 2003. He gave a medical history of PTSD and oral pain associated with severely abraded maxillary teeth. Physical examination showed no functional impairment due to loss of motion, however, maxillary function was severely compromised due to maxillary tooth destruction. The dental diagnosis was severe bruxism, probably associated with service trauma and secondary to PTSD and chronic major depressive disorder. Upon consideration of the overall evidence, the Board finds that the record contains credible supporting evidence that the veteran's bruxism is proximately due to the service- connected PTSD. Accordingly, service connection is warranted. ORDER Entitlement to service connection for bruxism, as secondary to service-connected PTSD, is granted. ____________________________________________ J. E. Day Veterans Law Judge, Board of Veterans' Appeals IMPORTANT NOTICE: We have attached a VA Form 4597 that tells you what steps you can take if you disagree with our decision. We are in the process of updating the form to reflect changes in the law effective on December 27, 2001. See the Veterans Education and Benefits Expansion Act of 2001, Pub. L. No. 107-103, 115 Stat. 976 (2001). In the meanwhile, please note these important corrections to the advice in the form: ? These changes apply to the section entitled "Appeal to the United States Court of Appeals for Veterans Claims." (1) A "Notice of Disagreement filed on or after November 18, 1988" is no longer required to appeal to the Court. (2) You are no longer required to file a copy of your Notice of Appeal with VA's General Counsel. ? In the section entitled "Representation before VA," filing a "Notice of Disagreement with respect to the claim on or after November 18, 1988" is no longer a condition for an attorney-at-law or a VA accredited agent to charge you a fee for representing you.