93 Decision Citation: BVA 93-07424 Y93 BOARD OF VETERANS' APPEALS WASHINGTON, D.C. 20420 DOCKET NO. 92-03 877 ) DATE ) ) ) THE ISSUES Entitlement to service connection for tinnitus and a jaw disability, including bruxism and a temporomandibular joint syndrome as secondary to service-connected post-traumatic stress disorder (PTSD). REPRESENTATION Appellant represented by: The American Legion ATTORNEY FOR THE BOARD Marshall O. Potter, Jr., Associate Counsel INTRODUCTION The veteran had active service from April 1942 to October 1945. This appeal is from a December 1991 decision by the Department of Veterans Affairs (VA) Fargo, North Dakota, Medical and Regional Office Center (RO) which denied the veteran's claim of service connection for tinnitus and a jaw disability, including bruxism and temporomandibular joint syndrome, as secondary to his service-connected PTSD. The veteran submitted a notice of disagreement in January 1992. He was provided with a statement of the case dated in February 1992. He submitted a substantive appeal later that month. This case was received at the Board of Veterans' Appeals (Board) in March 1992 and docketed in April 1992. In May 1992, The American Legion, the veteran's representa- tive submitted written argument in support of the claims. By decision in June 1990 the Fargo, North Dakota, VA Medical and Regional Office Center (VAMC) denied the veteran's claim for certain VA dental eligibility. The veteran submitted a notice of disagreement in November 1990. He was provided with a statement of the case in February 1991. He thereafter submitted no substantive appeal. Thus, the Board has no jurisdiction over such issue as it is not ripe for appellate adjudication. CONTENTIONS OF APPELLANT ON APPEAL The veteran contends that his tinnitus and jaw disability, including bruxism and a temporomandibular joint syndrome are causally related to his PTSD. The veteran has asserted that a private dentist said the bruxism was due to his PTSD. DECISION OF THE BOARD In accordance with the provisions of 38 U.S.C.A. § 7104 (West 1991), following review and consideration of all evidence and material of record in the veteran's claims file, and for the following reasons and bases, it is the decision of the Board that the preponderance of the evidence is against the claims of service connection for tinnitus and a jaw disability, including bruxism and a temporomandibular joint syndrome. FINDING OF FACT The veteran's tinnitus and jaw disability, including bruxism and a temporomandibular joint syndrome, are not etiologically related to his service-connected PTSD. CONCLUSION OF LAW The veteran's tinnitus and jaw disability, including bruxism and temporomandibular joint syndrome, are not proximately due to or the result of his service-connected PTSD. 38 U.S.C.A. § 5107(a); 38 C.F.R. § 3.310(a) (1992). REASONS AND BASES FOR FINDINGS AND CONCLUSION The veteran's claims are well grounded within the meaning of 38 U.S.C.A. § 5107(a). That is, he has presented claims which are not inherently implausible. We are satisfied that all relevant facts have been properly developed. No further assistance to the veteran is required to comply with the duty to assist him. Id. I. Factual Background The veteran's service medical records contain no reference to tinnitus or a jaw disability including bruxism or temporomandibular joint syndrome. The evidentiary record contains reports from private physicians, VA outpatient treatment records, and reports pertaining to periods of VA hospitalization through July 1987 which contain no reference to tinnitus or a jaw disability, including bruxism or temporomandibular joint syndrome. In March 1990, the veteran was admitted to a VA hospital at which time he underwent a dental consultation. At that time he gave a history of jaw pain beginning in 1989 and of being seen by a private dentist, but that no cause was found for the pain. On examination, the consultant observed the veteran had tenderness and bilateral joint crepitation in the jaw. He also observed that the veteran was "bruxing." The impression was temporomandibular joint syndrome/ myofascial pain on the left side. In August 1990 the veteran sought medical treatment at a VA outpatient clinic and was observed to be anxious. No reference to temporomandibular joint syndrome or bruxism was made. In February 1991, he complained of ringing in his ears and jaw pain while seeking treatment at a VA clinic. In March 1991 he complained that his left jaw and ears hurt. This was considered to be due to bruxism. The veteran underwent a VA ear, nose and throat examination in August 1991 and reported that for many years he had had tinnitus. On examination, the ear, nose and throat were observed to be within normal limits. On audiological examination conducted at the same time the veteran also gave a history of tinnitus for many years. On clinical evaluation by a VA dentist in August 1991, it was noted that the veteran's temporomandibular joint was tender on the left side and asymptomatic on the right. The clinical impression was displacement of the disc on the left side causing temporoman- dibular dysfunction. A summary of this examination contains an opinion by the VA examining physician that there was no association established between PTSD and temporomandibular joint syndrome. J. B. Sleckman, M.D., examined the veteran in September 1991 and observed crepitation with movement of the jaw and tenderness of the temporomandibular joints. At that time the doctor received a history of pain in the jaw for several years and ringing in the left ear. The impression was temporomandibular joint syndrome, probably secondary to bruxism. VA tomograms taken in October 1991 resulted in an impression of a broader left mandibular condyle with narrowing of the anterior joint space on the left. The right temporomandibular joint appeared normal. II. Analysis Service connection may be granted for disability which is proximately due to or the result of a service-connected disease or injury. 38 C.F.R. 3.310(a) Each condition will now be discussed individually below. A. Bruxism The veteran's bruxism manifested itself in the late 1980's, at the earliest, many years subsequent to his World War II service. VA dental consultation conducted in March 1990 contains no opinion that that disorder was caused by his service-connected PTSD. At that time, the veteran stated that his private dentist had not found any cause for his left face pain. The veteran has submitted no medical or dental evidence to support his current theory that his bruxism is secondary to his service-connected PTSD. Therefore we find that service connection for bruxism secondary to his service-connected PTSD is not warranted. B. Temporomandibular Joint Syndrome The veteran's temporomandibular joint syndrome also manifested itself at a point in time many years remote from his separation from World War II active service. He has demonstrated certain symptoms to support that diagnosis. However, at the VA examination in August 1991, an opinion was expressed by the VA examining physician that there was no association established between temporomandibular joint syndrome and PTSD. At a VA clinical examination in March 1991, his temporomandibular joint syndrome was considered possibly secondary to bruxism. This is the same opinion expressed by Dr. Sleckman, at his examination of the veteran for the VA in September 1991. The veteran has submitted no medical evidence to support or corroborate his thesis, and as we are not required to accept every bald assertion made by a veteran as to service incurrence of a disability, service connection for temporomandibular joint syndrome, secondary to his service-connected PTSD, is not in order. See Wood v. Derwinski, 1 Vet.App. 190 (1991). C. Tinnitus The evidentiary record establishes that the veteran first complained of ringing in his ears while receiving medical treatment at a VA clinic in February 1991. At his VA examination in August 1991 he gave a history of tinnitus of many years' duration. However, medical evidence of record does not support the veteran's contention that his tinnitus is causally related to his service-connected PTSD. Neither has he submitted any medical evidence to support that contention. Thus, we find that service connection for tinnitus, secondary to PTSD, is not in order. ORDER Service connection for tinnitus and a jaw disability, including bruxism and temporomandibular joint syndrome, as secondary to service-connected PTSD is denied. BOARD OF VETERANS' APPEALS WASHINGTON, D.C. 20420 L. W. TOBIN STEPHEN A. JONES J. F. GOUGH NOTICE OF APPELLATE RIGHTS: Under 38 U.S.C.A. § 7266 (West 1991), a decision of the Board of Veterans' Appeals granting less than the complete benefit, or benefits, sought on appeal is appealable to the United States Court of Veterans Appeals within 120 days from the date of mailing of notice of the decision, provided that a Notice of Disagreement concerning an issue which was before the Board was filed with the agency of original jurisdiction on or after November 18, 1988. Veterans' Judicial Review Act, Pub. L. No. 100-687, § 402 (1988). The date which appears on the face of this decision constitutes the date of mailing and the copy of this decision which you have received is your notice of the action taken on your appeal by the Board of Veterans' Appeals.