Citation Nr: 0909195 Decision Date: 03/12/09 Archive Date: 03/26/09 DOCKET NO. 06-06 697 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in Seattle, Washington THE ISSUE Entitlement to service connection for bruxism secondary to service-connected post-traumatic stress disorder (PTSD). REPRESENTATION Appellant represented by: Disabled American Veterans WITNESSES AT HEARING ON APPEAL Veteran, Spouse. ATTORNEY FOR THE BOARD H.J. Baucom, Associate Counsel INTRODUCTION The Veteran had active service from April 1966 to January 1970. This matter comes before the Board of Veterans' Appeals (BVA or Board) from a May 2005 rating decision of the Department of Veterans Affairs (VA), Regional Office (RO) in Seattle, Washington, which denied service connection for bruxism secondary to the Veteran's service connected post-traumatic stress disorder(PTSD). On February 13, 2009 a travel board hearing was held and the transcript is of record. This appeal has been advanced on the Board's docket pursuant to 38 C.F.R. § 20.900(c) (2007). 38 U.S.C.A. § 7107(a)(2) (West 2002). FINDINGS OF FACT The medical evidence relates the Veteran's bruxism to his service-connected PTSD. CONCLUSION OF LAW The criteria for entitlement to service connection for bruxism have been met. 38 U.S.C.A. §§ 1110, 1131, 5107, 7104 (West 2002 & Supp. 2007); 38 C.F.R. §§ 3.303, 3.304 (2008). REASONS AND BASES FOR FINDINGS AND CONCLUSION In light of the favorable action taken herein, discussion of whether VA has met its duties of notification and assistance is not required, and deciding the appeal at this time is not prejudicial to the veteran. Service connection may be established for disability resulting from injury or disease incurred in service. 38 U.S.C.A. § 1110. Service connection connotes many factors, but basically, it means that the facts, as shown by evidence, establish that a particular injury or disease resulting in disability was incurred coincident with service. A determination of service connection requires a finding of the existence of a current disability and a determination of a relationship between that disability and an injury or disease in service. See Pond v. West, 12 Vet. App. 341 (1999); Hickson v. West, 12 Vet. App. 247, 253 (1999). Additionally, service connection can be granted on a secondary basis. Except as provided in 38 C.F.R. § 3.300(c), disability which is proximately due to or the result of a service-connected disease or injury shall be service connected. When service connection is thus established for a secondary condition, the secondary condition shall be considered a part of the original condition. 38 C.F.R. § 3.310(a). The standard of proof to be applied in decisions on claims for veterans' benefits is set forth in 38 U.S.C.A. § 5107. A veteran is entitled to the benefit of the doubt when there is an approximate balance of positive and negative evidence. See also, 38 C.F.R. § 3.102. When a veteran seeks benefits and the evidence is in relative equipoise, the veteran prevails. See Gilbert v. Derwinski, 1 Vet. App. 49 (1990). The preponderance of the evidence must be against the claim for benefits to be denied. See Alemany v. Brown, 9 Vet. App. 518 (1996). There are four medical opinions addressing the cause of the Veteran's bruxism. In an October 2004 letter, Dr. E.K., a VA staff psychiatrist, opined that the Veteran's bruxism was directly related to his PTSD. Dr. E.K. explained that the Veteran's nocturnal bruxism was an associated feature of his sleep disturbances of nightmares and insomnia, which are manifestations of his PTSD. In April 2005 a VA examiner opined that the Veteran's bruxing habit may be exacerbated by his PTSD, but it was not possible to determine whether the bruxing was caused by it. In a February 2006 letter Dr. D.S., the Veteran's treating dentist, opined that the Veteran's problems of PTSD and bowel disorder were directly related and causal to severe bruxism (tooth grinding). Dr. D.S. opined that it was more likely as not that these conditions were directly caused by post traumatic stress and that they were accelerating quickly. In a July 2007 report Dr. S.A. stated that he reviewed all the records provided and diagnosed the Veteran with bruxism, TMJ dysfunction and concluded that "bruxism is a complex issue." In a September 2007 addendum request Dr. S.A. was asked whether it was at least as likely as not that the Veteran's bruxism was due to his PTSD. Dr. S.A. responded that he could not resolve the issue without resorting to mere speculation. In an additional September 2007 addendum Dr. S.A. was asked whether the Veteran's bruxism was at least as likely as not aggravated by the PTSD, to which he replied "less than likely." The April 2005 VA examiner and the July/September 2007 VA examiner both stated that they were unable to say whether the Veteran's bruxism was caused by his PTSD. The April 2005 VA examiner said that the Veteran's bruxism could be exacerbated by his PTSD and the July/September 2007 VA examiner said it was less than likely that the Veteran's bruxism was less than likely aggravated by his PTSD. Both opinions are equivocal, and neither opinion is supported by a strong rationale. The medical evidence presents no other opinions or evidence against a finding that the Veteran's bruxism is related to his service connected PTSD. On the other hand, the opinions of the Veteran's VA treating psychiatrist and private treating dentist unequivocally state that the Veteran's bruxism is directly related to his service connected PTSD. Both of these opinions are adequately supported with a medical rationale. The evidence clearly supports a grant of service connection. ORDER Entitlement to service connection for bruxism secondary to service-connected post-traumatic stress disorder (PTSD) is granted. ____________________________________________ RONALD W. SCHOLZ Veterans Law Judge, Board of Veterans' Appeals Department of Veterans Affairs