Citation Nr: 1321971 Decision Date: 07/10/13 Archive Date: 07/18/13 DOCKET NO. 09-36 322 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in Chicago, Illinois THE ISSUE Entitlement to service connection for dental trauma (bruxism), to include as secondary to service-connected posttraumatic stress disorder (PTSD). REPRESENTATION Appellant represented by: Veterans of Foreign Wars of the United States WITNESS AT HEARING ON APPEAL Appellant ATTORNEY FOR THE BOARD J. Davitian, Counsel INTRODUCTION The Veteran had active service from February to July 1984, May to September 1991, and February 2003 to September 2005. This matter comes before the Board of Veterans' Appeals (BVA or Board) on appeal from a September 2007 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO) in Chicago, Illinois, that denied service connection for PTSD and dental trauma (bruxism). During the pendency of the appeal, a June 2012 rating decision granted service connection for PTSD. The appeal is REMANDED to the RO via the Appeals Management Center (AMC), in Washington, DC. VA will notify the appellant if further action is required. REMAND A preliminary review of the record indicates that this claim requires additional development. During a March 2013 hearing before the undersigned Veterans Law Judge, the Veteran stated that she had tooth grinding that began at about the same time that she underwent the stressor underlying her service-connected PTSD. She stated that she received dental treatment and a mouth guard while stationed at Camp Anaconda in Iraq. The Veteran is competent to report that her tooth grinding began at the same time as the stressor underlying her service-connected PTSD. See Falzone v. Brown, 8 Vet. App. 398, 405 (1995). Lay testimony is competent to establish the presence of observable symptomatology and "may provide sufficient support for a claim of service connection." Layno v. Brown, 6 Vet. App. 465, 469 (1994). Since the Veteran's testimony raises the possibility that her bruxism began during active duty, or that her service-connected PTSD caused or aggravated her bruxism, the Board finds that a remand is necessary in order for the RO to obtain a VA medical opinion. See McLendon v. Nicholson, 20 Vet. App. 79 (2006). In addition, the Veterans Claims Assistance Act of 2000 (VCAA) requires that VA assist a claimant by providing the claimant a medical examination or obtaining a medical opinion when such an examination or opinion is necessary to make a decision on a claim. 38 U.S.C.A. §§ 5103, 5103A (West 2002 & Supp. 2009); 38 C.F.R. § 3.159 (2012). With respect to the Veteran's hearing testimony as to dental problems and treatment during active duty, the Board observes that her service treatment records contain no dental treatment records. In September 2004, she indicated that she had a dental problem consisting of an overbite 100 percent and molars that were out of alignment. In April 2005 she stated that she had severe tooth or gum trouble, described by an examiner as molar inequality(?). She denied dental problems in May 2005. During the March 2013 hearing, the Veteran also stated that after active duty she received dental care from the Jesse Brown VA Medical Center (VAMC) for over one year. She stated that she had one tooth extracted by a private dentist. Beginning in November or December 2012, she started receiving treatment at the Dental Clinic at Great Lakes Medical Center, a military facility. The Veteran's claims file and/or Virtual VA eFolder contain VA treatment records from April 2011 to March 2012, from the North Chicago Division, Captain James A. Lovell Federal Health Care Center. Her claims file and/or Virtual VA eFolder also contain VA treatment records from February 2006 to October 2009, from the Chicago Division, Jesse Brown VAMC. The Veteran's claims file additionally contains records of dental treatment at the Jesse Brown VAMC from June to August 2007. The record before the Board includes no records from the Great Lakes Medical Center or any private dentist. In this regard, VA has a duty to assist the appellant in obtaining evidence necessary to substantiate a claim. 38 U.S.C.A. § 5103A (West 2002 & Supp. 2009); 38 C.F.R. § 3.159(c)(2) (2012). There are also heightened obligations to assure that the record is complete with respect to Federal Government records. 38 U.S.C.A. § 5103A; 38 C.F.R. § 3.159(c). VA treatment records are deemed to be constructively of record in proceedings before the Board. Bell v. Derwinski, 2 Vet. App. 611, 613 (1992). Accordingly, the case is REMANDED for the following action: 1. Obtain any and all available inservice dental records, from all appropriate sources. Document the efforts made to obtain these records along with any negative responses. 2. Obtain and associate with the claims file and the Virtual VA eFolder copies of all VA medical records (including all dental records) that are not already of record, to include all records from the Captain James A. Lovell Federal Health Care Center and Jesse Brown VAMC. 3. Obtain and associate with the claims file and the Virtual VA eFolder copies of all medical records from the Dental Clinic at Great Lakes Medical Center. 4. After obtaining any necessary authorization and information from the Veteran, obtain all available treatment records pertaining to the Veteran from the private dentist the Veteran referred to during the March 2013 hearing. Document the efforts made to obtain these records along with any negative responses. 5. Then, schedule the Veteran for an examination by an appropriate VA examiner to determine the nature, extent and etiology of any dental bruxism that may be present. The claims file and Virtual VA eFolder must be made available to the examiner. Following a review of the relevant medical evidence in the claims file and Virtual VA eFolder, the medical history (including that set forth above), and the results of the clinical evaluation and any tests that are deemed necessary, the examiner is asked to opine: (1) whether it is at least as likely as not (50 percent or more likelihood) that any bruxism is related to the Veteran's active duty; and (2) whether it is at least as likely as not (50 percent or more likelihood) that any bruxism is proximately due to or chronically aggravated by the Veteran's service-connected PTSD. A complete rationale for all opinions expressed must be provided. 6. Then, readjudicate the Veteran's claim. If the benefit sought on appeal remains denied, the appellant and her representative should be provided a supplemental statement of the case and afforded an opportunity to respond. The case should be returned to the Board for appellate review. The appellant has the right to submit additional evidence and argument on the matter or matters the Board has remanded. Kutscherousky v. West, 12 Vet. App. 369 (1999). This claim must be afforded expeditious treatment. The law requires that all claims that are remanded by the Board of Veterans' Appeals or by the United States Court of Appeals for Veterans Claims for additional development or other appropriate action must be handled in an expeditious manner. See 38 U.S.C.A. §§ 5109B, 7112 (West Supp. 2012). _________________________________________________ MILO H. HAWLEY Veterans Law Judge, Board of Veterans' Appeals Under 38 U.S.C.A. § 7252 (West 2002), only a decision of the Board of Veterans' Appeals is appealable to the United States Court of Appeals for Veterans Claims. This remand is in the nature of a preliminary order and does not constitute a decision of the Board on the merits of your appeal. 38 C.F.R. § 20.1100(b) (2012).