Citation Nr: 18138014 Decision Date: 09/24/18 Archive Date: 09/24/18 DOCKET NO. 16-22 556 DATE: September 24, 2018 REMANDED Entitlement to service connection for bruxism, to include as due to or a symptom of a psychiatric disorder, is remanded. REASONS FOR REMAND The Veteran served on active duty from July 2007 to December 2014. This matter is before the Board of Veterans’ Appeals (Board) on appeal of a June 2015 rating decision of a Regional Office (RO) of the Department of Veterans Affairs (VA). A claim of service connection for a dental disorder is also considered a claim for VA outpatient dental treatment. Mays v. Brown, 5 Vet. App. 302, 206 (1993). In dental claims, the RO adjudicates the claim for service connection and the VA Medical Center adjudicates the claim for outpatient treatment. As the current issue of service connection for bruxism stems from an adverse determination by the RO, the dental issue addressed herein must be limited to service connection for compensation purposes only. The claim for VA outpatient dental treatment is referred to the Agency of Original Jurisdiction (AOJ) for further referral to the appropriate VA medical facility. See 38 C.F.R. §§ 17.161 and 38 C.F.R. § 19.9(b) (2017). The duty to assist requires VA to provide an examination when the record contains competent evidence that the claimant has a current disability or signs and symptoms of a current disability, the record indicates that the disability or signs and symptoms of disability may be associated with military service, and the record does not contain sufficient information to make a decision on the claim. 38 U.S.C. § 5103A(d) (2012); 38 C.F.R. § 3.159(c)(4) (2017); see also McLendon v. Nicholson, 20 Vet. App. 79, 83 (2006). VA has a duty to ensure any medical examination or opinion it provides is adequate. Barr v. Nicholson, 21 Vet. App. 303, 312 (2007) (overruled on other grounds, Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013)). A medical opinion is adequate where it is based upon consideration of the full medical history and describes a disability in sufficient detail so that the Board's evaluation will be fully informed. Stefl v. Nicholson, 21 Vet. App. 120, 123 (2007). Entitlement to service connection for bruxism, to include as due to or as a symptom of a psychiatric disorder, is remanded. The Veteran claims service connection for bruxism and reports continued teeth grinding in his January 2016 notice of disagreement (NOD) and May 2016 VA form 9. Dental records document bruxism and the Veteran’s use of a mouth guard during his active service. The RO provided a May 2015 VA temporomandibular joint (TMJ) examination. The examiner did not diagnose any TMJ disability, but he noted the Veteran’s reports of clenching and grinding his teeth at night. The examiner did not confirm a diagnosis of bruxism and did not discuss the etiology of this condition. An April 2015 VA mental disorders examination was also provided. The examiner did not diagnose any psychiatric disorders. She recorded the Veteran’s report of nighttime teeth grinding in the past with no recent instances of teeth grinding. No diagnosis or etiology for bruxism was included in the examination report. In his NOD, the Veteran claims his teeth grinding may be related to general stress during his active service. On his VA form 9, he describes a specific stressful incident where he responded to a suicide on board the U.S.S. Halsey. The Veteran’s reports of current teeth grinding and notations of bruxism in his service dental records trigger the VA duty to provide an appropriate medical examination. See McLendon, supra. The prior TMJ and mental health examinations did not confirm or rule out a diagnosis of bruxism and did not address the etiology of the condition. They are inadequate for the Board to make a determination on the claim for service connection. See Stefl, supra. New VA examinations, to evaluate this claim, are necessary. The matter is REMANDED for the following action: 1. Obtain and associate with the file all outstanding VA treatment records. 2. Ask the Veteran to complete a VA Form 21-4142 for any dentist or medical professional who has provided treatment for bruxism or mental health conditions associated with bruxism. Make two requests for the authorized records from any treatment provider identified, unless it is clear after the first request that a second request would be futile. 3. Schedule the Veteran for an examination by a dental professional to determine whether the Veteran has a current diagnosis of bruxism or had a diagnosis of bruxism at any point in the appeal period (from December 25, 2014 to the present) If bruxism is not diagnosed, the examiner must address the Veteran’s report of teeth grinding and explain why these reports do not support a diagnosis of bruxism. If bruxism is diagnosed, at any point in the course of the appeal, the examiner should address its etiology and opine whether it is at least as likely as not (probability of 50 percent or greater) related to an in-service injury, event, or disease, including the bruxism noted in the service dental records. 4. If the dental examiner finds bruxism, but determines that it is unrelated to the Veteran’s active service, including the bruxism noted in service, then schedule an examination with an appropriate mental health professional to determine if the bruxism is due to or a symptom of a psychiatric disability. If the mental health examiner determines bruxism is due to or a symptom of a psychiatric disability, he should provide a diagnosis of the psychiatric condition(s) and opine whether the condition(s) are at least as likely as not (50 percent or greater probability) related an in-service injury, event or disease, including reports of stress in-service and an instance where the Veteran responded to a suicide. M. HYLAND Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD Jeanne Celtnieks, Associate Counsel