Citation Nr: 20044065 Decision Date: 06/30/20 Archive Date: 06/30/20 DOCKET NO. 18-39 294 DATE: June 30, 2020 ORDER An initial 10 percent rating is granted for bruxism, subject to the law and regulations governing the award of monetary benefits. FINDING OF FACT For the entire period on appeal, it is at least as likely as not that the Veteran’s bruxism has been manifested by functional loss equivalent to interincisal range of motion limited to between 31 and 40 millimeters (mm), with no need for dietary restrictions. CONCLUSION OF LAW Resolving reasonable doubt in the Veteran’s favor, the criteria for an initial 10 percent disability rating for bruxism have been met. 38 U.S.C. § 1155, 5107; 38 C.F.R. §§ 4.1, 4.2, 4.3, 4.7, 4.150, Diagnostic Code (DC) 9905 (2018); 38 C.F.R. § 4.150, DC 9905 (2017). REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty in the United States Marine Corps from October 2001 to October 2005. His decorations include the Purple Heart, the Combat Action Ribbon, and the National Defense Service Medal. This matter comes to the Board of Veterans’ Appeals (Board) on appeal from an August 2015 rating decision issued by the Department of Veterans Appeals (VA) Regional Office (RO) in North Little Rock, Arkansas. The RO granted service connection and a 0 (zero) percent (noncompensable) rating for bruxism, effective February 3, 2015. Entitlement to a compensable rating for bruxism The Veteran maintains that the current noncompensable rating assigned for bruxism does not adequately reflect the severity of his disability. He maintains, in part, that VA has not addressed the problem relating to the advanced wear of his teeth. Disability evaluations are determined by the application of a schedule of ratings, which is in turn based on the average impairment of earning capacity caused by a given disability. 38 U.S.C. § 1155; 38 C.F.R. § 4.1. Separate diagnostic codes identify the evaluations to be assigned to the various disabilities. If there is a question as to which of two evaluations shall be applied, the higher evaluation will be assigned if the disability picture more nearly approximates the criteria required for that rating. Otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7. If different disability ratings are warranted for different periods of time over the life of a claim, “staged” ratings may be assigned. Hart v. Mansfield, 21 Vet. App. 505 (2007); Fenderson v. West, 12 Vet. App. 119, 125-26 (1999). The Veteran’s bruxism has been rated under 38 C.F.R. § 4.150, DC 9905, as temporomandibular disorder. VA amended the criteria for rating dental and oral conditions, effective September 10, 2017. See Schedule for Rating Disabilities; Dental and Oral Conditions, 82 Fed. Reg. 36,080 (Aug. 3, 2017). The new criteria apply to all applications for benefits received by VA, or that are pending before the agency of original jurisdiction, on or after September 10, 2017. The Board may not apply a current regulation prior to its effective date, unless the regulation explicitly provides otherwise. Kuzma v. Principi, 341 F.3d 1327 (Fed. Cir. 2003). Prior to September 10, 2017, a 10 percent rating was assigned where the inter-incisal range of motion of the temporomandibular articulation was limited to between 31 and 40mm or where lateral excursion was limited to between 0 and 4mm. A 20 percent rating was assigned for inter-incisal range of motion limited to between 21 and 30mm; a 30 percent rating between 11 and 20mm; and a maximum 40 percent rating between 0 and 10mm. 38 C.F.R. § 4.150, DC 9905 (2017). Under the current regulation, a 10 percent rating can be assigned for lateral excursion that is limited to between 0 and 4mm. 38 C.F.R. § 4.150, DC 9905 (2018). If a Veteran’s maximum unassisted vertical inter-incisal opening is measured to be between 30 and 34mm, the Veteran is awarded a 10 percent rating without dietary restrictions to mechanically altered foods; a 20 percent rating with dietary restrictions to soft and semi-solid foods; and 30 percent with dietary restrictions to full liquid and pureed foods. Id. If a Veteran’s maximum unassisted vertical inter-incisal opening is measured to be between 21 and 29mm, the Veteran is awarded a 20 percent rating without dietary restrictions to mechanically altered foods; a 30 percent rating with dietary restrictions to soft and semi-solid foods; and 40 percent with dietary restrictions to full liquid and pureed foods. Id. If a Veteran’s maximum unassisted vertical inter-incisal opening is measured to be between 11 and 20mm, the Veteran is awarded a 30 percent rating without dietary restrictions to mechanically altered foods; and 40 percent with dietary restrictions to all mechanically altered foods. Id. If a Veteran’s maximum unassisted vertical inter-incisal opening is measured to be between 0 and 10mm, the Veteran is awarded a 40 percent rating without dietary restrictions to mechanically altered foods; and 50 percent with dietary restrictions to all mechanically altered foods. Id. The Board has reviewed all the evidence in the Veteran’s claims file. Although the Board has an obligation to provide adequate reasons and bases supporting this decision, there is no requirement that the evidence submitted by the Veteran or obtained on his behalf be discussed in detail. Rather, the Board’s analysis below will focus specifically on what evidence is needed to substantiate the claim and what the evidence in the claims file shows, or fails to show, with respect to the claim. See Gonzales v. West, 218 F.3d 1378, 1380-81 (Fed. Cir. 2000); Timberlake v. Gober, 14 Vet. App. 122, 128-30 (2000). The Veteran was examined for VA compensation purposes in August 2015. He reported that he ground his teeth, slept with a dental guard, and had wear on his teeth that was advanced for his age. August 2015 VA Examination Report. He did not report any pain/soreness in his face or joints, or problems with chewing or talking, but indicated that he had had clicking/popping of his joints in the past. Objectively, the examiner remarked that the Veteran had heavy attrition affecting his dentition and that it was suggestive of parafunctional activity, such as bruxing. No measurements with respect to interincisal range of motion were recorded. The Veteran underwent another VA examination in June 2018. He reported flare-ups in terms of sensitivity to hot and cold liquids, but otherwise denied functional loss/impairment. Objectively, the examiner noted that the interincisal range of motion was “[g]reater than 34mm” and that lateral excursion was “[g]reater than 4mm,” bilaterally. There was no evidence of pain on motion or with chewing; no evidence of localized tenderness or pain on palpation of the joint or associated soft tissue; and no evidence of crepitus or clicking. No change in range of motion was noted after repetitive use testing, and it was noted that pain, weakness, fatigability, and incoordination did not limit functional ability with repeated use or during flare-ups. The examiner further noted that the Veteran did not require a mechanically altered foods diet and that no degenerative or traumatic arthritis of the temporomandibular joint was noted on X-ray. The evidence also reflects that the Veteran received care for his bruxism from private dentists. Doctor C.F. stated that the Veteran had been under his care since January 2014, exhibited an advanced wear pattern due to bruxism, and would require comprehensive restorative treatment in the future. Until then, the use of a nightguard was recommended. Following review of the evidence, and the applicable law and regulations, the Board finds that the evidence supports the assignment of a 10 percent rating for the Veteran’s bruxism. None of the evidence affirmatively demonstrates that the Veteran’s range of interincisal excursion has been limited to between 31 and 40mm, so as to warrant a compensable rating under the former version of DC 9905. However, the Veteran has described instances of clicking/popping of his temporomandibular joint and has indicated he experiences some level of pain. See July 2016 notice of disagreement (“I currently have little to no pain now . . . .”). In addition, the most recent VA examination report indicates only that his interincisal range of motion is “greater than 34mm,” without specifying whether his range of motion is also greater than 40mm. Accordingly, and resolving reasonable doubt in his favor, a 10 percent rating is granted. The preponderance of the evidence is against the assignment of a rating in excess of 10 percent, however. None of the evidence suggests that the Veteran’s interincisal range of motion has ever been limited to less than 31mm or that he has dietary restrictions to mechanically altered foods. In addition, a rating for limited lateral excursion cannot be combined with a rating for limited interincisal movement, whether under the former or current rating criteria. In arriving at these conclusions, the Board has considered the Veteran’s argument to the effect that he should be compensated for the excessive wear of his teeth. In that regard, the Board notes that VA compensation is available for only certain specified types of dental disorders. For other types of dental disorders, a claimant may receive treatment, but not compensation. 38 U.S.C. § 1712; 38 C.F.R. §§ 3.381, 4.150, 17.161. Essentially, in order to obtain compensation for individual teeth, it must be shown, among other things, that the teeth in question have been lost. See generally 38 C.F.R. § 4.150 (providing for compensation for lost teeth due to service-connected trauma or disease resulting in loss of substance of the body of the maxilla or mandible). Here, the Veteran has not lost the teeth at issue. Accordingly, compensation for that aspect of his disability is not payable. DAVID A. BRENNINGMEYER Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board Bradley Willis, Associate Counsel The Board’s decision in this case is binding only with respect to the instant matter decided. This decision is not precedential and does not establish VA policies or interpretations of general applicability. 38 C.F.R. § 20.1303.