Citation Nr: 21004132 Decision Date: 01/26/21 Archive Date: 01/26/21 DOCKET NO. 13-15 102 DATE: January 26, 2021 REMANDED Entitlement to service connection for temporomandibular joint disease is remanded. REASONS FOR REMAND The Veteran served on active duty in the United States Army from June 1975 to June 1997. For his meritorious service, the Veteran was awarded (among other decorations) the Army Commendation Medal and Army Achievement Medal. This matter comes before the Board of Veteran’s Appeals (Board) on appeal from a November 2012 rating decision by the Department of Veterans Affairs (VA) Regional Office (RO). This matter was previously before the Board in April 2018 and June 2020. Both the April 2018 and June 2020 Board decisions remanded the matter for additional development. The Veteran additionally appealed the issue of entitlement to service connection for left hip disability, left shoulder disability, and bilateral lower extremity neurological disability (claimed as restless leg syndrome). The claim for service connection for a left hip disability was granted by the RO in a February 2020 rating decision. Then, the Board granted service connection for the Veteran’s left shoulder disability in the June 2020 decision. Additionally, in an October 2020 rating decision, the RO granted service connection for right and left lower extremity sciatica (claimed as bilateral restless leg syndrome). Therefore, these awards for service connection constitute a full grant of benefits sought on appeal, these issues are no longer on appeal. 1. Entitlement to service connection for TMJ is remanded. The Veteran contends his TMJ is related to service or alternatively, is secondary to his service-connected headache disability. VA obtained a new opinion in October 2020. The VA examiner stated the Veteran’s claimed condition of TMJ was less likely than not incurred in or caused by the claimed in-service injury, event, or illness. The VA examiner referenced the private opinion from Dr. W. C. C.; Dr. W. C. C. stated the Veteran’s TMJ was due to his service. The 2020 VA examiner stated there is no objective evidence of related complaints or treatment during service and stated the private opinion was not written until 9 years following the Veteran’s separation from service. Regarding secondary service connection, the VA examiner stated the claimed condition is less likely than not proximately due to or the result of the Veteran’s service-connected condition. The VA examiner concluded tension headaches are not an established etiology of TMJ in medical literature, but noted TMJ may cause tension headaches. The VA examiner reported a baseline of severity of TMJ could not be determined. The VA examiner concluded the Veteran’s TMJ was not at least as likely as not aggravated beyond its natural progression. The 2020 VA opinion is inadequate for evaluation purposes. The VA examiner stated the Veteran’s TMJ is less likely than not incurred in or caused by the claimed in-service injury, event, or illness. While the VA examiner concluded there is no objective evidence of complaints during service, the only rationale provided that the Veteran’s TMJ is not related to service was that the private opinion was written 9 years post separation from service. This is not a sufficient rationale in support of that determination. The October 2020 addendum opinion provided was unclear, insufficient, and did not provide rationale for the conclusions reached. Further, the examiner determined that the Veteran’s claimed TMJ is less likely as not related to his tension headaches because the causal relationship is flipped; that is, that his TMJ may cause his headaches and not the other way around. Considering that the Veteran had tension headaches during his active service (and has been service-connected for this disability since his retirement), one must question then whether the Veteran’s in-service tension headaches were caused by TMJ, thus lending credence to the idea that the Veteran’s TMJ began during service. As such, the October 2020 opinion is inadequate, and a remand is warranted for a new opinion to be obtained. The matter is REMANDED for the following action: 1. Obtain an addendum opinion addressing the questions below. If the reviewing examiner determines that the opinions requested may not be offered without first examining the Veteran, please schedule a VA examination with an appropriate clinician. a) The Veteran contends he had TMJ while in service and he submitted a private opinion linking his disability to service. The examiner is to provide an opinion as to whether it is at least as likely as not the Veteran’s TMJ was incurred in-service or is otherwise causally related to his active duty. In answering this question, the examiner is to discuss the Veteran’s in-service history of tension headaches and whether that diagnosis is evidence that TMJ was present in service. b) Whether the Veteran’s TMJ disability is at least as likely as not proximately due to, the result of, or aggravated by any service-connected disabilities, namely his tension headaches. A complete rationale for all requested opinions must be provided. The examiner must address the relevant evidence of record, including service treatment records referencing TMJ pain and the February 2006 letter from Dr. W. C. C. indicating the Veteran had TMJ and that the disability was due to service. Evan M. Deichert Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board J. Mouzakis, 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.