Citation Nr: 21061393 Decision Date: 10/01/21 Archive Date: 10/01/21 DOCKET NO. 18-45 429 DATE: October 1, 2021 REMANDED Entitlement to service connection for temporomandibular joint dysfunction (TMD) is remanded. REASONS FOR REMAND The Veteran had active service in the United States Marine Corps from June 1986 to August 1986 and from April 1991 to October 2013. This matter comes to the Board of Veterans' Appeals (the Board) on appeal from a December 2016 rating decision in which the Agency of Original Jurisdiction (AOJ) denied the Veteran's claim for entitlement to service connection for TMD. The Veteran participated in a hearing before the undersigned Veterans Law Judge in May 2018. A transcript of this hearing is of record. 1. Entitlement to Service Connection for TMD The Veteran contends that he is entitled to service connection for TMD. He states his jaw pain had its initial onset during active service. Moreover, he asserts that he was treated for bruxism and clenching of the teeth during service, and this bruxism caused his current TMD. In the alternative, the Veteran has raised the theory that his current TMD is secondary to his service-connected generalized anxiety disorder with major depressive disorder and posttraumatic stress disorder (PTSD). The Veteran received a VA examination in May 2018. When VA provides an examination, it must ensure that the examination is adequate. Barr v. Nicholson, 21 Vet. App. 303, 311 (2007). To be adequate, a medical examination report must contain clear conclusions, supporting data, and a reasoned medical explanation connecting the two. Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 301 (2008). The examination should be based upon consideration of the Veteran's prior medical history and describe the disability and symptoms in sufficient detail to allow the Board to make a fully informed decision. Stefl v. Nicholson, 21 Vet. App. 120, 123 (2007). The examiner who performed the May 2018 VA examination opined that it is less likely than not that the Veteran's current jaw pain is related to his active service. He rationalized that there is no objective evidence of jaw pain during service. It was also noted that the Veteran's dental examinations had showed normal temporomandibular joint (TMJ) results. Problematically, that the examiner focused solely on whether there was an in-service diagnosis of TMD. He did not appear to consider whether the Veteran's current TMD is etiologically related to the Veteran's reports of in-service bruxism and clenching of the teeth. As such, the May 2018 VA examination is insufficient to accurately determine whether there is a nexus between the Veteran's active service and his current TMD diagnosis. Nieves-Rodriguez, 22 Vet. App. at 301. Moreover, since the May 2018 VA examination, the Veteran has raised the theory that he is entitled to service connection for TMD on a secondary basis. He argues that his service-connected generalized anxiety disorder with major depressive disorder and PTSD has caused bruxism, which subsequently led to the development of TMD. Because no VA examiner has opined on the relationship between the Veteran's TMD and his service-connected generalized anxiety disorder with major depressive disorder and PTSD, the Board cannot make a fully-informed decision on the issue of entitlement to service connection on a secondary basis. Accordingly, the Board concludes that a remand is necessary to obtain a new medical opinion that addresses the Veteran's reports of in-service bruxism and clenching of the teeth, as well as a potential relationship between his TMD and his service-connected generalized anxiety disorder with major depressive disorder and PTSD. The matter is REMANDED for the following action: Schedule the Veteran for a VA examination to determine the nature and etiology of his TMD. After reviewing the Veteran's claims file and examining the Veteran, with any necessary testing, the examiner should opine on the following: 1. Identify/diagnose any TMD disorder that presently exists or that has existed during the appeal period. If a diagnosis of TMD is not made, the examiner should reconcile such a finding with the diagnosis of TMD made by Dr. S.R. in November 2018. The examiner should also comment on whether the Veteran experiences any functional impairment of the jaw due to pain. 2. For any TMD disorder or functional impairment of the jaw, is it at least as likely as not that it had its initial onset in service or is otherwise etiologically related to his active service, to include his reports of in-service bruxism and clenching of the teeth? 3. For any TMD disorder or functional impairment of the jaw, is it at least as likely as not that it: (a.) Is proximately due to his service-connected generalized anxiety disorder with major depressive disorder and PTSD; or (b.) Underwent any incremental increase in disability or any additional impairment of earning capacity, regardless of its permanence, due to his service-connected generalized anxiety disorder with major depressive disorder and PTSD? 4. Provide a rationale to support the opinions proffered. MICHAEL A. HERMAN Veterans Law Judge Board of Veterans' Appeals Attorney for the Board R.M. Sachs, 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.