Citation Nr: 21005959 Decision Date: 02/03/21 Archive Date: 02/03/21 DOCKET NO. 15-28 536 DATE: February 3, 2021 REMANDED The issue of entitlement to service connection for bruxism, including as secondary to service-connected posttraumatic stress disorder (PTSD), with anxiety disorder NOS and ETOH dependence, is remanded. REASONS FOR REMAND The Veteran served on active duty from December 1965 to November 1967. In January 2019, the Veteran testified under oath before the undersigned Veterans Law Judge at a videoconference hearing. A transcript of the hearing is of record. In May 2019, the Board remanded the issue on appeal for additional development. At that time, the issue of entitlement to service connection for an acquired psychiatric disability, to include PTSD and anxiety disorder NOS with ETOH dependence was also remanded. However, in a July 2020 rating decision, the issue of entitlement to service connection for PTSD, with anxiety disorder NOS and ETOH dependence was granted. As this constitutes a complete grant of the benefit sought, the issue is no longer before the Board. The Board acknowledges an April 2019 extension request from the Veteran, which requested an extension “in order to gather the required medical evidence to perfect my appeal.” This request was not ruled upon prior to the May 2019 Board decision, at which time five issues on appeal were granted, and the remaining two were remanded for additional development. It is unclear whether the request had been associated with the file prior to the May 2019 decision. Regardless, the Board notes that the May 2019 remand instructions included development for additional treatment records, and in October 2019, the Veteran was provided with VA Forms 21-4142 and 21-4142a. Accordingly, since his April 2019 request for an extension, the Veteran has been given ample opportunity to submit additional evidence. Here, in the present remand, the Board is once again directing development for additional records, and the Veteran will have even further opportunity to submit any evidence he wishes to be considered. Accordingly, the Board finds that the Veteran’s motion is now moot. Referral The Board notes that a claim for service connection for a dental disability is also a claim for VA outpatient dental treatment. Mays v. Brown, 5 Vet. App. 302 (1993). The Veteran’s present claim has been treated by the agency of original jurisdiction (AOJ) as a claim for service connection and compensation. The issue of entitlement to VA outpatient dental treatment is not currently in appellate status. To the extent that the Veteran seeks VA outpatient dental treatment for his claimed bruxism, the Board refers this claim to the AOJ for appropriate action. Specifically, the AOJ should refer the claim for dental treatment to the appropriate VA Medical Center. Entitlement to service connection for bruxism, including as secondary to service-connected PTSD, with anxiety disorder NOS and ETOH dependence. The Board finds that additional development is needed prior to final adjudication of the remaining issue on appeal. Specifically, the Board finds that clarification is needed regarding the Veteran’s diagnosis. The Board acknowledges the December 2019 VA examination and July 2020 VA opinion, both of which indicate that the Veteran does not have bruxism. However, an August 2013 VA examination for PTSD notes bruxism. At the January 2019 videoconference hearing, the Veteran testified that his “jaw is tired” when he wakes up in the morning and that his teeth are flat and worn. In a November 2012 submission, the Veteran states “I have been told by more than one dentist my teeth are worn down from grinding my teeth while sleep [sic]. I was fitted for a mouth guard & must wear it every night.” Upon remand, the Board asks that an examination address the August 2013 VA examination, and the Veteran’s lay statements regarding his symptoms. In addition, if the Veteran does have bruxism, the Board asks for clarification as to whether the bruxism can be considered an independent disability; or is it rather a manifestation of his service-connected PTSD, with anxiety disorder NOS and ETOH dependence. In particular, the Board requires clarification of the December 2019 VA opinion. Here, it states that “[b]ruxism is a symptom,” and that “literature shows that Bruxism has multiple potential risk factors including PTSD.” However, the opinion then goes on to state that it has “no accepted etiology, therefore etiology cannot be given without pure speculation.” The Board asks that an examiner address specifically whether it is at least as likely as not that the bruxism is an independent disability; or whether it is at least as likely as not a manifestation (symptom) of his service-connected PTSD, with anxiety disorder NOS and ETOH. The Board notes also that in the January 2020 VA examination for PTSD, bruxism was not identified. Accordingly, upon remand, the Board requires clarification. Further, if the Veteran’s bruxism cannot be considered an independent disability, the Board asks that the examiner address whether the Veteran’s claimed bruxism results in a dental disability, such as temporomandibular disorder. Again, the Board notes the Veteran’s statements above regarding his jaw and damage to his teeth. In addition, the Board notes that a March 1968 VA record shows that noncompensable dental conditions of teeth #4 and #5, were incurred in or aggravated by his military service. Finally, the Board finds that there may be records outstanding to associate with the claim file. At the January 2019 videoconference hearing, the Veteran stated that his dentist sold his practice, but that his records were still available. He indicated an intention to try to obtain them. The Veteran’s testimony suggests that he was describing private treatment, and it does not appear that since the hearing any private treatment records pertaining to dental treatment were added to the claim file. The Board notes also that in April 2019 the Veteran submitted an extension request to obtain medical evidence. The Veteran noted that he had “recently moved and . . . [had] been unable to gather the evidence needed.” To the extent that there are records outstanding, the Board asks that they be obtained upon remand. The matter is REMANDED for the following action: 1. After securing any necessary consent forms from the Veteran, obtain any outstanding treatment records, to include any VA and/or private treatment records, pertaining to the issue on appeal. In addition, the Board notes that two documents on the electronic docket are faded and difficult to read. See Docket, 05/30/2019 and 08/22/2019. Legible copies should be associated with the claim file, if possible. All efforts should be documented in the claim file. If any records could not be obtained, this should be noted in the claim file. 2. Upon completion of the above, schedule the Veteran for a VA examination to clarify his diagnosis. Specifically, the Board asks that the examiner address: (a) Whether it is at least as likely as not (i.e., a 50 percent or greater probability) that the Veteran has bruxism. In providing the opinion, the examiner is asked to address: (1) the December 2019 VA examination and July 2020 VA opinion, which indicate that the Veteran does not have bruxism; (2) the August 2013 VA examination for PTSD that notes bruxism; (3) the Veteran’s lay statements, including his testimony at the January 2019 videoconference hearing, where he indicates that his “jaw is tired” when he wakes up in the morning and that his teeth are flat and worn. Also, a November 2012 submission, in which the Veteran states, “I have been told by more than one dentist my teeth are worn down from grinding my teeth while sleep [sic]. I was fitted for a mouth guard & must wear it every night.” (b) If the examiner determines that it is at least as likely as not that the Veteran has bruxism, the examiner is then asked to address whether it is at least as likely as not that the bruxism is an independent disability; or whether it is at least as likely as not that it is a manifestation (symptom) of his service-connected PTSD, with anxiety disorder NOS and ETOH dependence. (c) If the examiner determines that it is at least as likely as not an independent disability, the examiner is then asked to address whether is it at least as likely as not that the bruxism is caused by the Veteran’s active duty service. In drafting an opinion, the Board asks that the examiner address a March 1968 VA record, which shows that noncompensable dental conditions of teeth #4 and #5, were incurred in or aggravated by his military service. The examiner should also provide an opinion as to whether it is at least as likely as not proximately due to, or the result of, or aggravated (permanently worsened) beyond normal progression by the Veteran’s service-connected PTSD, with anxiety disorder NOS and ETOH dependence. (d) If the examiner determines that the Veteran has bruxism, but it is not at least as likely as not that the bruxism is an independent disability, the Board asks that the examiner address whether the Veteran’s claimed bruxism results in a dental disability, such as temporomandibular disorder. The examiner is asked to address the Veteran’s lay statements, including his testimony at the January 2019 videoconference hearing, where he indicates that his “jaw is tired” when he wakes up in the morning and that his teeth are flat and worn. Also, a November 2012 submission, in which the Veteran states, “I have been told by more than one dentist my teeth are worn down from grinding my teeth while sleep [sic]. I was fitted for a mouth guard & must wear it every night.” In addition, the Board asks that the examiner address a March 1968 VA record, which shows that noncompensable dental conditions of teeth #4 and #5, were incurred in or aggravated by his military service. The VA examiner should be given access to the claim file. The examiner should state that a review of the claim file was completed. The examiner must provide a comprehensive report including complete rationales for all opinions and conclusions reached, citing the objective medical findings leading to the conclusions. A detailed rationale is requested for all opinions provided.   3. If upon completion of the above action the issue is denied, the case should be returned to the Board after compliance with appellate procedures. E. I. VELEZ Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board K. Foster, 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.