Citation Nr: 21007286 Decision Date: 02/09/21 Archive Date: 02/09/21 DOCKET NO. 17-17 204 DATE: February 9, 2021 REMANDED Entitlement to service connection for a jaw disorder, to include temporomandibular joint disease (TMJ), is remanded. REASONS FOR REMAND The Veteran had active service from January 1957 to January 1977, including in the Republic of Vietnam. The Board of Veterans’ Appeals (Board) previously remanded this case for additional development in December 2017 and September 2020. Those Board remands are incorporated herein by reference. Service connection for a jaw disorder, to include TMJ The Veteran contends that he has a jaw condition related to an in-service injury. On VA examination in May 2019, the examiner opined that the Veteran’s jaw condition was less likely than not incurred in, or caused by, the claimed in-service injury, event, or illness. As rationale, the examiner explained that there was no documentation of complaints of, treatment for, or diagnoses of TMJ in the service medical records. On VA examination in February 2020, the examiner also opined that the Veteran’s jaw condition was less likely than not incurred in, or caused by, the claimed in service injury, event, or illness. The examiner explained that the Veteran does not appear to have any TMJ dysfunction other than complaints of some pain with chewing and slight tenderness of the TMJ—and that these complaints were first noted in 2015, almost 40 years after separation from military service. The examiner found no evidence of any relevant injury in the Veteran’s medical records. Although a likely old left mandibular fracture was noted on X-rays in 2015, the examiner explained that it is unlikely that this fracture occurred during service, when care would certainly have been required. However, the Board notes that the Veteran has a documented diagnosis of TMJ. Significantly, the examiner did not inquire as to any other time the Veteran’s jaw may have been fractured and simply assumed the old fracture shown occurred after service because there were no records of in-service treatment. It is also worthy of note that the Veteran has been forthcoming in stating that he did not seek treatment for his jaw when he injured it in service and that he was in the Republic of Vietnam when the injury occurred. In accordance with the September 2020 remand, an additional medical opinion was obtained concerning the diagnosis and etiology of the Veteran’s claimed jaw condition. That opinion stated, in its entirety, “Medical literature does not document the ability of a previously diagnosed TMJ gradually leading to and/or subsequently causing a mandibular fracture. However, a mandible fracture or dislocation can cause TMJ disease. Despite the Veteran’s June 2016 statement regarding jaw injury, a search of the pertinent records provided have no indication of such injury or TMJ disease during his service. Hence, it is not at least as likely as not that the temporomandibular joint disease was incurred during service.” Unfortunately, the Board finds that the September 2020 addendum opinion did not adequately address the remand directives, and focused on whether the Veteran’s diagnosed TMJ caused a fracture, but ignored whether the old fracture could be consistent with an injury during service. While the examiner noted that such injury would require medical attention, there was no consideration given to the fact that the record does not contain any record post-service of treatment for, and injury of, the Veteran’s jaw until the 2015 fracture was found – the lack of treatment for which the examiner relied as the basis for the opinion that the condition was not service-related. Regretfully, the Board must again remand this matter for an additional, well-reasoned medical opinion concerning the Veteran’s diagnosed jaw condition. Accordingly, this matter is REMANDED for the following action: Forward the Veteran’s claims file to the February 2020 VA examiner—or another examiner if the February 2020 examiner is not available—for a clarifying medical opinion regarding the etiology of the Veteran’s jaw disorder. Upon review of the record, the examiner is asked to: (a.) explain whether, absent any jaw injury between 1979 diagnosis of TMJ and the 2015 diagnosis of an old fracture of the left mandible, the diagnosed old fracture is consistent with an injury as the Veteran describes from his service in Vietnam. The examiner is reminded that there is no evidence of record that the Veteran injured his jaw after service, and the Veteran is competent to report his injury and symptoms thereof. (b.) Provide rationale as to whether it is at least as likely as not (50% probability or more) that such an in-service injury as the Veteran has reported, caused, or is otherwise etiologically related to, his diagnosed TMJ in 1979. In other words, if the Veteran’s injury is consistent with a fracture or dislocation that occurred during service, is it as likely as not that such injury is related to his TMJ and/or his other current symptoms? THERESA M. CATINO Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board M.E. Lee 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.