Citation Nr: 21025390 Decision Date: 04/28/21 Archive Date: 04/28/21 DOCKET NO. 16-22 556 DATE: April 28, 2021 ORDER Entitlement to service connection for bruxism is denied. FINDINGS OF FACT 1. The Veteran does not have a dental condition for which compensation can be granted. 2. Bruxism is not proximately due to the result of or aggravated by service-connected disease or injury. CONCLUSION OF LAW Bruxism does not meet the requirements for compensation purposes. 38 U.S.C. §§ 1110, 1712, 5103, 5103A, 5107 (West 2014); 38 C.F.R. §§ 3.102, 3.103, 3.159, 3.381, 4.150 (2017).   REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran had active service from July 2007 to December 2014. This case comes before the Board of Veterans Appeals (Board) on appeal from a June 2015 rating decision of a Department of Veterans Affairs (VA) Regional Office (RO). With respect to the Veteran’s dental claim, it is unclear whether he may be seeking entitlement to VA outpatient dental treatment. The United States Court of Appeals for Veterans Claims (Court) specifically has held that a claim for service connection for a dental disorder is also a claim for VA outpatient dental treatment. Mays v. Brown, 5 Vet. App. 302 (1993). His present claim has been treated by the agency of original jurisdiction (AOJ) as a straightforward claim for service connection and compensation. The issue of entitlement to outpatient dental treatment has not been adjudicated by VA, and is not currently in appellate status. As such, the Board finds that if the Veteran intended to file a claim for dental treatment, then he should file such a claim. In September 2018, the Board remanded this case for further development. The September 2018 remand required that any outstanding VA treatment records be obtain, additional examinations be provided and new medical opinions on their findings be issued. Accordingly, the Board’s remand instructions have been substantially complied with. See Stegall v. West, 11 Vet. App. 268, 271 (1998).   1. Pertinent Legal Criteria Veterans are entitled to compensation from VA if they develop a disability “resulting from personal injury suffered or disease contracted in line of duty, or for aggravation of a preexisting injury suffered or disease contracted in line of duty.” 38 U.S.C. § 1110 (wartime service), 1131 (peacetime service). To establish a right to compensation for a present disability, a veteran must show: “(1) the existence of a present disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the present disability and the disease or injury incurred or aggravated during service”-the so-called “nexus” requirement. Shedden v. Principi, 381 F.3d 1163, 1167 (Fed.Cir. 2004). The Board notes that the Veteran has not claimed that his disabilities on appeal are the result of combat with the enemy. Therefore, the combat provisions of 38 U.S.C. § 1154 (2012) are not for consideration. Dental conditions for which service-connected compensation benefits are available and set forth under 38 C.F.R. § 4.150, Diagnostic Codes 9900-9916. These conditions include loss of whole or part of the mandible, nonunion or malunion of the mandible, loss of part of the ramus, loss of whole or part of the maxilla, nonunion or malunion of the maxilla, loss of the condyloid or coronoid process, or loss of any part of the hard palate. Id. Compensation is also available for loss of teeth only if such is due to loss of substance of body of maxilla or mandible. See Simmington v. West, 11 Vet. App. 41 (1998). For loss of the teeth, bone loss through trauma or disease, such as osteomyelitis, must be shown for compensable purposes. The loss of the alveolar process as a result of periodontal disease is not considered disabling. See 38 C.F.R. § 4.150, Diagnostic Code 9913. In addition, to be compensable, the lost masticatory surface for any tooth cannot be restorable by a suitable prosthesis. Id. Treatable carious teeth, replaceable missing teeth, dental or alveolar abscesses, and periodontal disease will be considered service connected solely for the purpose of establishing eligibility for outpatient dental treatment and cannot be considered for compensation purposes. 38 U.S.C. § 1712 (West 2014); 38 C.F.R. §§ 3.381, 4.150 (2017). After the evidence is assembled, it is the Board’s responsibility to evaluate the entire record. See 38 U.S.C. § 7104(a) (2012). When there is an approximate balance of evidence regarding the merits of an issue material to the determination of the matter, the benefit of the doubt in resolving each issue shall be given to the claimant. See 38 U.S.C. § 5107 (2012); 38 C.F.R. §§ 3.102, 4.3 (2019). 2. Direct Service Connection The Veteran contends that he is entitled to compensation for bruxism. On Veteran’s September 2014 discharge examination, the Veteran’s psychiatric evaluation was reported normal and dental condition was considered acceptable. Veteran’s dental class was reported as a class 2 on his discharge examination. Veterans with a dental class 2 are those who require non-urgent dental treatment or reevaluation for oral conditions, which are unlikely to result in dental emergencies within 12 months. On May 2008 Veteran was provided a periodic dental examination where Veteran was complaining of pain and sensitivity. The examination noted that wear facet was evident from examination of Veteran’s teeth. The Veteran reported that his spouse told him that Veteran grinds his teeth at night. On May 2009 Veteran was provided a periodic dental examination where he did not have any complaints. The examination noted that Veteran reported slight bruxing at night. A medical note made on February 2014 noted that Veteran was delivered a night guard for his mouth. The note stated the guard was for limited generalized occlusal wear and that Veteran had a history of bruxism. During an oral examination conducted on May 2014 the Veteran was noted wearing a soft occlusal guard. The Board notes that Veteran’s post-service treatment records are silent on any symptoms or treatment related to Veteran’s dental condition. On May 2015 the VA provided a temporomandibular joint (TMJ) disability examination to the Veteran. The examination noted that there was no pain on the range of motion testing, no swelling, and no palpitation. The range of motion for both left and right lateral excursion were reported as greater than 4mm. The range of motion for opening mouth measured by inter-incisal distance was reported as greater than 40mm. The examination noted that Veteran knows he is a clencher and grinder at night and that he has subsequent wear on his teeth. The Veteran’s jaw was noted to be within normal limits and was not diagnosed with a temporomandibular joint condition. On September 2018 the Board issued a remand on Veteran’s case. The Board noted that the May 2015 examination did not rule out a diagnosis of bruxism and did not address the etiology of the Veteran’s teeth grinding. The Board remanded to obtain any outstanding VA treatment records, additional examinations, and proper medical opinions. On October 2019 Veteran was provided a VA examination for temporomandibular disorders. Veteran reported flare-ups on the both the left and right TMJs that occurred daily lasting for an hour or two. Veteran’s range of motion testing on both the right and left lateral excursion were reported 0-4mm. Veteran’s range of motion measured by inter-incisal distance was reported as greater than 34mm. Pain was reported on the examination if Veteran opened his mouth, but no functional loss was noted. Veteran was subsequently diagnosed with bruxism and was noted as most likely etiology was stress, anxiety, and wear on teeth. On December 2019, a VA medical opinion was issued as a result of the October 2019 examination. The VA examiner opined that Veteran’s claimed bruxism with mouth guard was less likely than not incurred in or caused by the claimed in-service injury, event, or illness. The examiner noted that Veteran stated he is not aware of his bruxism, but that it is mainly his wife who can hear him at night. Further Veteran explained to examiner that his clenching maybe due to the fact that he is in school. The examiner also noted that while Veteran was provided two occlusal guards, the Veteran didn’t wear them stating it was uncomfortable and then later lost them. The Veteran stated that he was unsure of any incident or reason that may have caused his bruxism. Veteran did reference an incident being a first responder in a suicide and stated he might have had unconscious stress due to the incident. The Veteran further states that his bruxism may have been the result of the change in environment from being put on active service. The examiner opined that because claimant is unsure of the cause of bruxism, Veteran’s occlusal anatomy and the lack of wearing an occlusal guard the claimed condition is less likely than not incurred or cause by the claimed in-service injury, event, or illness. In regard to the theory of direct service connection, the claim is denied. Here, there was some evidence of bruxism during service and the evidence is u8nclear as to whether there is post-service bruxism. For the purpose of this decision, we accept the lay evidence that he has at least intermittent bruxism. Compensation is granted for only certain dental abnormalities. Here, bruxism is not an enumerated abnormality and the Board is without legal authority to grant compensation for this condition. Secondary service connection Veteran contends alternatively that bruxism is due to a psychiatric disorder or symptom. We have considered the theory under section 3.310. Here, the Veteran i9s service connected for the right knee, left wrist, left shoulder and left wrist. There is no lay or medical evidence that any service connected disease or injury caused or aggravated bruxism. More specifically, there is an assertion that bruxism is associated with a psychiatric disorder. At this time, service connection for a psychiatric disorder is not in effect and section 3.310 is not applicable. Further review establishes that the service treatment records and post-treatment records are silent on any psychiatric disorder. The Board notes that on Veteran’s September 2014 discharge examination psychiatric was reported as normal. The Board notes that Veteran’s psychiatric state was examined once in January 2015 with a traumatic brain injury screening. The Veteran denied experiencing any traumatic brain injury related events during deployment. Further testing of Veteran found that he was negative for PTSD, depression, and alcohol abuse. The Board provided a mental disorder examination to Veteran on April 2015. The examiner noted that Veteran reported before military he had a happy childhood with no abuse or neglect. It was noted that the Veteran at the time of examination had positive relationships with different family members. Veteran reported not having problems with drugs, alcohol, or arrests. Veteran as well had been happily married for 1.5 years and was unemployed, but focusing on school instead. The Veteran denied mental health treatment at any time and denied suicidal ideation/homicidal ideation. The examination did note that Veteran complained that he used to have issues sleeping past 5AM. Veteran explained that while in the military he had to wake up at 5AM and since getting out he had trouble sleeping past 5AM when he wanted to. Veteran reported that he purchased some blackout curtains and is now able to sleep in when he wants too. Further the Veteran stated he felt he is sleep better now and denied any daytime sleepiness that impaired him. Veteran also denied any symptoms commonly associated with sleep including depression, anxiety, and PTSD. The VA examiner ultimately opined that Veteran was not diagnosed with any mental disorders. On October 2020 a VA examination was provided to the Veteran to determine if Veteran’s bruxism is due to or a symptom of a psychiatric disability. The VA examiner opined that the claimed condition was at least as likely as not incurred in or caused by the claimed in-service injury, event, or illness. The VA examiner stated only that this was due to excess stress under military service. Here, a psychiatric disability has not been identified. The examiner’s only rationale on her positive opinion is that it is possible that the excess stress from military stress cause the bruxism. The Veteran is not service connected to a psychiatric disability and has not been diagnosed with one. Stress or excessive stress is in fact not a psychiatric disability. While the VA medical opinion is consistent with the in-service reports of bruxism, it also establishes that the bruxism is not due to a recognized psychiatric disorder. Conclusion For the reasons and bases expressed above, the Board finds that the preponderance of the evidence is against the Veteran’s claim of entitlement to service connection for bruxism. His bruxism is not a recognized disability for compensation purposes and is not proximately due to, the result of, or aggravated by a service-connected disease or injury. The benefit sought on appeals is accordingly denied. H. N. SCHWARTZ Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board Konieczny, Adam 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.