tmj After experiencing traumatic and sometimes life-threatening conditions which can happen during military service, some Veterans—both male and female—suffer from post-traumatic stress disorder (PTSD). Most people know that this is a serious mental health condition with symptoms ranging from severe nightmares and flashbacks to insomnia and increasing anxiety and social isolation. However, what many people don’t know is that PTSD is linked to a number of other physical impairments including temporomandibular joint (TMJ) disorder.

What is TMJ disorder exactly?

This is how the Cleveland Clinic describes this condition:

The temporomandibular joint or TMJ acts like a sliding hinge, connecting your jawbone to your skull. Dysfunction can lead to pain and discomfort. Jaw pain, difficulty chewing, and clicking and locking of the jaw joint are some of the symptoms.”

How does TMJ disorder affect people?

 While TMJ disorder is not life-threatening, it can have a significant impact on an individual’s everyday activities. The pain caused by the disorder can interfere with their ability to work and interact with others and it can make the two most basic activities of life—sleep and eating—painful and difficult.

How are TMJ and PTSD linked?

There isn’t a singular cause of TMJ disorder; it can be a result of many different factors or a combination of factors. Medical research has shown a strong link between PTSD and TMJ disorder.

Typically, a Veteran with PTSD is constantly operating in a “fight or flight” mode. They may believe that there is danger at every turn, and this leads to bodily responses. A common response may be bruxism, a condition where a person grinds, clenches, or gnashes their teeth for prolonged periods of time; it can occur when awake or asleep. A Veteran with PTSD may also cope with stress by holding their breath which can aggravate TMJ disorder symptoms. The afflicted individual may not even be aware of these reactions. Medical researchers believe that bruxism when combined with breath holding and the inflammation caused by the release of stress hormones are potential triggers of TMJ disorder.

Treating TMJ disorder can be difficult. Usual therapies involve a combination of cognitive-behavioral therapy, meditation, breathing exercises, and antidepressant medication. Veterans with PTSD and TMJ disorder need to learn to cope with stress and how to reduce behaviors such as jaw clenching and breath-holding that are linked to increased TMJ pain. Physicians may prescribe physical therapy and, in some cases, even surgery to treat TMJ pain.

How does the VA evaluate TMJ disorder?

The VA evaluates Veterans with TMJ disorder under 38 CFR § 4.150, Schedule of Ratings – Dental and Oral Conditions, Diagnostic Code 9905. The compensation you may be awarded varies depending on how far you can open your mouth and whether your doctor recommended a restrictive diet and the type of diet. (Some Veterans who have TMJ can only eat ground, mashed, pureed, soft, chopped, blended, liquid, or semi-solid foods.) You could receive a rating from 10% to 50% for service-connected TMJ disorder.

You can open your jaw or move it side to side and front to back for chewing. The VA only rates one of those directions. If you have trouble with more than one, the VA will rate you based on which direction gives you the highest disability rating. Here’s how the VA rates TMJ disorders:

  • If you can open your jaw up to 10 mm unassisted, the VA pays 50% if you have dietary restrictions prescribed by your doctor and 40 % if you do not have dietary restrictions.
  • If you can open your jaw from 11 to 20 mm without assistance, the VA will pay 40% if you have dietary restrictions prescribed by your doctor and 30% for no dietary restrictions.
  • If you can open your jaw from 21 to 29 mm without assistance, the VA will pay 40% if your diet is restricted to liquid or pureed foods, 30% if you have dietary restrictions of soft and semi-solid food, and 20% if you do not have dietary restrictions.
  • If you can open your jaw from 30 to 34 mm without assistance, the VA will pay 30% if you are restricted to liquid and pureed foods, 20% if your dietary restrictions include soft and semi-solid food, and 10% if your doctor did not recommend dietary restrictions.

Most people can open their jaws from 35 to 50 mm.

What is a secondary condition for TMJ disorder?

All too often, Veterans applying for disability benefits overlook secondary conditions and miss out on much-needed benefits they are entitled to. You’re eligible for secondary disability benefits if your illness or injury has caused another different or separate condition. If you’re currently being treated for PTSD related to your military service and you have any impairment related to your condition, you may qualify for a higher rating and additional compensation This includes TMJ disorder as well as conditions caused by dysfunction in the temporomandibular joint, such as bruxism, headaches, tinnitus, hearing loss, and neck pain.

Proving secondary service-connected disabilities can be tricky and unfortunately, the VA often denies secondary service-connected disabilities. To win your case for secondary benefits first you must prove that your PTSD was service connected, that is, directly caused by your military service. To establish this proof, you will want to submit evidence of your diagnosis, medical tests, treatments, and any other relevant evidence. Then you will need to provide evidence of nexus—a connection—between your primary and secondary disabilities. Here it is critical that you have testimony or reports from medical experts to back up your claim.

Where to turn for help?

Because filing for VA disability benefits can be complicated and sometimes frustrating, it’s important to hire an experienced VA disability attorney to help with your claim. There’s no easy formula for addressing Veterans’ claims, especially for secondary disabilities. Our VA disability attorneys at Cuddigan Law examine each case individually, develop the best strategy, and work with you to submit your claim or file an appeal if you have been turned down for benefits. Call us for a free evaluation of your situation. If you hire us, we only get paid when you win your case.

Are you coping with PTSD?

We encourage you to download our free book: PTSD and VA Disability Benefits: Finding a Path to Healing. Just click this link to get this comprehensive guide delivered to your inbox.  We are confident you will find it invaluable in helping you apply for and win the VA benefits you have rightfully earned.

Sean D. Cuddigan
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SSA and VA Disability Attorney in Omaha, Nebraska