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C&P Exam Prep: Mandible, Loss of Approximately Half
DBQ Overview
Interview + Physical- Form Name
- oral-and-dental
- Form Code
- oral-and-dental
- Page Count
- 7
- Examiner Type
- Dentist or Oral Surgeon
- Estimated Duration
- 20-30 minutes
- Exam Format
- Interview + Physical
What to Expect During Your Exam
Exam Overview
To document the extent of mandibular bone loss, determine whether the temporomandibular articulation is involved, assess prosthetic replaceability, and establish a disability rating under DC 9902 reflecting the true functional and structural impact of your condition.
What the examiner evaluates:
- Quantity of mandibular bone lost (less than one-half vs. one-half or more, including the ramus)
- Whether the temporomandibular articulation (TMJ) is involved in the loss
- Whether the residual defect is replaceable by a prosthesis (e.g., implant-supported device, obturator, plate)
- Functional ability to chew, bite, and speak
- Presence of pain, instability, malocclusion, or open bite deformity
- History of surgical resection, trauma, osteomyelitis, osteoradionecrosis, or osteonecrosis
- Associated soft tissue defects, lip involvement, or tongue involvement
- Prior treatment history including surgery, radiation therapy, chemotherapy, and prosthetic fitting
- Current status of any prosthetic device and its adequacy in restoring function
- Associated conditions such as malunion, nonunion, or TMD
- Any residuals or complications of treatment
The examination will typically include a clinical intraoral and extraoral inspection, palpation of residual mandibular structure, assessment of jaw movement and occlusion, and review of imaging (panoramic X-ray, CT scan, or MRI). Bring all prior imaging on disc or hard copy if available. The examiner will review your claims file and any diagnostic imaging on record. You have the right to request that the exam be recorded in most states - confirm state-specific rules before your appointment.
Typical duration: 20-30 minutes
Mandibular Bone Loss Extent Assessment
The proportion of the mandible that has been lost, including whether the ramus and temporomandibular articulation are involved. This is the single most critical structural determination for DC 9902 rating.
What to expect:
The examiner will palpate the jaw, review surgical records, and examine imaging to determine how much mandibular bone is absent. They will compare loss relative to the total mandible including rami.
Key thresholds:
- Loss of one-half or more, involving temporomandibular articulation, NOT replaceable by prosthesis — 70% disability rating
- Loss of one-half or more, involving temporomandibular articulation, replaceable by prosthesis — 50% disability rating
- Loss of one-half or more, NOT involving temporomandibular articulation, NOT replaceable by prosthesis — 40% disability rating
- Loss of one-half or more, NOT involving temporomandibular articulation, replaceable by prosthesis — 30% disability rating
- Loss of less than one-half, involving temporomandibular articulation, NOT replaceable by prosthesis — 70% disability rating
- Loss of less than one-half, involving temporomandibular articulation, replaceable by prosthesis — 50% disability rating
Tips:
- Bring all surgical operative reports and pathology reports documenting the extent of resection
- If imaging was done at a private facility, bring the images on disc plus the radiology report
- Ask your treating oral surgeon to write a letter clearly stating what percentage of the mandible was removed and whether the condyle/TMJ was involved
- If you have a prosthesis, bring it to the exam and be prepared to demonstrate its fit, function, and any limitations
Pain considerations: Report any pain associated with the residual mandibular structure, prosthesis use, chewing, or jaw movement. Describe pain on your worst days accurately.
Temporomandibular Articulation Involvement Assessment
Whether the condyle, condylar neck, or temporomandibular joint itself was resected or is involved in the bone loss. Involvement significantly increases the rating.
What to expect:
The examiner will review surgical records and imaging to determine if the TMJ condyle was removed or if bone loss extends to involve the articular surface. They may also assess jaw opening range of motion.
Key thresholds:
- TMJ articulation involved in resection or loss — Increases rating by approximately 20-30 percentage points compared to non-TMJ-involved loss at the same extent
- TMJ articulation NOT involved — Lower rating tier applies (30% or 40% depending on prosthetic replaceability)
Tips:
- Review your operative note - it will state whether condylectomy or condylar resection was performed
- If unsure, ask your oral surgeon or maxillofacial surgeon to clarify in writing before your exam
- If you have jaw clicking, locking, or limited opening due to TMJ involvement, describe this clearly to the examiner
Pain considerations: TMJ-area pain, clicking, locking, and deviation of the jaw on opening are all relevant findings. Report these symptoms even if you have adapted to them.
Prosthetic Replaceability Assessment
Whether the mandibular defect can be adequately replaced by a prosthesis (such as a reconstruction plate, fibula free flap with implants, obturator, or removable partial denture). This is a key rating bifurcation point.
What to expect:
The examiner will assess whether a prosthesis currently exists and whether it adequately restores form and function. They will note whether the defect is anatomically and technically amenable to prosthetic replacement.
Key thresholds:
- Defect NOT replaceable by prosthesis (technically or due to failed attempts) — Higher rating applies at each tier (40% or 70%)
- Defect IS replaceable by prosthesis (even if not currently fitted) — Lower rating applies at each tier (30% or 50%)
Tips:
- If you have tried prosthetic rehabilitation and it failed (poor fit, infection, inability to tolerate), document this clearly with treatment records
- If you currently have a prosthesis, honestly describe its limitations - does it slip, cause pain, fail to restore adequate chewing function?
- If your defect has been deemed non-reconstructable by your surgeon, bring that documentation
- Note that being theoretically replaceable by prosthesis even if you currently lack one can reduce your rating - discuss this with a VSO before your exam
Pain considerations: Prosthesis-related pain (pressure sores, mucosal irritation, pain with wear) should be reported accurately as it affects functional use and quality of life.
Jaw Range of Motion and Functional Chewing Assessment
The ability to open and close the jaw, bite, chew, and perform basic oral functions. Relevant to associated conditions and functional impairment documentation.
What to expect:
The examiner may measure maximum incisal opening (normal is typically 40-50 mm), assess lateral excursions, and observe chewing function. Malocclusion, open bite, and deviation on opening are noted.
Key thresholds:
- Severe open bite limiting oral intake to liquid or soft diet — Supports higher severity rating; may trigger separate DC consideration for malunion
- Moderate open bite impairing mastication — Supports documentation of functional impairment at current rating level
Tips:
- Report your worst-day functional ability, not just how you function when well-rested
- Describe specific foods you cannot eat due to your jaw condition
- If you experience fatigue, pain, or weakness with prolonged chewing, mention this explicitly
- Bring a food diary or written log of dietary restrictions if helpful
Pain considerations: Pain with jaw movement, chewing, and even speaking should be described in detail including location, character (sharp, aching, throbbing), frequency, duration, and aggravating factors.
Rating Criteria Breakdown
| Rating % | Criteria | Key Symptoms |
|---|---|---|
| 70% | Loss of one-half or more of the mandible (including ramus), involving the temporomandibular articulation, NOT replaceable by prosthesis. OR Loss of less than one-half of the mandible, involving the temporomandibular articulation, NOT replaceable by prosthesis. |
CFR: 38 CFR 4.150, DC 9902: Loss of one-half or more involving temporomandibular articulation, not replaceable by prosthesis = 70%; Loss of less than one-half involving temporomandibular articulation, not replaceable by prosthesis = 70%. |
| 50% | Loss of one-half or more of the mandible (including ramus), involving the temporomandibular articulation, replaceable by prosthesis. OR Loss of less than one-half of the mandible, involving the temporomandibular articulation, replaceable by prosthesis. |
CFR: 38 CFR 4.150, DC 9902: Loss of one-half or more involving temporomandibular articulation, replaceable by prosthesis = 50%; Loss of less than one-half involving temporomandibular articulation, replaceable by prosthesis = 50%. |
| 40% | Loss of one-half or more of the mandible (including ramus), NOT involving the temporomandibular articulation, NOT replaceable by prosthesis. |
CFR: 38 CFR 4.150, DC 9902: Loss of one-half or more not involving temporomandibular articulation, not replaceable by prosthesis = 40%. |
| 30% | Loss of one-half or more of the mandible (including ramus), NOT involving the temporomandibular articulation, replaceable by prosthesis. |
CFR: 38 CFR 4.150, DC 9902: Loss of one-half or more not involving temporomandibular articulation, replaceable by prosthesis = 30%. |
70% Loss of one-half or more of the mandible (including ramus), ...
Loss of one-half or more of the mandible (including ramus), involving the temporomandibular articulation, NOT replaceable by prosthesis. OR Loss of less than one-half of the mandible, involving the temporomandibular articulation, NOT replaceable by prosthesis.
Key Symptoms
- Condyle or condylar neck resected - TMJ destroyed or absent
- Defect not amenable to prosthetic reconstruction
- Severe limitation of jaw function
- Inability to chew solid foods
- Significant facial disfigurement
- Pain with any jaw movement
- Dependence on liquid or soft diet
- Speech impairment
CFR: 38 CFR 4.150, DC 9902: Loss of one-half or more involving temporomandibular articulation, not replaceable by prosthesis = 70%; Loss of less than one-half involving temporomandibular articulation, not replaceable by prosthesis = 70%.
50% Loss of one-half or more of the mandible (including ramus), ...
Loss of one-half or more of the mandible (including ramus), involving the temporomandibular articulation, replaceable by prosthesis. OR Loss of less than one-half of the mandible, involving the temporomandibular articulation, replaceable by prosthesis.
Key Symptoms
- Condyle or condylar neck resected - TMJ involved
- Prosthesis present and provides some functional restoration
- Residual limitation of jaw movement despite prosthesis
- Prosthesis-related complications (pain, poor fit, mucosal irritation)
- Moderate dietary restriction
- Difficulty chewing hard or tough foods
- Jaw deviation or malocclusion present
CFR: 38 CFR 4.150, DC 9902: Loss of one-half or more involving temporomandibular articulation, replaceable by prosthesis = 50%; Loss of less than one-half involving temporomandibular articulation, replaceable by prosthesis = 50%.
40% Loss of one-half or more of the mandible (including ramus), ...
Loss of one-half or more of the mandible (including ramus), NOT involving the temporomandibular articulation, NOT replaceable by prosthesis.
Key Symptoms
- Extensive mandibular body or body-plus-ramus loss without condylar involvement
- Defect not prosthetically reconstructable
- Significant masticatory dysfunction
- Open bite or severe malocclusion
- Facial asymmetry and disfigurement
- Dietary restriction to soft or liquid foods
- Speech impairment from structural defect
CFR: 38 CFR 4.150, DC 9902: Loss of one-half or more not involving temporomandibular articulation, not replaceable by prosthesis = 40%.
30% Loss of one-half or more of the mandible (including ramus), ...
Loss of one-half or more of the mandible (including ramus), NOT involving the temporomandibular articulation, replaceable by prosthesis.
Key Symptoms
- Extensive mandibular loss without TMJ involvement
- Prosthesis present providing partial functional restoration
- Residual functional limitations despite prosthetic use
- Some dietary restrictions remain
- Prosthesis maintenance needs and compliance issues
CFR: 38 CFR 4.150, DC 9902: Loss of one-half or more not involving temporomandibular articulation, replaceable by prosthesis = 30%.
How to Describe Your Symptoms
Eating and Chewing Function
How to describe:
Describe specifically which foods you cannot eat, how long it takes you to eat a meal, whether you must cut food into tiny pieces, blend food, or rely on a liquid diet. Quantify impairment - for example, 'I can only eat soft foods and it takes me 45 minutes to eat a meal that used to take 15 minutes.'
Worst-day example:
“On my worst days, jaw pain and instability make it impossible to chew anything solid. I subsist on smoothies and pureed food for days at a time. I cannot eat at restaurants because nothing on the menu is safe for me to chew. Social eating causes me significant embarrassment and anxiety.”
What the examiner listens for:
Specific dietary restrictions, functional limitations on chewing duration and food type, pain with mastication, weight loss or nutritional consequences, and whether prosthesis (if present) actually restores adequate chewing function.
Understatements to avoid:
Saying 'I manage okay' or 'I've adjusted' - the examiner needs to hear your true functional baseline, not your coping strategies. Adapting to a liquid diet is not the same as having normal chewing function.
Pain
How to describe:
Describe the location (residual jaw, surgical site, TMJ area, ear, neck), character (sharp, aching, throbbing, burning), frequency (constant vs. intermittent), severity on a 0-10 scale on both average and worst days, and what aggravates or relieves it. Include radiation patterns if pain spreads to the ear, temple, or neck.
Worst-day example:
“On my worst pain days, the aching in my jaw and surgical site is a 9 out of 10. Any movement - talking, eating, or even yawning - sends sharp pain through the entire side of my face. I cannot sleep on that side and require prescription pain medication to function.”
What the examiner listens for:
Constant vs. episodic pain, pain with function vs. at rest, pain severity at worst, pain medication use and frequency, and how pain limits daily activities including work, sleep, and social interaction.
Understatements to avoid:
Do not minimize pain by saying 'it's not that bad' or 'I just deal with it.' Provide accurate worst-day descriptions per M21-1 guidance.
Speech and Communication
How to describe:
Describe whether your speech is affected - slurring, difficulty with certain consonants or vowel sounds, need for repeat requests in conversation, avoidance of speaking in public, and impact on employment or social activities.
Worst-day example:
“When my jaw is swollen or painful, my speech becomes noticeably slurred. I avoid phone calls and meetings at work because people frequently cannot understand me and I find it humiliating to repeat myself. I have withdrawn from social activities that require sustained conversation.”
What the examiner listens for:
Observable speech impairment during the exam, history of speech therapy, impact on occupational and social functioning, and whether structural defect or prosthesis affects articulation.
Understatements to avoid:
Do not dismiss speech issues as minor. If your communication is affected - even occasionally - report it accurately, as it reflects the true functional impact of your condition.
Prosthesis Function and Complications
How to describe:
If you have a prosthesis, describe how well it functions, how long you can wear it before discomfort forces removal, any history of sores or wounds from prosthesis use, how often it requires repair or replacement, and whether it truly restores chewing ability. If you do not have a prosthesis, explain why (surgical inaccessibility, failed attempts, financial barriers, anatomical limitations).
Worst-day example:
“I can only wear my prosthesis for two to three hours before pressure sores develop on the residual ridge. I spend most of the day without it, which means I cannot eat a normal diet for most of the day. The prosthesis has fractured three times and does not restore normal bite force.”
What the examiner listens for:
Whether the prosthesis is truly adequate to restore function, complications of prosthetic use, compliance barriers, duration of wear tolerance, and whether the defect is genuinely not replaceable by prosthesis.
Understatements to avoid:
Do not imply a prosthesis fully restores your function if it does not. The examiner needs to understand what the prosthesis actually does and does not restore.
Facial Disfigurement and Psychological Impact
How to describe:
Describe any visible facial asymmetry, sunken or absent jaw contour, drooling, inability to keep lips closed, and the psychological and social impact of disfigurement including depression, anxiety, social withdrawal, and avoidance of mirrors or public spaces.
Worst-day example:
“The visible collapse on the right side of my jaw makes me extremely self-conscious. I avoid social events and have stopped eating in public entirely. I have been diagnosed with depression that my mental health provider directly attributes to my facial disfigurement following the surgery.”
What the examiner listens for:
Observable disfigurement, drooling, lip incompetence, functional soft tissue defects, and any psychiatric or psychological conditions secondary to the disfigurement that may warrant separate claims.
Understatements to avoid:
Do not omit the psychological dimension. If disfigurement has led to depression, anxiety, or PTSD, these may be separately ratable secondary conditions.
Flare-Ups and Variable Symptoms
How to describe:
Describe what triggers worsening episodes (chewing hard foods, cold weather, stress, prolonged talking, dental procedures), how long flare-ups last, how frequently they occur, and what your functional level is during a flare-up versus your baseline.
Worst-day example:
“At least once a week, my jaw condition flares severely - the area swells, pain increases to an 8 or 9 out of 10, and I cannot open my mouth more than a finger-width. These episodes last two to four days and force me to miss work or cancel social plans entirely.”
What the examiner listens for:
Frequency and duration of flare-ups, triggers, functional decline during flares, and whether current rating criteria capture worst-day function rather than only average-day function.
Understatements to avoid:
Do not only describe how you feel on a good day. Per M21-1 guidance, the examiner must consider the full range of your condition including flare-ups.
Common Mistakes to Avoid
Failing to bring operative or surgical reports documenting extent of mandibular resection
The examiner's determination of how much mandible was lost - the most critical rating factor - depends heavily on documented surgical records. Without them, the examiner may underestimate the extent of loss.
Instead: Request copies of all operative reports, pathology reports, and discharge summaries from the facility where your resection was performed. Bring originals or certified copies to the exam.
Impact: All rating levels - affects whether 30%, 40%, 50%, or 70% is assigned
Not clarifying whether the condyle or TMJ was involved in the resection
TMJ involvement is a binary switch in the rating criteria that dramatically affects your rating. If the examiner cannot confirm TMJ involvement from records, you may be rated at a lower tier.
Instead: Obtain a letter from your oral surgeon or maxillofacial surgeon explicitly stating whether the condyle, condylar neck, or TMJ articulation was resected or affected. Reference your imaging and surgical reports.
Impact: Difference between 30-40% and 50-70%
Overstating the adequacy of a poorly functioning prosthesis
If you describe your prosthesis as working well, the examiner may check the 'replaceable by prosthesis' box, dropping your rating by 20 percentage points at each tier even if your prosthesis provides minimal functional benefit.
Instead: Accurately describe all limitations, complications, and failures of your prosthesis. If it is inadequate, say so specifically - poor fit, pain, inability to chew, frequent breakage, sores, or limited wear time.
Impact: Difference between 40-70% (not replaceable) and 30-50% (replaceable)
Only describing average-day symptoms rather than worst-day symptoms
VA disability ratings are intended to capture the full disability picture including worst-day function. Understating symptoms leads to underrating.
Instead: Describe both your typical day and your worst days. Per M21-1 guidance, the examiner should capture the highest level of functional impairment, including during flare-ups.
Impact: All rating levels
Failing to mention secondary conditions such as speech impairment, psychological effects, or soft tissue defects
DC 9902 captures structural bone loss, but secondary conditions like soft tissue injury (DC for lips, tongue), depression, speech impairment, or nutritional consequences may be separately ratable and increase your overall combined rating.
Instead: Before your exam, identify all conditions caused or worsened by your mandibular loss. Mention them to the examiner and ensure they are documented. Consider separate claims for each secondary condition.
Impact: Combined disability rating - secondary conditions add to overall evaluation
Not bringing existing imaging (panoramic X-rays, CT scans, MRI) to the exam
Radiographic confirmation of bone loss extent is critical for documenting the claim. If VA does not have current imaging on file, the examiner may not be able to fully confirm the extent of loss.
Instead: Bring all jaw imaging on disc plus printed radiology reports. If imaging is old, request updated imaging from your treating dentist or oral surgeon before the exam.
Impact: All rating levels - imaging confirms structural findings
Minimizing dietary restrictions by saying 'I've adapted to eating soft foods'
Adaptation to a restricted diet due to jaw disability is itself evidence of functional loss. If you frame adaptation as normalcy, the examiner may not appreciate the severity of your impairment.
Instead: Explicitly state that you have been forced to change your diet and describe what you can no longer eat. Use specific examples such as inability to eat steak, apples, crusty bread, or raw vegetables.
Impact: Supports higher functional impairment documentation at all levels
Prep Checklist
Before Your Exam
Day Of
During the Exam
After the Exam
Your Rights During a C&P Exam
- You have the right to an adequate, thorough, and contemporaneous C&P examination. If the exam is inadequate - for example, if the examiner does not review your claims file, does not examine you in person, or fails to address key rating factors - you have the right to request a new examination.
- You have the right to submit your own independent medical evidence, including private dental or oral surgery evaluations, nexus letters, and treating provider statements, which VA must consider and weigh against the C&P examiner's findings.
- You have the right to record your C&P examination in most states. Confirm your specific state's laws before your appointment. Recording is permitted when conducted in compliance with applicable state regulations.
- You have the right to know what was documented in your C&P examination DBQ. Request a copy through VA.gov, your VSO, or a FOIA request. Review it for accuracy as soon as it is available.
- You have the right to appeal an examination or rating decision you believe is incorrect. The VA PACT Act and AMA provide multiple appeal lanes: Supplemental Claim (new and relevant evidence), Higher-Level Review (different VA adjudicator), and Board of Veterans' Appeals (Veterans Law Judge review).
- You have the right to have a VSO representative, accredited claims agent, or attorney assist you at no cost during the claims process. Contact your state's Department of Veterans Affairs, DAV, VFW, American Legion, or other VSO for free representation.
- You have the right to request that your exam be conducted in person if a telehealth or records-only exam is proposed and you believe an in-person examination is necessary for an accurate evaluation of your condition.
- You have the right to the benefit of the doubt. Under 38 USC 5107(b), when there is an approximate balance of positive and negative evidence regarding any issue material to your claim, VA shall give the benefit of the doubt to you.
- You have the right to submit a buddy statement (VA Form 21-10210) or personal statement (VA Form 21-4138) describing your symptoms and functional limitations. These lay statements are evidence and must be considered by the examiner and adjudicator.
- You have the right to continuity of ratings. If you are already rated under DC 9902, VA cannot reduce your rating without finding material improvement in your condition under actual ordinary conditions of life and work, and must follow the due process requirements of 38 CFR 3.105.
Related Conditions
- Mandible, Loss of, Complete, Between Angles More severe variant under DC 9901 rated at 100%; if your loss has progressed or is more extensive than originally rated, DC 9901 may apply
- Temporomandibular Disorder (TMD) If TMJ articulation is involved in your mandibular loss and you have residual TMJ dysfunction (pain, limited opening, clicking, locking), a separate claim under DC 9905 may be warranted for any additional TMD component
- Mandible, Malunion Of If residual mandibular segments have healed in malposition causing open bite deformity, a separate or alternative rating under the malunion diagnostic code may apply
- Mandible, Nonunion Of If residual mandibular segments have failed to unite following fracture or surgery, a nonunion rating under DC 9904 with false motion may apply in addition to or instead of DC 9902
- Teeth, Loss of Due to Loss of Substance of Body of Maxilla or Mandible DC 9913 covers tooth loss resulting from mandibular bone loss trauma or disease; if teeth were lost as a direct result of mandibular resection and the masticatory surface cannot be restored by prosthesis, a separate evaluation under DC 9913 may apply
- Lips, Injuries Of Soft tissue defects involving the lips may result from mandibular resection or reconstruction; separately ratable under 38 CFR 4.150 if present
- Tongue, Loss of Whole or Part Composite oromandibular resections may involve partial tongue removal; separately ratable if tongue loss occurred in conjunction with mandibular loss
- Osteomyelitis, Osteoradionecrosis, or Osteonecrosis of the Jaw If mandibular loss was caused by or is complicated by osteomyelitis, osteoradionecrosis from radiation therapy, or medication related osteonecrosis (MRONJ), this underlying condition is separately documented and may affect service connection pathways
- Depression or Anxiety Secondary to Service-Connected Condition Facial disfigurement and functional limitations from mandibular loss can cause or aggravate depression and anxiety; a secondary mental health claim is potentially ratable under 38 CFR 3.310
- Oral Neoplasm (Malignant or Benign) If mandibular loss resulted from oncologic resection for oral cancer, the underlying neoplasm and its active or residual status may be separately ratable under the appropriate neoplasm diagnostic code series
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This C&P exam preparation guide is for educational purposes only and does not constitute legal, medical, or claims advice. Always consult with a qualified Veterans Service Organization (VSO) representative or VA-accredited attorney for guidance specific to your claim. Never exaggerate, minimize, or fabricate symptoms during a C&P examination.