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C&P Exam Prep: Mandible, Loss of Whole

DC 9901 dental-and-oral 38 CFR 4.150

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, whether it constitutes complete loss between the angles, and to assess the functional and structural impact on the veteran's ability to eat, speak, swallow, and maintain oral health. The examiner will determine the applicable rating level under DC 9901 (complete loss between angles = 100%) or related codes for partial loss under DC 9902.

What the examiner evaluates:

  • Extent and anatomical boundaries of mandibular bone loss (complete between angles vs. partial)
  • Whether the loss involves the ramus and/or temporomandibular articulation
  • Replaceability by prosthesis (whether a suitable prosthesis can restore function)
  • Current functional status: mastication, deglutition (swallowing), and speech
  • Presence of facial disfigurement or soft tissue defects associated with mandibular loss
  • History and results of reconstructive surgery, bone grafting, or prosthetic rehabilitation
  • Associated conditions: osteomyelitis, osteoradionecrosis, osteonecrosis, or oral neoplasm
  • Current symptoms including pain, facial asymmetry, drooling, and nutritional deficits
  • Review of diagnostic imaging (X-ray, CT scan, panoramic/intraoral imaging, MRI, PET scan)
  • Treatment history including surgery, radiation therapy, chemotherapy, and other therapeutic procedures

The exam typically takes place at a VA medical center or contracted facility. An oral surgeon or dentist will conduct both a structured interview and a clinical examination of the oral cavity and facial structures. Bring all prior imaging studies, surgical reports, and treatment records. You have the right to request that the exam be recorded in most states.

Typical duration: 20-30 minutes

Assessment of Mandibular Bone Loss Extent

Determines whether the loss is complete between the angles (DC 9901) or partial, and identifies involvement of the ramus and temporomandibular articulation for accurate DC 9902 sub-classification.

What to expect:

The examiner will visually inspect the oral cavity and facial structures, palpate remaining bone, and review diagnostic imaging. They will determine anatomical landmarks including the angles of the mandible to establish completeness of bone loss.

Key thresholds:

  • Complete loss between angles of mandible — 100% under DC 9901 - this is the highest rating available for mandibular loss
  • Loss of one-half or more including ramus, involving temporomandibular articulation, not replaceable by prosthesis — 70% under DC 9902
  • Loss of one-half or more including ramus, involving temporomandibular articulation, replaceable by prosthesis — 50% under DC 9902
  • Loss of one-half or more including ramus, not involving temporomandibular articulation, not replaceable by prosthesis — 40% under DC 9902
  • Loss of one-half or more including ramus, not involving temporomandibular articulation, replaceable by prosthesis — 30% under DC 9902
  • Loss of less than one-half including ramus, involving temporomandibular articulation, not replaceable by prosthesis — 70% under DC 9902

Tips:

  • Ensure all imaging (CT, panoramic X-ray, MRI) is available at the exam and that it clearly documents the extent of bone loss.
  • If you have surgical records confirming the anatomical extent of resection, bring those to explicitly document bone loss between angles.
  • Clarify with your examiner whether loss extends to or beyond the angles bilaterally, as this is the threshold for DC 9901 at 100%.

Pain considerations: Describe any chronic pain in the jaw region, phantom pain, or pain at surgical/reconstruction sites, including how it varies on your worst days.

Prosthetic Replaceability Assessment

Determines whether the lost mandibular structure can be adequately replaced by a suitable prosthesis, which directly affects the rating level under DC 9902 (though DC 9901 complete loss is rated at 100% regardless).

What to expect:

The examiner will assess whether you currently wear a mandibular prosthesis, whether one is feasible given your remaining anatomy, and whether it restores functional mastication. They will document prosthesis type, fit, and functional adequacy.

Key thresholds:

  • Not replaceable by prosthesis — Higher rating tier at each level of partial mandibular loss under DC 9902
  • Replaceable by prosthesis — Lower rating tier at each level of partial mandibular loss under DC 9902; note that DC 9901 (complete loss) rates at 100% regardless

Tips:

  • If you have been told by an oral surgeon or prosthodontist that a prosthesis is not feasible or has failed, bring documentation of that clinical opinion.
  • If you wear a prosthesis but it does not adequately restore chewing function, describe specifically how it fails - slippage, inability to chew solid food, pain during use.
  • Do not assume that having a prosthesis means function is restored - accurately describe all limitations you experience even while wearing it.

Pain considerations: Describe pain caused by prosthesis wear, including sore spots, pressure points, and whether pain prevents you from wearing it consistently.

Masticatory Function Evaluation

Assesses your ability to chew food normally, which is a primary functional consequence of mandibular loss and relevant to the functional impact section of the DBQ.

What to expect:

The examiner will ask about your diet, what foods you can and cannot eat, how long meals take, and whether you have lost weight due to dietary restrictions. This is primarily history-based but may include visual inspection of remaining dentition and soft tissue.

Key thresholds:

  • Unable to chew any solid food; restricted to liquid or pureed diet — Supports highest functional impairment documentation, consistent with 100% rating under DC 9901
  • Severely limited mastication; can eat only soft foods — Supports significant functional impairment documentation

Tips:

  • Be specific about foods you cannot eat and what your typical daily diet looks like.
  • Describe how meal preparation has changed - if someone must prepare blended or pureed meals for you, state that clearly.
  • Note any unintended weight loss or nutritional deficiencies documented by your physician.

Pain considerations: Describe pain during any attempt to chew, including whether it is constant, triggered by jaw movement, or worsened by temperature of food.

Speech and Communication Assessment

Documents the impact of mandibular loss on speech intelligibility and communication, which is a significant functional consequence rated under the functional impact section of the DBQ.

What to expect:

The examiner will observe your speech during the interview, note any dysarthria, articulation deficits, or compensatory behaviors. They may ask whether others have difficulty understanding you.

Key thresholds:

  • Speech largely unintelligible to unfamiliar listeners — Supports documentation of severe functional impairment
  • Significant articulation deficits requiring compensatory strategies — Supports documentation of moderate-to-severe functional impairment

Tips:

  • If you use augmentative communication devices or have received speech therapy, bring records of that treatment.
  • Describe specific social and occupational consequences of your speech impairment - job difficulties, social withdrawal, avoidance of phone calls.
  • Note whether your speech is worse when fatigued or when not wearing a prosthesis.

Pain considerations: Describe any pain or fatigue associated with prolonged speaking, including how it limits your daily communication.

Facial Disfigurement and Soft Tissue Assessment

Documents visible facial deformity, asymmetry, scarring, and soft tissue changes resulting from mandibular loss and associated surgeries, which may support additional ratings for disfigurement.

What to expect:

Visual inspection of the face, chin, and neck. The examiner may measure or photograph areas of visible deformity. Scarring from surgical approaches will be documented.

Key thresholds:

  • Severe visible facial disfigurement affecting appearance and function — May support separate or combined ratings for facial disfigurement under applicable diagnostic codes

Tips:

  • Do not minimize visible deformity - describe its impact on your self-image, social interactions, and employment.
  • Bring photographs if the deformity is not fully apparent on a good day versus typical presentation.
  • Note any difficulties with drooling, mouth closure, or lip seal related to mandibular loss.

Pain considerations: Describe any pain or hypersensitivity in scarred or reconstructed areas of the face and neck.

Estimate

Rating Criteria Breakdown

100% Complete loss of the mandible between the angles. This is th ...

Complete loss of the mandible between the angles. This is the maximum rating under DC 9901 and applies when the entire body of the mandible between the two angles (gonions) has been lost. This level of loss results in profound functional impairment of mastication, speech, swallowing, and facial structure.

Key Symptoms

  • Complete absence of mandibular body between both angles
  • Profound mastication impairment - typically unable to chew solid food
  • Severe speech impairment - dysarthria, articulation deficits
  • Facial disfigurement - loss of lower facial support and contour
  • Difficulty maintaining oral competence - drooling, inability to close mouth normally
  • Swallowing dysfunction requiring dietary modification
  • Nutritional deficits or weight loss secondary to dietary restriction
  • Significant psychological impact from disfigurement and functional loss
  • History of extensive surgical resection confirmed by operative reports and imaging

CFR: 38 CFR 4.150, DC 9901: 'Mandible, loss of, complete, between angles - 100'. This is a single-criteria rating at 100% for complete loss between the angles.

70% Under DC 9902 (referenced for context): Loss of one-half or ...

Under DC 9902 (referenced for context): Loss of one-half or more of the mandible including the ramus, involving the temporomandibular articulation, NOT replaceable by prosthesis; OR loss of less than one-half including the ramus, involving the temporomandibular articulation, NOT replaceable by prosthesis. This criterion is relevant if the examiner characterizes loss as less than complete between angles.

Key Symptoms

  • Loss of one-half or more of mandible including ramus
  • Involvement of temporomandibular joint articulation
  • Prosthetic replacement not feasible or has failed
  • Significant masticatory impairment
  • TMJ dysfunction on affected side(s)
  • Restricted jaw movement and oral opening
  • Facial asymmetry and structural compromise

CFR: 38 CFR 4.150, DC 9902: Loss of one-half or more including ramus, involving temporomandibular articulation, not replaceable by prosthesis - 70%.

50% Under DC 9902: Loss of one-half or more of the mandible incl ...

Under DC 9902: Loss of one-half or more of the mandible including the ramus, involving the temporomandibular articulation, replaceable by prosthesis.

Key Symptoms

  • Loss of one-half or more of mandible including ramus
  • Involvement of temporomandibular joint
  • Prosthesis available but with documented functional limitations
  • Moderate masticatory impairment even with prosthesis
  • Ongoing symptoms despite prosthetic use

CFR: 38 CFR 4.150, DC 9902: Loss of one-half or more including ramus, involving temporomandibular articulation, replaceable by prosthesis - 50%.

40% Under DC 9902: Loss of one-half or more of the mandible incl ...

Under DC 9902: Loss of one-half or more of the mandible including the ramus, NOT involving the temporomandibular articulation, NOT replaceable by prosthesis.

Key Symptoms

  • Loss of one-half or more of mandible including ramus
  • Temporomandibular joint preserved
  • Prosthetic replacement not feasible
  • Significant masticatory and speech impairment

CFR: 38 CFR 4.150, DC 9902: Loss of one-half or more including ramus, not involving temporomandibular articulation, not replaceable by prosthesis - 40%.

30% Under DC 9902: Loss of one-half or more of the mandible incl ...

Under DC 9902: Loss of one-half or more of the mandible including the ramus, NOT involving the temporomandibular articulation, replaceable by prosthesis.

Key Symptoms

  • Loss of one-half or more of mandible including ramus
  • TMJ preserved
  • Prosthesis available and functional
  • Some residual masticatory or speech limitation

CFR: 38 CFR 4.150, DC 9902: Loss of one-half or more including ramus, not involving temporomandibular articulation, replaceable by prosthesis - 30%.

How to Describe Your Symptoms

Mastication and Eating

How to describe:

Describe your diet in concrete, specific terms. State which food categories you cannot eat at all (e.g., raw vegetables, meat, bread), which you can eat only after extensive modification (pureed, blended, cut very small), and how long meals take compared to before your injury. Describe nutritional supplements or feeding assistance you require.

Worst-day example:

“On my worst days, even swallowing thickened liquids is painful and exhausting. I cannot eat any solid food whatsoever. My wife prepares all my meals as pureed blends. Mealtimes take 45 minutes to an hour and I often stop eating due to fatigue and pain before I have consumed enough calories. I have lost 22 pounds since my surgery.”

What the examiner listens for:

Specific dietary restrictions, weight loss, nutritional deficits, dependence on others for meal preparation, use of feeding tubes or nutritional supplements, duration of meals, and any aspiration events.

Understatements to avoid:

Do not say 'I manage okay' or 'I get by.' If you are eating a restricted diet, describe exactly what that means in daily terms. Do not minimize weight loss or dietary dependence.

Speech and Communication

How to describe:

Be specific about which sounds or words are most affected. Describe how often people ask you to repeat yourself, whether you avoid phone calls or conversations, and how your speech changes throughout the day as you fatigue. Note whether speech is better or worse with or without a prosthesis.

Worst-day example:

“On my worst days my speech is almost entirely unintelligible, especially on the phone. Even people who know me well cannot understand most of what I say. I have stopped going to social events and I cannot work in any job that requires speaking to others. I use a text-to-speech app on my phone for most communication now.”

What the examiner listens for:

Intelligibility to unfamiliar vs. familiar listeners, avoidance of verbal communication, use of assistive communication devices, impact on employment and social functioning, and speech fatigue.

Understatements to avoid:

Do not demonstrate your best possible speech at the exam. Speak as you normally would. Do not say 'people usually understand me' if that only applies to close family members who are accustomed to your speech.

Pain

How to describe:

Describe the location, character (sharp, burning, aching, throbbing), frequency, and severity of pain on a 0-10 scale. Distinguish between baseline daily pain and worst-day pain. Describe what triggers or worsens pain - movement, eating, speaking, temperature changes, prosthesis contact. Note medications you take and whether they provide relief.

Worst-day example:

“On my worst days, the pain in my jaw and surgical site is a constant 8 out of 10. It radiates into my ear and neck. Any attempt to open my mouth or speak causes sharp stabbing pain. I take prescription pain medication twice daily but it only partially controls the pain. I cannot sleep on my side due to pain and I wake several times per night.”

What the examiner listens for:

Pain severity at baseline and during flare-ups, pain triggers, medication use and adequacy of pain control, impact of pain on sleep, daily activities, and ability to work.

Understatements to avoid:

Do not rate your pain at its best or on a typical controlled day. Report your pain as it is on a bad day. Do not say 'I take ibuprofen and it's fine' if you are on stronger medications or if pain remains despite treatment.

Facial Disfigurement and Psychological Impact

How to describe:

Describe visible changes to your facial appearance - asymmetry, chin retraction, lower lip sagging, inability to close mouth fully - and how these affect your daily life, self-esteem, and social functioning. Note any mental health treatment received for adjustment to disfigurement.

Worst-day example:

“I avoid mirrors. I have not been to a family event in over a year because strangers stare at my face and children are frightened. I was referred to a mental health provider for depression and anxiety related to my appearance. I cannot maintain eye contact with people I meet because I am ashamed of how I look. My marriage has been significantly strained.”

What the examiner listens for:

Social withdrawal, depression, anxiety, avoidance of public situations, impact on intimate relationships, self-esteem, and whether the veteran has sought or received mental health treatment.

Understatements to avoid:

Do not minimize the psychological impact of disfigurement to appear stoic. The examiner needs to understand the full human cost of this condition. If you have been diagnosed with depression or PTSD related to disfigurement, state that clearly.

Swallowing and Aspiration

How to describe:

Describe any difficulty swallowing (dysphagia), including whether you have choked or aspirated food or liquid. Note if you have received swallowing therapy, use thickened liquids, or have had aspiration pneumonia. Describe positional adjustments you make to swallow safely.

Worst-day example:

“On my worst days I cannot swallow thin liquids without coughing and choking. I have been hospitalized once for aspiration pneumonia. My speech therapist has me on thickened liquids only. I have to tuck my chin and turn my head to the side every time I swallow, and even then I often cough after eating.”

What the examiner listens for:

Dysphagia severity, history of aspiration events, aspiration pneumonia hospitalizations, use of thickened liquids, swallowing therapy, and compensatory swallowing strategies.

Understatements to avoid:

Do not omit swallowing difficulties - they are a direct functional consequence of mandibular loss and are critical to documenting the full severity of impairment.

Functional Impact on Daily Life and Employment

How to describe:

Describe how your condition affects your ability to work, maintain personal hygiene (oral hygiene, saliva control), socialize, care for your family, and perform daily activities. Be specific about tasks you can no longer perform or require assistance with.

Worst-day example:

“On my worst days I cannot leave my home. I cannot work in any capacity - I was a sales representative and was unable to return after my surgery because I cannot speak clearly or eat a meal in a professional setting. I require assistance with oral hygiene care and cannot wear my prosthesis for more than two hours due to pain and pressure sores. I am fully dependent on my wife for meal preparation and often for personal care.”

What the examiner listens for:

Loss of employment, vocational retraining, inability to perform specific work tasks, dependence on caregivers, and inability to perform activities of daily living independently.

Understatements to avoid:

Do not assume the examiner will infer functional loss from the diagnosis alone. Explicitly connect the physical findings to your daily functional limitations.

Common Mistakes to Avoid

Prep Checklist

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Before Your Exam

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During the Exam

After the Exam

Your Rights During a C&P Exam

  • You have the right to a thorough, adequate C&P examination. If the examination is inadequate (too brief, records not reviewed, physical exam not performed), you may request a new examination by contacting your VSO or filing a notice of disagreement.
  • You have the right to audio-record your C&P examination in most states. Check your state's recording consent laws and notify the VA in advance if you plan to record.
  • You have the right to bring a support person (family member, caregiver, or VSO representative) to your C&P examination.
  • You have the right to submit a personal statement and lay evidence (buddy statements) in addition to the C&P examination findings. These can address any gaps or inaccuracies in the DBQ.
  • You have the right to request a copy of the completed DBQ through your VSO, eBenefits, or a FOIA request. Review it for completeness and accuracy.
  • If the C&P examiner's opinion is unfavorable or inaccurate, you have the right to obtain an independent medical opinion (IMO/IME) from a private provider to submit as counter-evidence.
  • The benefit of the doubt rule (38 CFR 4.3) requires that when evidence is in approximate balance regarding any issue material to the determination, it shall be resolved in your favor.
  • You are entitled to have all prior treatment records, service records, and medical evidence reviewed by the examiner before completing the DBQ. If the examiner has not reviewed your records, state this and request that they do so.
  • Under 38 CFR 4.7, where there is a question as to which of two evaluations shall be applied, the higher evaluation will be assigned if the disability more closely approximates the criteria required for that rating.
  • Complete loss of the mandible between the angles under DC 9901 carries a single 100% rating - there is no ambiguity at this level. Ensure the examiner documents whether the loss meets this anatomical criterion precisely.
  • You have the right to request that secondary and associated conditions (osteomyelitis, osteoradionecrosis, facial disfigurement, mental health conditions) be separately evaluated and rated.

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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.