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C&P Exam Prep: Maxilla or Mandible, Loss of (Both Jaws)
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 nature, extent, and functional impact of the loss of both the maxilla (upper jaw) and mandible (lower jaw) for VA disability rating purposes under 38 CFR 4.150, Diagnostic Code 9910. The examiner will assess what portion of each jaw is lost, whether a prosthesis can restore function, and how the condition affects chewing, speech, swallowing, and daily activities.
What the examiner evaluates:
- Extent and location of maxillary and mandibular bone loss (which portions, including ramus involvement)
- Whether the temporomandibular joint (TMJ) articulation is involved or preserved
- Whether a prosthesis can adequately replace the lost masticatory (chewing) surface
- Current prosthetic status: whether veteran wears a prosthesis, how well it functions, and complications
- Residual symptoms including pain, difficulty chewing, swallowing, speaking, and drooling
- History of trauma, cancer, osteomyelitis, osteoradionecrosis, or osteonecrosis leading to jaw loss
- Surgical history including dates and type of resection or reconstruction
- Associated conditions such as loss of teeth, soft tissue injury, lip injury, tongue involvement, and oral neoplasm
- Malunion or non-union of jaw fractures confirmed by diagnostic imaging
- Functional impact on work, nutrition, communication, and psychosocial wellbeing
- Review of relevant imaging studies (X-ray, CT scan, MRI, panoramic radiograph)
Conducted in a clinical or dental operatory setting. The examiner will perform a direct oral and facial examination. Bring all prior imaging (panoramic X-rays, CT scans, operative reports) and a list of all prosthetic appliances used. If the exam is conducted via telehealth or records review only, ensure all functional limitations are thoroughly documented in writing prior to the exam.
Typical duration: 20-30 minutes
Assessment of Jaw Bone Loss Extent
The anatomic extent of mandibular and maxillary bone loss, including whether loss is less than one-half or one-half or more of the mandible, whether the ramus is involved, and whether the TMJ articulation is affected.
What to expect:
The examiner will visually inspect and palpate the jaw structures, review prior surgical reports, and reference imaging studies. They will document which specific portions of each jaw are absent or surgically removed.
Key thresholds:
- Complete loss of mandible between angles — 100% under DC 9901
- Loss of one-half or more of mandible including ramus, involving TMJ, not replaceable by prosthesis — 70% under DC 9902
- Loss of one-half or more of mandible including ramus, involving TMJ, replaceable by prosthesis — 50% under DC 9902
- Loss of one-half or more of mandible including ramus, not involving TMJ, not replaceable by prosthesis — 40% under DC 9902
- Loss of one-half or more of mandible including ramus, not involving TMJ, replaceable by prosthesis — 30% under DC 9902
- Loss of less than one-half of mandible including ramus, involving TMJ, not replaceable by prosthesis — 70% under DC 9902
- Loss of less than one-half of mandible including ramus, not involving TMJ, not replaceable by prosthesis — 30% under DC 9902
- Both jaws lost (combined maxilla and mandible) — Evaluated under DC 9910; rated on the predominant or most disabling jaw condition with consideration for bilateral involvement
Tips:
- Request that the examiner document in millimeters or anatomical landmarks exactly how much bone is absent from each jaw.
- Bring operative or pathology reports that specify the resection margins for each jaw.
- If reconstruction (e.g., fibular free flap, titanium plate) was performed, clarify whether the examiner considers it a prosthesis for rating purposes - reconstructed bone may still leave significant functional deficits.
- Note whether TMJ involvement affects opening, closing, lateral excursion, and protrusion of the jaw.
Pain considerations: If residual bone edges or reconstruction hardware cause pain with jaw movement, eating, or pressure, describe this clearly. Pain at the surgical site or phantom jaw pain is a legitimate finding the examiner should document.
Prosthetic Restorability Assessment
Whether a suitable prosthesis (obturator, mandibular reconstruction prosthesis, denture, or implant-supported prosthesis) can restore masticatory function to a functional level. This is a critical rating fork under DC 9902, 9903, and 9913.
What to expect:
The examiner will ask whether you currently wear a prosthesis, how functional it is, whether you can eat solid foods, and whether there are complications such as instability, pain, sores, or inability to retain the appliance. They may examine fit and stability of any existing prosthetic appliance.
Key thresholds:
- Masticatory surface NOT restorable by suitable prosthesis — Higher rating tier applicable (e.g., 70%, 50%, 40%, 30%, or 100%)
- Masticatory surface IS restorable by suitable prosthesis — Lower rating tier applicable; under DC 9913, may result in 0% if prosthesis fully restores function
Tips:
- A prosthesis that exists but does not adequately restore function should be described as 'not adequately restoring masticatory function' - do not simply say 'I have a prosthesis' without explaining its limitations.
- Document all specific difficulties: the prosthesis slips, causes sores, cannot be worn for more than a few hours, requires removal to eat certain foods, or does not allow you to chew firm foods.
- Bring the prosthetic appliance to the exam if possible so the examiner can evaluate its fit and your ability to use it.
- If you have been told by a prosthodontist or oral surgeon that a satisfactory prosthesis cannot be fabricated due to insufficient bone or soft tissue, bring that documentation.
Pain considerations: Pain or discomfort while wearing the prosthesis - including mucosal irritation, pressure sores, or pain with chewing - directly affects functional restorability and should be communicated in detail.
Mandibular Malunion or Non-Union Assessment
Whether fractured jaw segments have healed in a misaligned position (malunion) or have failed to heal (non-union), confirmed by diagnostic imaging. Severity is assessed by degree of open bite (anterior-posterior or lateral).
What to expect:
Examiner will review imaging and assess bite alignment. They will look for false motion (movement at fracture site in non-union) and degree of malocclusion in malunion cases.
Key thresholds:
- Non-union confirmed by imaging, severe (with false motion) — Higher severity rating under DC 9902 non-union criteria
- Non-union confirmed by imaging, moderate (without false motion) — Moderate rating under non-union criteria
- Malunion causing severe open bite — Higher severity malunion rating
- Malunion causing moderate open bite — Moderate malunion rating
- Malunion causing only mild or no open bite — Lower malunion rating
Tips:
- Ensure recent imaging (panoramic X-ray, CT scan) is in your claims file before the exam.
- If you experience jaw movement or clicking at a fracture site, demonstrate this to the examiner.
- Describe how the bite misalignment affects your ability to chew, speak clearly, or close your mouth fully.
Pain considerations: Pain at non-union or malunion sites with jaw use, especially chewing or speaking at length, should be described in terms of frequency, intensity (0-10 scale), and functional impact.
Functional Impact Assessment - Chewing, Speech, Swallowing
The real-world functional consequences of bilateral jaw loss on eating, nutrition, speech intelligibility, swallowing safety, and social interaction.
What to expect:
The examiner will ask about your diet, ability to chew various food textures, any history of aspiration or choking, speech changes, drooling, and social/occupational limitations. This assessment informs the DBQ functional impact fields.
Key thresholds:
- Unable to eat solid foods; restricted to pureed or liquid diet — Supports 'not replaceable by prosthesis' finding and higher rating
- Significant speech impairment affecting communication — May support additional rating or SMC consideration
- Inability to maintain adequate nutrition due to chewing inability — Supports higher rating and consideration of extraschedular evaluation
Tips:
- Describe your most restricted diet on a typical day and on your worst days.
- Mention specific foods you can no longer eat that were part of your normal diet.
- If you have lost significant weight due to difficulty eating, document this with medical records.
- If speech intelligibility is affected, describe whether people often ask you to repeat yourself, whether you avoid phone calls, or whether you have been referred to speech therapy.
Pain considerations: Pain with chewing, swallowing, or prolonged speaking is a key functional factor. Report worst-day pain levels and how pain affects the duration and quality of eating and communication.
Rating Criteria Breakdown
| Rating % | Criteria | Key Symptoms |
|---|---|---|
| 100% | Complete loss of the mandible between the angles (DC 9901). This represents the most severe form of mandibular loss, involving the entire symphysis and body between both mandibular angles, resulting in complete loss of lower jaw function. |
CFR: 38 CFR 4.150, DC 9901: 'Mandible, loss of, complete, between angles - 100' |
| 70% | Loss of one-half or more of the mandible including the ramus, involving temporomandibular articulation, not replaceable by prosthesis (DC 9902). Also applies to loss of less than one-half of the mandible including the ramus, involving TMJ 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' |
| 50% | Loss of one-half or more of the mandible including the ramus, involving temporomandibular articulation, replaceable by prosthesis (DC 9902). Prosthesis exists but the extent of bone loss and TMJ involvement still produces significant disability. |
CFR: 38 CFR 4.150, DC 9902: 'Loss of one-half or more, Involving temporomandibular articulation - Replaceable by prosthesis 50' |
| 40% | Loss of one-half or more of the mandible including the ramus, NOT involving temporomandibular articulation, not replaceable by prosthesis (DC 9902). TMJ is preserved but extensive bone loss prevents adequate prosthetic restoration. |
CFR: 38 CFR 4.150, DC 9902: 'Loss of one-half or more, Not involving temporomandibular articulation - Not replaceable by prosthesis 40' |
| 40% | Teeth loss due to loss of substance of maxilla or mandible body without loss of continuity - loss of all teeth where masticatory surface cannot be restored by suitable prosthesis (DC 9913). |
CFR: 38 CFR 4.150, DC 9913: 'Loss of all teeth - 40' (where masticatory surface cannot be restored by suitable prosthesis). Note: Applies only to bone loss through trauma or disease such as osteomyelitis, not periodontal disease. |
| 30% | Loss of one-half or more of the mandible including the ramus, not involving TMJ, replaceable by prosthesis (DC 9902). Alternatively, loss of less than one-half of the mandible including the ramus, not involving TMJ, not replaceable by prosthesis. |
CFR: 38 CFR 4.150, DC 9902: 'Loss of one-half or more, Not involving temporomandibular articulation - Replaceable by prosthesis 30' and 'Loss of less than one-half, Not involving temporomandibular articulation - Not replaceable by prosthesis 30' |
| 20% | Loss of less than one-half of the mandible including the ramus, not involving TMJ, replaceable by prosthesis (DC 9902). Partial jaw loss with preserved TMJ and functional prosthetic restoration, but residual deficits remain. |
CFR: 38 CFR 4.150, DC 9902: 'Loss of less than one-half, Not involving temporomandibular articulation - Replaceable by prosthesis 20' |
100% Complete loss of the mandible between the angles (DC 9901). ...
Complete loss of the mandible between the angles (DC 9901). This represents the most severe form of mandibular loss, involving the entire symphysis and body between both mandibular angles, resulting in complete loss of lower jaw function.
Key Symptoms
- Total absence of mandibular body between angles
- Complete inability to masticate
- Severe speech impairment
- Inability to retain lower denture
- Need for liquid or tube feeding
- Significant facial disfigurement
- Difficulty maintaining oral hygiene
- Psychosocial impact from facial disfigurement
CFR: 38 CFR 4.150, DC 9901: 'Mandible, loss of, complete, between angles - 100'
70% Loss of one-half or more of the mandible including the ramus ...
Loss of one-half or more of the mandible including the ramus, involving temporomandibular articulation, not replaceable by prosthesis (DC 9902). Also applies to loss of less than one-half of the mandible including the ramus, involving TMJ articulation, not replaceable by prosthesis.
Key Symptoms
- Loss of half or more of mandible with ramus
- TMJ joint involvement with loss of condylar function
- Prosthesis cannot adequately restore masticatory function
- Severely limited or absent jaw opening and closing
- Chronic pain at resection site or TMJ area
- Inability to chew solid or semi-solid foods
- Significant speech deficits
- Recurrent infections or wound breakdown at surgical site
CFR: 38 CFR 4.150, DC 9902: 'Loss of one-half or more, Involving temporomandibular articulation - Not replaceable by prosthesis 70'
50% Loss of one-half or more of the mandible including the ramus ...
Loss of one-half or more of the mandible including the ramus, involving temporomandibular articulation, replaceable by prosthesis (DC 9902). Prosthesis exists but the extent of bone loss and TMJ involvement still produces significant disability.
Key Symptoms
- Loss of half or more of mandible with ramus and TMJ involvement
- Prosthesis available but function remains significantly limited
- Restricted diet despite prosthesis
- Prosthesis instability or pain with use
- Fatigue with prolonged chewing or speaking
- Social avoidance due to prosthetic limitations
CFR: 38 CFR 4.150, DC 9902: 'Loss of one-half or more, Involving temporomandibular articulation - Replaceable by prosthesis 50'
40% Loss of one-half or more of the mandible including the ramus ...
Loss of one-half or more of the mandible including the ramus, NOT involving temporomandibular articulation, not replaceable by prosthesis (DC 9902). TMJ is preserved but extensive bone loss prevents adequate prosthetic restoration.
Key Symptoms
- Extensive mandibular body and ramus loss without condylar involvement
- Jaw opening preserved but chewing function absent
- No adequate prosthesis available or tolerable
- Diet restricted to soft or liquid foods
- Speech affected by missing jaw structure
- Chronic wound care requirements at resection site
CFR: 38 CFR 4.150, DC 9902: 'Loss of one-half or more, Not involving temporomandibular articulation - Not replaceable by prosthesis 40'
40% Teeth loss due to loss of substance of maxilla or mandible b ...
Teeth loss due to loss of substance of maxilla or mandible body without loss of continuity - loss of all teeth where masticatory surface cannot be restored by suitable prosthesis (DC 9913).
Key Symptoms
- All teeth lost due to bone loss from trauma or disease (e.g., osteomyelitis)
- Not due to periodontal disease - must be due to loss of bone substance
- No suitable prosthesis can restore chewing surface
- Complete inability to chew without functional denture
CFR: 38 CFR 4.150, DC 9913: 'Loss of all teeth - 40' (where masticatory surface cannot be restored by suitable prosthesis). Note: Applies only to bone loss through trauma or disease such as osteomyelitis, not periodontal disease.
30% Loss of one-half or more of the mandible including the ramus ...
Loss of one-half or more of the mandible including the ramus, not involving TMJ, replaceable by prosthesis (DC 9902). Alternatively, loss of less than one-half of the mandible including the ramus, not involving TMJ, not replaceable by prosthesis.
Key Symptoms
- Significant mandibular bone loss with ramus, TMJ preserved
- Prosthesis available but with notable limitations
- OR lesser bone loss without TMJ involvement and no adequate prosthesis
- Moderate dietary restrictions
- Prosthetic appliance requires frequent adjustment or causes sores
CFR: 38 CFR 4.150, DC 9902: 'Loss of one-half or more, Not involving temporomandibular articulation - Replaceable by prosthesis 30' and 'Loss of less than one-half, Not involving temporomandibular articulation - Not replaceable by prosthesis 30'
20% Loss of less than one-half of the mandible including the ram ...
Loss of less than one-half of the mandible including the ramus, not involving TMJ, replaceable by prosthesis (DC 9902). Partial jaw loss with preserved TMJ and functional prosthetic restoration, but residual deficits remain.
Key Symptoms
- Partial mandibular loss, ramus may be involved, TMJ preserved
- Prosthesis functional but may not fully restore normal chewing
- Mild to moderate dietary limitations
- Occasional prosthetic discomfort or instability
CFR: 38 CFR 4.150, DC 9902: 'Loss of less than one-half, Not involving temporomandibular articulation - Replaceable by prosthesis 20'
How to Describe Your Symptoms
Chewing and Eating Ability
How to describe:
Describe specifically which food textures you can and cannot eat. Use concrete examples: 'I cannot chew bread, meat, raw vegetables, or anything requiring sustained bite force. I subsist primarily on pureed foods, soups, and protein shakes.' Quantify how long meals take and whether you experience pain or fatigue during eating.
Worst-day example:
“On my worst days, even soft foods like mashed potatoes cause pain at my resection site and I cannot finish a meal without stopping multiple times. I often skip meals because the effort and pain are not worth it, and I have lost 20 pounds over the past year because of this.”
What the examiner listens for:
Specific diet restrictions, evidence that the prosthesis does not adequately restore chewing, weight loss or nutritional deficiency, pain or fatigue with eating, total meal duration, and need for diet modification.
Understatements to avoid:
Do not say 'I manage okay' if you have significantly restricted your diet. Do not say 'I wear a prosthesis' without adding that it does not fully restore function, slips, or causes pain.
Prosthesis Function and Tolerability
How to describe:
If you have a prosthesis, describe its limitations honestly and specifically: 'My obturator fits poorly and causes ulcers on my gum tissue. I can only wear it for 2-3 hours before pain forces me to remove it. It does not allow me to eat anything firmer than scrambled eggs.' If you were told no suitable prosthesis is possible, bring that clinical documentation.
Worst-day example:
“On bad days, I cannot wear my prosthesis at all due to pain and swelling at the surgical site. I go the entire day without wearing it, which means I cannot speak clearly or eat in public. I have canceled social engagements and avoided work meetings because of this.”
What the examiner listens for:
Whether a prosthesis truly restores masticatory function or merely exists nominally, frequency of prosthesis use, complications, and whether the veteran can tolerate it for functional meal duration.
Understatements to avoid:
Do not say your prosthesis 'works fine' if you avoid wearing it due to pain, sores, or poor fit. The examiner may check 'replaceable by prosthesis' based on minimal statements, significantly reducing your rating.
Pain at Surgical Site and Jaw Area
How to describe:
Rate pain on a 0-10 scale and describe what triggers it, how long it lasts, and what relieves it. Describe both resting pain and pain with activity (chewing, speaking, yawning, or contact). Mention whether pain is constant, intermittent, or episodic with flare-ups.
Worst-day example:
“On my worst days, I have constant 7-8 out of 10 aching pain at my resection site that radiates into my cheek and ear. Speaking for more than 5 minutes causes a sharp 9 out of 10 pain spike. I require prescription pain medication on these days and cannot perform my normal job duties.”
What the examiner listens for:
Consistent pain pattern, pain level during activity versus rest, impact on sleep, and whether pain limits daily or occupational function.
Understatements to avoid:
Do not minimize pain by saying 'it's not that bad' or 'I manage with Tylenol' if your actual experience involves significant functional limitation. Report your worst days accurately.
Speech and Communication
How to describe:
Describe specific speech changes: 'I have difficulty pronouncing words with labial or dental consonants (p, b, t, d, s). People frequently ask me to repeat myself. I avoid phone calls because my speech is not clear. I have attended speech therapy.' If hypernasal speech results from palate or maxillary involvement, describe this specifically.
Worst-day example:
“On my worst days, my speech is so slurred and nasal that my family cannot understand me without looking at my face. I have declined job opportunities that require customer interaction because of my speech deficit.”
What the examiner listens for:
Objective speech changes noted during the interview, veteran's self-report of communication difficulties, avoidance behaviors, and referral to speech-language pathology.
Understatements to avoid:
Do not underreport speech changes simply because you have adapted or use workarounds. The adaptation itself (written communication, avoiding phone use) is evidence of functional limitation.
Facial Disfigurement and Psychosocial Impact
How to describe:
Describe visible facial contour changes, inability to close the mouth, drooling, and the psychosocial consequences. Be specific: 'I have a visible depression where my jaw was. I cannot fully close my lips due to missing mandibular support, which causes drooling and embarrassment in public.'
Worst-day example:
“On my worst days, I avoid all social situations because of my appearance. I have not eaten in public in over a year. I experience depression and anxiety directly related to my facial disfigurement and inability to communicate normally.”
What the examiner listens for:
Visible disfigurement noted on examination, drooling, inability to close mouth, and impact on social and occupational functioning.
Understatements to avoid:
Do not fail to mention psychosocial impacts because they seem unrelated to a dental exam. Functional impairment from disfigurement is directly relevant to VA rating and potential SMC consideration.
Secondary Conditions and Complications
How to describe:
Describe any complications from jaw loss or its treatment: chronic infections, fistulas, osteomyelitis recurrence, osteoradionecrosis from radiation therapy, hardware failure, aspiration pneumonia from swallowing difficulties, or nutritional deficiencies.
Worst-day example:
“Since my jaw resection, I have had three hospitalizations for infection at the surgical site. I require periodic hyperbaric oxygen treatments for osteoradionecrosis. I was diagnosed with malnutrition last year due to inability to maintain adequate caloric intake by mouth.”
What the examiner listens for:
History of complications, treatment for secondary conditions, pattern of recurring infections or wound breakdown, and evidence of systemic effects from jaw loss.
Understatements to avoid:
Do not fail to mention secondary complications because they feel like separate issues. All complications directly caused by or related to the service-connected jaw loss are relevant to the rating.
Common Mistakes to Avoid
Saying 'I have a prosthesis' without explaining its functional limitations
The examiner will check 'replaceable by prosthesis' on the DBQ, which triggers the lower rating tier. Simply having a prosthesis does not mean your masticatory function is restored.
Instead: Describe the prosthesis in detail: fit, stability, pain with use, hours per day worn, foods still unavailable with it, and any complications. If it does not restore normal chewing, say so explicitly with examples.
Impact: Can drop rating from 70% to 50%, from 40% to 30%, or from 30% to 20% under DC 9902
Describing only average-day symptoms rather than worst-day symptoms
VA rating policy per M21-1 requires documentation of the full range of disability. Raters use the full spectrum of your condition, including flare-ups and worst days, to assign a rating.
Instead: Explicitly describe your worst days: the most severe pain, the most restricted function, the longest duration of inability to eat or speak. Use the phrase 'on my worst days' to ensure this is captured.
Impact: Affects all rating levels by potentially underrepresenting disability severity
Failing to document the cause of jaw loss (trauma vs. disease vs. periodontal disease)
Under DC 9913, ratings for tooth loss apply ONLY to bone loss from trauma or disease such as osteomyelitis - NOT from periodontal disease. Failing to establish the correct etiology can result in a 0% non-compensable rating.
Instead: Bring service records, operative reports, and pathology reports establishing that jaw or tooth loss resulted from service-connected trauma, cancer, osteomyelitis, osteoradionecrosis, or other compensable disease - not periodontal disease.
Impact: Could result in 0% if etiology is classified as periodontal disease under DC 9913
Not mentioning all affected structures - treating the exam as only about bone loss
The DBQ covers loss of teeth, lips, tongue, soft tissue, TMD, and oral neoplasms as separate ratable conditions. Each may qualify for an additional rating under a separate diagnostic code.
Instead: At the exam, mention all related conditions: loss of teeth, lip involvement, tongue changes, soft tissue scarring, TMJ dysfunction, and any oral neoplasm history. Ask the examiner to evaluate and document each separately.
Impact: Missing secondary conditions can mean 10-40% additional ratings not captured
Failing to bring prior imaging or surgical records to the exam
Non-union and malunion ratings specifically require confirmation by diagnostic imaging. Without imaging, the examiner may not be able to check the appropriate severity level.
Instead: Bring or ensure the VA has all relevant imaging: panoramic X-rays, CT scans, operative reports, and pathology reports. Request records from treating facilities well in advance of the exam.
Impact: Non-union and malunion ratings at 30%, 40%, 50%, or 70% may not be assigned without imaging confirmation
Not reporting the impact on work and social functioning
The DBQ specifically asks about functional impact on occupational and daily activities. Failure to report these limits the examiner's ability to fully document disability.
Instead: Prepare specific examples of how the condition affects your job, social life, eating in public, communication, and relationships. Provide concrete examples rather than vague statements.
Impact: Affects extraschedular consideration and overall VA benefits picture
Describing pain only as 'manageable' without quantifying it
Examiners document what veterans report. Vague or minimized pain descriptions result in clinical notes that underrepresent actual disability severity.
Instead: Use a numerical scale (0-10), describe frequency (daily, several times per week), describe triggers and duration, and describe how pain limits specific activities. Report worst-day pain separately from average pain.
Impact: Affects all rating levels and potential SMC considerations
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 request a copy of your completed Disability Benefits Questionnaire (DBQ) after the examination.
- You have the right to record your C&P examination in most states, subject to applicable state consent laws. Inform the examiner before beginning.
- You have the right to a thorough and contemporaneous examination. If the exam is inadequate - too brief, records not reviewed, functional impact not assessed - you may request a new examination.
- You have the right to submit additional evidence (lay statements, buddy statements, private medical opinions) after the C&P exam and before a rating decision is issued.
- You have the right to obtain a private dental or oral surgery opinion (nexus or severity opinion) to supplement or rebut a C&P exam finding.
- You have the right to request a higher-level review or file a Notice of Disagreement if you believe the rating decision does not accurately reflect the severity of your condition.
- Under 38 CFR 3.303 and 3.304, direct service connection requires: a current diagnosis, an in-service event or injury, and a medical nexus linking the two. You have the right to submit evidence establishing each element.
- If your jaw loss resulted from treatment for a service-connected condition (e.g., radiation for service-connected oral cancer), you may be entitled to secondary service connection under 38 CFR 3.310.
- You have the right to VA dental treatment for service-connected compensable dental conditions, including maintenance care necessary to preserve oral health and chewing function (Class I dental treatment).
- Loss of both jaws may qualify you for Special Monthly Compensation (SMC) under 38 U.S.C. 1114, depending on total disability picture. You have the right to have SMC eligibility evaluated automatically when rating criteria are met.
- You have the right to request that the VA consider all applicable diagnostic codes, not just the one listed in your claim. If your condition could be rated under DC 9901, 9902, 9903, or 9910, ask that all codes be considered to ensure the highest applicable rating.
- The benefit of the doubt standard under 38 CFR 3.102 requires VA to resolve reasonable doubt in your favor when the evidence is in approximate balance.
Related Conditions
- Mandible, Loss of, Complete, Between Angles Directly related diagnostic code (DC 9901) under 38 CFR 4.150. Complete loss between mandibular angles rates at 100%. May apply as component of bilateral jaw loss under DC 9910.
- Mandible, Loss of, Including Ramus Directly related diagnostic code (DC 9902) covering partial to extensive mandibular loss with ramus involvement. Rating varies from 20% to 70% based on extent, TMJ involvement, and prosthetic restorability.
- Maxilla, Loss of, Partial or Complete Companion diagnostic code for maxillary bone loss under 38 CFR 4.150. Bilateral jaw loss (DC 9910) involves both maxillary and mandibular loss evaluated together.
- Teeth, Loss of, Due to Loss of Substance of Maxilla or Mandible DC 9913 provides ratings for tooth loss specifically caused by jaw bone loss (not periodontal disease). May be rated separately from jaw bone loss ratings. Ranges from 0% (restorable by prosthesis) to 40% (all teeth lost, not restorable).
- Temporomandibular Disorder (TMD) Jaw loss frequently involves or secondarily causes TMJ dysfunction. TMD is evaluated on a separate DBQ and may yield an additional rating under DC 9905 based on limited jaw opening (interincisal distance).
- Osteomyelitis or Osteoradionecrosis of the Jaw A common underlying cause of jaw bone loss leading to DC 9910 ratings. Active or recurrent osteomyelitis or osteoradionecrosis may be separately ratable under DC 9904 or 9905 and supports the etiology requirement for DC 9913 tooth loss ratings.
- Soft Tissue Injury of the Mouth Jaw resection frequently involves or results in soft tissue loss, scarring, or fistula formation. Soft tissue injuries of the mouth may be separately ratable under DC 9916 and should be evaluated at the same C&P exam.
- Lips, Injuries of Jaw loss and reconstruction may involve lip involvement or lip injury. Rated under DC 9900 and can be evaluated at the same dental DBQ exam.
- Tongue, Loss of Whole or Part Oral cancer resections involving both jaw and tongue may include partial glossectomy. Tongue loss is separately ratable under DC 9914 and significantly impacts speech and swallowing.
- Oral Neoplasm (Malignant or Benign) Oral cancer is a frequent underlying cause of jaw resection. A service connected oral malignancy may be the primary condition, with jaw loss as a residual. Active malignancy and residuals are separately ratable.
- Malnutrition / Nutritional Deficiency Chronic inability to chew from bilateral jaw loss can cause significant nutritional deficiency or malnutrition, which may be ratable as a secondary condition or support extraschedular consideration.
- Depression or Anxiety Secondary to Facial Disfigurement Visible facial disfigurement and functional loss from bilateral jaw loss frequently causes or aggravates mental health conditions. Secondary service connection for depression or PTSD secondary to jaw loss may be pursued under 38 CFR 3.310.
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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.