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C&P Exam Prep: Maxilla or Mandible, Malunion or Nonunion of
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 current severity of maxillary or mandibular malunion or nonunion, confirm diagnosis via imaging, and assign a disability rating under 38 CFR 4.150 DC 9916 (maxilla) or DC 9903 (mandible) based on objective clinical and radiographic findings including presence or absence of false motion, degree of open bite, and degree of displacement.
What the examiner evaluates:
- Presence and type of malunion (maxilla or mandible) or nonunion confirmed by diagnostic imaging
- Presence or absence of false motion (abnormal mobility of bone fragments) in nonunion cases
- Degree of anterior or posterior open bite displacement in malunion cases (mild, moderate, or severe)
- Occlusal relationship and bite function
- Jaw opening range of motion and functional limitations
- Pain with jaw movement, chewing, and speaking
- History and outcome of prior surgical or non-surgical treatments (fixation, reconstruction, etc.)
- Associated complications such as osteomyelitis, osteoradionecrosis, or loss of teeth
- Impact on daily activities including eating, speaking, and oral hygiene
- Review of prior imaging studies (X-ray, CT scan, panoramic radiograph, MRI)
Exam is typically conducted in a dental examination chair. The examiner will review your records, take a history, and perform a clinical oral and jaw examination. Imaging may be ordered or reviewed at this visit. Bring copies of all relevant prior imaging reports and treatment records. You have the right to request that the exam be recorded in most states.
Typical duration: 20-30 minutes
Presence of False Motion (Nonunion Assessment)
Abnormal mobility or movement between bone fragments at the fracture site, indicating nonunion with false motion - the key determinant for the 30% rating under DC 9916 for maxillary nonunion and DC 9903 for mandibular nonunion.
What to expect:
The examiner will attempt to gently manipulate the jaw and fractured bone segments to assess whether abnormal movement is present between fragments. The examiner will also reference diagnostic imaging (X-ray, CT, panoramic radiograph) to confirm nonunion. You may feel discomfort or pressure during this assessment.
Key thresholds:
- Nonunion WITH false motion confirmed by imaging — 30% rating under DC 9916 (maxilla) or DC 9903 (mandible)
- Nonunion WITHOUT false motion confirmed by imaging — 10% rating under DC 9916 (maxilla) or DC 9903 (mandible)
Tips:
- Inform the examiner if you feel abnormal movement, clicking, or instability in your jaw or upper jaw area during the assessment.
- Mention if you have ever been told by a dentist, oral surgeon, or radiologist that your fracture did not heal properly.
- Bring all prior imaging reports (panoramic X-ray, CT scan, MRI) that document the nonunion.
- Describe any episodes where your jaw or jaw fragments feel like they shift or move abnormally when eating or speaking.
Pain considerations: Report pain or discomfort at the fracture site both at rest and during manipulation. If the examiner's assessment causes pain, say so clearly and describe its severity on a 0-10 scale.
Degree of Open Bite (Malunion Assessment)
The extent to which the upper and lower teeth fail to make contact when the jaw is closed, caused by displacement from malunion. This determines mild, moderate, or severe classification for rating purposes under DC 9916.
What to expect:
The examiner will assess your bite by asking you to close your mouth naturally and will observe the space between upper and lower teeth. They may measure the vertical gap between teeth in millimeters and assess whether it is anterior (front teeth) or posterior (back teeth). They will also evaluate the functional impact on chewing.
Key thresholds:
- Severe anterior or posterior open bite with displacement — 30% rating under DC 9916
- Moderate anterior or posterior open bite with displacement — 10% rating under DC 9916
- Mild or no open bite with displacement — 0% rating under DC 9916 (non-compensable)
Tips:
- Show the examiner your bite on your worst functional day - if you have swelling or muscle spasms periodically that worsen the bite, describe this accurately.
- Explain which foods you cannot eat because of your open bite (e.g., inability to bite into sandwiches, apples, or hard foods).
- If your open bite has worsened over time, describe the progression.
- Mention if your bite has shifted since the original injury or since surgery.
Pain considerations: Describe pain specifically associated with biting, chewing, or trying to close your mouth fully. Note whether pain prevents you from achieving full occlusion.
Jaw Range of Motion (ROM) Assessment
Maximum mouth opening, lateral excursion (side-to-side jaw movement), and protrusion. While ROM is not a direct rating criterion for DC 9916, it documents functional impairment and associated TMJ effects.
What to expect:
The examiner will ask you to open your mouth as wide as possible, move your jaw side to side, and push your jaw forward. Measurements may be taken with a ruler or caliper in millimeters. Normal maximum mouth opening is approximately 40-50mm.
Key thresholds:
- Maximum opening less than 10mm — Indicates severe functional impairment; may support higher rating or secondary TMJ claim
- Maximum opening 10-30mm — Indicates moderate limitation; documents functional impact for remarks section
Tips:
- Open your mouth to the point where you first feel pain or significant restriction - do not push through severe pain.
- If your jaw catches, clicks, deviates, or feels unstable during opening, tell the examiner.
- Describe your ROM on your average bad day, not your best day.
- If you have a separate TMJ condition caused by the malunion or nonunion, ask the examiner to note this as a possible secondary condition.
Pain considerations: If opening your mouth fully causes pain, report it immediately. Describe the location, character (sharp, aching, throbbing), and severity of the pain during the movement.
Diagnostic Imaging Review (X-Ray, CT, Panoramic Radiograph)
Imaging is required by regulation (38 CFR 4.150 Note for DC 9916) to confirm maxillary nonunion. It documents fracture site characteristics, fragment position, degree of displacement, and healing status.
What to expect:
The examiner may order new imaging (panoramic X-ray, CT scan, or periapical X-rays) or review existing imaging. CT scans are the gold standard for evaluating three-dimensional fragment displacement and confirming nonunion. Bring all prior imaging discs or reports to the exam.
Key thresholds:
- Imaging confirms nonunion (fracture line visible, no bridging callus) — Required for any rating under DC 9916 nonunion category; without imaging confirmation, nonunion rating cannot be assigned
- Imaging confirms malunion with measurable displacement — Supports severity classification (mild/moderate/severe open bite) for DC 9916 malunion category
Tips:
- Bring all prior imaging reports, CT scan discs, and panoramic X-ray results to the exam.
- If your treating oral surgeon or dentist has recent imaging confirming your condition, bring a copy of those reports.
- Ask the examiner to document imaging findings in the DBQ, not just note that imaging was reviewed.
- If no imaging has been done recently, politely ask the examiner whether updated imaging is needed to accurately document your current condition.
Pain considerations: Inform the examiner if positioning for imaging (e.g., panoramic X-ray positioning) causes pain or is difficult due to your jaw condition.
Rating Criteria Breakdown
| Rating % | Criteria | Key Symptoms |
|---|---|---|
| 30% | Maxillary nonunion WITH false motion (confirmed by diagnostic imaging), OR maxillary malunion with displacement causing SEVERE anterior or posterior open bite. For mandible (DC 9903): Severe nonunion with false motion confirmed by imaging. |
CFR: 38 CFR 4.150 DC 9916: Nonunion with false motion = 30%. Malunion with displacement causing severe anterior or posterior open bite = 30%. 38 CFR 4.150 DC 9903: Mandible nonunion severe with false motion = 30%. |
| 10% | Maxillary nonunion WITHOUT false motion (confirmed by diagnostic imaging), OR maxillary malunion with displacement causing MODERATE anterior or posterior open bite. For mandible (DC 9903): Moderate nonunion without false motion confirmed by imaging. |
CFR: 38 CFR 4.150 DC 9916: Nonunion without false motion = 10%. Malunion with displacement causing moderate anterior or posterior open bite = 10%. 38 CFR 4.150 DC 9903: Mandible nonunion moderate without false motion = 10%. |
| 0% | Maxillary malunion with displacement causing only MILD or NO anterior or posterior open bite. This is a non-compensable rating but still establishes service connection, which may be important for future increases or secondary conditions. |
CFR: 38 CFR 4.150 DC 9916: Malunion with displacement causing mild or no open bite = 0% (non-compensable). Note: A 0% rating still establishes service connection, protecting future claims if the condition worsens. |
30% Maxillary nonunion WITH false motion (confirmed by diagnosti ...
Maxillary nonunion WITH false motion (confirmed by diagnostic imaging), OR maxillary malunion with displacement causing SEVERE anterior or posterior open bite. For mandible (DC 9903): Severe nonunion with false motion confirmed by imaging.
Key Symptoms
- Palpable or visible abnormal movement between maxillary bone fragments (false motion)
- Severe open bite - significant gap between upper and lower teeth preventing any meaningful occlusal contact
- Inability to bite or chew most foods
- Severe functional impairment of mastication
- Pain at fracture site with any jaw movement
- Instability of the maxilla or mandible during normal function
- Diagnostic imaging confirming nonunion with absence of bony bridging at fracture site
- Significant difficulty with speech due to jaw displacement
- Requirement for liquid or pureed diet due to inability to chew
CFR: 38 CFR 4.150 DC 9916: Nonunion with false motion = 30%. Malunion with displacement causing severe anterior or posterior open bite = 30%. 38 CFR 4.150 DC 9903: Mandible nonunion severe with false motion = 30%.
10% Maxillary nonunion WITHOUT false motion (confirmed by diagno ...
Maxillary nonunion WITHOUT false motion (confirmed by diagnostic imaging), OR maxillary malunion with displacement causing MODERATE anterior or posterior open bite. For mandible (DC 9903): Moderate nonunion without false motion confirmed by imaging.
Key Symptoms
- Confirmed nonunion on imaging but no palpable abnormal mobility between fragments
- Moderate open bite - noticeable gap between upper and lower teeth with partial contact only
- Difficulty chewing hard or tough foods
- Partial functional limitation of mastication
- Intermittent or activity-related pain at fracture site
- Mild to moderate speech difficulty
- Ability to eat soft foods but significant restriction from normal diet
CFR: 38 CFR 4.150 DC 9916: Nonunion without false motion = 10%. Malunion with displacement causing moderate anterior or posterior open bite = 10%. 38 CFR 4.150 DC 9903: Mandible nonunion moderate without false motion = 10%.
0% Maxillary malunion with displacement causing only MILD or NO ...
Maxillary malunion with displacement causing only MILD or NO anterior or posterior open bite. This is a non-compensable rating but still establishes service connection, which may be important for future increases or secondary conditions.
Key Symptoms
- Minimal or no visible gap between upper and lower teeth
- Near-normal occlusal contact despite documented malunion
- Minimal or no functional limitation of chewing
- Mild or no pain with jaw function
- Displacement confirmed on imaging but not producing significant open bite
CFR: 38 CFR 4.150 DC 9916: Malunion with displacement causing mild or no open bite = 0% (non-compensable). Note: A 0% rating still establishes service connection, protecting future claims if the condition worsens.
How to Describe Your Symptoms
False Motion / Nonunion Instability
How to describe:
Describe any sensation of abnormal movement, shifting, or instability in your upper jaw (maxilla) or lower jaw (mandible) during everyday activities. Use specific, functional examples: 'When I chew on the left side, I can feel my jaw bone shift,' or 'My dentist told me the fracture never healed and there is movement between the bone pieces.' Be precise about when it occurs and how frequently.
Worst-day example:
“On my worst days, I can feel my upper jaw shift when I try to bite down on anything firmer than soft bread. The movement is accompanied by a sharp pain at the fracture site and I have to stop eating. This happens several times a week and forces me to eat only soft or liquid foods for the rest of the day.”
What the examiner listens for:
Spontaneous reporting of abnormal bone mobility, specific functional triggers for the instability, frequency of episodes, and whether the instability was documented by treating providers. The examiner needs to check the 'with false motion' box to support a 30% rating, so they are listening for credible, consistent descriptions of abnormal mobility.
Understatements to avoid:
Do not say 'my jaw feels a little loose sometimes' if you experience clear abnormal movement - describe it with precision. Do not wait for the examiner to ask; volunteer this information during your history.
Open Bite and Occlusal Dysfunction
How to describe:
Describe the gap between your upper and lower teeth and its functional consequences. Quantify it if possible ('My front teeth have a gap of about [X]mm when I close my mouth fully') and describe what you cannot do because of it. Explain whether the open bite is anterior (front of mouth) or posterior (back of mouth), or both.
Worst-day example:
“On my worst days, the gap between my upper and lower front teeth is severe enough that I cannot bite into any solid food at all. I cannot eat a sandwich, apple, or piece of meat. I have been on a primarily soft or liquid diet for the past [X] months because biting causes my jaw to shift painfully. My speech is also noticeably affected and I have to repeat myself frequently.”
What the examiner listens for:
Specific foods that cannot be consumed, whether the open bite is anterior versus posterior, severity of the gap, functional impact on mastication and speech, and whether the condition has worsened over time. This directly informs the mild/moderate/severe classification.
Understatements to avoid:
Do not say 'I just avoid certain foods' without specifying what foods and how this affects your nutrition and quality of life. Do not minimize the bite problem by saying 'I manage okay' if you have significantly altered your diet.
Pain at the Fracture Site
How to describe:
Describe pain location (upper jaw, lower jaw, cheekbone area, chin), character (sharp, aching, throbbing, burning), severity (0-10 scale), frequency (constant, intermittent, activity-related), and duration. Distinguish between pain at rest, pain with chewing, pain with speaking, and pain with jaw opening.
Worst-day example:
“On my worst days, the pain at the fracture site in my upper jaw is a 7/10 constant ache that spikes to 9/10 when I try to chew anything. The pain radiates toward my eye and cheek. I take [medication] but it only partially controls it, and the pain disrupts my sleep and prevents me from eating normally for 3-4 days at a time.”
What the examiner listens for:
Consistent, believable description of pain that correlates with the documented fracture site. The examiner will note pain during clinical manipulation, but your verbal report of pain patterns is equally important for the DBQ functional impact section.
Understatements to avoid:
Do not rate your pain on a 'good day' during the exam. Per M21-1 guidance, you should report your symptoms as they are on a typical bad day or flare. Do not say 'it's not that bad today' without clarifying that today may not represent your typical condition.
Functional Impact on Daily Life
How to describe:
Describe specific, concrete limitations in work, social life, nutrition, and self-care caused by your jaw condition. Include dietary restrictions, weight changes from inability to eat normally, difficulty speaking in professional or social settings, limitations in physical activities, and any psychological impact such as embarrassment or social withdrawal.
Worst-day example:
“Because of my jaw condition, I have lost [X] pounds over the past [X] months because I cannot eat normally. I avoid eating in public because of how I look and the difficulty I have. I cannot perform my job duties that require clear speech and I have had to request accommodations. On bad days, the pain and instability prevent me from concentrating on any task.”
What the examiner listens for:
Specific, concrete examples of functional loss rather than vague generalizations. The DBQ has a dedicated field for functional impact, and the examiner needs enough detail to accurately complete that section.
Understatements to avoid:
Do not say 'it affects my life a bit' - be specific and quantify the impact wherever possible. Do not fail to mention nutritional consequences, social withdrawal, or work limitations.
Treatment History and Residuals
How to describe:
Provide a chronological account of all treatments received for the fracture: initial fracture care, surgical fixation (ORIF, plates, screws, wires), subsequent surgeries for hardware failure or nonunion, bone grafting, orthodontic treatment, and any ongoing treatment. Describe what was attempted, what helped, what failed, and what residual problems remain despite treatment.
Worst-day example:
“Despite two surgeries including open reduction and internal fixation and a subsequent bone grafting procedure, my fracture never achieved bony union according to my oral surgeon. I still have hardware in place but continue to experience pain, instability, and an open bite. The most recent imaging in [year] still showed the fracture line without bridging callus.”
What the examiner listens for:
Whether nonunion persists despite treatment, whether surgery resulted in residual complications, and the overall treatment timeline. This information populates the treatment history sections of the DBQ and supports the severity classification.
Understatements to avoid:
Do not omit failed treatments or previous surgeries. Each treatment attempt and its outcome is important context for the examiner to understand why your condition is rated at its current severity.
Common Mistakes to Avoid
Failing to bring imaging documentation to the exam
VA regulation explicitly requires diagnostic imaging confirmation for maxillary nonunion ratings under DC 9916, and mandibular nonunion under DC 9903. Without imaging, the examiner cannot check the nonunion boxes on the DBQ, potentially resulting in a lower or denied rating.
Instead: Gather all panoramic X-rays, CT scan reports, periapical X-ray reports, and any radiologist or oral surgeon notes documenting nonunion or malunion. Bring physical copies and/or imaging discs to the exam. Request that your treating dentist or oral surgeon provide a letter summarizing imaging findings if formal reports are unavailable.
Impact: 30% or 10% nonunion ratings
Describing symptoms only on the day of the exam rather than on a typical bad day
C&P exams capture a single point in time, but your rating should reflect the average severity of your condition including flare-ups. If you happen to be having a relatively good day, describing only current symptoms may result in an underrated condition.
Instead: Per M21-1 guidance, accurately describe your symptoms on a typical bad day or during a flare-up. Use phrases like 'On my worst days, which occur approximately [X] times per month...' and contrast that with your best days. This is not exaggeration - it is accurate reporting of the full range of your condition.
Impact: All rating levels
Not volunteering information about false motion
The difference between a 10% and 30% rating for nonunion is entirely dependent on the presence or absence of false motion. If you do not proactively describe abnormal bone movement, the examiner may not specifically test for it or may default to 'without false motion.'
Instead: Proactively tell the examiner at the beginning of the history: 'I want to make sure you know that I experience abnormal movement/instability at my fracture site. My [oral surgeon/dentist] described this as false motion.' Describe specific triggers and frequency.
Impact: 30% vs. 10% nonunion rating
Minimizing dietary restrictions and functional impairment
The severity of the open bite (mild/moderate/severe) is the key rating determinant for malunion under DC 9916. Functional impact from the open bite - especially dietary restrictions - helps the examiner correctly classify severity. Veterans often underreport these limitations out of habit or stoicism.
Instead: Prepare a specific list of foods you cannot eat and activities you cannot perform because of your open bite. Mention any weight loss, nutritional supplements used as meal replacements, or diet modifications. These details directly inform the mild/moderate/severe classification.
Impact: 30% vs. 10% vs. 0% malunion rating
Failing to mention associated conditions such as secondary TMJ disorder or tooth loss
Malunion and nonunion can cause secondary conditions including TMJ disorders, tooth loss, and nerve damage. These may be separately ratable or support a higher overall combined rating. If you do not mention them, the examiner will not document them.
Instead: Tell the examiner about all oral and jaw symptoms, even if you are not sure they are related. Specifically mention any jaw clicking, locking, or TMJ pain; any teeth lost due to the fracture; any numbness or tingling in the jaw or face (inferior alveolar nerve damage); and any sinus complications if the maxilla is involved.
Impact: Secondary conditions and combined rating
Assuming the examiner has reviewed your records
Examiners may have limited time and may not have thoroughly reviewed your claims file before the exam. Key documentation such as operative reports, prior imaging, or treating provider statements may be missed.
Instead: Bring your own copies of key documents. At the start of the exam, briefly summarize your history: the service-connected injury or event, when it occurred, initial treatment, subsequent complications, and current status. Do not assume the examiner knows your full history.
Impact: All rating levels and service connection
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 a thorough and accurate C&P examination. The examiner must be fully informed of your claimed condition and must conduct a complete evaluation consistent with the DBQ requirements.
- You have the right to request a new C&P examination if you believe the original examination was inadequate, incomplete, or did not accurately reflect your condition. This can be done by submitting a supplemental claim with a statement explaining the deficiency.
- You have the right to submit buddy statements, lay statements, and independent medical opinions as evidence to supplement or contradict C&P exam findings.
- You have the right to obtain a copy of your completed DBQ. Request it through VA.gov, your VSO, or a Freedom of Information Act (FOIA) request after your exam.
- In most states, you have the right to audio or video record your C&P examination for your personal records. Check your state's recording consent laws before the exam.
- You have the right to have a VSO representative, accredited claims agent, or VA-accredited attorney assist you in preparing for your exam and reviewing the results.
- You have the right under 38 CFR 3.159(c)(4) to a VA examination when your claim requires one, and the examination must be adequate for rating purposes - including, for DC 9916 nonunion claims, confirmation by diagnostic imaging.
- You have the right to benefit of the doubt: when there is an approximate balance of positive and negative evidence regarding any issue material to your claim, the benefit of the doubt shall be given to you (38 CFR 3.102).
- You have the right to request a higher-level review or file a Board of Veterans' Appeals appeal if you disagree with the rating decision based on the C&P examination findings.
- Under 38 CFR 4.150 DC 9916, the VA is required to confirm maxillary nonunion by diagnostic imaging studies. If your exam was conducted without imaging review or documentation, you have the right to request a new examination that complies with this regulatory requirement.
Related Conditions
- Temporomandibular Disorder (TMD) Malunion or nonunion of the mandible or maxilla can cause secondary TMJ dysfunction due to altered occlusion, abnormal bite mechanics, and displacement of condylar position. If you have TMJ symptoms (clicking, locking, pain at the joint), this may be separately ratable as a secondary condition.
- Mandible, Loss of Portion of (DC 9904) Veterans with severe nonunion may have undergone surgical debridement or resection resulting in actual loss of mandibular bone, which is rated under a different diagnostic code. If bone was surgically removed, ensure the DBQ accurately captures whether mandibular loss has occurred.
- Osteomyelitis of the Jaw Nonunion fractures are susceptible to chronic osteomyelitis (bone infection). If you have or have had jaw bone infection related to your service connected fracture, this may be separately ratable as a secondary condition under DC 9903 notes or a related dental/oral code.
- Loss of Teeth (DC 9913/9914) Fractures of the maxilla or mandible frequently result in tooth loss, either from direct trauma or from surgical treatment. Teeth lost due to a service connected injury may be ratable under DC 9913 (loss of teeth due to trauma or disease of bone) rather than periodontal disease codes.
- Limitation of Motion of the Temporomandibular Joint (DC 9905) Malunion or nonunion can directly cause limited jaw opening (trismus) and restricted TMJ motion. If ROM limitation exists, it may be separately ratable under DC 9905 as a secondary condition to your malunion/nonunion.
- Chronic Pain Syndrome Persistent pain from maxillary or mandibular malunion or nonunion can develop into a chronic pain condition with systemic effects. If pain related functional impairment exceeds what is captured by the dental rating, a chronic pain secondary claim may be appropriate.
- Maxilla, Loss of Portion of (DC 9916 related) As with the mandible, severe maxillary nonunion may result in surgical resection of bone. Ensure the examiner distinguishes between malunion/nonunion and actual bone loss, as these may be rated differently.
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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.