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C&P Exam Prep: Ramus, Loss of

DC 9907 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 ramus loss, whether prosthetic replacement is feasible, whether the temporomandibular joint (TMJ) is involved, and any functional impairments affecting mastication, speech, and daily activities. The examiner must determine which specific rating criterion under DC 9907 or DC 9902 applies to your condition.

What the examiner evaluates:

  • Exact extent and location of mandibular ramus loss (less than one-half vs. one-half or more)
  • Whether the temporomandibular articulation (TMJ) is involved in the area of loss
  • Whether the condition is replaceable or not replaceable by prosthesis
  • Current prosthetic status and functional adequacy of any existing prosthesis
  • Masticatory function and ability to chew various food consistencies
  • Speech articulation and intelligibility impairment
  • Facial asymmetry or cosmetic deformity resulting from ramus loss
  • Any associated complications such as osteomyelitis, osteoradionecrosis, or osteonecrosis
  • TMJ range of motion and presence of trismus or limited mouth opening
  • Pain levels during function, at rest, and with jaw movement
  • Nutritional impact and dietary restrictions due to masticatory dysfunction
  • Review of diagnostic imaging (X-rays, CT scans, panoramic radiographs) confirming the extent of bone loss
  • History of surgical intervention, radiation therapy, chemotherapy, or other treatments
  • Nexus between current condition and service-connected event or injury

The exam will typically occur in a dental exam room. You may be asked to open and close your mouth, move your jaw laterally, and demonstrate any limitation in jaw function. The examiner will visually inspect and palpate the jaw area. Bring any existing dentures, partial prostheses, or splints to the exam. Panoramic X-rays or CT imaging may be requested if not recently obtained. You have the right to request that the exam be recorded in most states - check your state laws and notify the VA in advance.

Typical duration: 20-30 minutes

Extent of Ramus Loss Assessment

The proportion of the mandibular ramus that has been lost - specifically whether loss involves less than one-half or one-half or more of the mandible including the ramus, and whether the temporomandibular articulation is involved.

What to expect:

The examiner will review surgical reports, imaging (panoramic X-ray, CT scan), and conduct a clinical examination to quantify the amount of bone loss. They will determine which DBQ checkbox applies: loss of less than one-half including the ramus, or loss of one-half or more including the ramus, with or without TMJ involvement.

Key thresholds:

  • Loss of one-half or more of mandible including ramus - NOT replaceable by prosthesis - with TMJ involvement — 70% under DC 9902
  • Loss of one-half or more of mandible including ramus - Replaceable by prosthesis - with TMJ involvement — 50% under DC 9902
  • Loss of one-half or more of mandible including ramus - NOT replaceable by prosthesis - without TMJ involvement — 40% under DC 9902
  • Loss of one-half or more of mandible including ramus - Replaceable by prosthesis - without TMJ involvement — 30% under DC 9902
  • Loss of less than one-half of mandible including ramus - NOT replaceable by prosthesis — 20% under DC 9907
  • Loss of less than one-half of mandible including ramus - Replaceable by prosthesis — 10% under DC 9907

Tips:

  • Bring copies of all surgical operative reports documenting what bone was resected.
  • Bring your most recent panoramic X-ray or CT scan results - these are the primary imaging modalities the examiner will rely on.
  • If you have not been evaluated for a prosthesis, clearly tell the examiner so they can document prosthetic replaceability accurately.
  • If an existing prosthesis is inadequate, ill-fitting, or does not restore function, communicate this clearly - it may affect whether the condition is considered 'replaceable.'
  • The distinction between 'replaceable' and 'not replaceable' is critical to your rating - be prepared to explain why your condition cannot be adequately restored with a prosthesis.

Pain considerations: Report any pain experienced during jaw movement, chewing, or palpation of the surgical site. Note whether pain prevents comfortable prosthesis wear.

Temporomandibular Joint (TMJ) Involvement Assessment

Whether the area of mandibular loss includes or directly affects the temporomandibular articulation (condyle-fossa joint relationship).

What to expect:

The examiner will assess whether the condylar process and/or ramus loss has disrupted or eliminated TMJ function. This determination significantly impacts the rating - TMJ involvement elevates the applicable rating tier under DC 9902.

Key thresholds:

  • TMJ involvement confirmed — Moves rating to higher tier (e.g., 70% vs. 40% for same extent of loss)
  • No TMJ involvement — Applies lower tier ratings (40% or 30% for one-half or more loss)

Tips:

  • If your condyle was removed as part of the ramus resection, explicitly state this to the examiner.
  • Report any clicking, popping, locking, or pain localized to the TMJ area.
  • Note if you have difficulty fully opening your mouth or moving your jaw side to side.
  • Ask the examiner to document in the DBQ whether TMJ articulation is or is not involved.

Pain considerations: Describe any preauricular pain, joint noise, or discomfort with jaw movement that may indicate TMJ disruption.

Mouth Opening Range of Motion (Interincisal Distance)

The maximum distance the mouth can open, measured in millimeters between upper and lower incisor edges. Normal range is approximately 35-50 mm.

What to expect:

The examiner will ask you to open your mouth as wide as possible. They may use a millimeter ruler or caliper to measure. They will also assess lateral excursion and protrusive movement.

Key thresholds:

  • Less than 10 mm opening — Severe trismus - may support higher functional impairment documentation and secondary TMJ rating
  • 10-20 mm opening — Moderate limitation - supports documentation of functional impairment
  • Greater than 35 mm — Near-normal range - examiner should still document whether prosthesis is adequate

Tips:

  • Do not take pain medication that would mask your true level of functional limitation before the exam.
  • If your mouth opening is worse on certain days or after extended use, describe your worst-day opening ability.
  • Report any asymmetric jaw deviation during opening, as this documents structural changes from ramus loss.
  • If trismus or scar tissue limits your opening, tell the examiner how this affects eating, dental care, and speech.

Pain considerations: Tell the examiner if opening your mouth to maximum extent causes pain, and rate that pain on a 0-10 scale. Note whether pain at maximum opening is your typical experience or occurs only on worst days.

Prosthesis Adequacy Evaluation

Whether an existing or potential prosthesis can adequately replace the lost ramus structure and restore functional anatomy. The key VA distinction is 'replaceable by prosthesis' versus 'not replaceable by prosthesis.'

What to expect:

The examiner will assess whether you currently wear a prosthesis, whether it fits and functions adequately, and whether reconstruction is technically feasible given your anatomy. This may involve reviewing prior consultation notes from prosthodontists or oral surgeons.

Key thresholds:

  • Not replaceable by prosthesis — Higher rating tier applies (20% for DC 9907 partial loss; 40% or 70% for DC 9902 larger loss)
  • Replaceable by prosthesis — Lower rating tier applies (10% for DC 9907 partial loss; 30% or 50% for DC 9902 larger loss)

Tips:

  • Bring your current prosthesis to the exam so the examiner can evaluate its fit and function.
  • If your prosthesis causes pain, sores, poor fit, or inadequate function, document this clearly.
  • If you have been told by a dental specialist that prosthetic reconstruction is not feasible, bring that documentation.
  • If you have not had a prosthetic consultation, ask whether one is warranted - the lack of a prosthesis does not automatically mean 'not replaceable.'
  • Describe specific functional deficits that persist even with your current prosthesis in place.

Pain considerations: Note whether wearing the prosthesis causes pain or irritation that limits how long you can wear it daily.

Estimate

Rating Criteria Breakdown

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 the temporomandibular articulation, NOT replaceable by prosthesis. This is the highest rating under DC 9902 and reflects the most severe structural and functional loss where no adequate prosthetic replacement exists and TMJ function is lost.

Key Symptoms

  • Extensive mandibular resection including condyle and ramus
  • Complete loss of TMJ articulation on affected side(s)
  • No feasible prosthetic reconstruction available
  • Severe masticatory dysfunction - inability to chew solid or semi-solid foods
  • Significant speech impairment due to structural loss
  • Major facial asymmetry and cosmetic deformity
  • Dependence on liquid or pureed diet
  • Chronic pain in the surgical area and surrounding structures
  • Trismus or severely limited mouth opening

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

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 the temporomandibular articulation, replaceable by prosthesis. Significant structural loss with TMJ involvement where some prosthetic restoration is technically possible, though full functional restoration may not be achievable.

Key Symptoms

  • Extensive mandibular and ramus loss including condyle
  • Loss of TMJ articulation
  • Prosthetic replacement is technically feasible but may not fully restore function
  • Moderate-to-severe masticatory dysfunction even with prosthesis
  • Dietary restrictions persist with prosthesis in place
  • Facial asymmetry with partial cosmetic correction possible
  • Speech difficulty that persists despite prosthetic use

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

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 the temporomandibular articulation, NOT replaceable by prosthesis. Extensive loss that spares the condyle/TMJ but cannot be prosthetically restored.

Key Symptoms

  • Extensive ramus and mandibular body resection sparing the condyle
  • TMJ articulation is preserved or unaffected
  • Prosthetic reconstruction is not technically feasible
  • Significant masticatory dysfunction
  • Structural deficiency in the ramus-body region
  • Facial contour deformity without prosthetic correction

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

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 the temporomandibular articulation, replaceable by prosthesis. Extensive loss sparing the TMJ where prosthetic reconstruction is achievable.

Key Symptoms

  • Major ramus/mandible loss with preserved condyle
  • Prosthetic reconstruction feasible
  • Residual masticatory impairment even with prosthesis
  • Dietary modifications required
  • Some persistent speech difficulty

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

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 replaceable by prosthesis. Under DC 9907, partial ramus loss that cannot be adequately restored with a prosthetic device.

Key Symptoms

  • Partial ramus loss (less than one-half of total mandible including ramus)
  • No feasible prosthetic option to replace lost bone
  • Moderate masticatory dysfunction
  • Some dietary limitation
  • Mild-to-moderate speech impairment
  • Visible structural deficit without prosthetic correction

CFR: 38 CFR - 4.150, DC 9907: Loss of less than one-half of the mandible including the ramus, not replaceable by prosthesis - 20 percent.

10% Loss of less than one-half of the mandible including the ram ...

Loss of less than one-half of the mandible including the ramus, replaceable by prosthesis. Under DC 9907, partial ramus loss where an adequate prosthetic restoration can be placed.

Key Symptoms

  • Partial ramus loss (less than one-half)
  • Prosthetic replacement is feasible and functionally adequate
  • Mild masticatory dysfunction
  • Minor dietary restrictions
  • Mild or no speech impairment
  • Cosmetic deficit partially correctable with prosthesis

CFR: 38 CFR - 4.150, DC 9907: Loss of less than one-half of the mandible including the ramus, replaceable by prosthesis - 10 percent.

How to Describe Your Symptoms

Masticatory Dysfunction

How to describe:

Describe specifically which food textures you cannot chew, how long it takes to eat a meal, whether you must cut food into very small pieces, and whether you avoid certain foods entirely. Quantify: 'I can only eat soft foods like mashed potatoes and yogurt. I cannot chew bread, meat, or raw vegetables. Meals take me 45 minutes because I must process each bite extensively with my remaining teeth and tongue.'

Worst-day example:

“On my worst days, even soft foods like pasta cause pain in my jaw when I try to chew. I have subsisted on protein shakes and pureed foods for up to a week at a time following flare-ups of pain and swelling at the surgical site. I have lost [X] pounds since my surgery because eating is painful and exhausting.”

What the examiner listens for:

Specific food restrictions, weight loss associated with dietary changes, duration of meals, compensatory eating behaviors, pain with mastication, and social isolation from inability to eat normal foods.

Understatements to avoid:

Do not say 'I manage fine' or 'I've gotten used to it.' These statements suggest your condition has no functional impact. Instead, accurately describe every accommodation you make and every activity you avoid because of your jaw condition.

Speech Impairment

How to describe:

Note whether people frequently ask you to repeat yourself, whether you avoid speaking in certain situations, whether your speech has changed since the surgery, and whether specific sounds are difficult to form. Example: 'Since losing part of my ramus, I have noticeable difficulty forming consonant sounds. Coworkers and family members frequently ask me to repeat myself. I avoid public speaking situations and phone calls when possible.'

Worst-day example:

“On days when my jaw pain and swelling are at their worst, my speech becomes significantly more difficult to understand. My family has to guess what I am saying. I have called in sick to work on at least [X] occasions because I could not communicate effectively enough to do my job.”

What the examiner listens for:

Observable speech changes during the exam itself, descriptions of social or occupational impact, specific sounds affected, and whether speech therapy has been sought or recommended.

Understatements to avoid:

Do not minimize speech changes by saying 'people understand me most of the time.' If any accommodation is needed, describe it fully and accurately.

Pain and Discomfort

How to describe:

Use a 0-10 pain scale. Distinguish between resting pain, functional pain (chewing, speaking, yawning), and pain at your worst. Describe the character of pain (aching, sharp, throbbing, burning), its location, radiation pattern, frequency, and what makes it worse or better. Example: 'My baseline pain is a 4/10 dull ache over the surgical site. When I try to chew anything firm, pain spikes to 8/10. I wake up at night at least twice a week with jaw pain at 6/10.'

Worst-day example:

“On my worst days, which occur approximately [X] times per month and last [X] days, my jaw pain is a 9/10. I cannot eat solid food, cannot speak clearly, and cannot concentrate on work or daily tasks. I require [medications, ice, rest] and am unable to leave my home on these days.”

What the examiner listens for:

Pain frequency, severity on worst days versus average days, impact on sleep, ability to work, and daily activities. The examiner must document your condition as it exists across the full spectrum of presentation, not just how you appear on the exam day.

Understatements to avoid:

Do not describe only your average or best days. Per M21-1 guidance, your condition should be rated based on its full impact including worst-day presentations. If you happen to be having a good day at the exam, proactively tell the examiner: 'Today is actually a better day for me - my typical presentation is worse than what you are seeing right now.'

Prosthesis Function and Limitations

How to describe:

If you have a prosthesis, describe its limitations honestly and specifically. Note how many hours per day you can comfortably wear it, whether it causes sores or irritation, whether it moves or falls out during eating or speaking, and whether it actually restores function to a meaningful degree.

Worst-day example:

“On my worst days I cannot wear my prosthesis at all due to pain and swelling at the fitting site. Even on better days I can only tolerate it for [X] hours before irritation and soreness force me to remove it. Without it in place, I cannot eat any solid food or speak clearly.”

What the examiner listens for:

Hours of daily prosthesis use, pain with prosthesis wear, functional restoration achieved or not achieved, and whether the prosthesis is truly 'replaceable' in a meaningful functional sense.

Understatements to avoid:

Do not say 'the prosthesis works fine' if it does not fully restore your function. A prosthesis that is technically present but does not restore adequate function may still support a finding of impaired function.

Facial Deformity and Psychosocial Impact

How to describe:

Accurately describe any visible facial asymmetry, contour changes, or cosmetic deformity resulting from ramus loss. Note impact on social interactions, confidence, employment, and relationships. Example: 'The left side of my jaw is noticeably sunken since surgery. Strangers frequently ask what happened to my face. I avoid social situations and have stopped attending family gatherings because of embarrassment and discomfort.'

Worst-day example:

“On days when swelling is present in the surgical area, my facial asymmetry is even more pronounced. I have declined job interviews and social events because of how my face looks and because I cannot eat or speak normally in public.”

What the examiner listens for:

Specific cosmetic deficits visible on examination, social withdrawal, occupational limitations, and mental health impact of disfigurement.

Understatements to avoid:

Do not dismiss cosmetic impact as trivial. Facial deformity resulting from bone loss has real functional and psychosocial consequences that are relevant to your overall disability picture.

Associated Complications

How to describe:

Report any complications such as recurrent infections, osteomyelitis, osteoradionecrosis, or wound healing problems in the surgical area. These are separate ratable conditions that may also affect the rating or support secondary service connection. Example: 'I have had [X] episodes of infection requiring antibiotics at the surgical site since my procedure. My oral surgeon diagnosed osteomyelitis in [year] and I was hospitalized for IV antibiotics.'

Worst-day example:

“During active infection episodes, I experience severe pain, swelling, fever, and complete inability to eat anything by mouth. These episodes last approximately [X] days and occur [X] times per year.”

What the examiner listens for:

History of osteomyelitis, osteoradionecrosis, wound dehiscence, non-union, fistula formation, or other surgical site complications. These are separately ratable under DC 9905 and related codes.

Understatements to avoid:

Do not fail to mention any infection, complication, or additional diagnosis in the jaw area. Every complication should be accurately reported and documented.

Common Mistakes to Avoid

Prep Checklist

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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, accurate, and impartial C&P examination conducted by a qualified dentist or oral surgeon with knowledge of the specific diagnostic codes applicable to mandibular and ramus loss.
  • You have the right to request that the C&P examination be recorded (audio or video) in most states. Check your state's recording consent laws and notify the VA in advance in writing if you wish to record.
  • You have the right to submit a written statement correcting factual errors in a completed C&P examination report by filing a statement in support of claim with your VA regional office.
  • You have the right to request a copy of the completed DBQ and C&P examination report. Submit your request in writing to your VA regional office.
  • You have the right to submit a private medical opinion or nexus letter from your own treating oral surgeon or dentist, which VA must consider in rating your claim under the duty to assist.
  • You have the right to request a new C&P examination if you believe the original examination was inadequate - for example, if the examiner did not have appropriate dental/oral surgery expertise, if the exam was too brief to adequately assess your condition, or if critical findings (such as TMJ involvement) were not documented.
  • You have the right to bring a representative, accredited claims agent, VSO, or attorney to your C&P examination for support. Notify the VA in advance if you plan to bring anyone to the appointment.
  • Under the benefit-of-the-doubt standard (38 CFR - 3.102), 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 the claimant.
  • You have the right to appeal any rating decision you disagree with through the Supplemental Claim, Higher-Level Review, or Board of Veterans' Appeals lanes under the Appeals Modernization Act.
  • You have the right to have your claim evaluated based on your worst-day presentations and the full range of your disability, not only how you present on the day of the examination. Per M21-1 guidance, examiners should document the condition as it typically presents across its full spectrum.

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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.