The Mouth and Teeth

Topics:

The Lower Jaw
The Upper Jaw
The Jaw Joint
The Palates
The Teeth
Cancer and Tumors of the Mouth and Teeth
Other Mouth and Teeth Conditions
DBQs for Mouth and Teeth Conditions
Principles that Apply

--The VA changed the codes and ratings for Dental and Oral Conditions on September 10, 2017. See the Historic VASRDs page for all codes and ratings from before this date. Not all codes were changed, so if the code cannot be found on the Historic VASRDs page, the ratings did not change.--

For conditions that require the diagnosis to be made by "imaging studies," these include tests like X-rays, CT scans, MRIs, PETs (positron emission tomography), radionuclide bone scans, ultrasonographies, and other similar tests. Basically, any test that can clearly and fully provide enough data to undeniably diagnose the condition and its severity is acceptable, but proof of these tests must be included in the medical evidence in order for the condition to be fully ratable.

Any loss of smellloss of taste, nerve damagerespiratory problemsloss of the ability to speak, or other symptoms caused by any of these conditions can be rated separately. These codes are just for any physical and mechanical conditions of the mouth and teeth (loss of bone, inability to chew, etc.). All other symptoms can be rated separately.

Reminder: The VA will give a Military Disability Rating for each service-connected condition a service member has, but the DoD will only rate service-connected conditions that make a service member Unfit for Duty.


The Lower Jaw

The mandible, or lower jawbone, is the only movable bone on the head. Military disability is given for mouth and teeth conditions

Code 9900: Osteomyelitis, osteoradionecrosis, or osteonecrosis (a.k.a. ONJ) of the mandible is rated under code 5000, osteomyelitis.

Code 9901: If the entire mandible is missing or is completely non-functional, then it is rated 100%.

Code 9902: Any partial loss of the mandible, including the ramus, is rated under this code.

If at least half or more of the mandible is missing, it is rated 70% if it interferes with the ability to chew and cannot be replaced by a prosthesis, 50% if it interferes with the ability to chew but can be replaced by a prosthesis, 40% if it does not interfere with the ability to chew and cannot be replaced by a prosthesis, and 30% if it does not interfere with the ability to chew and can be replaced by a prosthesis.

If less than half of the mandible is missing, it is rated 70% if it interferes with the ability to chew and cannot be replaced by a prosthesis, 50% if it interferes with the ability to chew but can be replaced by a prosthesis, 20% if it does not interfere with the ability to chew but cannot be replaced by a prosthesis, and 10% if it does not interfere with the ability to chew and can be replaced by a prosthesis. Military disability is given for mouth and teeth conditions

Code 9903: If the mandible has been broken and did not heal back together correctly (nonunion or fibrous union), then it is rated 30% if there is abnormal or additional motion at the point of the break and 10% if there isn’t any additional or abnormal motion.

This conditionmust be clearly shown and diagnosed by an imaging study.

Code 9904:  If the mandible has been broken and did heal, but not correctly so that there is a definite disfigurement to the bone (malunion), it is rated under this code. If the disfigurement causes a large gap between either the front teeth or the back teeth when the jaw is closed, it is rated 20%. If it causes a small gap between either the front teeth or the back teeth when the jaw is closed, it is rated 10%. If it does not cause a gap between the teeth at all, then it is rated 0%.

Code 9909: If the coronoid process is missing, then it is rated 10% for one side and 20% for both sides.

 

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The Upper Jaw

Military disability is given for mouth and teeth conditions

The maxilla, or upper jawbone, is connected directly to the skull.

Code 9900: Osteomyelitis, osteoradionecrosis, or osteonecrosis (a.k.a. ONJ) of the maxilla is rated under code 5000, osteomyelitis.

Code 9914: If more than half of the maxilla is missing and cannot be replaced by a prosthetic piece it is rated 100%. If it can be replaced by a prosthesis, then it is rated 50%.

Code 9915: If 25 to 50 percent of the maxilla is missing and cannot be replaced by a prosthesis, then it is rated 40%. If it can be replaced by a prosthesis, then it is rated 30%. If less than 25 percent of the maxilla is missing and cannot be replaced, then it is rated 20%, and if it can be replaced, it is rated 0%.

Code 9916: If the maxilla has been broken and, after treatment, hasn’t healed back together (nonunion) or has healed incorrectly, causing definite disfigurement to the bone (malunion), it is rated under this code. 

For nonunion, if there is abnormal motion at the point of the break, then it is rated 30%. If there is no motion at the point of the break, then it is rated 10%. To qualify for rating, a nonunion must be clearly shown and diagnosed by an imaging study.

For malunion, if the disfigurement causes a large gap between either the front teeth or the back teeth when the jaw is closed, it is rated 30%. If it causes a medium gap between either the front teeth or the back teeth when the jaw is closed, it is rated 10%. If it causes only a small gap between the front teeth or the back teeth, then it is rated 0%.

 

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The Jaw Joint

Military disability is given for mouth and teeth conditions

The temporomandibular joint, jaw joint, includes the condyloid process of the mandible. This process includes the condyle and the condyle neck.

Code 9908: If the condyloid process is missing on one or both sides, then it is rated 30%.

Code 9905: Temporomandibular disorder, (known as “TMD” and also incorrectly referred to as “TMJ”) is rated based on limited motion of the joint and the ability to eat regular or mechanically altered food. 

“Mechanically altered foods” include liquid, blended, chopped, pureed, ground, mashed, soft, and semisolid foods. A physician must record that your condition requires you to eat only mechanically altered foods in order for it to be rated. If a medical record does not state this, then it’ll be assumed that you are able to eat normally.  

For limited motion, the jaw can move in two directions: open and closed, and side-to-side. Only one direction of motion can be rated. If the jaw is limited in both directions, then only the one that will give the higher rating is used. Only unassisted motion is used to rate limited motion, so even if the jaw could open further with help, it is only rated on how far it can move naturally without assistance. 

If the jaw can’t move side-to-side more than 4 millimeters (mm), then it is rated 10%.
If the jaw can’t open more than 10 mm (about 0.4 of an inch), then it is rated 50% when only able to eat mechanically altered food, and 40% when able to eat normally. 
If it can open between 11 and 20 mm (about 0.4 to 0.8 of an inch), it is rated 40% when only able to eat mechanically altered food, and 30% when able to eat normally. 
If it can open between 21 and 29 mm (about 0.8 to 1.1 inches), it is rated 40% when restricted to full liquid and pureed foods only, 30% when limited to soft and semi-solid foods only, and 20% when able to eat normally. 
If it can open between 30 and 34 mm (about 1.2 to 1.3 inches), it is rated 30% when restricted to full liquid and pureed foods only, 20% when limited to soft and semi-solid foods only, and 10% when able to eat normally.

Note: The Painful Motion principle applies in cases of TMJ or any other condition that causes pain when moving the jaw. So, whether or not the jaw can move, the minimum rating if pain is present is 10%.

 

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The Palates

Military disability is given for mouth and teeth conditions

The hard palate is the hard tissue that makes up the roof of the mouth. Directly behind it is a softer tissue called the soft palate.

Only the hard palate is rated in the VASRD. Most conditions of the soft palate do not cause symptoms and are not rated by the VASRD. They could be rated under these codes, however, if the conditions and symptoms are similar.

Code 9911: If any portion of the hard palate is missing, it is rated under this code. If half or more has been lost and it cannot be replaced by a prosthesis, it is rated 30%. If less than half has been lost and it cannot be replaced by a prosthesis, it is rated 20%. If half or more has been lost and it can be replaced by a prosthesis, it is rated 10%, and if lessthan half has been lost and it can be replaced by a prosthesis, it is rated 0%.

 

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The Teeth

The loss of teeth by themselves are not ratable since they are not truly disabling and are easily replaced by false teeth. Teeth also cannot be rated if they are lost from naturally occurring diseases related to ageing. They must be lost as a result of injury, accident, or diseases such as osteomyelitis.

If the loss of teeth is caused by part of either the maxilla or mandible missing, then it can either be rated under the following code or under the codes for the missing maxilla or mandible, whichever code provides the higher rating. If not enough of the mandible or maxilla is missing to qualify for a rating under their codes, then the condition is simply rated here. The condition cannot be rated twice, once for the maxilla or mandible and once for the teeth. Only one or the other. Military disability is given for mouth and teeth conditions

Code 9913: Regardless of how many teeth are missing, if they can be replaced by a prosthesis or false teeth, then it is rated 0%. If, however, they cannot be replaced, they are rated as follows:

All teeth missing is rated 40%. The loss of all the upper teeth or all the lower teeth is rated 30%. If all the upper and lower posterior teeth or all the upper and lower anterior teeth are missing, it is rated 20%. If only all the upper anterior teeth or all the lower anterior teeth are missing, it is rated 10%. If all the upper and lower teeth on one side are missing, then it is also rated 10%.

 

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Cancer and Tumors of the Endocrine System

Cancer and tumors are made up of the growth of abnormal cells. These cells can be benign—they do not destroy the good cells around them (tumors)—or they can be malignant—they destroy the cells around them (cancers). A “cancerous tumor” is just cancer under our definition.

Code 9917: All benign neoplasms (tumors or oral lesions) of the mouth and teeth are rated on the main structures of the mouth that they affect. So if the tumor affects the teeth, it would be rated under code 9913. If it affects the hard palate, it is rated under code 9911. If it causes disfigurement, it is rated under code 7800, etc. 

Code 9918: All malignant neoplasms (tumors and lesions) of the mouth and teeth are rated 100% while the condition is active and undergoing treatment. This 100% rating will continue for 6 months following the last treatment, at which point the VA will re-examine the condition and rate it based on any remaining symptoms, like loss of teeth or disfigurement.

 

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Other Mouth and Teeth Conditions

Diseases that affect the mouth and teeth can be found on the Diseases of the Musculoskeletal System page. All other mouth and teeth injuries or conditions will be rated analogously (see the Analogous and Equivalent Codes page) with the above ratings. The bottom line rule is to rate any condition under the code that BEST describes it, even if it is not exact.

 

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DBQs for Mouth and Teeth Conditions

Here are the Disability Benefits Questionnaires (DBQs) used for mouth and teeth conditions: TMJ DBQ and Mouth and Teeth Conditions (other) DBQ.

 

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Principles that Apply

Painful Motion: If pain is present with motion, then the minimum rating must be given.

Pyramiding: A single condition can only be rated once! However, if a nerve condition or other condition exists that is additional to the dental condition (not simply caused by it), then it can also be rated.

Probative Value: If two exams record the condition differently, the exam with the most thorough data and performed by the most qualified physician in that specialty will be the exam the rating is based on.

A Tie Goes to the Veteran: If there are two equally strong exams with conflicting information, or if the condition can be equally rated under two different codes, then the one that gives the highest rating will be assigned. Every conflict should be resolved in favor of the higher rating.

Accurate Measurements: It is essential that the necessary information to rate your condition is recorded by the physician in your exam. With the information on this page, you should know what needs to be measured and recorded. Make sure this happens correctly to ensure that you receive a proper rating.

 

Please see the Musculoskeletal Principles and the VASRD Principles pages for further guidance.

For muscle conditions, see The Facial Muscles. For other mouth conditions, see The Digestive System page. For disfigurements or scars, see the Scars page.

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