DC 9901 · 38 CFR 4.150
Mandible, Loss of Whole C&P Exam Prep
To document the extent of mandibular bone loss, whether it constitutes complete loss between the angles, and to assess the functional and structural impact on the veteran's ability to eat, speak, swallow, and maintain oral health. The examiner will determine the applicable rating level under DC 9901 (complete loss between angles = 100%) or related codes for partial loss under DC 9902.
- Format:
- Interview + Physical
- Typical duration:
- 20-30 minutes
- DBQ form:
- oral-and-dental (oral-and-dental)
- Examiner:
- Dentist or Oral Surgeon
What the examiner evaluates
- Extent and anatomical boundaries of mandibular bone loss (complete between angles vs. partial)
- Whether the loss involves the ramus and/or temporomandibular articulation
- Replaceability by prosthesis (whether a suitable prosthesis can restore function)
- Current functional status: mastication, deglutition (swallowing), and speech
- Presence of facial disfigurement or soft tissue defects associated with mandibular loss
- History and results of reconstructive surgery, bone grafting, or prosthetic rehabilitation
- Associated conditions: osteomyelitis, osteoradionecrosis, osteonecrosis, or oral neoplasm
- Current symptoms including pain, facial asymmetry, drooling, and nutritional deficits
- Review of diagnostic imaging (X-ray, CT scan, panoramic/intraoral imaging, MRI, PET scan)
- Treatment history including surgery, radiation therapy, chemotherapy, and other therapeutic procedures
The exam typically takes place at a VA medical center or contracted facility. An oral surgeon or dentist will conduct both a structured interview and a clinical examination of the oral cavity and facial structures. Bring all prior imaging studies, surgical reports, and treatment records. You have the right to request that the exam be recorded in most states.
Measurements and tests
Assessment of Mandibular Bone Loss Extent
What it measures: Determines whether the loss is complete between the angles (DC 9901) or partial, and identifies involvement of the ramus and temporomandibular articulation for accurate DC 9902 sub-classification.
What to expect: The examiner will visually inspect the oral cavity and facial structures, palpate remaining bone, and review diagnostic imaging. They will determine anatomical landmarks including the angles of the mandible to establish completeness of bone loss.
Critical thresholds
- Complete loss between angles of mandible 100% under DC 9901 - this is the highest rating available for mandibular loss
- Loss of one-half or more including ramus, involving temporomandibular articulation, not replaceable by prosthesis 70% under DC 9902
- Loss of one-half or more including ramus, involving temporomandibular articulation, replaceable by prosthesis 50% under DC 9902
- Loss of one-half or more including ramus, not involving temporomandibular articulation, not replaceable by prosthesis 40% under DC 9902
- Loss of one-half or more including ramus, not involving temporomandibular articulation, replaceable by prosthesis 30% under DC 9902
- Loss of less than one-half including ramus, involving temporomandibular articulation, not replaceable by prosthesis 70% under DC 9902
Tips
- Ensure all imaging (CT, panoramic X-ray, MRI) is available at the exam and that it clearly documents the extent of bone loss.
- If you have surgical records confirming the anatomical extent of resection, bring those to explicitly document bone loss between angles.
- Clarify with your examiner whether loss extends to or beyond the angles bilaterally, as this is the threshold for DC 9901 at 100%.
Pain considerations: Describe any chronic pain in the jaw region, phantom pain, or pain at surgical/reconstruction sites, including how it varies on your worst days.
Prosthetic Replaceability Assessment
What it measures: Determines whether the lost mandibular structure can be adequately replaced by a suitable prosthesis, which directly affects the rating level under DC 9902 (though DC 9901 complete loss is rated at 100% regardless).
What to expect: The examiner will assess whether you currently wear a mandibular prosthesis, whether one is feasible given your remaining anatomy, and whether it restores functional mastication. They will document prosthesis type, fit, and functional adequacy.
Critical thresholds
- Not replaceable by prosthesis Higher rating tier at each level of partial mandibular loss under DC 9902
- Replaceable by prosthesis Lower rating tier at each level of partial mandibular loss under DC 9902; note that DC 9901 (complete loss) rates at 100% regardless
Tips
- If you have been told by an oral surgeon or prosthodontist that a prosthesis is not feasible or has failed, bring documentation of that clinical opinion.
- If you wear a prosthesis but it does not adequately restore chewing function, describe specifically how it fails - slippage, inability to chew solid food, pain during use.
- Do not assume that having a prosthesis means function is restored - accurately describe all limitations you experience even while wearing it.
Pain considerations: Describe pain caused by prosthesis wear, including sore spots, pressure points, and whether pain prevents you from wearing it consistently.
Masticatory Function Evaluation
What it measures: Assesses your ability to chew food normally, which is a primary functional consequence of mandibular loss and relevant to the functional impact section of the DBQ.
What to expect: The examiner will ask about your diet, what foods you can and cannot eat, how long meals take, and whether you have lost weight due to dietary restrictions. This is primarily history-based but may include visual inspection of remaining dentition and soft tissue.
Critical thresholds
- Unable to chew any solid food; restricted to liquid or pureed diet Supports highest functional impairment documentation, consistent with 100% rating under DC 9901
- Severely limited mastication; can eat only soft foods Supports significant functional impairment documentation
Tips
- Be specific about foods you cannot eat and what your typical daily diet looks like.
- Describe how meal preparation has changed - if someone must prepare blended or pureed meals for you, state that clearly.
- Note any unintended weight loss or nutritional deficiencies documented by your physician.
Pain considerations: Describe pain during any attempt to chew, including whether it is constant, triggered by jaw movement, or worsened by temperature of food.
Speech and Communication Assessment
What it measures: Documents the impact of mandibular loss on speech intelligibility and communication, which is a significant functional consequence rated under the functional impact section of the DBQ.
What to expect: The examiner will observe your speech during the interview, note any dysarthria, articulation deficits, or compensatory behaviors. They may ask whether others have difficulty understanding you.
Critical thresholds
- Speech largely unintelligible to unfamiliar listeners Supports documentation of severe functional impairment
- Significant articulation deficits requiring compensatory strategies Supports documentation of moderate-to-severe functional impairment
Tips
- If you use augmentative communication devices or have received speech therapy, bring records of that treatment.
- Describe specific social and occupational consequences of your speech impairment - job difficulties, social withdrawal, avoidance of phone calls.
- Note whether your speech is worse when fatigued or when not wearing a prosthesis.
Pain considerations: Describe any pain or fatigue associated with prolonged speaking, including how it limits your daily communication.
Facial Disfigurement and Soft Tissue Assessment
What it measures: Documents visible facial deformity, asymmetry, scarring, and soft tissue changes resulting from mandibular loss and associated surgeries, which may support additional ratings for disfigurement.
What to expect: Visual inspection of the face, chin, and neck. The examiner may measure or photograph areas of visible deformity. Scarring from surgical approaches will be documented.
Critical thresholds
- Severe visible facial disfigurement affecting appearance and function May support separate or combined ratings for facial disfigurement under applicable diagnostic codes
Tips
- Do not minimize visible deformity - describe its impact on your self-image, social interactions, and employment.
- Bring photographs if the deformity is not fully apparent on a good day versus typical presentation.
- Note any difficulties with drooling, mouth closure, or lip seal related to mandibular loss.
Pain considerations: Describe any pain or hypersensitivity in scarred or reconstructed areas of the face and neck.
Rating criteria by percentage
100%
Complete loss of the mandible between the angles. This is the maximum rating under DC 9901 and applies when the entire body of the mandible between the two angles (gonions) has been lost. This level of loss results in profound functional impairment of mastication, speech, swallowing, and facial structure.
Key symptoms
- Complete absence of mandibular body between both angles
- Profound mastication impairment - typically unable to chew solid food
- Severe speech impairment - dysarthria, articulation deficits
- Facial disfigurement - loss of lower facial support and contour
- Difficulty maintaining oral competence - drooling, inability to close mouth normally
- Swallowing dysfunction requiring dietary modification
- Nutritional deficits or weight loss secondary to dietary restriction
- Significant psychological impact from disfigurement and functional loss
- History of extensive surgical resection confirmed by operative reports and imaging
From 38 CFR: 38 CFR 4.150, DC 9901: 'Mandible, loss of, complete, between angles - 100'. This is a single-criteria rating at 100% for complete loss between the angles.
70%
Under DC 9902 (referenced for context): Loss of one-half or more of the mandible including the ramus, involving the temporomandibular articulation, NOT replaceable by prosthesis; OR loss of less than one-half including the ramus, involving the temporomandibular articulation, NOT replaceable by prosthesis. This criterion is relevant if the examiner characterizes loss as less than complete between angles.
Key symptoms
- Loss of one-half or more of mandible including ramus
- Involvement of temporomandibular joint articulation
- Prosthetic replacement not feasible or has failed
- Significant masticatory impairment
- TMJ dysfunction on affected side(s)
- Restricted jaw movement and oral opening
- Facial asymmetry and structural compromise
From 38 CFR: 38 CFR 4.150, DC 9902: Loss of one-half or more including ramus, involving temporomandibular articulation, not replaceable by prosthesis - 70%.
50%
Under DC 9902: Loss of one-half or more of the mandible including the ramus, involving the temporomandibular articulation, replaceable by prosthesis.
Key symptoms
- Loss of one-half or more of mandible including ramus
- Involvement of temporomandibular joint
- Prosthesis available but with documented functional limitations
- Moderate masticatory impairment even with prosthesis
- Ongoing symptoms despite prosthetic use
From 38 CFR: 38 CFR 4.150, DC 9902: Loss of one-half or more including ramus, involving temporomandibular articulation, replaceable by prosthesis - 50%.
40%
Under DC 9902: Loss of one-half or more of the mandible including the ramus, NOT involving the temporomandibular articulation, NOT replaceable by prosthesis.
Key symptoms
- Loss of one-half or more of mandible including ramus
- Temporomandibular joint preserved
- Prosthetic replacement not feasible
- Significant masticatory and speech impairment
From 38 CFR: 38 CFR 4.150, DC 9902: Loss of one-half or more including ramus, not involving temporomandibular articulation, not replaceable by prosthesis - 40%.
30%
Under DC 9902: Loss of one-half or more of the mandible including the ramus, NOT involving the temporomandibular articulation, replaceable by prosthesis.
Key symptoms
- Loss of one-half or more of mandible including ramus
- TMJ preserved
- Prosthesis available and functional
- Some residual masticatory or speech limitation
From 38 CFR: 38 CFR 4.150, DC 9902: Loss of one-half or more including ramus, not involving temporomandibular articulation, replaceable by prosthesis - 30%.
Describing your symptoms accurately
Mastication and Eating
How to describe it: Describe your diet in concrete, specific terms. State which food categories you cannot eat at all (e.g., raw vegetables, meat, bread), which you can eat only after extensive modification (pureed, blended, cut very small), and how long meals take compared to before your injury. Describe nutritional supplements or feeding assistance you require.
Example: On my worst days, even swallowing thickened liquids is painful and exhausting. I cannot eat any solid food whatsoever. My wife prepares all my meals as pureed blends. Mealtimes take 45 minutes to an hour and I often stop eating due to fatigue and pain before I have consumed enough calories. I have lost 22 pounds since my surgery.
Examiner listens for: Specific dietary restrictions, weight loss, nutritional deficits, dependence on others for meal preparation, use of feeding tubes or nutritional supplements, duration of meals, and any aspiration events.
Avoid: Do not say 'I manage okay' or 'I get by.' If you are eating a restricted diet, describe exactly what that means in daily terms. Do not minimize weight loss or dietary dependence.
Speech and Communication
How to describe it: Be specific about which sounds or words are most affected. Describe how often people ask you to repeat yourself, whether you avoid phone calls or conversations, and how your speech changes throughout the day as you fatigue. Note whether speech is better or worse with or without a prosthesis.
Example: On my worst days my speech is almost entirely unintelligible, especially on the phone. Even people who know me well cannot understand most of what I say. I have stopped going to social events and I cannot work in any job that requires speaking to others. I use a text-to-speech app on my phone for most communication now.
Examiner listens for: Intelligibility to unfamiliar vs. familiar listeners, avoidance of verbal communication, use of assistive communication devices, impact on employment and social functioning, and speech fatigue.
Avoid: Do not demonstrate your best possible speech at the exam. Speak as you normally would. Do not say 'people usually understand me' if that only applies to close family members who are accustomed to your speech.
Pain
How to describe it: Describe the location, character (sharp, burning, aching, throbbing), frequency, and severity of pain on a 0-10 scale. Distinguish between baseline daily pain and worst-day pain. Describe what triggers or worsens pain - movement, eating, speaking, temperature changes, prosthesis contact. Note medications you take and whether they provide relief.
Example: On my worst days, the pain in my jaw and surgical site is a constant 8 out of 10. It radiates into my ear and neck. Any attempt to open my mouth or speak causes sharp stabbing pain. I take prescription pain medication twice daily but it only partially controls the pain. I cannot sleep on my side due to pain and I wake several times per night.
Examiner listens for: Pain severity at baseline and during flare-ups, pain triggers, medication use and adequacy of pain control, impact of pain on sleep, daily activities, and ability to work.
Avoid: Do not rate your pain at its best or on a typical controlled day. Report your pain as it is on a bad day. Do not say 'I take ibuprofen and it's fine' if you are on stronger medications or if pain remains despite treatment.
Facial Disfigurement and Psychological Impact
How to describe it: Describe visible changes to your facial appearance - asymmetry, chin retraction, lower lip sagging, inability to close mouth fully - and how these affect your daily life, self-esteem, and social functioning. Note any mental health treatment received for adjustment to disfigurement.
Example: I avoid mirrors. I have not been to a family event in over a year because strangers stare at my face and children are frightened. I was referred to a mental health provider for depression and anxiety related to my appearance. I cannot maintain eye contact with people I meet because I am ashamed of how I look. My marriage has been significantly strained.
Examiner listens for: Social withdrawal, depression, anxiety, avoidance of public situations, impact on intimate relationships, self-esteem, and whether the veteran has sought or received mental health treatment.
Avoid: Do not minimize the psychological impact of disfigurement to appear stoic. The examiner needs to understand the full human cost of this condition. If you have been diagnosed with depression or PTSD related to disfigurement, state that clearly.
Swallowing and Aspiration
How to describe it: Describe any difficulty swallowing (dysphagia), including whether you have choked or aspirated food or liquid. Note if you have received swallowing therapy, use thickened liquids, or have had aspiration pneumonia. Describe positional adjustments you make to swallow safely.
Example: On my worst days I cannot swallow thin liquids without coughing and choking. I have been hospitalized once for aspiration pneumonia. My speech therapist has me on thickened liquids only. I have to tuck my chin and turn my head to the side every time I swallow, and even then I often cough after eating.
Examiner listens for: Dysphagia severity, history of aspiration events, aspiration pneumonia hospitalizations, use of thickened liquids, swallowing therapy, and compensatory swallowing strategies.
Avoid: Do not omit swallowing difficulties - they are a direct functional consequence of mandibular loss and are critical to documenting the full severity of impairment.
Functional Impact on Daily Life and Employment
How to describe it: Describe how your condition affects your ability to work, maintain personal hygiene (oral hygiene, saliva control), socialize, care for your family, and perform daily activities. Be specific about tasks you can no longer perform or require assistance with.
Example: On my worst days I cannot leave my home. I cannot work in any capacity - I was a sales representative and was unable to return after my surgery because I cannot speak clearly or eat a meal in a professional setting. I require assistance with oral hygiene care and cannot wear my prosthesis for more than two hours due to pain and pressure sores. I am fully dependent on my wife for meal preparation and often for personal care.
Examiner listens for: Loss of employment, vocational retraining, inability to perform specific work tasks, dependence on caregivers, and inability to perform activities of daily living independently.
Avoid: Do not assume the examiner will infer functional loss from the diagnosis alone. Explicitly connect the physical findings to your daily functional limitations.
Common mistakes to avoid
Understating dietary restrictions
Why: Veterans often adapt to restricted diets and begin to view them as 'normal,' leading them to describe their eating as 'fine' when in fact they are subsisting on a severely modified diet.
Do this instead: Before the exam, write out exactly what you eat and drink in a typical day, including breakfast, lunch, dinner, and snacks. Bring this list and share it with the examiner. Note any nutritional supplements or weight loss.
Impact: 100% / functional impact documentation
Not bringing surgical and imaging records
Why: The examiner needs objective documentation to confirm the anatomical extent of mandibular loss. Without surgical operative reports and imaging, they may underestimate the extent of resection.
Do this instead: Gather all operative reports from mandibulectomy surgery, post-operative imaging (CT, panoramic X-ray, MRI), and any prosthodontic treatment records. Ensure these are in your VA claims file or bring copies to the exam.
Impact: 100% - complete loss between angles must be objectively confirmed
Failing to describe the worst-day presentation
Why: Veterans naturally present their best effort during exams. Examiners are instructed to rate based on the full range of severity, including worst-day functioning.
Do this instead: Explicitly tell the examiner: 'What I'm describing is how I am on a bad day, which represents my typical worst functioning.' Describe flare-ups, pain spikes, and days when function is most severely impaired.
Impact: All rating levels
Not disclosing all associated residuals and complications
Why: Veterans with complete mandibular loss often have multiple associated conditions - osteomyelitis, osteoradionecrosis, oral neoplasm, TMJ involvement, facial nerve injury - that each carry separate rating potential.
Do this instead: Prepare a complete list of all diagnoses, surgeries, and complications related to your mandibular condition. Disclose each one during the exam and ensure the examiner addresses each condition in the DBQ.
Impact: Multiple diagnostic codes; combined evaluation
Minimizing psychological and social impact
Why: Oral and facial disfigurement carries profound psychological consequences that are frequently underdisclosed. Veterans may feel embarrassed to discuss depression, social isolation, or relationship difficulties.
Do this instead: Clearly describe how the condition has affected your mental health, relationships, social life, and self-image. If you have received mental health treatment, disclose this and ensure a separate mental health claim is considered.
Impact: Functional impact documentation; potential separate mental health rating
Assuming the examiner knows the full history from records alone
Why: C&P examiners may have limited time to review voluminous records. If you do not verbally describe key events - the service-connected injury, surgeries, complications, and current symptoms - critical information may be omitted from the DBQ.
Do this instead: Prepare a one-page written summary of your condition's history - how it began in service, surgeries and treatments received, current symptoms, and functional limitations - and offer it to the examiner at the start of the appointment.
Impact: All rating levels; nexus documentation
Not asking the examiner to document prosthesis replaceability accurately
Why: Whether the mandibular defect is or is not replaceable by a suitable prosthesis is a binary determination that directly affects rating levels under DC 9902. Veterans who have failed prostheses or are not candidates for prosthetics may inadvertently receive a lower rating.
Do this instead: Bring documentation from your prosthodontist or oral surgeon regarding prosthetic candidacy, any prosthesis failures, reasons for non-replaceability, and limitations of current prosthetics. Explicitly tell the examiner if a prosthesis has been deemed not feasible.
Impact: DC 9902 sub-levels; 30-70% range
Prep checklist
- critical
Gather all surgical operative reports
Obtain copies of all mandibulectomy operative reports, reconstruction surgery notes, and bone grafting records. These documents define the anatomical extent of loss and are critical for confirming DC 9901 criteria.
before exam
- critical
Compile all diagnostic imaging
Gather CT scans, panoramic X-rays (panographics), MRI reports, and PET scan results that document mandibular bone loss. Confirm these are in your VA claims file or bring physical copies or a CD to the exam.
before exam
- critical
Obtain prosthodontic records
Collect records from your prosthodontist documenting prosthesis type, fitting history, functional outcome, and any notation that a prosthesis is not feasible or has failed. This is critical for replaceability determination.
before exam
- critical
Write a detailed symptom narrative
Write a one-to-two page summary covering: how the condition started in service, all surgeries and treatments received with dates, current symptoms on a typical day, and worst-day functioning. Include diet details, speech intelligibility, pain levels, and functional limitations.
before exam
- critical
Document dietary changes and weight history
Create a written record of your current diet, foods you can and cannot eat, meal preparation requirements, nutritional supplements used, and any documented weight loss. Obtain records of dietary counseling or nutritional therapy if received.
before exam
- recommended
Compile all treatment records
Gather records of radiation therapy, chemotherapy, speech therapy, swallowing therapy, and any other therapeutic procedures related to your mandibular condition. Include dates, providers, and treatment outcomes.
before exam
- recommended
Document associated conditions and diagnoses
List all associated diagnoses including osteomyelitis, osteoradionecrosis, osteonecrosis, oral neoplasm, facial nerve injury, and any mental health conditions related to disfigurement. Bring supporting documentation for each.
before exam
- optional
Request exam recording if applicable
Check your state's laws regarding recording C&P examinations. In most states you have the right to audio-record the exam. Notify the VA in advance if you plan to record and bring appropriate recording equipment.
before exam
- recommended
Consider bringing a support person
You may bring a spouse, family member, or VSO representative to the exam. A support person can help ensure all symptoms are communicated and can provide corroborating observations about your daily functional limitations.
before exam
- critical
Do not wear your prosthesis or do so consistently with your typical practice
If you typically do not wear your prosthesis due to pain, poor fit, or infeasibility, do not wear it to the exam simply to appear more functional. Present as you typically are. If you always wear it, wear it but be prepared to explain its limitations.
day of
- critical
Arrive on your typical worst-day presentation
Wear your typical daily attire. Do not present a 'best version' of yourself. If you typically experience more pain or fatigue in the morning, note that at the exam. Describe how you are on a bad day, not just on the day of the exam.
day of
- recommended
Bring all documents in an organized folder
Organize your surgical reports, imaging records, treatment records, and written symptom narrative in a clearly labeled folder. Offer to leave copies with the examiner and note that you want them entered into the record.
day of
- recommended
Bring a list of all current medications
Include prescription pain medications, antibiotics, supplements, and any other medications related to your oral and dental condition. Note dosages, frequency, and whether they adequately control your symptoms.
day of
- critical
Describe worst-day symptoms explicitly
Begin your symptom descriptions with phrases like 'On my worst days...' and 'When my condition flares up...' to ensure the examiner captures the full severity of impairment, not just your average or best-day presentation.
during exam
- critical
Confirm the examiner identifies the correct extent of bone loss
Politely confirm that the examiner is documenting whether the loss is complete between the angles of the mandible. If you have surgical documentation confirming this, reference it during the exam.
during exam
- critical
Address all functional domains
Ensure you have addressed mastication, speech, swallowing, pain, facial disfigurement, psychological impact, and occupational impact during the exam. If the examiner has not asked about a domain, volunteer the information.
during exam
- critical
Describe prosthesis limitations honestly
If you use a prosthesis but it does not restore full function, explicitly describe its limitations - inability to chew hard foods, pain during wear, hours per day you can tolerate it, and any failures or adjustments required.
during exam
- recommended
Report all associated diagnoses
Ensure the examiner documents all associated conditions including osteomyelitis, osteoradionecrosis, oral neoplasm, and any other diagnoses you have been given in connection with your mandibular loss.
during exam
- recommended
Document your recollection of the exam immediately
Immediately after the exam, write down what was discussed, what the examiner observed, what questions were asked, and your answers. Note anything that was not discussed or that you felt was inadequately captured.
after exam
- critical
Request a copy of the completed DBQ
You are entitled to a copy of the completed DBQ. Request it through your VSO or via a FOIA request if it is not provided. Review it for accuracy and report any errors or omissions to your VSO or accredited claims agent immediately.
after exam
- recommended
File a buddy statement from a caregiver
Ask your spouse, caregiver, or close family member to submit a VA buddy statement (VA Form 21-10210) describing your daily functional limitations, dietary dependence, speech impairment, and social withdrawal. This corroborating lay evidence can be powerful.
after exam
- recommended
Contact your VSO if the exam appears inadequate
If the exam was very brief (under 10 minutes), if the examiner did not perform a physical examination, if key symptoms were not discussed, or if the examiner appeared unfamiliar with mandibular loss rating criteria, contact your VSO immediately to request a new or supplemental examination.
after exam
Your rights during a C&P exam
- You have the right to a thorough, adequate C&P examination. If the examination is inadequate (too brief, records not reviewed, physical exam not performed), you may request a new examination by contacting your VSO or filing a notice of disagreement.
- You have the right to audio-record your C&P examination in most states. Check your state's recording consent laws and notify the VA in advance if you plan to record.
- You have the right to bring a support person (family member, caregiver, or VSO representative) to your C&P examination.
- You have the right to submit a personal statement and lay evidence (buddy statements) in addition to the C&P examination findings. These can address any gaps or inaccuracies in the DBQ.
- You have the right to request a copy of the completed DBQ through your VSO, eBenefits, or a FOIA request. Review it for completeness and accuracy.
- If the C&P examiner's opinion is unfavorable or inaccurate, you have the right to obtain an independent medical opinion (IMO/IME) from a private provider to submit as counter-evidence.
- The benefit of the doubt rule (38 CFR 4.3) requires that when evidence is in approximate balance regarding any issue material to the determination, it shall be resolved in your favor.
- You are entitled to have all prior treatment records, service records, and medical evidence reviewed by the examiner before completing the DBQ. If the examiner has not reviewed your records, state this and request that they do so.
- Under 38 CFR 4.7, where there is a question as to which of two evaluations shall be applied, the higher evaluation will be assigned if the disability more closely approximates the criteria required for that rating.
- Complete loss of the mandible between the angles under DC 9901 carries a single 100% rating - there is no ambiguity at this level. Ensure the examiner documents whether the loss meets this anatomical criterion precisely.
- You have the right to request that secondary and associated conditions (osteomyelitis, osteoradionecrosis, facial disfigurement, mental health conditions) be separately evaluated and rated.
Related conditions
- Mandible, Loss of (Including Ramus - Partial) DC 9902 governs partial mandibular loss including the ramus, rated 30-70% depending on extent, TMJ involvement, and prosthetic replaceability. Veterans with less than complete loss between angles will be rated under DC 9902 instead of DC 9901.
- Temporomandibular Disorder (TMD) Mandibular loss involving the temporomandibular articulation may also support a TMD claim. TMD is evaluated separately under 38 CFR 4.150 and may yield an additional rating for jaw function limitation.
- Osteomyelitis / Osteoradionecrosis of the Jaw A primary cause of mandibular loss, often resulting from radiation therapy for oral cancer or trauma. Osteomyelitis and osteoradionecrosis are documented in the DBQ and may support the etiology (nexus) of the mandibular loss claim.
- Oral Neoplasm (Oral Cancer) Many veterans with complete mandibular loss underwent mandibulectomy as treatment for oral cancer. The oral neoplasm may be separately rated and may also establish service connection for the mandibular loss.
- Teeth, Loss of (DC 9913) DC 9913 rates tooth loss resulting from loss of substance of the body of the maxilla or mandible (trauma or disease such as osteomyelitis, not periodontal disease). Veterans with mandibular loss will typically have associated tooth loss rated under this code.
- Soft Tissue Injury of the Mouth Mandibular loss is frequently accompanied by soft tissue defects of the floor of mouth, lips, and cheek. These may be separately evaluated and rated, contributing to the veteran's overall combined disability evaluation.
- Lips, Injuries of Extensive mandibular resection and reconstruction commonly affects lip competence and function. Lip injuries are separately codeable under 38 CFR 4.150 and should be assessed and documented at the C&P exam.
- Depression / Adjustment Disorder Secondary to Disfigurement Severe facial disfigurement from mandibular loss frequently causes secondary mental health conditions including major depressive disorder and adjustment disorder. Veterans should file a secondary service connection claim for any mental health condition caused or aggravated by mandibular loss.
- Malunion or Nonunion of Mandible In cases where mandibular reconstruction has been attempted, malunion or nonunion of the mandible may result and is separately rated under 38 CFR 4.150. Confirmed by diagnostic imaging and rated based on displacement severity.
Get a personalized prep packet
This guide covers what to expect for any veteran with this condition. If you have already uploaded your medical records, sign in to generate a packet that maps your specific symptoms to the DBQ fields your examiner will fill out.
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.