Maxilla or Mandible, Loss of (Both Jaws) C&P Exam Prep

Assessment of Jaw Bone Loss Extent

What it measures: The anatomic extent of mandibular and maxillary bone loss, including whether loss is less than one-half or one-half or more of the mandible, whether the ramus is involved, and whether the TMJ articulation is affected.

What to expect: The examiner will visually inspect and palpate the jaw structures, review prior surgical reports, and reference imaging studies. They will document which specific portions of each jaw are absent or surgically removed.

Pain considerations: If residual bone edges or reconstruction hardware cause pain with jaw movement, eating, or pressure, describe this clearly. Pain at the surgical site or phantom jaw pain is a legitimate finding the examiner should document.

Prosthetic Restorability Assessment

What it measures: Whether a suitable prosthesis (obturator, mandibular reconstruction prosthesis, denture, or implant-supported prosthesis) can restore masticatory function to a functional level. This is a critical rating fork under DC 9902, 9903, and 9913.

What to expect: The examiner will ask whether you currently wear a prosthesis, how functional it is, whether you can eat solid foods, and whether there are complications such as instability, pain, sores, or inability to retain the appliance. They may examine fit and stability of any existing prosthetic appliance.

Pain considerations: Pain or discomfort while wearing the prosthesis - including mucosal irritation, pressure sores, or pain with chewing - directly affects functional restorability and should be communicated in detail.

Mandibular Malunion or Non-Union Assessment

What it measures: Whether fractured jaw segments have healed in a misaligned position (malunion) or have failed to heal (non-union), confirmed by diagnostic imaging. Severity is assessed by degree of open bite (anterior-posterior or lateral).

What to expect: Examiner will review imaging and assess bite alignment. They will look for false motion (movement at fracture site in non-union) and degree of malocclusion in malunion cases.

Pain considerations: Pain at non-union or malunion sites with jaw use, especially chewing or speaking at length, should be described in terms of frequency, intensity (0-10 scale), and functional impact.

Functional Impact Assessment - Chewing, Speech, Swallowing

What it measures: The real-world functional consequences of bilateral jaw loss on eating, nutrition, speech intelligibility, swallowing safety, and social interaction.

What to expect: The examiner will ask about your diet, ability to chew various food textures, any history of aspiration or choking, speech changes, drooling, and social/occupational limitations. This assessment informs the DBQ functional impact fields.

Pain considerations: Pain with chewing, swallowing, or prolonged speaking is a key functional factor. Report worst-day pain levels and how pain affects the duration and quality of eating and communication.

100%

Complete loss of the mandible between the angles (DC 9901). This represents the most severe form of mandibular loss, involving the entire symphysis and body between both mandibular angles, resulting in complete loss of lower jaw function.

From 38 CFR: 38 CFR 4.150, DC 9901: 'Mandible, loss of, complete, between angles - 100'

70%

Loss of one-half or more of the mandible including the ramus, involving temporomandibular articulation, not replaceable by prosthesis (DC 9902). Also applies to loss of less than one-half of the mandible including the ramus, involving TMJ articulation, not replaceable by prosthesis.

From 38 CFR: 38 CFR 4.150, DC 9902: 'Loss of one-half or more, Involving temporomandibular articulation - Not replaceable by prosthesis 70'

50%

Loss of one-half or more of the mandible including the ramus, involving temporomandibular articulation, replaceable by prosthesis (DC 9902). Prosthesis exists but the extent of bone loss and TMJ involvement still produces significant disability.

From 38 CFR: 38 CFR 4.150, DC 9902: 'Loss of one-half or more, Involving temporomandibular articulation - Replaceable by prosthesis 50'

40%

Loss of one-half or more of the mandible including the ramus, NOT involving temporomandibular articulation, not replaceable by prosthesis (DC 9902). TMJ is preserved but extensive bone loss prevents adequate prosthetic restoration.

From 38 CFR: 38 CFR 4.150, DC 9902: 'Loss of one-half or more, Not involving temporomandibular articulation - Not replaceable by prosthesis 40'

30%

Loss of one-half or more of the mandible including the ramus, not involving TMJ, replaceable by prosthesis (DC 9902). Alternatively, loss of less than one-half of the mandible including the ramus, not involving TMJ, not replaceable by prosthesis.

From 38 CFR: 38 CFR 4.150, DC 9902: 'Loss of one-half or more, Not involving temporomandibular articulation - Replaceable by prosthesis 30' and 'Loss of less than one-half, Not involving temporomandibular articulation - Not replaceable by prosthesis 30'

20%

Loss of less than one-half of the mandible including the ramus, not involving TMJ, replaceable by prosthesis (DC 9902). Partial jaw loss with preserved TMJ and functional prosthetic restoration, but residual deficits remain.

From 38 CFR: 38 CFR 4.150, DC 9902: 'Loss of less than one-half, Not involving temporomandibular articulation - Replaceable by prosthesis 20'

40%

Teeth loss due to loss of substance of maxilla or mandible body without loss of continuity - loss of all teeth where masticatory surface cannot be restored by suitable prosthesis (DC 9913).

From 38 CFR: 38 CFR 4.150, DC 9913: 'Loss of all teeth - 40' (where masticatory surface cannot be restored by suitable prosthesis). Note: Applies only to bone loss through trauma or disease such as osteomyelitis, not periodontal disease.

Chewing and Eating Ability

How to describe it: Describe specifically which food textures you can and cannot eat. Use concrete examples: 'I cannot chew bread, meat, raw vegetables, or anything requiring sustained bite force. I subsist primarily on pureed foods, soups, and protein shakes.' Quantify how long meals take and whether you experience pain or fatigue during eating.

Example: On my worst days, even soft foods like mashed potatoes cause pain at my resection site and I cannot finish a meal without stopping multiple times. I often skip meals because the effort and pain are not worth it, and I have lost 20 pounds over the past year because of this.

Examiner listens for: Specific diet restrictions, evidence that the prosthesis does not adequately restore chewing, weight loss or nutritional deficiency, pain or fatigue with eating, total meal duration, and need for diet modification.

Avoid: Do not say 'I manage okay' if you have significantly restricted your diet. Do not say 'I wear a prosthesis' without adding that it does not fully restore function, slips, or causes pain.

Prosthesis Function and Tolerability

How to describe it: If you have a prosthesis, describe its limitations honestly and specifically: 'My obturator fits poorly and causes ulcers on my gum tissue. I can only wear it for 2-3 hours before pain forces me to remove it. It does not allow me to eat anything firmer than scrambled eggs.' If you were told no suitable prosthesis is possible, bring that clinical documentation.

Example: On bad days, I cannot wear my prosthesis at all due to pain and swelling at the surgical site. I go the entire day without wearing it, which means I cannot speak clearly or eat in public. I have canceled social engagements and avoided work meetings because of this.

Examiner listens for: Whether a prosthesis truly restores masticatory function or merely exists nominally, frequency of prosthesis use, complications, and whether the veteran can tolerate it for functional meal duration.

Avoid: Do not say your prosthesis 'works fine' if you avoid wearing it due to pain, sores, or poor fit. The examiner may check 'replaceable by prosthesis' based on minimal statements, significantly reducing your rating.

Pain at Surgical Site and Jaw Area

How to describe it: Rate pain on a 0-10 scale and describe what triggers it, how long it lasts, and what relieves it. Describe both resting pain and pain with activity (chewing, speaking, yawning, or contact). Mention whether pain is constant, intermittent, or episodic with flare-ups.

Example: On my worst days, I have constant 7-8 out of 10 aching pain at my resection site that radiates into my cheek and ear. Speaking for more than 5 minutes causes a sharp 9 out of 10 pain spike. I require prescription pain medication on these days and cannot perform my normal job duties.

Examiner listens for: Consistent pain pattern, pain level during activity versus rest, impact on sleep, and whether pain limits daily or occupational function.

Avoid: Do not minimize pain by saying 'it's not that bad' or 'I manage with Tylenol' if your actual experience involves significant functional limitation. Report your worst days accurately.

Speech and Communication

How to describe it: Describe specific speech changes: 'I have difficulty pronouncing words with labial or dental consonants (p, b, t, d, s). People frequently ask me to repeat myself. I avoid phone calls because my speech is not clear. I have attended speech therapy.' If hypernasal speech results from palate or maxillary involvement, describe this specifically.

Example: On my worst days, my speech is so slurred and nasal that my family cannot understand me without looking at my face. I have declined job opportunities that require customer interaction because of my speech deficit.

Examiner listens for: Objective speech changes noted during the interview, veteran's self-report of communication difficulties, avoidance behaviors, and referral to speech-language pathology.

Avoid: Do not underreport speech changes simply because you have adapted or use workarounds. The adaptation itself (written communication, avoiding phone use) is evidence of functional limitation.

Facial Disfigurement and Psychosocial Impact

How to describe it: Describe visible facial contour changes, inability to close the mouth, drooling, and the psychosocial consequences. Be specific: 'I have a visible depression where my jaw was. I cannot fully close my lips due to missing mandibular support, which causes drooling and embarrassment in public.'

Example: On my worst days, I avoid all social situations because of my appearance. I have not eaten in public in over a year. I experience depression and anxiety directly related to my facial disfigurement and inability to communicate normally.

Examiner listens for: Visible disfigurement noted on examination, drooling, inability to close mouth, and impact on social and occupational functioning.

Avoid: Do not fail to mention psychosocial impacts because they seem unrelated to a dental exam. Functional impairment from disfigurement is directly relevant to VA rating and potential SMC consideration.

Secondary Conditions and Complications

How to describe it: Describe any complications from jaw loss or its treatment: chronic infections, fistulas, osteomyelitis recurrence, osteoradionecrosis from radiation therapy, hardware failure, aspiration pneumonia from swallowing difficulties, or nutritional deficiencies.

Example: Since my jaw resection, I have had three hospitalizations for infection at the surgical site. I require periodic hyperbaric oxygen treatments for osteoradionecrosis. I was diagnosed with malnutrition last year due to inability to maintain adequate caloric intake by mouth.

Examiner listens for: History of complications, treatment for secondary conditions, pattern of recurring infections or wound breakdown, and evidence of systemic effects from jaw loss.

Avoid: Do not fail to mention secondary complications because they feel like separate issues. All complications directly caused by or related to the service-connected jaw loss are relevant to the rating.