What Is the VA Rating for TMJ? DC 9905 Criteria, Inter-Incisal Range, and the Secondary Conditions Most Veterans Miss

VA rates temporomandibular joint disorder (TMJ/TMD) under Diagnostic Code 9905 with ratings from 10% to 50%.

But most veterans walk into their C&P exam without understanding how the rating actually works — and leave with a lower rating than they deserve.

The problem is that DC 9905 changed dramatically in 2017. It went from a simple four-level scale to a complex matrix that combines jaw opening measurements with dietary restriction documentation. And most advocacy content still explains it wrong.

In this guide, I'll break down exactly how DC 9905 works, the measurement traps that cost veterans rating percentages, and the secondary conditions that can multiply your total disability well beyond 50%.

DC 9905 Rating Criteria — The Complete Table

Under 38 CFR 4.150, Diagnostic Code 9905, the VA rates TMJ based on two intersecting criteria: (1) maximum unassisted vertical jaw opening in millimeters and (2) whether a physician has documented that you require a mechanically altered diet.

The 2017 regulatory overhaul (effective September 10, 2017) changed everything. The old system was a simple four-level scale capped at 40%. The new system is a matrix that allows ratings up to 50%.

Current DC 9905 Rating Table (Post-September 2017)

Lateral Excursion (Side-to-Side Movement)

Here's what this means in practice:

If your vertical opening is 25mm (20% rating) and your lateral excursion is 3mm (10% rating), you get the 20% — not 30%. The VA picks the higher value only.

How VA Measures Your Jaw: Inter-Incisal Range and Lateral Excursion

At your C&P exam, the examiner will measure two things.

Inter-incisal range is the vertical distance between your top and bottom front teeth when you open your jaw as wide as possible, without assistance. Normal range is 35 to 50 millimeters. The examiner measures in millimeters using a ruler or calibrated tool.

Lateral excursion is how far you can move your lower jaw from side to side. This is a secondary measurement that only produces a 10% rating at 0-4mm.

Why this matters:

The examiner measures your maximum unassisted opening. That means they cannot help you open your jaw. And they cannot ask you to push past your pain. They measure the point where your jaw stops on its own.

The Bilateral Single-Rating Rule

Even if both sides of your jaw are affected, the VA issues only one DC 9905 rating. The Court confirmed this in Vilfranc v. McDonald (2017) — because the TMJ operates as a single functional unit, bilateral involvement does not entitle you to two separate ratings.

The Dietary Documentation Trap

This is where most TMJ claims lose rating percentages unnecessarily.

Look at the rating table again. At every opening range, dietary restrictions can push your rating one or two tiers higher. A veteran with 15mm opening gets 30% without dietary documentation — but 40% with it.

Here's the trap:

The VA requires that a physician document your dietary restrictions in your medical record. You cannot simply tell the C&P examiner that you eat only soft foods. The examiner cannot note dietary restrictions based on your self-report alone.

The Four Levels of Dietary Restriction

The VA recognizes four tiers of mechanically altered diet, from most restrictive (most favorable for rating) to least:

1. Full liquid foods — highest restriction, best for rating purposes
2. Pureed foods — high restriction
3. Soft foods — moderate restriction
4. Semi-solid foods — lowest restriction level

Service Connection Pathways for TMJ

There are three main ways to establish service connection for TMJ.

1. Direct Service Connection

TMJ caused directly by military service. Common scenarios include:

• Dental trauma — jaw injury from impact, vehicle accidents, training exercises, or combat
• Intubation injuries — jaw damage during military surgical procedures
• Blast exposure — concussive force affecting jaw alignment
• Physical training injuries — contact sports, combatives, or falls

2. Secondary to PTSD (Most Common Pathway)

This is the most well-documented secondary connection for TMJ. The chain works like this:

PTSD → jaw clenching → bruxism (teeth grinding) → TMJ damage

Research shows that 56% of veterans with PTSD have TMD symptoms compared to just 20% of non-PTSD veterans. The stress response from PTSD causes involuntary jaw clenching, often during sleep, which gradually damages the temporomandibular joint.

If you're already service-connected for PTSD and you've developed jaw pain, clicking, or limited opening, this is your strongest pathway.

3. Secondary to Other Service-Connected Conditions

TMJ can also be secondary to:

• Traumatic brain injury (TBI) — head trauma with facial/jaw involvement
• Migraines — jaw tension during migraine episodes (bidirectional relationship)
• Sleep apnea — constant jaw movements during airway obstruction can cause TMJ damage

Secondary Conditions You Can Claim with TMJ

TMJ doesn't just affect your jaw. It creates a network of secondary conditions that can dramatically increase your total combined rating.

This is where most veterans leave money on the table.

Tinnitus (DC 6260 — 10%)

The anatomical proximity of inner ear structures to the TMJ creates a well-documented medical nexus. TMJ dysfunction can cause ringing, buzzing, or clicking sounds in the ears. Many veterans don't realize their tinnitus may be caused by their jaw condition.

Migraines and Headaches (DC 8100 — Up to 50%)

The Board of Veterans' Appeals has granted headaches secondary to TMJ in multiple decisions. TMJ-related muscle tension and nerve compression can trigger chronic headache patterns. At the maximum 50% rating, migraines alone add significant monthly compensation.

Cervical Strain / Neck Pain (DC 5237 — Up to 50%)

Chronic jaw clenching creates muscle tension that radiates to the cervical spine. Veterans with TMJ frequently develop neck pain and limited range of motion in the cervical area.

Depression and Anxiety (DC 9434 — Up to 100%)

Chronic pain from service-connected TMJ can cause or aggravate mental health conditions. This secondary claim has no rating cap and can be filed based on the psychological impact of living with persistent jaw pain.

Sleep Apnea (DC 6847 — Currently Up to 50%)

TMJ dysfunction affects jaw alignment and tongue position, which can cause airway obstruction during sleep. The Board has recognized this as a cognizable theory for secondary service connection. Epidemiological studies support the link — research shows patients with obstructive sleep apnea are three times more likely to have chronic TMJ.

VA Dental Care (Hidden Benefit)

TMJ is rated as a dental disability. A service-connected TMJ rating of 10% or higher unlocks comprehensive VA dental care for the condition — not just monthly compensation. This alone can save thousands in dental and oral surgery costs.

C&P Exam Tips for TMJ Claims

Your C&P exam is where your rating gets decided. Here is what the examiner will do and how to prepare.

What the Examiner Measures

• Maximum unassisted vertical jaw opening — inter-incisal range in mm
• Lateral excursion — side-to-side movement in mm
• Pain on motion — at what point in the range of motion pain begins
• Crepitus or clicking — joint sounds during movement
• Functional impact — how TMJ affects your daily activities

How to Prepare

• Get dietary restrictions documented by your physician before the exam — this is the single most impactful thing you can do
• Report your worst days, not your best — describe flare-up frequency and severity
• Document pain onset point — tell the examiner exactly where in the range of motion your pain starts
• Bring a list of medications — NSAIDs, muscle relaxants, night guards, and other treatments you use for TMJ
• Describe functional impact — difficulty eating, talking, yawning, sleeping
• Mention all secondary symptoms — headaches, ear pain, tinnitus, neck pain

The Flare-Up Question

The examiner should ask about flare-ups. This matters because of the DeLuca v. Brown framework — if your jaw opening during a flare-up falls into a lower range than your baseline measurement, the VA must consider that flare-up limitation when assigning your rating.

For example, if your baseline opening is 25mm (20% rating) but during flare-ups it drops to 15mm, the examiner should document the flare-up range. BVA decisions have awarded higher ratings based on flare-up ROM that is "more consistent with" a lower measurement range.

Legal Protections Most Veterans Don't Know About

The Painful Motion Floor (Section 4.59)

If your jaw opening is 35mm or more (technically "normal" range), you might think you get 0%. But under 38 CFR 4.59, if you have documented pain on motion, you are entitled to a minimum 10% rating.

The Court confirmed this applies to DC 9905 in Vilfranc v. McDonald (2017). The BVA has awarded 10% to veterans with jaw opening over 40mm who had painful motion documented.

This is frequently missed at the Regional Office level.

If you were denied because your jaw opening was in the normal range but you clearly have painful TMJ, cite 38 CFR 4.59 and Vilfranc in your appeal.

Medication Protection (Jones v. Shinseki)

The VA cannot reduce your TMJ rating because pain medications partially control your symptoms. Under Jones v. Shinseki (2012) and Ingram v. Collins (2025), the VA cannot factor in the ameliorative effects of medication unless the specific diagnostic code lists medication as a rating criterion.

DC 9905 does not list medication as a rating criterion.

This means if you're taking NSAIDs, muscle relaxants, or tricyclic antidepressants for jaw pain, the VA must rate your TMJ based on your functional impairment — not how well the medication controls it.

Pre-2017 Rating Review

If you were rated under the old DC 9905 criteria before September 10, 2017, and were never re-evaluated under the new criteria, you may have been systematically underrated. The old system capped at 40% and did not include dietary restriction tiers. The new system allows 50% and provides more granular rating levels.

Your Next Move

TMJ is one of the most underrated conditions in the VA system. Between the dietary documentation trap, the complex post-2017 rating matrix, and the secondary conditions most veterans never file, there is a significant gap between what veterans deserve and what they receive.

Here is what to do right now:

1. Get a physician to document your dietary restrictions in your medical record before your next C&P exam or increase claim
2. File secondary conditions — tinnitus, headaches, neck pain, and mental health conditions can multiply your total rating
3. If your PTSD causes jaw clenching, file TMJ as secondary to PTSD with a nexus letter explaining the bruxism mechanism
4. If you were rated before 2017, request a re-evaluation under the current criteria
5. Document flare-ups with your treating physician so the C&P examiner has baseline evidence