What DC 9905 Covers
Diagnostic Code 9905 in 38 CFR 4.150 is the VA's rating code for temporomandibular joint disorder. It is one of a small number of codes in the dental and oral conditions schedule that are rated on objective range-of-motion findings, similar in spirit to the musculoskeletal codes in 38 CFR 4.71a. The rating reflects functional impairment of chewing, speaking, and other oral activities rather than the appearance or pain of the joint itself.
TMJ disorder is common among veterans. Service-related mechanisms include head and neck trauma (motor vehicle accidents, falls, blast exposure), cervical whiplash, prolonged use of mouth-held equipment, dental injury, and PTSD-related bruxism and parafunctional clenching. Service treatment records often document the precipitating event or the early signs of TMJ dysfunction (clicking, popping, intermittent locking, masticatory muscle pain).
TMJ Disorder: The Underlying Pathology
The temporomandibular joint is a bilateral synovial joint between the mandibular condyle and the temporal bone, with an articular disc that divides the joint into upper and lower compartments. The joint operates as both a hinge (rotation) and a slider (translation), and its function depends on coordinated activity of the disc, the lateral pterygoid muscle, and the surrounding masticatory musculature.
TMJ disorder encompasses several pathologic categories under the Diagnostic Criteria for Temporomandibular Disorders (DC/TMD):
- Myalgia and myofascial pain of the masticatory muscles
- Disc displacement with or without reduction
- Degenerative joint disease (osteoarthritis) of the TMJ
- Subluxation or dislocation
- Adhesions and fibrous or bony ankylosis
Bruxism and Parafunctional Clenching
Sleep bruxism (nighttime grinding) and awake clenching are major drivers of TMJ disorder. Both are strongly associated with chronic stress, anxiety, and PTSD. Sustained masticatory muscle activation produces masseter and temporalis hypertrophy, lateral pterygoid trigger points, microtrauma to the articular disc, and eventual disc displacement.
Whiplash and Cervical Mechanisms
Cervical whiplash from motor vehicle accidents or blast exposure can directly injure the TMJ apparatus through inertial loading and disrupt the cervico-mandibular postural relationship. Many studies have documented TMJ symptoms emerging or worsening after whiplash injury.
Direct Trauma
Mandibular or zygomatic fractures, traumatic disc displacement, and dental trauma can produce structural injury to the joint apparatus.
The Rating Tiers in Detail
DC 9905 was substantively revised in 2017 and continues to apply with the following structure.
Inter-Incisal Range Schedule
- 10 percent: inter-incisal range of 31 to 40 mm with dietary restriction to mechanically softened diet
- 20 percent: inter-incisal range of 21 to 30 mm
- 30 percent: inter-incisal range of 11 to 20 mm
- 40 percent: inter-incisal range of 0 to 10 mm
The dietary-restriction component of the 10 percent tier requires documentation that the veteran can only tolerate a mechanically softened diet (puree, soft solids, liquid) at that range.
Lateral Excursion Schedule
Lateral excursion of 0 to 4 mm is rated 10 percent. The lateral excursion rating is not combined with the inter-incisal rating; the higher of the two governs.
Articular Masticatory Tissue Loss
Loss of approximately one-half or more of the maxilla or mandible articular masticatory tissue, with restriction of inter-incisal motion to 0 to 10 mm, is rated up to 50 percent. This tier captures veterans with severe destructive arthropathy, post-traumatic or post-surgical loss of joint tissue, or ankylosis.
Separate Ratings for Each Joint
When TMJ disorder is unilateral and produces unilateral measurements, only one joint is rated. When bilateral, the bilateral factor under 38 CFR 4.26 may apply if the measurements support separate involvements; however, inter-incisal opening is itself a bilateral measurement, so the schedule typically captures the overall functional limitation as a single rating.
How the Measurements Are Taken
The examination is best performed by a dental professional or oral surgeon, but C&P examiners frequently perform it as well.
Inter-Incisal Opening
The maximum inter-incisal opening is measured with a ruler or specialized TMJ caliper. The veteran is asked to open the mouth as widely as possible without producing severe pain. The distance is measured from the incisal edge of the upper central incisor to the incisal edge of the lower central incisor. The normal range is approximately 40 to 55 mm; restriction below 40 mm is potentially compensable.
Lateral Excursion
With the teeth slightly apart, the veteran is asked to shift the mandible as far as possible to one side and then to the other. The displacement of the lower incisor midline from the upper incisor midline is measured. Normal lateral excursion is approximately 8 to 12 mm; restriction below 4 mm is compensable.
Functional Loss Documentation
Beyond the raw measurements, the examiner should document pain with opening, the point at which pain begins, any clicking, popping, or crepitus on motion, deviation of the mandible during opening (suggesting unilateral disc dysfunction), and any locking episodes.
Dietary Impairment
For the 10 percent inter-incisal tier, the record should document the dietary modification: what foods the veteran cannot eat, what mechanical preparation (cutting, blending, pureeing) is required, and whether dietary restriction is constant or intermittent.
Secondary Service Connection Pathways
Several secondary pathways arise under 38 CFR 3.310.
TMJ Secondary to PTSD
The strongest and most common secondary theory is TMJ disorder secondary to service-connected PTSD or anxiety through stress-induced bruxism and parafunctional clenching. Multiple peer-reviewed studies have demonstrated elevated rates of bruxism and TMJ disorder among veterans with PTSD, with mechanisms including sympathetic hyperarousal, sleep disruption with arousal-associated bruxism, and increased baseline masticatory muscle tone. The nexus letter should articulate this autonomic-nociceptive mechanism.
TMJ Secondary to Cervical Spine Injury
A service-connected cervical spine injury can alter the cervico-mandibular postural relationship and produce or aggravate TMJ disorder. The biomechanical theory is well established in the dental and physical therapy literature.
TMJ Secondary to Headaches or TBI
Service-connected migraine or post-traumatic headache disorders frequently coexist with TMJ disorder, and TBI is independently associated with TMJ symptoms.
TMJ Secondary to Service-Connected Dental Condition
Tooth loss, malocclusion from service-connected dental injury, and complications of service-connected oral surgery can predispose to TMJ disorder.
Evidence That Supports the Rating
The records that most strongly support a defensible DC 9905 rating include the following.
Dental or Oral Surgery Evaluation
A dental, oral surgery, or orofacial pain evaluation establishing the DC/TMD diagnostic category (myalgia, disc displacement, arthralgia, arthritis) and documenting the inter-incisal and lateral excursion measurements.
Imaging
Panoramic radiograph for screening; cone-beam CT for bony detail (condyle morphology, erosions, osteophytes); MRI for soft-tissue detail (disc position, joint effusion).
Bruxism Documentation
Dental notes documenting masseter or temporalis hypertrophy, occlusal wear patterns, and any prior occlusal splint prescription. Spousal observation of nighttime grinding is competent lay evidence.
Treatment History
Occlusal splint prescription and compliance, physical therapy course, botulinum toxin injections to the masseter or temporalis, intra-articular injections, arthrocentesis, arthroscopy, or open joint surgery. Treatment intensity is correlated with severity.
Functional Limitation
Dietary diary documenting modified-texture diet, statements describing inability to yawn, speak for prolonged periods, or perform occupational tasks requiring sustained jaw use (singing, public speaking, instructor roles).
Common Pitfalls
Several recurring issues weaken TMJ claims.
Missing Goniometric Measurement
Examinations that note "limited opening" without a specific millimeter measurement leave the rater without the data needed for the schedule. The specific measurement is essential.
Conflating Pain With Range
DC 9905 is rated on range of motion, not pain. The pain-with-opening finding is relevant under 38 CFR 4.59 for minimum compensable consideration, but the rating tier is determined by the millimeter measurement.
Missing PTSD Linkage
When a veteran has service-connected PTSD and a separate TMJ claim, omitting the PTSD-bruxism secondary theory leaves a strong pathway unused. The nexus letter should articulate the autonomic-nociceptive mechanism explicitly.
Failure to Document Dietary Restriction
The 10 percent tier requires dietary restriction at the 31 to 40 mm range; without dietary documentation, that tier may default to 0 percent.
Frequently Asked Questions
Diagnostic Code 9905 in 38 CFR 4.150 is the VA's rating code for temporomandibular joint (TMJ) disorder. It is rated on the basis of inter-incisal range of motion (the maximum vertical opening between the upper and lower central incisors) and range of lateral excursion. The schedule provides tiers from 10 to 50 percent based on the degree of restriction, with additional ratings available for dietary impairment and articular masticatory tissue loss.
Under the schedule, inter-incisal range of 31 to 40 mm is rated 10 percent if there is dietary impairment with only mechanically softened diet tolerance; 21 to 30 mm is 20 percent; 11 to 20 mm is 30 percent; and 0 to 10 mm is 40 percent. Lateral excursion of 0 to 4 mm is rated 10 percent (this rating is not combined with the inter-incisal restriction rating). Loss of approximately one-half or more of the maxilla or mandible articular masticatory tissue, with restriction of inter-incisal motion to 0 to 10 mm, can be rated up to 50 percent.
Yes. Under 38 CFR 3.310, TMJ disorder can be secondary to service-connected PTSD or anxiety through stress-induced bruxism and parafunctional clenching; secondary to a service-connected cervical spine or head/neck injury through altered biomechanics; or secondary to a service-connected dental condition. The medical opinion must articulate the bruxism, biomechanical, or dental mechanism specific to this veteran.
Strong records include dental or oral surgery evaluation with goniometer measurements of maximum inter-incisal opening and lateral excursion, imaging (panoramic radiograph, cone-beam CT, MRI), documentation of clicking, popping, or locking, history of bruxism or nighttime clenching, treatment history (occlusal splints, physical therapy, botulinum toxin, arthrocentesis), dietary modification history, and a description of functional limitation including pain with chewing, speaking, and yawning.
Need a Medical Opinion for a TMJ Claim?
Semper Solutus provides MD-authored medical opinions for veterans with TMJ disorder, including direct service connection and secondary nexus letters linking TMJ to PTSD-driven bruxism, cervical spine injury, or head and neck trauma under 38 CFR 3.310. Schedule a free consultation to discuss your claim.
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