Dental conditions, jaw disorders, and oral health issues rated under the dental schedule.
How Dental & Oral conditions are rated
Dental and oral claims run on two separate tracks. The first is compensation: the schedule at 38 CFR §4.150 rates conditions of the jaw bones, the jaw joint, and the hard palate, along with tooth loss caused by loss of jaw bone. The second is service connection for treatment purposes only, under 38 CFR §3.381, which can establish eligibility for VA outpatient dental treatment without any compensation rating.
§3.381(b) draws the line. "Treatable carious teeth, replaceable missing teeth, dental or alveolar abscesses, and periodontal disease are not compensable disabilities," but they "may nevertheless be service connected solely for the purpose of establishing eligibility for outpatient dental treatment." The same paragraph extends that treatment-only service connection to other dental conditions rated noncompensable under §4.150. The rest of the section considers each tooth separately, against its condition at entry, and many of its rules turn on whether a filling, an extraction, or new disease came "after 180 days or more of active service." Calculus and acute periodontal disease are not service connected for treatment purposes, and neither are third molars or impacted or malposed teeth unless disease or pathology developed after 180 days or more of active service (or, for third molars, was due to combat or in-service trauma).
On the compensation side, §4.150 rates by structure and function. Temporomandibular disorder (DC 9905) is rated on the interincisal range, the "maximum unassisted vertical opening" in millimeters, together with any dietary restriction to mechanically altered foods. The levels run from 10% at 30 to 34 mm without dietary restriction to 50% at 0 to 10 mm with restriction to all mechanically altered foods. A separate 10% covers lateral excursion of 0 to 4 mm, but ratings for limited interincisal movement "shall not be combined" with ratings for limited lateral excursion. The notes treat 35 to 50 mm as the normal range of opening and require that a texture-modified diet be "recorded or verified by a physician."
Loss of bone is rated with prosthetics in mind. The codes for loss of the mandible, maxilla, and hard palate separate loss that is "replaceable by prosthesis" from loss that is not, and the loss that cannot be replaced is rated higher. DC 9913 covers loss of teeth due to "loss of substance of body of maxilla or mandible," and it is compensable only where the lost chewing surface cannot be restored by a suitable prosthesis. Its note says these ratings apply to bone loss through trauma or disease such as osteomyelitis, "and not to the loss of the alveolar process as a result of periodontal disease, since such loss is not considered disabling." Nonunion of the mandible (DC 9903) and of the maxilla (DC 9916) must be confirmed by diagnostic imaging studies.
Two more rules round out the section. A note at the top of §4.150 directs that loss of vocal articulation, smell, or taste, neurological impairment, respiratory dysfunction, and other impairments be evaluated separately under their own codes and combined under §4.25. And malignant neoplasms of the hard and soft tissue (DC 9918) are rated 100%, continuing beyond the end of treatment until a mandatory VA examination six months later, with any change subject to §3.105(e). Without recurrence or metastasis, residuals such as lost bone or teeth are then rated.