Mandible Malunion — VA Disability Rating Criteria (DC 9904)
Diagnostic Code 9904 · 38 CFR §4.150
What Is It?
Mandible malunion means a fracture of the lower jaw healed, but it healed in the wrong position. This misalignment causes the upper and lower teeth to not meet properly, creating what is called an open bite — a gap between the upper and lower teeth when you try to close your mouth. Veterans typically develop mandible malunion from jaw fractures sustained during combat, vehicle accidents, training injuries, or falls during military service. The severity of the rating depends on how much the malunion displaces your bite. A severe open bite means your front or back teeth cannot touch at all when you close your jaw, making it very difficult to bite into food or chew effectively. Treatment may involve corrective jaw surgery (orthognathic surgery), orthodontic treatment, or prosthetic appliances to compensate for the misalignment.
Rating Criteria
| Rating | Criteria |
|---|---|
| 20% | The mandible healed with displacement causing a severe anterior or posterior open bite. Your front teeth or back teeth have a significant gap when you try to close your mouth, making biting and chewing extremely difficult. |
| 10% | The mandible healed with displacement causing a moderate anterior or posterior open bite. There is a noticeable gap when you close your mouth, but some teeth still make contact and you retain partial chewing function. |
| 0% | The mandible healed with some displacement, but it does not cause an anterior or posterior open bite. Your teeth still meet when you close your mouth, so chewing function is largely preserved despite the malunion. |
Evidence Needed
Imaging studies (CT scan, panoramic X-ray, or cephalometric X-ray) clearly showing the malunion and degree of displacement are essential. A dental or oral surgery evaluation documenting the open bite — specifically whether it is anterior (front teeth do not meet), posterior (back teeth do not meet), and the severity — is critical. Service treatment records documenting the original jaw fracture establish the service connection. If you have had any corrective surgery or orthodontic treatment, include those records as well.
C&P Exam Tips
The examiner will evaluate your bite alignment and the degree of displacement. When asked to close your mouth, close naturally — do not try to force your teeth together if there is a gap. The examiner needs to see the open bite as it actually is. Describe the functional problems: which foods you cannot eat, whether you have to cut food into very small pieces, whether you experience jaw pain with chewing. If you have dental appliances to help compensate, explain how well they work. The distinction between moderate and severe open bite drives the rating difference, so make sure the examiner thoroughly documents the gap.
How to File
File on VA Form 21-526EZ. Describe the in-service injury that caused the jaw fracture that healed incorrectly. Include imaging studies, dental evaluations documenting the open bite, and service treatment records. If you also have limited jaw opening or TMD symptoms, consider filing those under DC 9905 as well since malunion and TMD are distinct conditions.
Common Mistakes
The most common mistake is confusing malunion (DC 9904) with nonunion (DC 9903). Malunion means the bone healed in the wrong position; nonunion means it did not heal at all. They are rated differently with different criteria. Another error is not getting imaging that clearly demonstrates the open bite and degree of displacement. Without objective imaging evidence, the VA may assign a lower rating. Also, not filing separately for TMD if you also have limited jaw opening leaves potential compensation on the table.
Frequently Asked Questions
What is the difference between malunion and nonunion of the mandible?
Malunion (DC 9904) means the fractured bone segments healed but in an incorrect position, causing bite misalignment. Nonunion (DC 9903) means the bone segments never joined together at all, causing abnormal movement (false motion) at the fracture site. Both affect jaw function but are rated under different diagnostic codes with different criteria.
Can I get separate ratings for mandible malunion and TMJ?
Potentially yes. Mandible malunion (DC 9904) rates the bite displacement caused by improper bone healing, while TMD (DC 9905) rates limited jaw opening and dietary restrictions. If you have measurable impairment in both areas, both should be documented and claimed separately.