Chronic Osteomyelitis of the Jaw — VA Disability Rating (DC 9900)
Diagnostic Code 9900 · 38 CFR §4.150
What Is It?
DC 9900 covers chronic osteomyelitis, osteonecrosis, or osteoradionecrosis of the maxilla (upper jaw) or mandible (lower jaw). Osteomyelitis is a bone infection; osteonecrosis is bone death from loss of blood supply; and osteoradionecrosis is bone death caused by radiation therapy. For veterans, jaw osteomyelitis may develop from combat injuries to the face, dental infections that went untreated during deployments, or complications from dental procedures during service. Osteoradionecrosis can develop after radiation treatment for service-connected head and neck cancers. The key thing to know is that DC 9900 does not have its own specific rating levels — instead, the VA rates the condition using the criteria from DC 5000 (chronic osteomyelitis of any bone), which is found under the musculoskeletal rating schedule.
Rating Criteria
| Rating | Criteria |
|---|---|
| 60% | Rated under DC 5000 (chronic osteomyelitis). Frequent episodes with constitutional symptoms such as fever, chills, weight loss, and the need for ongoing antibiotic therapy or repeated surgical procedures. The condition significantly limits your ability to function. |
| 30% | Rated under DC 5000. Definite involucrum (new bone formation around dead bone) or sequestrum (dead bone fragments), with or without draining sinus tract. Recurrent episodes requiring treatment. |
| 20% | Rated under DC 5000. Discharging sinus or other evidence of active infection within the past five years. Treatment history showing ongoing management of the condition. |
| 10% | Rated under DC 5000. Inactive osteomyelitis following repeated episodes, without evidence of active infection for five or more years. |
Evidence Needed
Dental and oral surgery records documenting the diagnosis with imaging (panoramic X-ray or CT scan) showing bone involvement are essential. Service treatment records documenting the original injury, infection, or radiation exposure help establish the service connection. Records of ongoing treatment — antibiotics, surgical debridement, hyperbaric oxygen therapy, or other interventions — demonstrate the chronic nature and severity. Since the condition is rated under DC 5000, evidence showing the pattern of episodes, any constitutional symptoms (fever, chills, weight loss), and the presence of involucrum, sequestrum, or draining sinuses is important.
C&P Exam Tips
Describe the pattern of your symptoms: how often flare-ups occur, what treatment you need during episodes, and whether you experience constitutional symptoms like fever, chills, or weight loss. Explain jaw pain, difficulty chewing, swelling, and any drainage. If you have had surgical procedures like debridement, describe them and any complications. The examiner needs to assess whether the condition is active or in remission and the current extent of bone involvement. Since this is rated under DC 5000, the focus is on whether the infection is active, how frequently it recurs, and what level of treatment it requires.
How to File
File on VA Form 21-526EZ referencing DC 9900. Submit dental records, imaging studies, and treatment records showing the history of infection or bone necrosis. If the condition is secondary to radiation for a service-connected cancer, reference the primary cancer claim. A nexus letter from an oral surgeon connecting the jaw condition to military service is recommended. Be aware that the VA will apply the rating criteria from DC 5000 (chronic osteomyelitis), so frame your evidence around infection activity, treatment history, and constitutional symptoms.
Common Mistakes
The biggest mistake is not understanding that DC 9900 is rated under DC 5000 criteria, not under its own rating levels. This means you need evidence that fits the DC 5000 framework — infection activity, episodes, constitutional symptoms, involucrum, sequestrum, draining sinuses. Not documenting the chronic nature of the condition (ongoing infections, repeated treatments, persistent symptoms) weakens the claim. Also, not connecting the jaw infection to an in-service dental condition, injury, or radiation treatment creates a nexus gap.
Frequently Asked Questions
Why is jaw osteomyelitis rated under DC 5000 instead of having its own rating levels?
The 2017 revision of the dental rating schedule streamlined DC 9900 to reference the existing chronic osteomyelitis criteria under DC 5000 in the musculoskeletal section. This ensures consistent evaluation of osteomyelitis regardless of which bone is affected. The DC 5000 criteria focus on infection activity, frequency of episodes, and systemic impact.
Can jaw osteomyelitis be service-connected?
Yes. If the infection resulted from a dental injury during service, untreated dental problems during deployment, or complications from service-connected radiation treatment, it can be service-connected. A nexus letter from an oral surgeon explaining the connection is typically needed.