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 rating levels. 38 CFR 4.150 says only: "Rate as osteomyelitis, chronic under diagnostic code 5000." DC 5000, "Osteomyelitis, acute, subacute, or chronic," sits in the musculoskeletal schedule at 38 CFR 4.71a and prints five evaluations: 100, 60, 30, 20 and 10 percent. There is no 0 percent row.
Rating Criteria
| Rating | Criteria |
|---|---|
| 100% | Rated under DC 5000. Of the pelvis, vertebrae, or extending into major joints, or with multiple localization or with long history of intractability and debility, anemia, amyloid liver changes, or other continuous constitutional symptoms. |
| 60% | Rated under DC 5000. Frequent episodes, with constitutional symptoms. |
| 30% | Rated under DC 5000. With definite involucrum (a shell of new bone formed around dead bone) or sequestrum (a fragment of dead bone), with or without discharging sinus. |
| 20% | Rated under DC 5000. With discharging sinus or other evidence of active infection within the past 5 years. Under Note (2) to DC 5000, this rating requires an established recurrent osteomyelitis and is not assignable after an initial infection with no later reactivation; it is assigned once only, to cover all sites of previously active infection, with a future ending date. |
| 10% | Rated under DC 5000. Inactive, following repeated episodes, without evidence of active infection in past 5 years. Under Note (2) to DC 5000, 2 or more episodes following the initial infection are required. |
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 treatment — antibiotics, surgical debridement, hyperbaric oxygen therapy, or other interventions — document the course of the condition. Since the condition is rated under DC 5000, the evidence that matters most is what those criteria turn on: the date of each episode of active infection or drainage, any constitutional symptoms (such as fever, weight loss, anemia, or debility), imaging that shows involucrum or sequestrum, and whether the disease is present at more than one site.
C&P Exam Tips
Describe the pattern of your symptoms: how often flare-ups occur, when the last episode of active infection or drainage was, 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 or resection, describe them and any complications. The examiner needs to assess whether the condition is active or inactive and the current extent of bone involvement. Since this is rated under DC 5000, the focus is on whether there has been active infection in the past 5 years, how many episodes there have been since the initial infection, whether there is involucrum or sequestrum, and whether there are constitutional symptoms.
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 (osteomyelitis), so frame your evidence around what those criteria turn on: the date of each episode of active infection, recurrence after the initial infection, imaging showing involucrum or sequestrum, 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 — dates of active infection, recurrence, constitutional symptoms, involucrum, sequestrum, discharging sinuses. Not documenting the course of the condition (each episode of infection and when it occurred) weakens the claim, because the 20 and 10 percent levels depend on recurrence after the initial infection and on whether there has been active infection in the past 5 years. 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?
Because that is how the dental schedule is written. DC 9900 in 38 CFR 4.150 says only "Rate as osteomyelitis, chronic under diagnostic code 5000," so the jaw is evaluated on the same criteria as osteomyelitis of any other bone. DC 5000 prints 100, 60, 30, 20 and 10 percent, based on the site and extent of the disease and continuous constitutional symptoms, frequent episodes with constitutional symptoms, involucrum or sequestrum, and active infection within the past 5 years.
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.
What happens if the affected part of the jaw is removed?
Note (1) to DC 5000 states that a rating for osteomyelitis will not be applied following cure by removal or radical resection of the affected bone. What the surgery left may then be evaluated instead. The dental schedule has its own codes for loss of part or all of the mandible or maxilla, beginning at DC 9901.