How VA Rates TMJ and Bruxism: DC 9905 Range of Motion and Dietary Restriction Guide

Temporomandibular joint disorder (TMJ or TMD) is evaluated under 38 CFR 4.150, Diagnostic Code 9905. The word bruxism does not appear in 38 CFR 4.150. 38 CFR 4.20 says that when an unlisted condition is encountered it is permissible to rate under a closely related disease or injury in which "not only the functions affected, but the anatomical localization and symptomatology are closely analogous", and that "conjectural analogies will be avoided".

Ratings under DC 9905 are primarily determined by maximum unassisted inter-incisal movement (jaw opening measured in millimeters). Interincisal range (maximum unassisted vertical opening): 0 to 10 mm: 50 with dietary restrictions to all mechanically altered foods, 40 without. 11 to 20 mm: 40 with restrictions to all mechanically altered foods, 30 without. 21 to 29 mm: 40 with restrictions to full liquid and pureed foods, 30 with restrictions to soft and semi-solid foods, 20 without. 30 to 34 mm: 30 with full liquid and pureed, 20 with soft and semi-solid, 10 without. The lateral excursion row (0 to 4 mm) is 10 percent. Note (1) says ratings for limited interincisal movement "shall not be combined with ratings for limited lateral excursion".

Note (3) describes four levels of mechanically altered foods (full liquid, puree, soft, semisolid). It says "To warrant elevation based on mechanically altered foods, the use of texture-modified diets must be recorded or verified by a physician."

Note (2) gives 35 to 50 mm as the normal maximum unassisted vertical jaw opening "for VA compensation purposes". Records potentially relevant to jaw opening and diet include dental and treatment records.