VA Disability for Temporomandibular Joint Dysfunction (TMJ)

What is Temporomandibular Joint Dysfunction (TMJ)?

The temporomandibular joint acts like a sliding hinge, connecting your jawbone to your skull.  TMJ disorders can cause pain in your jaw joint and in the muscles that control jaw movement.  In most cases, the pain and discomfort associated with TMJ dysfunction is temporary and can be relieved with self-managed care or nonsurgical treatments.  Surgery is typically a last resort after conservative measures have failed, but some people with TMJ disorders may benefit from surgical treatments.  Common signs and symptoms of TMJ dysfunction may include the following:

• Pain or tenderness of your jaw
• Pain in one or both of the temporomandibular joints
• Aching pain in and around your ear
• Difficulty chewing or pain while chewing
• Aching facial pain
• Locking of the joint, making it difficult to open or close your mouth
• Clicking sound or grating sensation when you open your mouth or chew

Painful TMJ dysfunction can occur if the shock-absorbing disk erodes or moves out of its proper alignment, the joint’s cartilage is damaged by arthritis, or the joint is damaged by a blow or other impact.  However, in many cases the cause of TMJ dysfunction is not clear.  Many veterans experience TMJ as a result of their time in military service.  If you are a veteran who believes your TMJ is due to your service, you may qualify for VA disability benefits.

Service Connection for TMJ

Prior to receiving VA disability benefits for TMJ, veterans must establish service connection.  There are multiple types of service connection; however, the following two types are most common in claims for TMJ:

Direct Service Connection

To establish direct service connection, veterans must demonstrate three things to VA: (1) a current diagnosis; (2) an in-service event, injury, or illness; and (3) a medical nexus linking the current diagnosis to the in-service event.  Here, the veteran must have a current diagnosis of TMJ.  An example of an in-service event could be an IED blast, as TMJ is associated as being a chronic pain disorder linked to IED-related conditions.  Specifically, the IED blast may result in severe injury to the jaw or the muscles near the head and neck, thereby causing TMJ.  Finally, the veteran must have a doctor opine that their TMJ is “at least as likely as not” due to their service.

Secondary Service Connection

Secondary service connection is warranted when a veteran has a primary service-connected condition that then causes or aggravates a secondary condition.  A June 2014 study showed that veterans with post-traumatic stress disorder (PTSD) have higher rates of TMJ and significantly poorer TMJ functional status than veterans without PTSD.  In this case, if veterans are already service-connected for PTSD, they may be eligible to file a secondary claim for TMJ stating that it was caused or aggravated by their PTSD.  Similar to direct service connection, VA will look for a current diagnosis of TMJ and medical evidence supporting the link between the veteran’s TMJ and their service-connected PTSD.

How VA Rates TMJ

VA rates TMJ under 38 CFR § 4.150, Schedule of Ratings – Dental and Oral Conditions, Diagnostic Code 9905.  Essentially the rating criteria is based on limited motion of the joint and the ability to eat regular or mechanically altered food.  Here, mechanically altered foods include liquid, blended, chopped, pureed, ground, mashed, soft, and semisolid foods.  Importantly, it is not enough for veterans to report that they eat mechanically altered foods.  Instead, a treating physician must record that their condition requires them to eat only mechanically altered foods in order to receive a disability rating under that specific criteria.  Additionally, the limitation of motion involves (1) opening and closing the jaw and (2) moving the jaw side-to-side.  Only one direction of motion will be rated.  If the veteran experiences limitation of motion in both directions, then the one that will give the highest disability rating is used.  The rating criteria is broken down as follows:

Interincisal Range of Motion (opening and closing the jaw)

• 0 to 10 millimeters (mm) of maximum unassisted vertical opening:
  • 50% – with dietary restrictions to all mechanically altered foods
  • 40% – without dietary restrictions to mechanically altered foods
• 11 to 20 mm of maximum unassisted vertical opening:
  • 40% – with dietary restrictions to all mechanically altered foods
  • 30% – without dietary restrictions to mechanically altered foods
• 21 to 29 mm of maximum unassisted vertical opening:
  • 40% – with dietary restrictions to full liquid and pureed foods
  • 30% – with dietary restrictions to soft and semi-solid foods
  • 20% – without dietary restrictions to mechanically altered foods
• 30 to 34 mm of maximum unassisted vertical opening
  • 30% – with dietary restrictions to full liquid and pureed foods
  • 20% – with dietary restrictions to soft and semi-solid foods
  • 10% – without dietary restrictions to mechanically altered foods

Importantly, for VA compensation purposes, the normal maximum unassisted range of vertical jaw opening is from 35 to 50 mm.

Lateral Excursion Range of Motion (moving the jaw side-to-side)

• 10% – 0 to 4 mm