TMJ VA Rating

Temporomandibular joint dysfunction is one of the few conditions VA rates not under the big musculoskeletal schedule in § 4.71a but under the dental and oral schedule in 38 CFR § 4.150, diagnostic code 9905. That detail matters, because the rating logic is different from a knee or a shoulder. There's no goniometer-and-degrees-of-flexion table here. The examiner measures how far your mouth opens in millimeters, how far the jaw slides side to side, and then asks a question most range-of-motion codes never ask: what can you actually eat.

The diet question is the part most veterans don't see coming. DC 9905 was amended effective September 10, 2017, and the current version builds the rating on three inputs: interincisal range of motion (the gap between your upper and lower front teeth at maximum opening, in millimeters), lateral excursion (the side-to-side range), and whether the condition forces a dietary restriction to mechanically altered foods (full liquid, puree, soft, or semisolid). The evaluation climbs as the opening gets smaller and as the diet gets more restricted. The top of the code, 50 percent, requires an opening of 10 millimeters or less plus a diet restricted to mechanically altered foods.

This page covers the DC 9905 rating chart, the three inputs that drive the rating, what the C&P examiner has to measure, TMJ secondary to PTSD and bruxism, TMJ from an in-service jaw injury, headaches and migraines arising from TMJ, and why VA denies TMJ claims. One number to set the stage. A ruling is one issue the Board decided in one decision; one decision often rules on several issues. Across 1,979 decided Board rulings on temporomandibular joint dysfunction from 2021 to 2026, 47.5 percent were remanded, more than were granted or denied. When the Board sends these claims back, the most common reason is an inadequate VA exam or opinion.

TL;DR

• TMJ dysfunction is rated under 38 CFR § 4.150, diagnostic code 9905 (temporomandibular disorder), not under the § 4.71a musculoskeletal schedule.
• DC 9905 was amended effective September 10, 2017. The current version rates on three things: interincisal range of motion in millimeters together with whether the condition requires a dietary restriction, or lateral excursion range. A rating for limited opening cannot be combined with a rating for limited lateral excursion.
• The lower your maximum mouth-opening (interincisal distance) in millimeters, the higher the rating. The top of the code, 50 percent, requires an opening of 10 millimeters or less with a diet restricted to mechanically altered foods.
• Diet is a real rating lever. At 21 to 34 millimeters of opening, the evaluation increases as the diet moves from no restriction, to soft and semi-solid foods, to full liquid and pureed foods. At 20 millimeters or less, a physician-recorded restriction to mechanically altered foods raises the rating one step.
• Lateral excursion limited to 0 to 4 millimeters warrants a 10 percent evaluation under the current code.
• The full millimeter-to-percent table is below. Quote the current text of DC 9905 when you argue a tier, because the 2017 amendment changed the structure.
• Bruxism (teeth grinding or clenching) has no diagnostic code of its own. VA rates what it causes, such as TMD under DC 9905.
• Common secondary chains run under 38 CFR § 3.310: TMJ secondary to bruxism driven by service-connected PTSD or anxiety, and headaches or migraines arising secondary to TMJ. TMJ from an in-service jaw or facial injury is usually a direct claim.
• Across 1,979 decided Board rulings on temporomandibular joint dysfunction from 2021 to 2026, 19.3% were granted, 33.1% denied and 47.5% remanded. Remand is the most common outcome, and the grant rate is 5.4 points below the Board-wide 24.7%.
• In the Board's service connection rulings on TMJ, direct claims outnumbered secondary ones, and the two were granted at nearly the same rate; the Board section below shows both.

TMJ VA rating criteria (DC 9905)

The first thing to understand is that the version of DC 9905 you may have seen in an older decision or an old forum post is probably the pre-2017 code. The amendment effective September 10, 2017 rebuilt how the code works: it added the diet restriction to the mouth-opening measurement and kept the 10 percent level for limited side-to-side motion.

The current DC 9905 rates temporomandibular disorder on three measured or documented inputs.

• Interincisal range of motion: the maximum unassisted vertical opening between the upper and lower front teeth (incisors), measured in millimeters.
• Range of lateral excursion: the side-to-side movement of the jaw, measured in millimeters.
• Dietary restriction: whether the condition requires the veteran to eat mechanically altered foods (full liquid, puree, soft, or semisolid).

The evaluation rises as the interincisal opening gets smaller and as the diet becomes more restricted. The top of the code, 50 percent, requires an opening of 0 to 10 millimeters plus a diet restricted to mechanically altered foods. Lateral excursion limited to 0 to 4 millimeters warrants a 10 percent evaluation.

The current text of DC 9905 at § 4.150 sets these tiers for maximum unassisted vertical opening.

• 0 to 10 mm: 50 percent with dietary restriction to all mechanically altered foods; 40 percent without.
• 11 to 20 mm: 40 percent with dietary restriction to all mechanically altered foods; 30 percent without.
• 21 to 29 mm: 40 percent with restriction to full liquid and pureed foods; 30 percent with restriction to soft and semi-solid foods; 20 percent without.
• 30 to 34 mm: 30 percent with restriction to full liquid and pureed foods; 20 percent with restriction to soft and semi-solid foods; 10 percent without.
• Lateral excursion of 0 to 4 mm: 10 percent.

Three notes shape how these apply. Note (1) says a rating for limited opening cannot be combined with a rating for limited lateral excursion. Note (2) sets normal maximum unassisted opening at 35 to 50 mm for VA purposes. Note (3) says a texture-modified diet must be recorded or verified by a physician before it can raise the rating. The 2017 amendment is exactly the kind of change that makes old numbers wrong. When you or your representative argue a tier, quote the current regulation.

The practical takeaway: smaller opening, more restricted diet, higher rating. That is the rating engine.

How the TMJ rating works: opening, side-to-side motion and diet

Most range-of-motion codes have one lever: degrees. DC 9905 has three, and they interact. Understanding each one tells you what evidence to build.

Lever one: interincisal opening (in millimeters). This is the headline measurement. The examiner has the veteran open as wide as possible and measures the vertical gap between the upper and lower front teeth (incisors) in millimeters. For VA purposes, normal maximum unassisted opening is 35 to 50 millimeters. The more limited the opening, the higher the rating, up to the 50 percent ceiling at 10 millimeters or less with a diet restriction. If the C&P report doesn't contain a measured interincisal distance in millimeters, the rater is missing the primary input.

Lever two: lateral excursion (in millimeters). This is the side-to-side slide of the lower jaw. The current code provides that lateral excursion limited to 0 to 4 millimeters warrants a 10 percent evaluation. It is its own measurement and its own pathway to a compensable rating, distinct from the vertical opening. It cannot be combined with a rating for limited opening, so it matters most when the opening is 35 millimeters or more and does not rate on its own. An exam that measures only vertical opening and skips lateral excursion has left a measurement out.

Lever three: dietary restriction. This is the lever veterans miss most often, and it is built into the code. The evaluation increases as the diet becomes more restricted: from no restriction, to soft and semi-solid foods, to full liquid and pureed foods. Soft, semi-solid, full liquid, and pureed diets all count as mechanically altered foods, which the regulation defines as blended, chopped, ground, or mashed so they are easy to chew and swallow. A veteran who can no longer chew steak or crusty bread and has shifted to soft or pureed food is describing a rating fact, not just a quality-of-life complaint. Note (3) requires that a physician record or verify the texture-modified diet.

The cleanest diet record states the level in concrete terms: which foods can no longer be eaten, what the veteran has switched to, when the switch happened, and why (pain on chewing, the joint locking mid-meal, the opening too small for normal bites). A treating physician's note capturing this is strong. The veteran's own statement to the C&P examiner, recorded in the report, matters too. A symptom and diet log carried into the exam keeps the diet history from being summarized away as "no significant complaints."

Note (1) limits how the levers combine: a rating for limited opening and a rating for limited lateral excursion cannot be combined. Bilateral joint involvement should still be documented as bilateral, because it describes the full disability picture, but the current DC 9905 criteria do not assign a higher tier for it.

Opening and diet work together. The top of the code is not reached by mouth-opening alone or diet alone. It is an opening of 10 millimeters or less plus a physician-recorded diet restriction. Build the record on all three measurements anyway, because any one of them can decide the tier.

The TMJ C&P exam: what the examiner has to measure

VA's public form for this exam is the Temporomandibular Disorders DBQ, which is separate from the Oral and Dental DBQ. Because the rating is built on specific measured inputs, the exam either captures them or it doesn't, and the high remand share in the Board data fits the view that it often doesn't.

The DBQ asks the examiner to record the items below.

• Interincisal distance at maximum opening, in millimeters. This is the central measurement.
• Lateral excursion, in millimeters, to the right and to the left.
• The same measurements after repeated use over time and during flare-ups, estimated in millimeters when the exam is not done at those times.
• Pain on motion, tenderness on palpation and crepitus, and whether they cause functional loss.
• Whether a physician has recorded or verified a mechanically altered diet, and at what level.

Clicking, popping, and locking, and whether the joint locks open or closed, belong in your description of the history even though the rating is anchored on the measurements. They support the functional picture and the diet restriction. A joint that locks closed mid-meal is the mechanism behind a soft-food diet.

When all of this is in the report, the rater has what the code needs. When it's sparse, the rater defaults to whatever is documented, which is usually less than the full picture. The exams I see the Board send back tend to be missing one of the core inputs: no millimeter measurement of interincisal opening, no lateral-excursion measurement, or no notation of dietary restriction at all. Each missing input is a tier the rater can't reach.

Pain, flare-ups and functional loss

Even though DC 9905 is built on measurements rather than a pure degrees table, the functional-loss principles still apply to the joint motion. DeLuca v. Brown, 8 Vet. App. 202 (1995), requires examiners to say whether pain could significantly limit function during flare-ups or with repeated use over time, not just report the static measurement on the day of the exam. Sharp v. Shulkin, 29 Vet. App. 26 (2017), requires the examiner to estimate the additional functional loss during a flare-up when the veteran reports flares, using the veteran's own account if needed, or to explain why an estimate isn't feasible. The TMJ DBQ builds this in: when pain is associated with movement, the examiner must say whether pain could significantly limit function during flare-ups or after repeated use, and estimate the opening in millimeters at those times.

For a jaw, this plays out in a recognizable way. The interincisal opening measured in a quiet clinic on a good day might be wider than what the veteran can manage during a flare, when the joint is inflamed, locking, or in spasm. If the veteran reports that on bad days the mouth barely opens and meals become liquid, that flare presentation is supposed to be part of the analysis, not waved off because the in-clinic number looked better.

Saunders v. Wilkie, 886 F.3d 1356 (Fed. Cir. 2018), is also worth knowing here. Pain that produces functional impairment can itself be a disability for VA purposes. For TMJ, where chronic pain on chewing and talking is the daily reality for many veterans, that principle supports putting the pain, and what it stops the veteran from doing, squarely in the record.

What to bring to the exam

Because DC 9905 is measurement-driven, the exam is the rating engine, even more so than in a typical orthopedic claim. If the examiner skips the millimeter measurement, the rating has no anchor. If lateral excursion is skipped, a compensable pathway is lost. If the diet restriction is never asked about, a built-in lever disappears.

Use C&P exam prep for the TMJ exam and track jaw symptoms, locking, and which foods you've had to drop before the exam. A log with dates, how wide the jaw opened on bad days, foods dropped, and locking episodes gives the examiner facts to record for the flare-up estimate and the rater facts to weigh.

TMJ secondary to PTSD, bruxism or a jaw injury

Many TMJ claims are built not on an in-service jaw injury but on another service-connected condition, under 38 CFR § 3.310, which allows service connection for a condition caused by, or aggravated by (Allen v. Brown, 7 Vet. App. 439 (1995)), a service-connected condition. In the Board's 2021 to 2026 service connection rulings on TMJ, direct claims outnumbered secondary ones, and the two were granted at nearly the same rate; the Board section below shows both.

TMJ and bruxism secondary to PTSD or anxiety

This is the chain that surprises people. A veteran with service-connected PTSD or anxiety grinds and clenches the teeth (bruxism), often at night, and develops jaw pain and dysfunction. Research supports part of that chain. People with severe PTSD report painful TMD, daytime clenching and sleep bruxism much more often than the general population (Knibbe, Journal of Oral Rehabilitation, 2022), and a review of war veterans found more TMD signs in those with PTSD (Minervini, Journal of Oral Rehabilitation, 2023). The step from grinding to joint damage is less settled: a systematic review found bruxism associated with jaw muscle and joint symptoms, but not in a direct, straight-line causal way (Baad-Hansen, Journal of Oral Rehabilitation, 2019). That is why the nexus opinion has to explain the mechanism in your case rather than lean on the association.

Bruxism itself is not rated. The rating schedule has no code for it, and when VA rewrote the dental and oral schedule in 2017 it declined to add one, explaining that bruxism is a symptom whose effects are already covered by the underlying condition being compensated. So the rating comes from what the grinding produced, such as TMD under DC 9905, not from the grinding.

The claim wins when the nexus opinion explains the mechanism end to end: how the mental health condition led to the clenching or grinding (ideally corroborated by a dental note describing worn or fractured dentition, a night guard, or the veteran's reported grinding), how that loading affected the temporomandibular joint, and why the jaw dysfunction followed. The opinion should address the time course and rule out unrelated causes.

It loses when the opinion skips that reasoning. "TMJ is secondary to PTSD" with nothing in between is not enough. A rater or Board member needs the pathway. The aggravation theory under Allen v. Brown is also available: even if the TMJ has another origin, a service-connected mental health condition that worsens it through bruxism can support secondary service connection, meaning the TMJ would be less severe but for the PTSD or anxiety. An opinion that answers only causation and skips aggravation is inadequate (El-Amin v. Shinseki, 26 Vet. App. 136 (2013)). The secondary conditions tool can help map the chain before you file.

TMJ from an in-service jaw or facial injury

A blow to the jaw, a facial fracture, a dental injury, or surgery in service can set up TMJ dysfunction that surfaces or worsens later. That is usually a direct service connection claim rather than a § 3.310 secondary one. The work is establishing the in-service event (STRs, line-of-duty records, buddy statements about the incident) and a medical opinion tying the current joint dysfunction to that trauma rather than to ordinary aging or a post-service event. If the injury itself is already service connected, such as a jaw fracture, TMJ can also be claimed as secondary to it.

Headaches and migraines secondary to TMJ

This chain runs the other direction. The jaw dysfunction is the cause, and the headache is the secondary condition. Painful TMD and migraine are strongly linked in both directions (Dias, Journal of Oral Rehabilitation, 2026), and an earlier review found the link with headaches for painful TMD but not for jaw joint problems without pain (Réus, Journal of the American Dental Association, 2022). TMJ-driven headaches and migraines can be service connected as a secondary condition when a medical opinion connects the jaw dysfunction to the headache pattern. This one matters for the combined rating, because migraines have their own code, DC 8100, with ratings up to 50 percent, separate from the TMJ rating. A veteran who only claims the jaw may be leaving the headache rating on the table.

For all of these claims, the standard for the nexus opinion is the same. A bare "more likely than not related" conclusion without reasoning carries little weight, because most of a medical opinion's probative value comes from its reasoning (Nieves-Rodriguez v. Peake, 22 Vet. App. 295 (2008)). The opinion has to identify the mechanism, address the time course, and account for alternative causes. A fully articulated opinion based on sound reasoning carries the claim. A generic one does not.

Why VA denies TMJ claims

Remand is the most common Board outcome for TMJ. Across 1,979 decided Board rulings on temporomandibular joint dysfunction from 2021 to 2026, 19.3% were granted, 33.1% denied and 47.5% remanded. That grant rate is 5.4 points below the Board-wide 24.7 percent.

When the Board denied TMJ service connection, the most common reason by far was that the record did not show a current diagnosed disability, ahead of no in-service event and no link to service. Beyond that, a few patterns repeat across BVA decisions involving TMJ. These are qualitative reads from the cases, not separate computed statistics.

No current TMJ diagnosis. Records mention jaw pain, clicking, or grinding, but no dentist or physician diagnosed a temporomandibular disorder. Without a diagnosed condition, there is nothing to rate under DC 9905.

No millimeter measurement of interincisal opening. The single most damaging gap. The rating code is built on the interincisal distance in millimeters, and an exam that says "limited jaw opening" without a measured number gives the rater nothing to map onto a tier. This is the kind of omission that produces an inadequate-exam finding and a remand. With remand the most common Board outcome on TMJ, at 47.5 percent of decided rulings, missing or vague measurements are a recurring theme.

Diet restriction never documented. Diet is a built-in lever, and it is the one most often missing from the record. A veteran who has quietly switched to soft food for years may never have said so to a provider, so it never made the chart. Without a physician recording or verifying the diet, an entire dimension of the code is invisible to the rater.

Lateral excursion skipped. Vertical opening gets measured, side-to-side motion does not. Because lateral excursion is its own pathway (limited to 0 to 4 millimeters warrants 10 percent), skipping it can cost a compensable finding.

Secondary nexus opinion is conclusory. For the bruxism-from-PTSD chain, decisions turn on the quality of the medical opinion. "TMJ is related to service" with no mechanism, no time course, no discussion of bruxism, and no answer on aggravation reads as non-probative, and the claim stalls or gets denied.

The headache secondary never gets claimed. Veterans claim the jaw and stop. The TMJ-driven headache or migraine, which can carry its own rating, never enters the picture, so the combined rating is lower than the full disability picture would support.

Among TMJ rulings the Board granted or denied, those with a private medical opinion in the record were granted far more often than the group as a whole, an association rather than proof of cause. That remand-heavy pattern is consistent with the gaps above: when the central measurements and the diet restriction aren't in the record, the Board either can't grant or has to send the case back for a better exam. The Board section below shows how often each denial and remand reason came up, how the Board ruled by the medical opinion it relied on, and what happened after a remand.

Questions veterans ask about TMJ

Is TMJ a VA disability?

Yes. VA rates temporomandibular disorder under Diagnostic Code 9905 in the dental and oral schedule, 38 CFR 4.150, at 10 to 50 percent based on how far your mouth opens, how far your jaw moves side to side, and whether a physician has recorded a restricted diet. It has to be service connected first, directly or as secondary to another service-connected condition.

What is the highest VA rating for TMJ?

50 percent, for a maximum unassisted mouth opening of 10 millimeters or less with a physician-recorded diet restricted to all mechanically altered foods. Without that diet restriction, the same opening rates 40 percent.

Can you get a VA rating for bruxism?

Not by itself. The rating schedule has no code for bruxism, and VA treats it as a symptom whose effects are rated through the condition it causes or comes from. If grinding or clenching has led to TMD, the TMD is rated under DC 9905.

Can TMJ be secondary to PTSD?

Yes, if a medical opinion explains how the PTSD led to clenching or grinding and how that caused or worsened the jaw condition. Studies find TMD and bruxism more common in people with PTSD, but the opinion still has to explain the link in your case and address aggravation as well as causation.

Can migraines be secondary to TMJ?

Yes. Headaches or migraines caused or worsened by a service-connected TMJ condition can be service connected under 38 CFR 3.310 and rated under their own code, DC 8100, separate from the TMJ rating. A medical opinion has to connect the jaw dysfunction to the headache pattern.

What does the TMJ C&P exam measure?

The Temporomandibular Disorders DBQ asks for mouth opening and side-to-side jaw motion in millimeters, estimates of both after repeated use and during flare-ups, pain and its effect on function, and whether a physician has verified a mechanically altered diet. If the report lacks the millimeter measurements, the rater is missing the main input.

Bottom Line

TMJ dysfunction is rated under § 4.150 DC 9905, on the dental and oral schedule rather than the musculoskeletal one, and the 2017 amendment built the rating on three inputs: how far your mouth opens in millimeters, how far the jaw slides side to side, and how restricted your diet has become. The evaluation climbs toward a 50 percent ceiling as the opening shrinks and the diet narrows, and a rating for limited opening cannot be combined with one for limited side-to-side motion. Quote the current regulation rather than an old summary. The recurring failure point, and a likely reason remand is the most common Board outcome on these claims, is a thin exam: no measured interincisal distance, no lateral excursion, no diet documentation. The cases that succeed tend to have all three captured, a physician-recorded diet history, and, where it applies, a fully reasoned nexus opinion tying the jaw to service-connected PTSD-driven bruxism or to in-service trauma, plus a claim for the TMJ-driven headache that is often left off entirely. Same condition, different paper trail, different outcome.

Related Conditions

TMJ claims commonly connect to migraines (a downstream secondary claim), TBI (where facial trauma and head injury overlap), PTSD, and anxiety (the mental health conditions that drive the bruxism pathway). Because the headache and the mental health pieces can carry their own ratings, veterans with jaw dysfunction should review the secondary conditions tool before assuming a single TMJ rating tells the whole story.

Methodology and Limitations

• Data source: Rating criteria from 38 CFR § 4.150, diagnostic code 9905 (temporomandibular disorder), as amended effective September 10, 2017 (82 FR 36080); the 2015 proposal (80 FR 44913) explains the added diet criteria, and the 2017 final rule records VA's decision not to give bruxism its own code. Secondary service connection from 38 CFR § 3.310; migraine ratings from § 4.124a, DC 8100. Exam content from VA's Temporomandibular Disorders DBQ (updated August 23, 2024). Case law from DeLuca v. Brown (functional loss), Sharp v. Shulkin (flare-up estimates), Saunders v. Wilkie (pain as disability), Allen v. Brown (secondary aggravation), El-Amin v. Shinseki (opinions that skip aggravation), and Nieves-Rodriguez v. Peake (weight of medical opinions). Medical statements are from Knibbe, "Prevalence of painful temporomandibular disorders, awake bruxism and sleep bruxism among patients with severe post-traumatic stress disorder," Journal of Oral Rehabilitation (2022); Minervini, "Post-traumatic stress, prevalence of temporomandibular disorders in war veterans," Journal of Oral Rehabilitation (2023); Baad-Hansen, "To what extent is bruxism associated with musculoskeletal signs and symptoms?," Journal of Oral Rehabilitation (2019); Dias, "Exploring the Bidirectional Association Between Migraine and Temporomandibular Disorders," Journal of Oral Rehabilitation (2026); and Réus, "Association between primary headaches and temporomandibular disorders," Journal of the American Dental Association (2022).
• Sample size: Board figures in this post come from Claim Raven's read of every Board decision from 2021 to 2026 that it holds: 511,036 decisions containing 1,378,030 rulings. Of 2,238 Board rulings on temporomandibular joint dysfunction, 1,979 were decided (granted, denied or remanded); the rest were dismissed, withdrawn or closed another way. Across 1,979 decided Board rulings on temporomandibular joint dysfunction from 2021 to 2026, 19.3% were granted, 33.1% denied and 47.5% remanded, against a Board-wide grant rate of 24.7% on decided rulings.
• Classification approach: Diagnostic code structure drawn from the current regulatory text of DC 9905. The millimeter and diet tiers on this page were checked against the eCFR text of DC 9905 on October 6, 2026.
• Limitations:
• Compensation tiers under DC 9905 are set by the current regulation. The millimeter cutoffs should be verified in the current regulatory text for any active claim, especially for periods before the September 10, 2017 amendment.
• The qualitative evidence-gap patterns are reads from BVA decisions, not separately computed statistics. The TMJ figures typed on this page are the overall Board figures: 1,979 decided rulings (19.3 percent granted, 33.1 percent denied, 47.5 percent remanded). The subgroup figures are in the Board section below the article. The data does not grade C&P exams.
• Selection bias: BVA-level patterns reflect cases that appealed. Most TMJ claims resolve at the RO level and aren't in any BVA dataset.
• These observations reflect patterns from the regulatory text, case law, and BVA decisions. They are not predictions of individual outcomes.