TMJ and VA dental care
TMJ has its own rating table in VA's dental and oral schedule. A service-connected dental or oral condition that is compensable (paid at 10 percent or higher) qualifies for Class I VA dental care.
The key word is compensable
VA sorts dental eligibility into classes. Class I is for a Veteran with a service-connected dental or oral condition that is compensable, meaning VA pays compensation for it (rated 10 percent or higher). VA's dental page says such a Veteran may qualify for any needed dental care.
Under 38 CFR 17.161(a), a Veteran with a service-connected compensable dental disability may be authorized any dental treatment indicated as reasonably necessary to maintain oral health and masticatory (chewing) function, with no time limit and no limit on repeat treatment.
How VA rates TMJ
Temporomandibular disorder (TMD, often called TMJ) is rated under Diagnostic Code 9905 in the dental and oral rating schedule, 38 CFR 4.150. The rating depends mainly on how far your mouth opens (inter-incisal range) and on diet limits:
- 30 to 34 mm opening: 10 percent without dietary restrictions to mechanically altered foods; 20 percent if limited to soft and semi-solid foods; 30 percent if limited to full liquid and pureed foods.
- 21 to 29 mm: 20 percent without dietary restrictions to mechanically altered foods; 30 percent (soft and semi-solid) or 40 percent (full liquid and pureed).
- 11 to 20 mm: 30 percent without dietary restrictions to mechanically altered foods; 40 percent if limited to mechanically altered foods.
- 0 to 10 mm: 40 percent without dietary restrictions to mechanically altered foods; 50 percent if limited to mechanically altered foods.
- Side-to-side movement (lateral excursion) of 0 to 4 mm: 10 percent.
A rating for limited opening and a rating for limited side-to-side movement are not combined. For VA purposes a normal opening is 35 to 50 mm. Mechanically altered foods means foods altered by blending, chopping, grinding or mashing so they are easy to chew and swallow, and the diet limits must be documented by a physician.
DC 9905 · without dietary restrictions to mechanically altered foods
A 0 percent rating is different
A service-connected dental condition rated 0 percent (noncompensable) does not qualify for Class I. It may qualify for narrower care only: Class II is one-time correction of the condition and has strict deadlines (generally apply within 180 days of discharge for those discharged after September 30, 1981), and Class II(a) covers conditions from combat wounds or service trauma. VA decides which class applies.
Other ways to qualify
Class IV is for a Veteran whose service-connected disabilities are rated 100 percent (38 CFR 17.161 also covers a Veteran entitled to the 100 percent rate through individual unemployability). VA's dental page says a 100 percent rate based on a temporary rating, such as a long hospital stay, does not qualify.
Next step
Both the Veterans Benefits Administration and the Veterans Health Administration can make decisions about dental benefits. VA says to apply for VA health care before going to a VA dental clinic, using Form 10-10EZ. Read VA's dental care page for the classes.
Where to call and where to go
Phone
- VA health care and enrollment questions: 877-222-8387, Monday through Friday, 8:00 a.m. to 8:00 p.m. ET (source: VA, How to apply for VA health care)
- VA disability benefits (rating and claim questions): 800-827-1000, Monday through Friday, 8:00 a.m. to 9:00 p.m. ET (source: VA regional benefit office page)
Go to
- VA dental care: classes and eligibility
- Apply for VA health care (Form 10-10EZ)
- How to file a VA disability claim
- Find a VA location near you
Free accredited help
VA says Veterans Service Organization (VSO) representatives are always free. Find an accredited representative on VA.gov.