DC 9909 · 38 CFR 4.150
Coronoid Process, Loss of C&P Exam Prep
To document the confirmed loss of the coronoid process of the mandible - a bony projection on the upper ramus of the jaw - and to establish whether the loss is unilateral (one side) or bilateral (both sides), which directly determines the disability rating under DC 9909.
- Format:
- Interview + Physical
- Typical duration:
- 20-30 minutes
- DBQ form:
- oral-and-dental (oral-and-dental)
- Examiner:
- Dentist or Oral Surgeon
What the examiner evaluates
- Confirmation of current diagnosis of coronoid process loss via clinical examination and/or diagnostic imaging
- Whether the loss is unilateral (one coronoid process) or bilateral (both coronoid processes)
- Etiology and history of the loss - traumatic, surgical/resection, pathologic, or service-related cause
- Associated functional limitations including impaired jaw opening (trismus or restricted range of motion), chewing difficulty, and pain
- Presence of any residuals, complications, or secondary conditions such as masticatory muscle dysfunction or adjacent bony changes
- Relationship between the coronoid process loss and any additional mandibular or maxillary pathology
- Review of all submitted service treatment records, private medical records, and imaging studies
- Nexus opinion regarding whether the condition was incurred in, aggravated by, or is otherwise related to military service
The exam will typically take place in a clinical dental or oral surgery setting. The examiner will perform a physical examination of the oral cavity and jaw, review your imaging history (X-rays, CT scans), and conduct a structured interview about your symptoms and history. Bring all relevant records, including service treatment records showing the injury or surgery, and any post-service imaging documenting the loss. The examiner completes the Dental and Oral Conditions DBQ form. You have the right to request that the exam be recorded in most states - check your state's recording law before your appointment.
Measurements and tests
Mandibular Range of Motion (Jaw Opening)
What it measures: Maximum interincisal distance (mouth opening) in millimeters, reflecting how much the loss of the coronoid process affects jaw mobility, including any restriction from scar tissue or muscular changes.
What to expect: The examiner will ask you to open your mouth as wide as possible and may use a millimeter ruler or caliper to measure the distance between your upper and lower incisor edges. They may also assess lateral and protrusive jaw movements. Normal adult interincisal opening is typically 35-55 mm.
Critical thresholds
- Less than 35 mm interincisal opening Indicates clinically significant restricted jaw opening; may support additional rating under DC 9905 (temporomandibular disorder limitation of motion) or document functional impairment beyond the structural loss alone.
- Bilateral coronoid process loss confirmed Rated at 20% under DC 9909 - the highest schedular rating for this condition.
- Unilateral coronoid process loss confirmed Rated at 10% under DC 9909.
Tips
- Measure and report your jaw opening on your worst days, not your best days.
- Notify the examiner if your jaw opening fluctuates - for example, it may be worse in the morning, after prolonged talking, or after eating hard foods.
- If jaw opening causes pain before reaching maximum range, tell the examiner explicitly - 'I have to stop before my maximum because of pain.'
- Mention any clicking, popping, locking, or catching sensations during jaw movement.
Pain considerations: If opening your jaw causes pain, report its location (e.g., near the jaw angle, in front of the ear, radiating to the temple), intensity on a 0-10 scale, and character (sharp, aching, throbbing). Pain that limits functional range of motion is a relevant finding and should be clearly communicated to the examiner.
Diagnostic Imaging Review (X-ray / CT Scan / Panoramic Radiograph)
What it measures: Confirms structural absence or significant loss of the coronoid process on one or both sides of the mandible. Imaging is the definitive method to confirm the anatomical diagnosis for rating purposes.
What to expect: The examiner may take new radiographs or review existing imaging from your records. A panoramic (panographic) X-ray is most commonly used for mandibular evaluation. CT scan provides more detailed three-dimensional confirmation. The examiner will document the imaging type, date, and findings on the DBQ.
Critical thresholds
- Radiographic confirmation of unilateral coronoid process absence or near-total loss Supports 10% rating under DC 9909.
- Radiographic confirmation of bilateral coronoid process absence or near-total loss Supports 20% rating under DC 9909.
Tips
- Bring copies of any prior CT scans, panoramic X-rays, or operative reports confirming the coronoid process loss - especially if they are from the time of service or shortly after discharge.
- If you had a coronoidectomy (surgical removal), bring operative notes and pathology reports.
- Ask your treating dentist or oral surgeon for a copy of any imaging reports in their records prior to your C&P exam.
- If imaging was taken in service, request copies from the National Personnel Records Center or your branch of service's medical records repository.
Pain considerations: Imaging itself is not painful but may require positioning of your head that is uncomfortable if you have jaw pain or limited mobility. Inform the radiology technician of any positioning limitations before the imaging begins.
Functional Masticatory Assessment (Chewing and Bite Function)
What it measures: Evaluates whether the loss of the coronoid process has resulted in functional impairment of chewing, biting, or swallowing, which supports the overall functional picture even though the rating under DC 9909 is structural in nature.
What to expect: The examiner will ask about your ability to eat various food textures, whether you avoid certain foods, and whether chewing causes pain or fatigue. This is primarily interview-based rather than a formal mechanical test.
Critical thresholds
- Significant chewing impairment documented Supports functional impact narrative on the DBQ, which may be considered in overall evaluation and in any claim for individual unemployability or extra-schedular consideration.
Tips
- Be specific: 'I can only chew soft foods because hard or crunchy foods cause pain on the left side of my jaw.'
- Mention if you have lost weight or changed your diet significantly because of chewing difficulties.
- Describe how chewing fatigue affects you - for example, 'After eating for 5 minutes, my jaw muscles ache and I have to stop.'
Pain considerations: Clearly describe any pain associated with chewing - location, quality, severity, and whether it causes you to stop eating or avoid meals. Pain with mastication is directly relevant to the functional impact section of the DBQ.
Rating criteria by percentage
20%
Bilateral loss of the coronoid process - confirmed absence or surgical removal of the coronoid process on BOTH sides of the mandible (right and left).
Key symptoms
- Confirmed bilateral coronoid process loss on imaging
- Potential bilateral restriction of jaw opening due to absent coronoid processes
- History of bilateral trauma, bilateral coronoidectomy, or bilateral pathologic destruction
- Possible bilateral masticatory dysfunction or pain
From 38 CFR: 38 CFR - 4.150, DC 9909: 'Coronoid process, loss of: Bilateral 20'
10%
Unilateral loss of the coronoid process - confirmed absence or surgical removal of the coronoid process on ONE side of the mandible only (right or left).
Key symptoms
- Confirmed unilateral coronoid process loss on imaging
- Possible unilateral restriction of jaw opening or deviation on opening
- History of unilateral trauma, unilateral coronoidectomy, or unilateral pathologic destruction
- Unilateral jaw pain or masticatory asymmetry
From 38 CFR: 38 CFR - 4.150, DC 9909: 'Coronoid process, loss of: Unilateral 10'
Describing your symptoms accurately
Structural Loss and Laterality
How to describe it: Clearly state which side or sides the coronoid process was lost - left, right, or both. Explain when the loss occurred (during service, in combat, due to a service-related injury or surgery) and how it was confirmed (imaging, surgery). Use precise language: 'I had my left coronoid process surgically removed in [year] due to [cause]' or 'My right coronoid process was destroyed by a fragment wound in [location/date].'
Example: On my worst days, the area where my coronoid process was removed aches deeply, and I feel the absence of that structure when I try to chew or speak for extended periods. My jaw feels unstable and fatigues quickly.
Examiner listens for: Confirmation that the veteran can accurately identify the laterality and cause of the coronoid process loss, and that the history is consistent with service records and imaging findings.
Avoid: Do not say 'it's fine now' or 'I don't notice it anymore' if you experience any ongoing functional limitations. The examiner needs to know about current symptoms, not just historical ones.
Jaw Opening and Range of Motion Limitation
How to describe it: Describe any difficulty opening your mouth fully. Use specific examples: 'I cannot open my mouth wide enough to bite into a sandwich,' or 'My jaw only opens about halfway compared to before my injury.' Note whether restriction is constant or varies with activity, time of day, or jaw use.
Example: On my worst days, I can barely open my mouth wide enough to fit two fingers vertically. I struggle to eat anything that requires a wide bite and my jaw muscles cramp after only a few minutes of chewing.
Examiner listens for: Functional limitation that correlates with or is attributable to the coronoid process loss, including any secondary muscle or soft tissue changes that restrict motion.
Avoid: Do not demonstrate your maximum jaw opening at the exam if your best-day range is not representative of typical function. Tell the examiner: 'This is a better day for me - on bad days I cannot open this far.'
Pain Associated with Jaw Use
How to describe it: Describe pain by location (e.g., in front of the ear, along the jaw angle, radiating to the temple or ear), quality (sharp, dull, aching, throbbing), intensity (0-10), frequency (constant vs. with use), and triggers (chewing, talking, yawning, weather changes). Also describe pain at rest versus with activity.
Example: On my worst days, even resting my jaw causes a dull ache rated 6 out of 10. When I try to eat something firm, the pain spikes to 8 out of 10 and I have to stop immediately. The pain radiates up toward my temple and I sometimes get headaches as a result.
Examiner listens for: Pain that is attributable to the coronoid process loss or its surgical/traumatic cause, including pain that limits functional use of the jaw. This contributes to the functional impact narrative on the DBQ.
Avoid: Do not minimize pain by saying 'it's manageable' without explaining what managing it requires - medications, dietary restrictions, activity avoidance. Describe the full impact accurately.
Functional Impact on Daily Activities
How to describe it: Describe specific activities that are limited by your coronoid process loss: eating (types of food avoided, meal duration, need to cut food into tiny pieces), speaking (jaw fatigue during long conversations, public speaking difficulty), sleeping (jaw pain at night, clenching), and occupational tasks (any job requiring prolonged talking, use of respiratory equipment, or physical jaw demands).
Example: On my worst days, I can only eat soft foods like soup, mashed potatoes, or yogurt. I avoid social meals because eating in public takes too long and causes visible discomfort. I have had to explain my jaw condition to employers because wearing certain respirators or dental equipment at work is painful.
Examiner listens for: Concrete examples of how the condition limits the veteran's daily life, occupational function, and social participation. This information populates the functional impact section of the DBQ and supports any extra-schedular or unemployability considerations.
Avoid: Do not focus only on the structural diagnosis. The examiner needs to hear about functional consequences. Saying only 'I had surgery' without describing ongoing limitations may result in an incomplete functional picture.
History of Treatment and Residual Complications
How to describe it: Describe all treatments received: surgical removal (coronoidectomy), reconstruction attempts, physical therapy for jaw mobility, pain management, and any ongoing follow-up care. Note any complications such as infection, nonunion of adjacent bone, nerve injury, or recurrent restriction.
Example: After my coronoidectomy in service, I developed scar tissue that progressively limited my jaw opening over several years. I completed two rounds of physical therapy that provided only temporary improvement. I currently take over-the-counter pain medication daily for jaw discomfort.
Examiner listens for: A treatment history consistent with a significant structural condition, ongoing need for management, and residual complications that reflect the severity and persistence of the disability.
Avoid: Do not omit post-service treatments or complications. Every treatment you have sought is evidence that the condition has continued to affect you and required ongoing management.
Common mistakes to avoid
Failing to clarify laterality (one side vs. both sides) clearly during the exam
Why: The entire rating distinction under DC 9909 hinges on whether the loss is unilateral (10%) or bilateral (20%). If the examiner documents this ambiguously, the rating may default to unilateral even if both sides are affected.
Do this instead: Explicitly state: 'I lost the coronoid process on BOTH sides' or 'I lost the coronoid process on my LEFT side only.' Confirm with the examiner that they are documenting the correct laterality before the exam concludes.
Impact: 10% vs. 20%
Presenting only structural loss without describing functional consequences
Why: While DC 9909 is a structural diagnosis, the functional impact section of the DBQ is critical for the overall disability picture and for any consideration of related conditions, extra-schedular ratings, or unemployability.
Do this instead: Prepare specific examples of daily functional limitations caused by the coronoid process loss - dietary restrictions, jaw pain, limited mouth opening, occupational impact - and communicate them clearly during the exam.
Impact: 10% and 20%
Bringing no imaging or surgical documentation to the exam
Why: The DBQ specifically requires confirmation of the diagnosis, and imaging (X-ray, CT scan, panoramic radiograph) or operative reports are the definitive evidence for coronoid process loss. Without this, the examiner may be unable to confirm the diagnosis or laterality.
Do this instead: Obtain copies of all relevant imaging studies (especially CT scans or panoramic X-rays), operative notes from any coronoidectomy, and pathology reports if the loss was due to tumor resection or trauma. Bring physical copies to the exam.
Impact: 10% and 20%
Downplaying symptoms because 'the surgery was years ago'
Why: VA disability ratings are based on your current condition, not the severity at the time of injury or surgery. Long-standing structural loss still warrants the appropriate rating, and any ongoing functional limitations remain relevant regardless of how much time has passed.
Do this instead: Focus on your CURRENT symptoms and limitations during the exam. Describe what your jaw feels like and functions like today, including on your worst days.
Impact: 10% and 20%
Not mentioning related conditions such as TMD, limited jaw opening (DC 9905), or adjacent bone loss
Why: Coronoid process loss may co-exist with or cause related conditions that are separately ratable. Failing to mention them may result in missed service connection for related disabilities.
Do this instead: Inform the examiner of all related oral and jaw conditions, including TMJ symptoms, limited mouth opening, pain with jaw movement, or any loss of adjacent mandibular structures. These may be separately rated under other diagnostic codes.
Impact: 10% and 20% (plus potential additional ratings)
Performing at maximum capacity during the exam rather than reporting typical or worst-day function
Why: C&P examiners are required to rate the condition as it typically presents, including on bad days. Veterans who push through pain to demonstrate maximum function during the exam may receive a rating that does not reflect their true disability level.
Do this instead: Report your typical and worst-day function accurately. If the examiner measures jaw opening and it is better than usual that day, say so explicitly: 'Today is a relatively good day - normally I cannot open this wide.'
Impact: 10% and 20%
Prep checklist
- critical
Gather all imaging studies confirming coronoid process loss
Collect panoramic X-rays, CT scans, or cone-beam CT images that confirm the absence of one or both coronoid processes. These may be from military treatment records, VA facilities, or private oral surgeons. Request copies from all providers if you do not already have them.
before exam
- critical
Obtain operative notes and surgical reports if coronoidectomy was performed
If your coronoid process was surgically removed (coronoidectomy), obtain the full operative report, anesthesia record, and any postoperative notes. These confirm the procedure, the laterality (left, right, or bilateral), and the indication for surgery. Request from military service records or treating hospital.
before exam
- critical
Request your service treatment records relating to the jaw injury or surgery
File a request with the National Personnel Records Center (NPRC) or your branch's records repository for all dental and oral surgery records from your service period. Also request any VA treatment records under the Veterans Benefits Management System (VBMS) or through MyHealtheVet.
before exam
- recommended
Write a detailed symptom journal covering the past 30 days
Document your daily jaw symptoms, noting: pain levels (0-10), jaw opening ability, foods you avoided, activities limited by your jaw condition, medications taken for jaw pain, and any days significantly worse than usual. Bring this journal to the exam and offer it to the examiner.
before exam
- critical
Identify and document the laterality of your coronoid process loss
Know with certainty whether you lost the coronoid process on one side (which side - left or right) or both sides. Confirm this from your imaging reports or operative notes before the exam so you can state it clearly and accurately.
before exam
- recommended
Prepare a written history of your condition including onset, cause, and progression
Write a brief but complete narrative: when the coronoid process was lost (date/year), how it happened (trauma, surgery, pathology), how the condition has progressed since then, all treatments received, and your current symptoms. Keep it factual and specific. You may submit this as a lay statement (VA Form 21-4138) with your claim.
before exam
- recommended
Review the DC 9909 rating criteria so you understand what the examiner must document
Under 38 CFR - 4.150, DC 9909, the only rating criteria are: Bilateral loss = 20%, Unilateral loss = 10%. Your goal is to ensure the examiner accurately documents and confirms the laterality of your loss with supporting evidence.
before exam
- optional
Check your state's recording law and consider recording the exam
Veterans have the right to record their C&P examination in most states. Check whether your state is a one-party or two-party consent state for audio recording. Notifying the examiner at the start of the exam is recommended. A recording can be important if you need to appeal or request a supplemental examination.
before exam
- recommended
Do not take pain medications before the exam that might mask your true symptom level
Unless medically required, avoid taking strong analgesics or muscle relaxants before your exam so that your pain and functional limitations are accurately observable. If you must take medications for safety reasons, inform the examiner what you took and note that your symptoms are partially masked.
day of
- critical
Bring all documents organized in a folder
Bring: (1) imaging studies and radiology reports, (2) operative notes and surgical records, (3) service treatment records referencing the jaw condition, (4) a list of all current medications for jaw pain, (5) your symptom journal, and (6) any private medical opinions or nexus letters from treating providers. Offer them to the examiner at the start of the visit.
day of
- recommended
Arrive early and be prepared to wait; pace yourself to conserve jaw energy
Avoid eating hard or chewy foods before the exam that might temporarily improve or worsen your jaw function in an unrepresentative way. Arrive at least 15 minutes early to complete any intake paperwork without rushing.
day of
- critical
Clearly state whether the loss is unilateral or bilateral at the beginning of the exam
Do not wait for the examiner to determine this from records alone. State clearly: 'I am here for loss of [left/right/both] coronoid process(es). This was [confirmed by CT scan / removed surgically on date X].' This ensures the examiner documents the correct laterality from the outset.
during exam
- critical
Report your worst-day jaw function, not your current or best-day function
Per M21-1 guidance, examiners should consider the full range of your condition including your worst presentations. Specifically tell the examiner: 'Today I am [better/worse] than average. On my worst days, my jaw function is [describe].'
during exam
- critical
Describe all functional limitations caused by the coronoid process loss
Cover: dietary restrictions, jaw opening limitations, pain with chewing or talking, jaw fatigue, occupational impact, and any social or recreational activities you have stopped or modified because of your jaw condition. Be specific and use concrete examples.
during exam
- recommended
Ask the examiner to confirm their findings before you leave
Before the exam concludes, ask: 'Have you documented the laterality of my coronoid process loss?' and 'Is there anything in my records or history you need clarification on?' You cannot review the DBQ before it is submitted, but you can ensure critical facts were addressed.
during exam
- recommended
Mention any related conditions that may be separately ratable
If you also have TMJ disorder, limited jaw opening independent of the coronoid process loss, or other mandibular or maxillary conditions, mention them. Say: 'I also experience [symptoms] that may be related to or separate from my coronoid process loss.' This alerts the examiner to potentially document additional ratable conditions.
during exam
- recommended
Write down everything you recall about the exam as soon as possible
Immediately after leaving, document: what the examiner said, what tests were performed, what questions were asked and how you answered, and whether you felt the exam was thorough. Note if the examiner seemed unfamiliar with the condition, failed to perform a physical examination, or spent less than 10 minutes with you.
after exam
- recommended
Request a copy of the completed DBQ through your VSO or accredited claims agent
Once the exam is complete, the DBQ becomes part of your claims file (VBMS). You can request a copy through your Veterans Service Organization (VSO) representative, accredited attorney, or claims agent, or through a FOIA request to the VA Regional Office handling your claim.
after exam
- optional
If the exam was inadequate, consider requesting a supplemental examination
If the examiner did not perform a physical examination, failed to review your records, did not address laterality, or spent less than a few minutes with you, you or your representative can request a supplemental C&P examination citing exam inadequacy. Document the inadequacy in writing promptly.
after exam
Your rights during a C&P exam
- You have the right to be examined by a qualified dentist or oral surgeon for dental and oral conditions - not a general physician unfamiliar with oral anatomy.
- You have the right to submit a personal statement (VA Form 21-4138) describing your symptoms and their impact on your daily life, which must be considered as lay evidence by the rating authority.
- You have the right to submit buddy statements from fellow service members, family members, or coworkers who have observed your jaw condition and its functional impact.
- You have the right to request an audio or video recording of your C&P examination in most states - verify your state's consent laws before the exam.
- You have the right to submit a private medical nexus opinion or independent medical examination (IME) from a treating oral surgeon or dentist to support your claim.
- You have the right to request a copy of the completed DBQ form through your accredited representative, VSO, attorney, or FOIA request after the exam is completed.
- You have the right to request a supplemental C&P examination if you believe the original examination was inadequate, incomplete, or did not accurately reflect your condition.
- You have the right to appeal a rating decision through the Supplemental Claim lane, Higher-Level Review lane, or Board of Veterans' Appeals if you disagree with the rating assigned based on the DBQ findings.
- You have the right to a benefit of the doubt - under 38 CFR - 3.102, when the evidence is in approximate balance, the VA must resolve the doubt in your favor.
- You have the right to have ALL relevant evidence considered, including service treatment records, private medical records, lay statements, and any imaging or operative reports you submit.
- You have the right to representation by an accredited VSO, attorney, or claims agent at no cost (VSO) or under fee agreement, who can help you prepare for your exam and review the DBQ for accuracy.
- You have the right to request that the VA obtain outstanding records, including military service records and VA treatment records, as part of the duty to assist.
Related conditions
- Condyloid Process, Loss of (One or Both Sides) Adjacent mandibular process - the condyloid process is the posterior projection of the mandibular ramus and forms the temporomandibular joint. Trauma or surgery affecting the coronoid process may also involve or later affect the condyloid process. Rated separately under DC 9908 at 30% (one or both sides).
- Temporomandibular Disorder (TMD) - Limitation of Motion Loss of the coronoid process may alter jaw biomechanics and masticatory muscle function, contributing to or worsening TMJ dysfunction. If TMD is separately diagnosed and ratable, it may be evaluated under DC 9905 in addition to DC 9909.
- Mandible, Non-Union of Traumatic loss of the coronoid process may be accompanied by mandibular fracture with non-union. Non-union of the mandible is rated separately under relevant DBQ criteria and diagnostic codes within 38 CFR - 4.150.
- Mandible, Malunion of Healed mandibular fractures associated with coronoid process trauma may result in malunion with open bite deformity, rated separately based on severity of open bite under 38 CFR - 4.150.
- Loss of Any Portion of Mandible (Other Than Periodontal Disease) Coronoid process loss that involves a larger portion of the mandibular ramus or body may qualify for rating under broader mandibular loss criteria. The examiner should document the extent of bone loss to determine the most favorable and accurate diagnostic code.
- Osteomyelitis / Osteoradionecrosis / Osteonecrosis of the Jaw Pathologic causes of coronoid process loss - such as osteomyelitis (bone infection) or medication-related osteonecrosis of the jaw (MRONJ) - may be separately ratable if they represent an active, ongoing condition distinct from the structural loss itself.
- Soft Tissue Injury of the Mouth Trauma causing coronoid process loss may also involve soft tissue injuries of the oral cavity, including scarring that contributes to restricted jaw opening and is separately ratable under 38 CFR - 4.150.
- Loss of Teeth (Service-Connected) Trauma or surgery causing coronoid process loss may also result in loss of teeth from reasons other than periodontal disease, which may be separately compensable under VA dental benefit provisions and DBQ criteria.
Get a personalized prep packet
This guide covers what to expect for any veteran with this condition. If you have already uploaded your medical records, sign in to generate a packet that maps your specific symptoms to the DBQ fields your examiner will fill out.
This C&P exam preparation guide is for educational purposes only and does not constitute legal, medical, or claims advice. Always consult with a qualified Veterans Service Organization (VSO) representative or VA-accredited attorney for guidance specific to your claim. Never exaggerate, minimize, or fabricate symptoms during a C&P examination.