Maxilla, Loss of Half or Less C&P Exam Prep

Extent of Maxillary Bone Loss Assessment

What it measures: The percentage of the maxilla (upper jaw bone) that has been lost, expressed as less than 25% or between 25-50% of the total maxillary structure, as this directly determines which rating tier applies under DC 9915.

What to expect: The examiner will visually inspect the oral cavity and palate, palpate the remaining maxillary structure, and review diagnostic imaging (panoramic X-ray, CT scan, or MRI) to estimate the proportion of maxillary bone that is absent. The examiner may use rulers or calibrated instruments to assess the dimensions of the defect.

Pain considerations: Document any pain associated with the defect site, including pain during chewing, pressure from prosthetic devices, or pain related to adjacent sinus involvement. Describe pain on your worst days, including frequency, severity on a 0-10 scale, and what triggers or worsens it.

Prosthesis Adequacy and Replacability Assessment

What it measures: Whether the maxillary defect can be adequately replaced by a prosthetic device (obturator, palatal prosthesis, implant-supported restoration) that restores form and function to a functional level.

What to expect: The examiner will assess whether a prosthesis is currently in use, whether it fits properly, whether it restores speech, chewing, and swallowing to a functional level, and whether the anatomy of the defect is amenable to prosthetic rehabilitation. The examiner may ask you to demonstrate chewing or speaking with and without the prosthesis.

Pain considerations: Note any pressure sores, mucosal irritation, or pain caused by prosthesis use. Describe how long you can comfortably wear the device and whether you must remove it during meals, sleep, or prolonged use.

Diagnostic Imaging Review (Panoramic X-Ray, CT Scan, MRI)

What it measures: Radiographic confirmation of the extent of maxillary bone loss, involvement of adjacent structures (nasal floor, orbital floor, zygoma, palate), and any residual pathology or bony changes.

What to expect: The examiner will review existing imaging if available. New imaging may be ordered if current studies are unavailable or outdated. CT scan is the gold standard for assessing three-dimensional bone loss.

Pain considerations: Imaging does not capture pain directly; supplement imaging data with verbal and written descriptions of pain and functional limitations.

0%

Loss of less than 25% of the maxilla where the defect is replaceable by a suitable prosthesis that adequately restores chewing, speech, and structural form.

From 38 CFR: Loss of less than 25 percent: Replaceable by prosthesis - 0 (38 CFR - 4.150, DC 9915)

20%

Loss of less than 25% of the maxilla where the defect is NOT replaceable by a suitable prosthesis, resulting in residual functional impairment that cannot be corrected prosthetically.

From 38 CFR: Loss of less than 25 percent: Not replaceable by prosthesis - 20 (38 CFR - 4.150, DC 9915)

30%

Loss of 25-50% of the maxilla where the defect is replaceable by a suitable prosthesis, though significant structural and potentially functional impairment remains.

From 38 CFR: Loss of 25 to 50 percent: Replaceable by prosthesis - 30 (38 CFR - 4.150, DC 9915)

40%

Loss of 25-50% of the maxilla where the defect is NOT replaceable by a suitable prosthesis, resulting in significant and uncorrectable functional impairment.

From 38 CFR: Loss of 25 to 50 percent: Not replaceable by prosthesis - 40 (38 CFR - 4.150, DC 9915)

Eating and Chewing Difficulty

How to describe it: Describe specifically which foods you cannot eat, how long meals take compared to before your injury, whether food or liquid escapes through the defect into your nasal cavity, and how often you experience choking or coughing while eating. Quantify the dietary restrictions (e.g., 'I can only eat soft foods, I cannot eat anything that requires biting or chewing hard textures').

Example: On my worst days, I cannot complete a meal without food passing into my nasal cavity, which causes choking and significant pain. I am limited to pureed foods and liquids and must eat in very small bites over 45 minutes to an hour. I have lost significant weight because eating is so difficult and painful.

Examiner listens for: The examiner is documenting whether chewing and swallowing are functionally impaired beyond what a prosthesis can correct, and whether dietary restrictions affect nutrition and daily functioning.

Avoid: Do not say 'I manage okay' or 'I get by.' Instead, accurately describe the full scope of dietary limitations and the effort required for each meal. Mention if you have avoided social eating situations due to embarrassment or difficulty.

Speech and Communication Impairment

How to describe it: Describe whether people frequently ask you to repeat yourself, whether you have a hypernasal quality to your speech, whether certain sounds or words are particularly difficult to produce, and whether speech impairment affects your ability to work or communicate in daily life.

Example: On my worst days, my speech is so hypernasal and difficult to understand that I avoid phone calls and in-person conversations. My family and coworkers frequently cannot understand me, and I have had to switch to text-based communication for many interactions.

Examiner listens for: The examiner is assessing velopharyngeal insufficiency, hypernasality, and articulatory imprecision caused by the palatal and maxillary defect, and whether the prosthesis (if present) corrects these deficits.

Avoid: Do not minimize speech changes. If you received speech therapy, mention it. If you stopped speech therapy because it did not help, say so. The examiner needs to understand the chronic, daily impact on communication.

Prosthesis Fit and Function

How to describe it: Describe precisely how long you can wear the prosthesis each day, what causes you to remove it, whether it stays in place during eating and speaking, whether it causes sores or pain, and whether wearing it actually restores your function to a near-normal level.

Example: On my worst days, I cannot tolerate wearing the prosthesis for more than a few hours due to pressure sores and pain on the remaining bone margins. Even when wearing it, food still escapes into my sinuses, and speech remains impaired. I must sleep without it and cannot eat a full meal even with it in place.

Examiner listens for: The examiner is making the critical determination of whether the defect is 'replaceable by prosthesis' - meaning the prosthesis must provide adequate functional restoration, not merely exist. If function is not adequately restored, the examiner should document the defect as 'not replaceable by prosthesis' for rating purposes.

Avoid: Do not say the prosthesis 'works fine' if it only partially restores function. Be specific about what remains impaired even with the prosthesis in place. The prosthesis replacing the bone does not automatically mean it replaces the function.

Nasal and Sinus Complications

How to describe it: Describe any oronasal communication (passage between mouth and nose), chronic sinusitis, nasal drainage into the mouth, difficulty breathing through the nose, recurrent sinus infections, and crusting or debris accumulation in the defect.

Example: On my worst days, I have constant nasal drainage pooling in the defect area, I cannot breathe through my nose at all on the affected side, and I have recurrent sinus infections requiring antibiotics at least four times a year. The crusting and odor from the defect is socially isolating.

Examiner listens for: The examiner is documenting secondary complications that affect quality of life and functional status beyond chewing and speech, which may support a higher rating or secondary service-connected conditions.

Avoid: Do not omit sinus or nasal symptoms. Veterans sometimes focus only on chewing and speech but sinus complications from maxillary loss are significant and relevant to the overall disability picture.

Pain and Discomfort at the Defect Site

How to describe it: Describe the location, character (sharp, aching, burning, pressure), severity (0-10 scale), frequency, duration, and triggers of pain. Note whether pain is present at rest or only with activity, and how it affects sleep, eating, and daily activities.

Example: On my worst days, I have constant throbbing pain across the entire left mid-face rated 8/10, which prevents me from eating, concentrating, or sleeping. Any pressure or touch to the area causes sharp pain. I take prescription pain medication but it only partially controls the pain.

Examiner listens for: The examiner is documenting pain as a component of overall functional impairment, which supports findings that the condition is not adequately controlled by prosthesis and contributes to work and daily life limitations.

Avoid: Do not say you have 'some discomfort' when you mean significant daily pain. Accurately report your worst days - the VA's M21-1 guidance specifies that disability is assessed considering the full range of symptoms, including worst-day presentations.

Psychological and Social Impact

How to describe it: Describe how the facial disfigurement, speech changes, and functional limitations affect your social interactions, employment, and mental health. Note if you have withdrawn from social activities, changed careers, or sought mental health treatment.

Example: On my worst days, I refuse to leave the house because of embarrassment about my appearance and the difficulty others have understanding my speech. I have withdrawn from family gatherings and lost my previous job in customer service because I could not communicate effectively.

Examiner listens for: While the rating for DC 9915 is structural/functional, the examiner documents functional impact comprehensively, and psychological impact supports secondary claims for conditions like depression or PTSD secondary to maxillary loss.

Avoid: Do not omit the emotional and social toll of this condition. This information may support secondary claims and helps the examiner fully understand the disability's impact on your life.