DC 9900 · 38 CFR 4.150
Maxilla or Mandible, Chronic Osteomyelitis or Osteoradionecrosis C&P Exam Prep
To document the nature, severity, and functional impact of chronic osteomyelitis, osteonecrosis, or osteoradionecrosis of the maxilla or mandible for VA disability rating purposes under DC 9900, rated by analogy to DC 5000 (chronic osteomyelitis).
- 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
- Presence and confirmation of chronic osteomyelitis, osteonecrosis, or osteoradionecrosis affecting the maxilla and/or mandible
- Current activity status of the infection or necrotic process (active vs. inactive)
- Presence of discharging sinus tracts in or around the jaw
- Presence of involucrum (new bone forming around dead bone) or sequestrum (dead bone fragments)
- Constitutional symptoms such as fever, chills, night sweats, fatigue, weight loss, anemia, and amyloid changes
- History of prior episodes, recurrences, and hospitalizations
- Any bone loss from the maxilla or mandible as a result of the condition
- Presence of nonunion or malunion of the jaw bones resulting from the condition
- Associated tooth loss due to the condition
- Soft tissue involvement including fistulas, trismus, and mucosal changes
- Prior surgical interventions including debridement, sequestrectomy, resection, or reconstruction
- History of radiation therapy, chemotherapy, or bisphosphonate use contributing to the condition
- Impact on eating, speaking, and daily functioning
- Diagnostic imaging findings including X-ray, CT scan, MRI, bone scan, or PET scan results
- Relationship between military service and the current condition
The exam will be conducted in a dental examination room or clinical setting. The examiner will review your service treatment records and any post-service treatment records before or during the exam. You may be asked to open and close your mouth, and the examiner will likely inspect the inside of your mouth, feel along the jawbone, and assess for fistulas or drainage. Bring all relevant dental and medical records, including imaging reports.
Measurements and tests
Assessment for Discharging Sinus
What it measures: Whether an active sinus tract (abnormal channel) is draining pus or fluid from infected or necrotic bone in the jaw area
What to expect: The examiner will visually inspect the mouth, gums, and surrounding facial/neck tissues for open wounds, fistulas, or drainage. They may probe sinus tracts to assess depth.
Critical thresholds
- Active discharging sinus present Supports at minimum a 20% rating under DC 5000 (discharging sinus or evidence of active infection within past 5 years)
- No discharging sinus, but active infection within past 5 years Supports 20% historical evaluation under DC 5000 with future ending date
- No sinus, inactive for more than 5 years Supports 10% rating if 2+ prior episodes documented
Tips
- If you have had a discharging sinus at any point, bring documentation or photographs if available
- Describe whether drainage has been intermittent or continuous, and when it was last active
- Note whether you had any sinus tracts that resolved after surgical debridement
Pain considerations: If the sinus tract area is tender or painful on palpation, clearly communicate this to the examiner, including intensity on a 0-10 scale and what worsens the pain.
Assessment for Involucrum and Sequestrum
What it measures: Presence of dead bone fragments (sequestrum) or new bone shell forming around dead bone (involucrum), confirmed by diagnostic imaging
What to expect: The examiner will review imaging studies such as panoramic X-ray, CT scan, or MRI. They may order new imaging if none is recent. Physical exam may include palpation of the jaw for irregularities.
Critical thresholds
- Definite involucrum or sequestrum confirmed on imaging Supports 30% rating under DC 5000 with or without discharging sinus
- No involucrum or sequestrum identified May limit rating to 20% or lower depending on other findings
Tips
- Bring all imaging reports and CDs or digital files of X-rays, CT scans, MRIs, or bone scans
- If imaging was done at a non-VA facility, provide the radiology reports specifically mentioning sequestrum or involucrum
- If your surgeon described removing dead bone (sequestrectomy), bring operative reports as this documents prior sequestrum
Pain considerations: Jaw pain during palpation of the affected area is a relevant finding. Be specific about location, radiation of pain, and severity.
Constitutional Symptom Assessment
What it measures: Systemic symptoms caused by chronic osteomyelitis including fever, chills, night sweats, weight loss, fatigue, anemia, and amyloid organ changes
What to expect: The examiner will ask about your overall health and whether you experience systemic symptoms attributable to the jaw infection. Lab results showing anemia or elevated inflammatory markers are relevant.
Critical thresholds
- Frequent episodes with constitutional symptoms present Supports 60% rating under DC 5000
- Involvement of pelvis, vertebrae, major joints, multiple locations, or long history with debility, anemia, or amyloid changes Supports 100% rating under DC 5000
- No constitutional symptoms Rating limited to 30% or below based on structural findings
Tips
- Keep a symptom diary documenting fever episodes, fatigue severity, unintentional weight loss, and night sweats
- Bring recent lab results showing CBC, ESR, CRP, or other inflammatory markers
- If you have been diagnosed with anemia in the context of your jaw condition, bring those records
Pain considerations: Fatigue and malaise are constitutional symptoms. Do not minimize these - they are explicit rating criteria at higher disability levels.
Mouth Opening and Jaw Function Assessment
What it measures: Functional capacity of the jaw including ability to open and close the mouth, chew, and speak, particularly if the condition has caused trismus, scarring, or bone loss
What to expect: The examiner may measure maximum mouth opening (interincisal distance) and assess for jaw deviation, limited range of motion, or occlusal abnormalities. This is especially relevant if osteoradionecrosis has caused fibrosis.
Critical thresholds
- Severely limited mouth opening (trismus) affecting eating and speaking Supports higher functional impairment documentation; may support separate rating for associated soft tissue injury or mandible loss
- Moderate limitation without complete restriction Documents ongoing functional disability
Tips
- Report your worst-day jaw opening, not just how it is on the exam day
- Describe any difficulty chewing hard, medium, or even soft foods
- Note if you have had to change your diet (e.g., liquid or pureed diet) due to jaw dysfunction
- Mention if jaw function worsens with prolonged use or stress on the joint
Pain considerations: Pain during jaw movement, at rest, and with eating should all be described separately with 0-10 pain scale ratings. Note how long pain lasts after activity and whether it is sharp, throbbing, or burning.
Bone Loss Extent Assessment
What it measures: The extent of any maxillary or mandibular bone loss resulting from the disease process, particularly relevant if osteoradionecrosis or osteomyelitis has required surgical resection
What to expect: The examiner will review surgical records, operative reports, and imaging to assess how much bone has been lost or removed. Physical exam will assess facial symmetry, occlusion, and prosthetic status.
Critical thresholds
- Loss of less than one-half of mandible including the ramus with satisfactory replacement prosthesis May support separate DC 9905 rating at 30%
- Loss of less than one-half of mandible including the ramus without satisfactory replacement May support separate DC 9905 rating at 40%
- Loss of one-half or more of mandible including ramus with satisfactory replacement May support separate rating at 50%
- Complete loss of mandible between angles Supports higher separate ratings under DC 9905
Tips
- Bring operative reports detailing the exact amount of bone resected
- If you have had reconstructive surgery (bone graft, titanium plate, jaw reconstruction), bring those operative and follow-up notes
- Document whether any prosthetic replacement (dental implants, obturator, prosthetic jaw) is functioning adequately
Pain considerations: Phantom pain or ongoing pain at surgical sites is a real and ratable symptom - communicate this clearly.
Rating criteria by percentage
100%
Osteomyelitis of the pelvis, vertebrae, or extending into major joints, OR with multiple localization, OR with long history of intractability and debility, anemia, amyloid liver changes, or other continuous constitutional symptoms. Note: For DC 9900, this would apply if the maxillary/mandibular osteomyelitis has spread to multiple sites or has produced long-standing debility with systemic constitutional symptoms.
Key symptoms
- Continuous constitutional symptoms (persistent fever, night sweats, chills)
- Documented anemia attributed to chronic infection
- Amyloid organ changes (liver, kidney) documented by biopsy or imaging
- Long history of intractability - infections that have not responded to treatment
- Debility - significant functional decline, inability to work or perform daily activities
- Multiple localization of osteomyelitis beyond the maxilla/mandible
From 38 CFR: Per DC 5000: osteomyelitis with amyloid liver changes, or with other continuous constitutional symptoms qualifies for 100%. M21-1 clarifies this requires documented systemic involvement.
60%
Frequent episodes of osteomyelitis with constitutional symptoms. This means recurrent flare-ups of active infection accompanied by systemic symptoms such as fever, chills, weight loss, or significant fatigue.
Key symptoms
- Frequent recurrences of active jaw infection requiring antibiotic treatment or hospitalization
- Constitutional symptoms present during episodes: fever, chills, malaise, weight loss
- Documented multiple hospitalizations for jaw osteomyelitis flares
- Significantly impaired quality of life and work capacity due to recurrent episodes
- Elevated inflammatory markers (CRP, ESR, WBC) during active episodes
From 38 CFR: Per DC 5000: 60% requires frequent episodes WITH constitutional symptoms. Both elements must be present - frequency alone or symptoms alone without recurrence would not meet this threshold.
30%
Definite involucrum or sequestrum confirmed by diagnostic imaging, with or without a discharging sinus tract.
Key symptoms
- Imaging-confirmed dead bone fragment (sequestrum) within the maxilla or mandible
- Imaging-confirmed involucrum (new bone forming around dead bone)
- May or may not have active drainage from a sinus tract
- History of surgical removal of sequestra (sequestrectomy)
- Ongoing jaw pain and limited function related to structural bone abnormality
From 38 CFR: Per DC 5000: 30% requires definite involucrum OR sequestrum confirmed by imaging. This is an imaging-dependent finding - the examiner cannot simply observe it clinically. Ensure imaging reports specifically mention these findings.
20%
Discharging sinus present OR other evidence of active infection within the past 5 years. Per M21-1, this is a historical evaluation with a future ending date set 5 years from documented inactivity. Requires at least 2 episodes to qualify for the historical 10% rating; the 20% requires active infection or sinus within 5 years.
Key symptoms
- Currently draining sinus tract in the jaw or facial area
- Documented active infection episode within the past 5 years (confirmed by treatment records)
- History of antibiotic treatment for jaw infection within the past 5 years
- Intermittent drainage from gum or facial fistula
- Recent surgical debridement of infected jaw bone within 5 years
From 38 CFR: Per DC 5000 Note 2: The 20% rating is assigned once to cover all sites of previously active infection and carries a future ending date 5 years from documented inactivity. Active discharge earns this rating independent of the historical rule.
10%
Inactive osteomyelitis following repeated episodes (minimum 2 or more episodes beyond initial infection required), without evidence of active infection in the past 5 years. This is a historical evaluation per M21-1.
Key symptoms
- Two or more documented prior episodes of active jaw osteomyelitis in service records or post-service treatment records
- Currently inactive - no signs of active infection, drainage, or elevated inflammatory markers
- No evidence of active infection for more than 5 years
- Residual symptoms such as chronic jaw pain, decreased bone density, or altered jaw structure may be present
- History of prior antibiotic courses or surgical procedures for jaw osteomyelitis
From 38 CFR: Per DC 5000 Note 2: The 10% historical rating requires 2 or more episodes following the initial infection. This rating is assigned once for all previously active sites. If the initial episode was in service, it counts as episode 1; subsequent recurrences count toward the 2+ episode requirement.
Describing your symptoms accurately
Pain in the Jaw
How to describe it: Describe the location (upper jaw/maxilla vs. lower jaw/mandible, which side), character (throbbing, sharp, burning, dull aching), severity on a 0-10 scale, frequency (constant vs. intermittent), what makes it worse (eating, touching the area, cold, heat, stress), and what relieves it. Distinguish between pain at rest and pain with activity.
Example: On my worst days, I have a constant 8/10 throbbing pain in my lower right jaw that radiates to my ear and temple. I cannot eat anything other than liquids because any jaw movement causes sharp stabbing pain at the infected site. The pain wakes me from sleep 3-4 times per night and requires prescription pain medication.
Examiner listens for: Specific location correlated with the anatomical site of osteomyelitis or osteoradionecrosis, character of pain consistent with bone infection, impact on activities of daily living, and medication requirements.
Avoid: Do not say 'it bothers me sometimes' or 'it's not that bad.' If your pain disrupts sleep, eating, or work, say so explicitly with specific examples and frequency.
Drainage and Sinus Tracts
How to describe it: Describe whether you have had any pus, blood, or fluid draining from your gum, a hole in your face or neck, or from inside your mouth. Note when it first appeared, how often it drains, the color and odor of the drainage, whether it ever resolves and then returns, and any odor or taste associated with it.
Example: During my worst flare-ups, I have a draining hole on the inside of my left lower gum that oozes yellowish-green pus with a foul taste. This has happened at least 4 times in the past 3 years, each time requiring a course of IV antibiotics. Between episodes the area is sore but not actively draining.
Examiner listens for: Whether drainage is current or historical, frequency and pattern of recurrence, whether it represents a true sinus tract connecting to infected bone, and whether it has been documented in medical records.
Avoid: Do not omit past drainage episodes even if currently resolved. Historical drainage is critical for rating purposes and must be in the record. Do not say 'it healed' without also saying 'and then it came back.'
Constitutional Symptoms
How to describe it: Describe any whole-body symptoms that accompany jaw infection episodes including fever (provide measured temperatures if possible), chills, drenching night sweats, unintentional weight loss (specify pounds lost), profound fatigue that limits activity, and any organ problems your doctors have linked to the chronic infection.
Example: During active infections, I run fevers of 101-103 degrees Fahrenheit for days at a time. I soak through my sheets with night sweats and cannot get out of bed due to extreme fatigue. I have lost 18 pounds over the past two years without trying, and my doctor says my blood tests show anemia that is related to the chronic infection in my jaw.
Examiner listens for: Documented fever, documented anemia, documented weight loss, and whether these symptoms are attributed by treating providers to the jaw osteomyelitis. These directly trigger the 60% and 100% rating criteria.
Avoid: Do not minimize fatigue as 'just being tired.' Describe how fatigue prevents you from working, caring for yourself, or completing tasks. If you have had lab work showing anemia or elevated inflammatory markers, reference those results.
Functional Impact on Eating and Nutrition
How to describe it: Describe in detail how the jaw condition affects your ability to eat. Include whether you can eat solid foods, soft foods, or only liquids; how long it takes you to eat a meal compared to before; whether you have lost weight due to dietary restrictions; and whether you require tube feeding or nutritional supplements.
Example: On my worst days I cannot open my mouth more than a finger's width due to swelling and pain, so I can only consume liquids through a straw. Even on better days I can only eat soft foods like yogurt or soup because anything requiring chewing causes severe jaw pain at the infected site. I have lost 15 pounds over the past year because eating is so painful and difficult.
Examiner listens for: Specific dietary restrictions, weight changes, nutritional status, and whether jaw dysfunction is causing secondary health problems related to inadequate nutrition.
Avoid: Do not say 'I manage fine.' If you have changed your diet, lost weight, or avoid social eating situations due to the condition, these are ratable impacts that must be communicated.
History of Episodes and Treatment
How to describe it: Provide a chronological account of every episode of jaw infection or flare-up, including when it started, how it was treated, how long it lasted, and whether it fully resolved or persisted. Include all surgeries, hospitalizations, antibiotic courses (oral and IV), hyperbaric oxygen therapy, and radiation history if applicable.
Example: My condition started in service in 2009 with swelling and pain in my lower jaw. I was hospitalized for 10 days and treated with IV antibiotics. It partially resolved but recurred in 2012 requiring surgery to remove dead bone. It has flared at least 5 additional times since then, most recently in 2022 requiring 6 weeks of IV antibiotics through a PICC line.
Examiner listens for: Total number of episodes (critical for the 10% and 20% historical rating thresholds), whether episodes are becoming more or less frequent, types of treatments required, and whether the condition has been declared 'cured' (which would impact rating).
Avoid: Do not omit any episode, even minor ones treated with oral antibiotics only. Every documented episode strengthens the record and supports higher rating criteria. Do not conflate all episodes into 'I've had it since service' without specifying distinct recurrences.
Impact on Work and Daily Life
How to describe it: Describe specifically how the condition affects your ability to work, socialize, sleep, and perform daily activities. Include number of work days missed per year, inability to perform certain job functions, need for accommodations, and impact on mental health.
Example: During active flare-ups I miss 2-3 weeks of work at a time because the pain, fatigue, and fever make it impossible to function. I have been passed over for promotion because of frequent absences. I avoid social situations because of the visible facial swelling and drainage odor. I have developed depression and anxiety related to the chronic nature of this condition.
Examiner listens for: Concrete examples of functional limitation, pattern of work absences, social withdrawal, and secondary psychiatric impact. The examiner needs to fill out the functional impact section of the DBQ.
Avoid: Do not say 'I push through it.' The examiner needs to understand your actual functional capacity on typical days and worst days, not your determination to cope. If you have had to change jobs or reduce hours, say so.
Common mistakes to avoid
Only describing current symptoms without mentioning prior episodes
Why: The 10% and 20% historical ratings under DC 5000 require documented recurrent episodes. If the examiner only documents your current status as inactive, you may receive a 0% rating even if you had multiple prior active infections.
Do this instead: Prepare a written timeline of every episode with approximate dates, treatments received, and treating facilities. Hand this to the examiner or bring it up explicitly. Ask the examiner to document your episode history in the DBQ history section.
Impact: 10% and 20%
Saying the condition is 'under control' or 'healed' without qualification
Why: Stating the condition is healed may lead the examiner to rate it as fully resolved (0%), when in reality it may be in a temporarily inactive phase with ongoing structural damage and risk of recurrence.
Do this instead: Distinguish between 'currently inactive' and 'cured.' Explain that osteomyelitis or osteoradionecrosis of the jaw is a chronic condition that fluctuates, and that current stability does not mean it is permanently resolved. Reference the residual structural damage still present.
Impact: 10%-30%
Failing to bring imaging reports documenting sequestrum or involucrum
Why: The 30% rating specifically requires confirmation of sequestrum or involucrum by diagnostic imaging. Without imaging documentation, the examiner cannot check that criterion, and you may be rated lower than warranted.
Do this instead: Gather all panoramic X-ray reports, CT scan reports, MRI reports, and bone scan reports. Highlight or flag reports that specifically mention sequestrum, involucrum, bone destruction, or cortical breakthrough. Bring both the written reports and digital images if possible.
Impact: 30%
Not mentioning constitutional symptoms like fever, night sweats, or anemia
Why: The 60% and 100% rating criteria are entirely driven by constitutional symptoms. If you have experienced these but do not mention them, the examiner will not know to document them, and you will be rated below your actual severity.
Do this instead: Explicitly mention every systemic symptom: fever episodes with temperatures, night sweats, chills, unintentional weight loss with specific pounds, fatigue severity and its impact, and any lab abnormalities like anemia. Bring supporting lab results.
Impact: 60% and 100%
Underreporting pain and functional limitations on exam day
Why: Examinations often occur on a relatively stable day, not a worst day. If you report your current mild-to-moderate symptoms as your typical state, the DBQ will underrepresent your actual disability level.
Do this instead: Explicitly tell the examiner your worst-day symptoms and how frequently worst days occur. Use language like: 'This is a relatively better day for me. On my worst days, which happen about X times per month, my symptoms are...' Request that the examiner document both typical and worst-day functioning.
Impact: All levels
Not disclosing radiation history or bisphosphonate use
Why: Osteoradionecrosis is directly caused by prior radiation therapy to the head/neck, and medication-related osteonecrosis (MRONJ) is caused by bisphosphonate drugs. If the examiner does not know about these exposures, they may mischaracterize the etiology and affect the nexus opinion.
Do this instead: Disclose any radiation therapy to the head, neck, or jaw (including treatment dates, doses, and facilities) and any use of bisphosphonate medications (Fosamax, Zometa, Aredia, etc.) even if prescribed post-service. Bring treatment records documenting these exposures.
Impact: All levels - nexus/service connection
Failing to mention associated tooth loss, bone resection, or prosthetics
Why: Teeth lost due to osteomyelitis or osteoradionecrosis, and any jaw bone that was surgically removed, may qualify for separate ratings under different diagnostic codes. Failing to mention these leaves additional ratable disabilities unaddressed.
Do this instead: Tell the examiner about every tooth lost due to the jaw infection (not periodontal disease), every surgical bone removal procedure, and any prosthetics (including whether they function satisfactorily). This may trigger evaluation under DC 9905, 9913, or other codes.
Impact: Additional separate ratings
Prep checklist
- critical
Compile complete episode timeline
Create a written chronological list of every episode of jaw osteomyelitis, osteonecrosis, or osteoradionecrosis. Include: approximate date of onset, symptoms experienced, treatment received (oral antibiotics, IV antibiotics, surgery, hyperbaric oxygen), treating facility, and how long it lasted before improving. Count the number of distinct recurrences - this directly impacts your rating level.
before exam
- critical
Gather all relevant imaging and reports
Collect panoramic dental X-rays, CT scans, MRIs, bone scans, and PET scans of the jaw. Bring both digital images (on CD or USB) and written radiology reports. Flag any reports mentioning sequestrum, involucrum, cortical bone destruction, bone necrosis, or sinus tracts. These findings directly support the 30% rating.
before exam
- critical
Obtain surgical and operative reports
Request copies of all operative reports from jaw surgeries including debridements, sequestrectomies, resections, bone grafts, and reconstructions. These documents confirm the nature and severity of your condition and any bone loss.
before exam
- critical
Gather lab results showing constitutional symptoms
Collect CBC results showing anemia, ESR and CRP results showing elevated inflammatory markers, and any other labs your doctors ordered during active infection episodes. Bring results from multiple time points to show a pattern.
before exam
- critical
Document radiation and medication history
If you received radiation therapy to the head or neck region, obtain radiation oncology records documenting the treatment site, dose, and dates. If you have taken bisphosphonate medications, list them with dates of use. Both are causally linked to osteonecrosis of the jaw.
before exam
- recommended
Prepare written symptom summary
Write a 1-2 page summary describing: your worst-day symptoms, how frequently worst days occur, impact on eating and nutrition, impact on work (days missed, job changes), impact on sleep, constitutional symptoms experienced during flares, and any medications currently required. Bring multiple copies.
before exam
- recommended
Request and review your VA claims file (C-file)
Request your C-file to verify what medical records VA already has. Identify any gaps - missing service treatment records, missing post-service records, or missing imaging - and bring those originals to the exam.
before exam
- recommended
Verify state recording law
Check whether your state permits one-party recording consent. In most states, veterans have the right to record their C&P examination. If permitted, bring a recording device (phone or dedicated recorder) to capture the exam for your records.
before exam
- recommended
Prepare photo documentation
If you have had facial swelling, sinus tract drainage, or visible oral abnormalities during flare-ups, photograph these and organize them chronologically. Visual documentation of active disease episodes is highly persuasive evidence.
before exam
- critical
Do not dress up or minimize your condition
Present yourself as you typically are, not at your best. If you normally use pain medication to function, take it as prescribed but note to the examiner that you are on medication and describe your baseline without it.
day of
- critical
Bring all documents in an organized folder
Organize documents by category: imaging reports, operative reports, treatment records (hospitalization records, antibiotic courses), lab results, and your personal symptom summary. Use labeled dividers so you can quickly locate specific records.
day of
- recommended
Arrive early and request the examiner review your records
Arrive 15-20 minutes early. Politely ask the examiner to confirm they have reviewed your service treatment records and relevant post-service records before beginning the examination.
day of
- optional
Notify examiner of recording intent
If recording the exam, notify the examiner at the start. Simply state: 'I would like to record this examination for my personal records.' You do not need their permission in a one-party consent state.
day of
- critical
Report worst-day symptoms explicitly
When the examiner asks how you are doing, describe both your current status AND your worst-day status. Say: 'Today is a moderate day for me. On my worst days - which happen about [X] times per month - I experience [specific symptoms].' The DBQ requires documentation of the full spectrum of your condition.
during exam
- critical
Enumerate every prior episode
Proactively tell the examiner how many distinct times the infection has recurred. This is the threshold factor for the 10% and 20% historical rating. Be specific: 'I have had at least [X] distinct active infection episodes requiring treatment, beyond my initial diagnosis.'
during exam
- critical
Describe all constitutional symptoms experienced during flares
Even if you do not currently have constitutional symptoms, describe them as they occurred during active episodes. Say: 'During my last active flare in [year], I had fever up to [temp], night sweats, lost [X] pounds, and was too fatigued to get out of bed for [X] days.' This supports the 60% and 100% rating criteria.
during exam
- recommended
Request that the examiner document the DBQ section on functional impact
Specifically ask whether the examiner has completed the functional impact section. Provide concrete examples: inability to eat solid food, dietary changes, weight loss, work absences, social isolation, and sleep disruption.
during exam
- critical
Clarify the distinction between inactive and cured
If the examiner uses the word 'resolved' or 'healed,' clarify: 'The infection is currently inactive, but the condition is chronic and I have had multiple recurrences. The underlying bone damage remains and I remain at high risk for recurrence.' This prevents a finding of 'cure by radical resection' which would result in 0%.
during exam
- recommended
Request a copy of the completed DBQ
After the exam, submit a written request to VA for a copy of the completed DBQ. Review it carefully for accuracy. If it contains factual errors or omits critical symptoms you reported, you have the right to submit a written rebuttal.
after exam
- recommended
Submit a personal statement (buddy statement or lay statement)
Within the next few weeks, submit a written personal statement (VA Form 21-4138 or equivalent) describing your symptoms, functional limitations, and the impact on your daily life. This supplements the DBQ and ensures your perspective is in the claims file.
after exam
- recommended
Follow up with treating providers for supporting letters
Ask your dentist, oral surgeon, or infectious disease specialist to write a letter documenting the chronic nature of your condition, number of recurrences, treatments required, and functional limitations. A nexus letter linking the condition to military service is especially valuable.
after exam
Your rights during a C&P exam
- You have the right to have all relevant evidence considered before the examiner reaches any conclusion - request confirmation that your service treatment records and post-service medical records were reviewed.
- You have the right to record your C&P examination in most states under one-party consent laws - check your state's recording consent laws before the exam.
- You have the right to submit additional evidence after the examination and before the VA issues a rating decision - use this window to submit supporting letters from treating providers.
- You have the right to request a copy of the completed DBQ after the examination - review it for accuracy and submit a rebuttal if it contains factual errors or omissions.
- You have the right to a fully adequate examination - if the examiner spends only a few minutes with you or does not review your records, you may request a new examination or submit a written complaint to the VA.
- You have the right to bring a representative (VSO, accredited claims agent, or attorney) to your C&P examination - they cannot speak during the exam but can be present.
- You have the right to appeal any rating decision through the Supplemental Claim, Higher-Level Review, or Board of Veterans Appeals lanes if you disagree with the outcome.
- You have the right to submit a buddy statement or lay statement describing your symptoms in your own words - lay evidence is legally competent evidence for observable symptoms under 38 CFR 3.303.
- If your condition was cured by radical resection (complete surgical removal of the affected bone), per M21-1 a 0% rating following convalescence may result - however, if the condition was NOT cured by resection and continues to cause symptoms or recurrences, you have the right to challenge a finding of cure.
- You have the right to request a nexus opinion from an independent medical examiner (IME) if you believe the VA examiner did not adequately address the connection between your condition and military service.
Related conditions
- Mandible, Loss of (DC 9905) Osteomyelitis or osteoradionecrosis may necessitate surgical resection of the mandible, resulting in partial or complete bone loss separately ratable under DC 9905 at 30-100% depending on extent of loss and prosthetic status.
- Maxilla, Loss of (DC 9908) If osteomyelitis or osteoradionecrosis of the maxilla requires surgical resection, the resulting bone loss may be separately ratable under DC 9908.
- Mandible, Nonunion of (DC 9903) Chronic infection or necrosis may result in failure of mandibular bone to unite (nonunion), which is separately ratable at 10% (moderate, no false motion) or 30% (severe, with false motion) under DC 9903.
- Mandible or Maxilla, Malunion of (DC 9904 / DC 9907) Osteomyelitis may cause abnormal healing of jaw bones resulting in malunion with malocclusion or open bite, ratable at varying levels under DC 9904 (mandible) or DC 9907 (maxilla) depending on severity of bite deformity.
- Temporomandibular Disorder (TMD) Chronic jaw infection and inflammation, or surgical interventions, can secondarily cause or worsen temporomandibular joint dysfunction, which is separately evaluated under the TMD DBQ and rated under DC 9905 series.
- Teeth, Loss of (DC 9913) Osteomyelitis, osteoradionecrosis, and their treatments commonly result in tooth loss. Teeth lost for reasons other than periodontal disease or normal extraction may be separately ratable under DC 9913.
- Oral Cancer / Oral Neoplasm Osteoradionecrosis is most commonly a consequence of radiation therapy for head and neck cancers. The underlying oral malignancy may be separately service-connected and rated if causally linked to military service (e.g., Agent Orange exposure, toxic exposure).
- Depression or Anxiety Secondary to Chronic Pain The chronic pain, disfigurement, repeated hospitalizations, and functional limitations of jaw osteomyelitis or osteoradionecrosis commonly cause or worsen depression and anxiety, which may be rated as secondary conditions under 38 CFR 3.310.
- Soft Tissue Injury of the Mouth Sinus tracts, fistulas, and scarring from jaw osteomyelitis or its surgical treatment may cause separately ratable soft tissue injuries of the mouth under applicable dental/oral diagnostic codes.
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.