Diagnostic Code 9911 · 38 CFR §4.150
The hard palate is the bony roof of your mouth that separates the oral cavity from the nasal cavity. Loss of part or all of the hard palate creates an opening (oronasal fistula) between the mouth and nose, causing food and liquid to escape into the nasal passages, difficulty with speech, and impaired chewing. Veterans may lose portions of the hard palate from combat injuries (blast trauma, gunshot wounds), surgical removal due to tumors, or complications from severe infections. A prosthetic device called an obturator can be fitted to cover the opening and partially restore function. The VA rates this condition based on two factors: how much of the hard palate is missing and whether a prosthesis can adequately replace the lost tissue.
| Rating | Criteria |
|---|---|
| 30% | Loss of half or more of the hard palate that cannot be replaced by a prosthesis. This represents a major structural defect that causes significant eating, breathing, and speech problems without the possibility of prosthetic correction. |
| 20% | Loss of less than half of the hard palate that cannot be replaced by a prosthesis. A smaller area is missing but prosthetic replacement is still not feasible, leaving ongoing functional impairment. |
| 10% | Loss of half or more of the hard palate that can be replaced by a prosthesis (obturator). The structural defect is significant but a prosthetic device adequately restores separation between the mouth and nose. |
| 0% | Loss of less than half of the hard palate that can be replaced by a prosthesis. The defect is small and a prosthetic device effectively corrects the problem. A 0% rating still establishes service connection for ongoing dental care. |
Imaging studies (CT scan is best) showing the extent of hard palate loss are essential. Surgical records documenting the cause — combat injury, tumor removal, or infection — are needed. Service treatment records establishing the in-service event are required. A prosthodontist evaluation documenting whether an obturator or other prosthesis can adequately restore function is critical, since prosthetic feasibility determines the rating level. If you use an obturator, records of its fitting and how well it works should be included.
An obturator is a dental prosthesis that covers the opening between the mouth and nasal cavity caused by hard palate loss. It plugs the hole, allowing more normal eating and speaking. The effectiveness of the obturator is a key factor in determining your VA rating — if it works well, the rating is lower; if it cannot adequately restore function, the rating is higher.
Yes. The hard palate is essential for producing many speech sounds. Loss of the hard palate typically causes hypernasal speech and difficulty articulating certain consonants. If you have speech impairment from palatal loss, it may be separately evaluated under the appropriate speech diagnostic code in addition to the DC 9911 rating.