Diagnostic Code 9906 · 38 CFR §4.150
The mandibular ramus is the vertical, broad portion of the lower jawbone that rises behind the molars and connects the horizontal body of the mandible to the temporomandibular joint and the muscles of mastication. Loss of half or more of the ramus is a severe injury that produces major functional impairment: the jaw loses its hinge mechanics on the affected side, chewing strength drops, the bite collapses or shifts toward the injured side, and significant facial asymmetry develops. The classic mechanism in veterans is combat trauma — gunshot or shrapnel wounds destroying the bone, blast injuries with comminuted facial fractures, or severe surgical resection for tumor or osteomyelitis treatment. The condition is often reconstructed with bone grafts, plates, and prosthetic dental rehabilitation, but the residual functional loss after reconstruction is typically substantial. DC 9906 sets the rating at 50 percent without prosthesis replacement; with replacement and successful reconstruction, the rating may be lower depending on the functional outcome, but the rating is more often evaluated under the separate disfigurement code DC 7800 or the temporomandibular joint code DC 9905 if those produce higher results.
| Rating | Criteria |
|---|---|
| 50% | Loss of half or more of the mandibular ramus, not replaceable by prosthesis or with significant residual functional limitation after reconstruction. The 50% rating is the schedular evaluation under DC 9906; when disfigurement under DC 7800 or temporomandibular joint impairment under DC 9905 rates higher, the higher rating is applied instead. |
Imaging — panoramic X-ray, CT of the maxillofacial region, or 3D facial reconstruction imaging — documenting the extent of bone loss is the centerpiece. Original trauma records (operative notes from initial wound debridement and any reconstruction) establish the in-service event. Pathology reports from any tumor resection or osteomyelitis debridement document the surgical history. Records of dental and oral surgery reconstruction — bone grafts, plates, dental implants, prosthetic rehabilitation — characterize the disease course. A current oral surgery or oral medicine consult evaluates the functional status: bite alignment, chewing capacity, range of jaw motion, pain on movement. Photographs document the residual facial asymmetry.
DC 9906 captures the bone defect itself with a 50% schedular rating. DC 7800 evaluates the disfigurement (visible facial asymmetry, scarring) up to 80%. DC 9905 evaluates the temporomandibular joint impairment when chewing motion is limited. The principle is that the rater applies whichever code produces the highest evaluation for the dominant functional or cosmetic impact, rather than stacking the codes. For most veterans with significant ramus loss, DC 7800 produces a higher rating than DC 9906 alone when facial disfigurement is substantial.
A successful reconstruction that fully restores chewing function and produces no residual asymmetry could drop the rating, but complete restoration is rare. Most reconstructions leave residual functional limitations (reduced chewing strength, altered bite, occasional pain), cosmetic asymmetry, and adjustment difficulties that support keeping the rating at 50% under DC 9906 or higher under DC 7800 or DC 9905. Document the residuals explicitly to preserve the rating.
Dental tooth loss has its own rating framework under DC 9913 (loss of teeth due to loss of substance of body of maxilla or mandible) and DC 9912 (loss of teeth, where the loss of bony substance is not significant). Tooth loss accompanying ramus loss can be claimed under those codes separately from the bone defect, and the rater applies the codes that together produce the highest combined evaluation.