Dental and oral conditions claimed for VA disability, other than temporomandibular disorder, are documented on this 7-page questionnaire. It covers loss of teeth from service-related trauma or disease such as osteomyelitis, loss of part of the mandible, maxilla or hard palate, malunion or nonunion of the jaw, tongue and lip injuries, osteonecrosis of the jaw and oral neoplasms. The examiner charts missing teeth by number and states whether a prosthesis can restore chewing surfaces.
The Veteran's dentist, oral surgeon or other examining clinician completes the form and signs the Section XIII certification; the title examples printed there include DDS and DMD. The Veteran fills in no part of it.
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Oral and Dental Conditions Including Mouth, Lips and Tongue (Other Than Temporomandibular Disorder Conditions) Disability Benefits Questionnaire
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No. The form states that loss of teeth or the alveolar process from periodontal disease is not considered disabling for VA purposes. It is intended for loss of teeth from service-related trauma, or from loss of jaw bone due to disease such as osteomyelitis, and asks whether a prosthesis can restore the chewing surfaces.
Item 5D uses the universal numbering chart: teeth 1 to 8 right upper, 9 to 16 left upper, 17 to 24 left lower and 25 to 32 right lower. The examiner also states whether the loss is due to loss of substance of the maxilla or mandible and whether it came from trauma or disease.