Veterans claiming a temporomandibular joint condition can have their own physician or dentist document it on this public questionnaire. It captures diagnoses with ICD codes, history and flare-ups, jaw motion measured as interincisal distance and lateral excursion, repetitive-use findings, physician-verified diet restrictions and imaging. VA uses it when deciding service connection and assigning a rating.
The Veteran's physician or dentist completes all sections and signs the Section IX certification with title (for example DDS, DMD, MD or DO), specialty, NPI and license. The Veteran has no section to fill in.
Download the current version from the source each time; forms change without notice.
Temporomandibular Disorders (TMDs) Disability Benefits Questionnaire
A form is listed only after its name and number were confirmed on the issuing agency’s or insurer’s own website, or in the form itself. Each entry links to that source. The list was last checked in October 2026. Forms and their requirements change without notice, so check the official page for the current version before you complete one.
Vero is not affiliated with, or endorsed by, the agencies and insurers listed here. Read our editorial policy.
Yes. VA lists the form as completed by the Veteran's physician or dentist, and the signature block asks for the examiner's title, giving DDS and DMD as examples alongside MD and DO. The examiner also provides specialty, NPI, license number and state, and certifies the information is accurate and current.
The examiner records interincisal distance and right and left lateral excursion in millimeters, first on initial testing and again after at least three repetitions. The form then asks for an estimate after repeated use over time and during flare-ups, and which factors, such as pain or fatigability, limit motion.
It can. Section IV asks whether the Veteran needs mechanically altered foods because of the disorder, either all levels (full liquid, puree, soft and semi-solid) or soft and semi-solid foods only. VA counts it only when a physician has recorded or verified the texture-modified diet.