TMJ Secondary to PTSD

Overview

Temporomandibular disorder (TMD, often called “TMJ”) affects the jaw joint and chewing muscles. It causes jaw pain, limited opening, clicking or locking, and difficulty chewing. For veterans with service-connected PTSD, the usual secondary theory is that PTSD-related jaw clenching and teeth grinding (bruxism), or bruxism caused by a PTSD medication, led to or worsened the jaw disorder.

VA rates TMD under Diagnostic Code 9905 in 38 CFR 4.150. The rating is based on how far you can open your mouth without help and on whether a physician has recorded that you need a texture-modified diet. It ranges from 10% to 50%. Because TMD is rated in the dental and oral system, a granted rating combines with your PTSD rating rather than overlapping it.

What the Research Shows

• Association in war veterans. A 2023 meta-analysis (Minervini et al., Journal of Oral Rehabilitation) pooled four studies with 596 subjects. TMD signs or symptoms were present in 56.2% of war-exposed subjects compared with 20.2% of unexposed subjects. War-related PTSD was associated with a higher risk of TMD signs such as muscle tenderness (RR 2.21). The review was small, so treat it as supporting evidence, not proof.
• Treating PTSD reduced jaw symptoms. In a 2024 study of 98 patients with severe PTSD and painful TMD (Knibbe et al., Journal of Oral Rehabilitation), painful TMD, awake bruxism, and sleep bruxism decreased after trauma-focused PTSD treatment, and much of the improvement held at six months. The authors called this preliminary support, but it is relevant to causation because the jaw symptoms moved with the PTSD.
• Medication-related bruxism. A 2025 systematic review (Wallem et al., Cranio) found an apparent association between SSRI antidepressants and bruxism, while noting that the studies were limited and not conclusive. If jaw clenching began after starting sertraline, paroxetine, fluoxetine, or a similar drug for PTSD, note the dates. A condition caused by treatment of a service-connected disability can be service connected.

TMD also has other common causes, including jaw injury, arthritis, and dental or bite problems. A persuasive opinion addresses those instead of ignoring them.

How VA Decides the Claim

• Causation (38 CFR 3.310(a)): TMD that is proximately due to service-connected PTSD, including through PTSD medication, is service connected.
• Aggravation (38 CFR 3.310(b)): If you had jaw problems before, VA compensates only the worsening caused by PTSD. It needs medical or dental evidence of the baseline severity before the worsening, and it subtracts that baseline and any natural progression.
• The opinion must address both. An examiner who concludes only that TMD is “not caused by” PTSD has not addressed aggravation, and that opinion is inadequate (El-Amin v. Shinseki, 26 Vet. App. 136 (2013)).

Evidence Requirements

• Current TMD diagnosis from a dentist, oral surgeon, or physician. Imaging (panoramic X-ray, MRI, or CT) helps if it shows joint changes, but a clinical diagnosis is enough.
• Service-connected PTSD. Your rating decision.
• Bruxism and clenching evidence. Dental notes describing tooth wear or fractured teeth, a prescribed occlusal splint or night guard, a sleep study noting bruxism, and a partner’s statement about nighttime grinding.
• A medical or dental opinion stating whether TMD is at least as likely as not caused by PTSD or its medications, and separately whether PTSD aggravated it, with reasoning tied to your records.
• Medication history with start dates, especially SSRIs or SNRIs.
• Diet documentation. Higher DC 9905 levels require that a physician record or verify the use of a texture-modified diet (soft, semi-solid, pureed, or full liquid). If you have been told to eat a soft diet, make sure it is in your medical record.
• Treatment records for splints, physical therapy, muscle relaxants, injections, or surgery.

Rating Criteria

TMD is rated under DC 9905, Temporomandibular disorder, in 38 CFR 4.150. For VA purposes, normal maximum unassisted vertical opening is 35 to 50 mm (Note 2).

Interincisal Range (Maximum Unassisted Vertical Opening)

For the 11 to 20 mm and 0 to 10 mm ranges, the regulation uses a single “dietary restrictions to all mechanically altered foods” level rather than separate soft and liquid levels.

Monthly compensation (single veteran, no dependents, 2026): 10% = $180.42; 20% = $356.66; 30% = $552.47; 40% = $795.84; 50% = $1,132.90

Lateral Excursion

• 0 to 4 mm of side-to-side movement: 10%

Important Notes on Rating

• A lateral excursion rating cannot be combined with an interincisal rating (Note 1). VA assigns the higher one.
• A dietary restriction counts only if a physician has recorded or verified the use of a texture-modified diet (Note 3).
• Pain, fatigability, and flare-ups that further limit motion are considered under 38 CFR 4.40, 4.45, and 4.59. The examiner should estimate additional loss of motion during flare-ups or after repeated use.
• Headaches from TMD may be claimed separately under the appropriate code only if they are not the same symptoms already compensated (38 CFR 4.14).

C&P Exam Tips

• Take your medications as prescribed. Do not skip pain medication or muscle relaxants for the exam. Instead, tell the examiner what you take and how your jaw is without it. The examiner is asked to describe your condition as it actually is and to estimate flare-up limitations.
• Follow the examiner’s instructions for jaw movement. The measurement is maximum unassisted opening. Report when pain starts and how it limits opening, and immediately tell the examiner about severe pain or a movement that feels unsafe so they can assess whether to stop or modify testing.
• Describe flare-ups in concrete terms. Say how often they happen, how long they last, what triggers them (such as stress, nightmares, or chewing), and how far you can open during a flare.
• Report your diet accurately, and bring the record if a physician prescribed a soft or pureed diet.
• Explain the clenching and grinding history. Tell the examiner when it began relative to PTSD symptoms or medications, and what your dentist or partner has observed.
• Bring dental records showing tooth wear, splints, or imaging.

For general preparation, see our C&P exam guide.

Medical Opinion (Nexus) Tips

A dentist, oral surgeon, or physician who has treated your jaw is a strong author. A persuasive opinion:

• States whether TMD is “at least as likely as not” caused by service-connected PTSD (including PTSD medication), and separately whether PTSD aggravated it
• Describes the chain in your case: PTSD symptoms or medication, then clenching or bruxism, then TMD, with the dates from your records
• Cites relevant literature, such as the studies above
• Addresses other causes such as prior jaw injury, bite problems, or arthritis
• For aggravation, identifies the baseline jaw function and how it changed

Impact on Combined Rating

VA combines ratings with the 38 CFR 4.25 combined ratings table. Each step uses the table value, and only the final value is rounded.

Example 1: PTSD 70% + TMD 10%

1. 70% combined with 10% = 73
2. 73 rounds to 70%, so there is no change on its own

Example 2: PTSD 70% + tinnitus 10% + TMD 10%

1. 70% combined with 10% = 73
2. 73 combined with 10% = 76
3. 76 rounds to 80%

Example 3: PTSD 70% + TMD 30% (for example, 21 to 29 mm of opening with a physician-recorded soft diet)

1. 70% combined with 30% = 79
2. 79 rounds to 80%

Use our VA disability calculator to check your own numbers.

Correction — October 21, 2026: Clarified that you should follow the examiner’s instructions during jaw testing and report when pain starts and how it limits you, rather than stopping at pain on your own.

For personalized guidance on your VA disability claim, consult a VA-accredited VSO, attorney, or claims agent.