TEMPOROMANDIBULAR JOINT (TMJ) DISORDER

MICHAEL MARTIN · 2026 · Case ID: 26005011

MIXED

Summary

The Veteran served from December 1991 to December 1994. This case concerns the Veteran's appeal for increased ratings for bruxism and bilateral articular disc disorder with masticatory myofascial pain, and entitlement to a Total Disability based on Individual Unemployability (TDIU) prior to July 24, 2017. The Board reviewed extensive evidence, including multiple VA examinations and treatment records, as well as private treatment records from Dr. F. Farokhian. The primary issue for the jaw disorder involved determining the correct rating based on the severity of motion limitation and pain, considering different versions of Diagnostic Code 9905 applicable before and after September 10, 2017. The Board found that the Veteran's limitations warranted a 10 percent rating prior to December 19, 2019, and a 20 percent rating from December 19, 2019, based on the prior version of the diagnostic code and affording the Veteran the benefit of the doubt. The Board denied higher ratings for the period prior to December 19, 2019, finding the evidence weighed against the claim. For the TDIU claim, the Board considered the Veteran's service-connected disabilities, including jaw disorder, tinnitus, and left ulnar nerve/shoulder issues, along with his education and work history. The Board found that while the Veteran's disabilities limited him to light, simple, routine work and prevented driving, this occupational profile still allowed for a range of available semiskilled jobs. Therefore, the Board concluded the Veteran was not unable to secure or follow a substantially gainful occupation and denied the TDIU claim.

Rationale

Benefit of the doubt afforded for 20% rating from Dec 19, 2019; Prior version of DC 9905 applied; Limitations did not warrant higher rating

Special Benefit

TDIU

Diagnostic Code

9905

Docket No.

17-63 141

Full Decision Text

Citation Nr: 26005011
Decision Date: 04/28/26 Archive Date: 04/28/26

DOCKET NO. 17-63 141
DATE: April 28, 2026

ORDER

Entitlement to a rating of 20 percent for bruxism and bilateral articular disc disorder reducing with masticatory myofascial pain is granted from December 19, 2019.

Entitlement to ratings in excess of 10 percent prior to December 19, 2019, and 20 percent from that date for bruxism and bilateral articular disc disorder reducing with masticatory myofascial pain is denied.

Entitlement to a total disability rating based on individual unemployability (TDIU) prior to July 24, 2017, is denied.

FINDINGS OF FACT

1. During the rating period prior to December 19, 2019, the Veteran's bruxism and bilateral articular disc disorder reducing with masticatory myofascial pain manifested in painful motion with inter-incisal range of 31 mm or greater and/or excursion of 0 to 4 mm and did not require dietary restrictions to mechanically altered foods.

2. From December 19, 2019, the Veteran's bruxism and bilateral articular disc disorder reducing with masticatory myofascial pain manifested in painful motion with inter-incisal range of from 21 mm to 30 mm and did not require dietary restrictions to mechanically altered foods.

3. The Veteran was not unable to secure and follow a substantially gainful occupation due to his service-connected disabilities prior to July 24, 2017.

CONCLUSIONS OF LAW

1. The criteria for entitlement to a rating of 20 percent for bruxism and bilateral articular disc disorder reducing with masticatory myofascial pain have been met from December 19, 2019. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 3.159, 3.400, 4.3, 4.7, 4.21, 4.150, Diagnostic Code 9905 (2026); 38 C.F.R. § 4.150, Diagnostic Code 9905 (2017).

2. The criteria for entitlement to ratings in excess of 10 percent prior to December 19, 2019, and 20 percent from that date for bruxism and bilateral articular disc disorder reducing with masticatory myofascial pain have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 3.159, 3.400, 4.3, 4.7, 4.21, 4.150, Diagnostic Code 9905 (2026); 38 C.F.R. § 4.150, Diagnostic Code 9905 (2017).

3. The criteria for entitlement to a TDIU prior to July 24, 2017, have not been met. 38 U.S.C. §§ 1155, 5103A, 5107; 38 C.F.R. §§ 3.340, 3.341, 4.16.

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

The Veteran had active service from December 1991 to December 1994.

This matter is on appeal of a November 2015 rating decision.

The Board remanded this matter in November 2019 and May 2022 with instruction to the Regional Office (RO) to obtain updated VA treatment records, make efforts to obtain outstanding private treatment records, send the Veteran a formal application for TDIU (VA Form 21-8940), afford the Veteran a VA examination to determine the severity of the service-connected jaw disorder, and obtain a retrospective opinion as to the severity of the service-connected jaw disorder since the start of the rating period.

In March 2023, the Board issued a decision that granted entitlement to a TDIU from July 24, 2017; remanded entitlement to a TDIU prior to July 24, 2017, for referral of the issue to VA's Director of Compensation Service for extraschedular consideration under 38 C.F.R. § 4.16(b); and denied higher ratings for the service-connected jaw disorder. The Veteran appealed the denial of higher ratings for the service-connected jaw disorder to the United States Court of Appeals for Veterans Claims (Court). In November 2023, the Court vacated the March 2023 Board decision's denial of higher ratings for the service-connected jaw disorder and remanded the issue for further consideration consistent with a
the Board issued a decision that granted entitlement to a TDIU from July 24, 2017; remanded entitlement to a TDIU prior to July 24, 2017, for referral of the issue to VA's Director of Compensation Service for extraschedular consideration under 38 C.F.R. § 4.16(b); and denied higher ratings for the service-connected jaw disorder. The Veteran appealed the denial of higher ratings for the service-connected jaw disorder to the United States Court of Appeals for Veterans Claims (Court). In November 2023, the Court vacated the March 2023 Board decision's denial of higher ratings for the service-connected jaw disorder and remanded the issue for further consideration consistent with a Joint Motion for Partial Remand (JMPR) filed by counsel for the Veteran and the VA Secretary. The parties to the JMPR agreed that the Board erred by not discussing whether a December 2019 VA examination, which documented inter-incisal range of 30 to 34 mm, entitled the Veteran to a higher rating under the version of the relevant diagnostic code in effect prior to September 10, 2017. The parties also agreed that the Board failed to address whether appropriate efforts were made to obtain treatment records from F. Farokhian, D.D.S., who provided letters in October 2016 and September 2017.

The Board remanded the matter, including the issue of entitlement to a TDIU prior to July 24, 2017, in February 2024 with instructions to the RO to make efforts to obtain records from Dr. Farokhian. In March 2024, the Veteran submitted a VA Form 21-4142, Authorization to Disclose Information to VA, for records from Dr. Farokhian. The RO made 2 attempts to obtain records from Dr. Farokhian, but was unsuccessful. It notified the Veteran of its unsuccessful attempt to obtain records from Dr. Farokhian in a November 2024 letter, which identifies the records VA was unable to obtain, provides an explanation of the efforts VA made to obtain the records, and informs the Veteran that he may submit any documents he may have in his possession or advise VA of the possible location of any such records. Accordingly, the RO satisfied the duty to assist in attempting to obtain records from Dr. Farokhian. See 38 C.F.R. § 3.159(c)(1) and (e).

In February 2025, the Board again remanded the matter with instructions to the RO to obtain records scanned into the VistA Imaging system. The RO associated the scanned documents with the record in March 2025.

In July 2025, the Board again remanded the matter with instructions to the RO to schedule the Veteran for a VA examination to determine the current nature and severity of the service-connected jaw disability and to obtain a retrospective opinion as to the severity of the disability at the time of September 2015, August 2017, December 2019, and August 2022 VA examinations.

In November 2025, the Board found that the RO's efforts to schedule the Veteran for a VA examination were inadequate. The Board therefore remanded the matter once again so that further efforts to schedule the Veteran for a VA examination and obtain a retrospective opinion could be made. The Veteran was provided a VA examination in November 2025. The November 2025 VA examiner examined the Veteran and provided opinions.

In February 2026, the Board found that the November 2025 VA examination provides adequate information as to the current severity of the Veteran's service-connected jaw disability, but that the November 2025 VA examiner's opinions did not substantially complete the July 2025 and November 2025 remand directives. The Board therefore again remanded the matter so that an adequate retrospective could be obtained. The RO obtained such an opinion in March 2026. Accordingly, the Board finds that VA at least substantially complied with the prior Board and Court remands. See 38 U.S.C. § 5103A(b); Stegall v. West, 11 Vet. App. 268, 271 (1998); D'Aries v. Peake, 22 Vet. App. 97, 105 (2008).

The Board has limited the discussion below to the relevant evidence required to support its findings of fact and conclusions of law, as well as to address any specific contentions regarding the case as raised directly by the Veteran or reasonably raised by the record. See Scott v. McDonald, 789 F.3d 1375, 1381 (Fed. Cir. 2015); Robinson v. Peake, 21 Vet. App. 545, 552 (2008).
§ 5103A(b); Stegall v. West, 11 Vet. App. 268, 271 (1998); D'Aries v. Peake, 22 Vet. App. 97, 105 (2008).

The Board has limited the discussion below to the relevant evidence required to support its findings of fact and conclusions of law, as well as to address any specific contentions regarding the case as raised directly by the Veteran or reasonably raised by the record. See Scott v. McDonald, 789 F.3d 1375, 1381 (Fed. Cir. 2015); Robinson v. Peake, 21 Vet. App. 545, 552 (2008). The Veteran should not assume that evidence that is not explicitly discussed in the decision has been overlooked. See Timberlake v. Gober, 14 Vet. App. 122 (2000) (noting that the law requires only that reasons for rejecting evidence favorable to the claimant be addressed).

1. Entitlement to ratings in excess of 10 percent prior to August 8, 2022, and 20 percent from that date for bruxism and bilateral articular disc disorder reducing with masticatory myofascial pain

The Veteran seeks increased ratings for bruxism and bilateral articular disc disorder reducing with masticatory myofascial pain. The applicable review period is from July 8, 2014, one year prior to receipt of the Veteran's intent to file a claim, through the present. See 38 C.F.R. § 3.400(o)(2).

Disability ratings are determined by the application of VA's Schedule for Rating Disabilities (Schedule), which is based on the average impairment of earning capacity. Separate diagnostic codes identify the various disabilities. 38 U.S.C. § 1155; 38 C.F.R. Part 4. Pertinent regulations do not require that all cases show all findings specified by the Schedule, but that findings sufficient to identify the disease and the resulting disability and, above all, coordination of the rating with impairment of function will be expected in all cases. 38 C.F.R. § 4.21; see also Mauerhan v. Principi, 16 Vet. App. 436 (2002).

When after careful consideration of all procurable and assembled data, a reasonable doubt arises regarding the degree of disability such doubt will be resolved in favor of the claimant. 38 C.F.R. § 4.3. Where there is a question as to which of two ratings shall be applied, the higher rating will be assigned if the disability picture more nearly approximates the criteria required for that rating. Otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7.

The Board will consider whether separate ratings may be assigned for separate periods of time based on facts found, a practice known as "staged ratings," in all claims for increased ratings. Hart v. Mansfield, 21 Vet. App. 505, 519 (2007).

The Veteran's service-connected jaw disability is currently rated at 10 percent prior to August 8, 2022, and 20 percent from that date under 38 C.F.R. § 4.150, Diagnostic Code 9905. The criteria for rating the service-connected jaw disability under Diagnostic Code 9905 were amended effective September 10, 2017, and the updated schedular criteria are applicable as of that date. See 82 Fed. Reg. 36,080 (August 3, 2017). If a law or regulation changes during the course of a claim or an appeal, the version more favorable to the Veteran will apply, to the extent permitted by any stated effective date in the amendment in question. 38 U.S.C. § 5110(g). If the revised version of the regulation is more favorable, the implementation of that regulation under 38 U.S.C. § 5110(g) can be no earlier than the effective date of that change. If the former version is more favorable, VA can apply the earlier version of the regulation for the period prior to, and from, the effective date of the change. 38 U.S.C. § 5110. Therefore, for the rating period prior to September 10, 2017, the Board will apply only the previous version of Diagnostic Code 9905. For the rating period beginning September 10, 2017, the Board will consider both version of Diagnostic Code 9905 and will apply the version more favorable to the Veteran.

Under the prior version of Diagnostic Code 9905, limitation of motion of the temporomandibular joint warrants a 10 percent rating if
effective date of that change. If the former version is more favorable, VA can apply the earlier version of the regulation for the period prior to, and from, the effective date of the change. 38 U.S.C. § 5110. Therefore, for the rating period prior to September 10, 2017, the Board will apply only the previous version of Diagnostic Code 9905. For the rating period beginning September 10, 2017, the Board will consider both version of Diagnostic Code 9905 and will apply the version more favorable to the Veteran.

Under the prior version of Diagnostic Code 9905, limitation of motion of the temporomandibular joint warrants a 10 percent rating if there is limitation of inter-incisal range of motion of 31 to 40 mm, or limitation of range of lateral excursion of 0 to 4 mm. A rating of 20 percent is warranted for inter-incisal range of 21 mm to 30 mm. A rating of 30 percent is warranted for inter-incisal range of 11 mm to 20 mm. A rating of 40 percent is warranted for inter-incisal range of 0 mm to 10 mm. A note provides that ratings for limited inter-incisal movement shall not be separately rated, for combination, with ratings for limited lateral excursion. 38 C.F.R. § 4.150, Diagnostic Code 9905 (2017).

Under the amended version of Diagnostic Code 9905, a 10 percent rating is warranted when range of lateral excursion is limited to between 0 and 4 millimeters, or when inter-incisal range is limited to 30 to 34 mm without dietary restrictions to mechanically altered foods. Ratings in excess of 10 percent are warranted when there is inter-incisal range limited to less than 30 to 34 mm with dietary restrictions to mechanically altered foods, or when there is inter-incisal range limited to 29 mm or less, with or without dietary restrictions to mechanically altered foods. 38 C.F.R. § 4.150, Diagnostic Code 9905 (2019).

Notes to the amended version of Diagnostic Code 9905 state that ratings for limited inter-incisal movement are not combined with ratings for limited lateral excursion. For VA compensation purposes, the normal maximum unassisted range of vertical jaw opening is from 35 to 50 mm. For VA compensation purposes, mechanically altered foods are defined as altered by blending, chopping, grinding or mashing so that they are easy to chew and swallow. There are four levels of mechanically altered foods: full liquid, puree, soft, and semisolid foods. To warrant elevation based on mechanically altered foods, the use of texture-modified diets must be recorded or verified by a physician. 38 C.F.R. § 4.150, Diagnostic Code 9905, Notes (1), (2), and (3) (2019).

Turning to the relevant evidence, the Veteran's VA treatment records reference his reports of dental and jaw pain. An August 2024 dentistry consultation note states that the Veteran had a maximum incisal opening of 35 mm and right and left lateral excursion of 7 mm. Such limitations warrant a 10 percent rating under the previous version of Diagnostic Code 9905 and are noncompensable under the current version of Diagnostic Code 9905. The treatment records do not otherwise include measurements for the Veteran's inter-incisal maximum unassisted vertical opening and do not indicate that the Veteran has dietary restrictions that have been recorded or verified by a physician due to the service-connected jaw disability.

At the September 2015 VA examination, the Veteran reported bilateral pressure pain in his head and ringing in his ears due to the service-connected jaw disability. He also reported bilateral jaw popping and 3 episodes of open dislocation of his jaw in the past. He has been able to manually reduce his jaw, and he has nocturnal bruxism that his dentist has said causes excessive attrition and wear on his porcelain crowns. He wakes in the morning with jaw pain. He denied flare-ups in his symptoms. On examination, the Veteran had right and left lateral excursion to 10 mm and inter-incisal distance of 40 mm. There was evidence of clicking bilaterally at about 35 mm of motion. The March 2026 VA examiner opined that at the time of the September 2015 VA examination the Veteran had right and left lateral excursion to 10 mm and inter-incisal distance of 40 mm on active and passive motion, on weight-bearing and nonweight-bearing, and on repeated use over time. The findings on examination at the September 2015 VA examination and provided by the
his porcelain crowns. He wakes in the morning with jaw pain. He denied flare-ups in his symptoms. On examination, the Veteran had right and left lateral excursion to 10 mm and inter-incisal distance of 40 mm. There was evidence of clicking bilaterally at about 35 mm of motion. The March 2026 VA examiner opined that at the time of the September 2015 VA examination the Veteran had right and left lateral excursion to 10 mm and inter-incisal distance of 40 mm on active and passive motion, on weight-bearing and nonweight-bearing, and on repeated use over time. The findings on examination at the September 2015 VA examination and provided by the March 2026 VA examiner do not warrant a rating in excess of 10 percent under the previous version of Diagnostic Code 9905.

At the August 2017 VA examination, the Veteran reported that he has pain and popping on both sides of his jaw. His jaw locks open or dislocates when he opens his mouth too wide. He denied flare-ups in his symptoms. On examination, the Veteran had right and left lateral excursion to 12 mm and inter-incisal distance of 42 mm. He had popping, localized tenderness, and evidence of pain with chewing on both sides. The examiner indicated that the Veteran had right lateral excursion to 10 mm, left lateral excursion to 12 mm, and inter-incisal distance of 42 mm on repeated use over time. The examiner also noted that the Veteran's service-connected jaw disability affects his concentration and that the Veteran cannot drive when he takes pain medications. The March 2026 VA examiner opined that at the time of the August 2017 VA examination the Veteran had right lateral excursion to 10 mm, left lateral excursion to 12 mm, and inter-incisal distance of 40 mm on active and passive motion, on weight-bearing and nonweight-bearing, and on repeated use over time. The findings on examination at the August 2017 VA examination and provided by the March 2026 VA examiner do not warrant a rating in excess of 10 percent under the previous version of Diagnostic Code 9905.

At the December 2019 VA examination, which was conducted on December 19, 2019, the Veteran reported that he has moderate to severe flare-ups in his jaw symptoms that are precipitated by opening the mouth too far or sleeping with his hand over his face. They occur every day. On examination, the Veteran had right lateral excursion of between 0 and 4 mm, left lateral excursion greater than 4 mm, and inter-incisal distance of 30 to 34 mm. There was evidence of clicking and localized tenderness bilaterally. The examiner opined that the Veteran would have pain, weakness, and incoordination on repeated use over time and during flare-ups, but would not have additional loss of motion in such instances. The examiner further indicated that the Veteran does not require a mechanically altered foods diet verified by a physician due to the service-connected jaw disability. The March 2026 VA examiner opined that at the time of the December 2019 VA examination the Veteran had right lateral excursion of between 0 and 4 mm, left lateral excursion greater than 4 mm, and inter-incisal distance of 30 to 34 mm on active motion, passive motion, weight-bearing, and nonweight-bearing. The findings on examination at the December 2019 VA examination and provided by the March 2026 VA examiner do not warrant a rating in excess of 10 percent under the current, amended version of Diagnostic Code 9905. However, the Board finds that, affording the Veteran the benefit of the doubt, the examiners' finding warrant a higher 20 percent rating under the previous version of Diagnostic Code 9905. Specifically, as stated above, inter-incisal range from 21 to 30 mm warrants a 20 percent rating under the previous version of Diagnostic Code 9905. If the benefit of the doubt is afforded to the Veteran, the findings that the Veteran's inter-incisal range was possibly as limited as 30 mm could fit within that range. Accordingly, the Board finds that a higher rating of 20 percent is warranted from December 19, 2019, the date of the December 2019 VA examination. The higher rating cannot be awarded from an earlier date because there is no probative evidence that the Veteran had inter-incisal distance limited to 30 mm or less during the rating period prior to December 19, 2019. See Swain v. McDonald, 27 Vet. App. 219, 224 (2015); see also 38 C.F.R. § 3.
is afforded to the Veteran, the findings that the Veteran's inter-incisal range was possibly as limited as 30 mm could fit within that range. Accordingly, the Board finds that a higher rating of 20 percent is warranted from December 19, 2019, the date of the December 2019 VA examination. The higher rating cannot be awarded from an earlier date because there is no probative evidence that the Veteran had inter-incisal distance limited to 30 mm or less during the rating period prior to December 19, 2019. See Swain v. McDonald, 27 Vet. App. 219, 224 (2015); see also 38 C.F.R. § 3.400(o)(2).

At the August 2022 VA examination, the Veteran reported that his service-connected jaw disability manifests in tinnitus, a stinging pain, popping, crepitus, clicking, pain on palpation, and limited jaw opening. He was not receiving any treatment for the condition. His jaw symptoms flare for 1 hour 2 to 3 times per week. The flare-ups are precipitated by eating and yawning and involve the jaw locking. On examination, the Veteran had right and left lateral excursion to greater than 4 mm bilaterally and inter-incisal distance of 21 to 29 mm. The examiner opined that the Veteran would not have additional limitation of motion on repeated use over time or during flare-ups. The examiner further indicated that the Veteran does not require a mechanically altered foods diet verified by a physician due to the service-connected jaw disability. The March 2026 VA examiner opined that at the time of the August 2022 VA examination the Veteran would not have further limitation of motion of the jaw on active and passive motion, on weight-bearing and nonweight-bearing, on repeated use over time, or during flare-ups. Such findings do not warrant a rating in excess of 20 percent rating under either the previous version of Diagnostic Code 9905 or the current version of Diagnostic Code 9905.

At the November 2025 VA examination, the Veteran reported that his service-connected jaw disability was worsening due to lack of sleep. He also reported that he has headaches, ear pain, and knee pain. His jaw cracks, clicks, and pops. It locks on the left side 1 to 2 times per day. He has stiffness in opening his mouth. He has had random, constant pain that is sharp, stabbing, diffuse, and throbbing and lasts for hours. His jaw symptoms flare daily for hours. The flare-ups are precipitated by grinding, chewing, eating, yawning, and sleeping. On examination, the Veteran had right and left lateral excursion to greater than 4 mm bilaterally and inter-incisal distance of 30 mm on initial testing, of 26 mm on active motion over time, and of 38 mm on passive motion bilaterally. The examiner opined that the Veteran would not have additional limitation of motion on repeated use over time or during flare-ups. The examiner further indicated that the Veteran does not require a mechanically altered foods diet verified by a physician due to the service-connected jaw disability. Such findings do not warrant a rating in excess of 20 percent rating under either the previous version of Diagnostic Code 9905 or the current version of Diagnostic Code 9905.

Based on a review of the subjective and clinical evidence, the Board finds that the Veteran's service-connected jaw disability did not warrant a rating in excess of 10 percent under Diagnostic Code 9905 prior to December 19, 2019, and warranted a rating of 20 percent, and no higher, during the period beginning December 19, 2019. The evidence does not reflect that the Veteran's disability manifested in restriction to a diet of soft and semi-solid food, as recorded or verified by a physician, or in a range of inter-incisal range of less than 21 mm of maximum unassisted vertical opening during the period beginning December 19, 2019. See 38 C.F.R. § 4.150, Diagnostic Code 9905, Note (3).

In reaching this determination, the Board has considered the Veteran's report of pain and popping in his temporomandibular joint. However, the Veteran's pain and popping have not resulted in functional impairment such that a rating is warranted based on such symptoms. Accordingly, there is no basis upon which to award a compensable rating under the relevant rating criteria. In addition, for all musculoskeletal disabilities, the Schedule contemplates functional loss, which may be manifested by, for example, decreased or abnormal excursion, strength, speed, coordination, or endurance. 38 C.F.R. § 4.40; Mitchell v. Shinseki, 25 Vet. App. 32, 37 (2011). For disabilities of the joints in particular, the Schedule specifically contemplates factors such as weakened movement; excess fatigability; pain on movement; disturbance of locomotion; and interference with sitting, standing, and weight bearing. 38 C.F.R. §§ 4.45, 4.59; Mitchell, 25 Vet. App. at 37. Thus, the schedular criteria for musculoskeletal disabilities contemplate a wide variety of manifestations of functional loss. In this case, the schedular criteria contemplate the Veteran's functional impairments caused by the service-connected jaw disability.

Based on the Veteran's symptomatology, the Board also concludes that there are no other applicable diagnostic codes that would warrant consideration for a higher rating.

The Board has also considered whether the Veteran may be entitled to higher ratings if the ameliorative effects of medications are discounted. See Ingram v. Collins, 38 Vet. App. 130 (2025). The VA examinations show that the Veteran reported that his flare-ups in symptoms are alleviated or improved by medications. Therefore, his reported symptoms during flare-ups do not reflect the ameliorative effects of medications. As discussed above, even during such periods of acute exacerbations in his symptoms when his symptoms are at their most severe and have not been ameliorated by medications, his symptoms do not warrant a higher rating. Accordingly, even if the ameliorative effects of medications are discounted, higher ratings are not warranted.

The Board acknowledges the arguments presented in the November 2023 brief prepared by the Veteran's representative before the Court. The Board finds that the issues raised by the representative regarding awarding a 20 percent rating based on the findings at the December 2019 VA examination; complying with the Board's May 2022 remand instructions regarding estimates of range of motion during flare-ups and on active motion, passive motion, weight bearing, and nonweight bearing; obtaining retrospective opinions; and undertaking efforts to obtain records from Dr. Farokian have been resolved, as discussed in the decision above. Therefore, the Board will not discuss those arguments further. However, the Board will discuss the representative's remaining arguments.

The representative argues that the Veteran is entitled to separate ratings for headaches and tooth decay/destruction. Regarding headaches, the Veteran has mentioned having head pain in association with his service-connected jaw disability during the pendency of the appeal. His child also reported that the Veteran's service-connected jaw disability "caused him to have insomnia and migraines so awful he would be bed-ridden but still could not sleep." However, the evidence does not show that the Veteran has had a diagnosed headache disability secondary to his service-connected jaw disability that may be separately ratable under 38 C.F.R. § 4.124a, Diagnostic Code 8100, or another relevant diagnostic code. As discussed above, the Veteran's pain associated with his service-connected jaw disability is contemplated by his rating under Diagnostic Code 9905. The medical treatment records do not show that the Veteran has been diagnosed with a headache condition separate from that pain. In addition, the Veteran's child's mention of the Veteran having migraines is vague, as it does not specify when such migraines occurred. Moreover, the child's statement is not substantiated by the medical treatment records dating during the rating period, which show no complaint of, treatment for, or diagnosis of migraines.

Regarding tooth decay/destruction, under VA law, compensation is only available for certain types of dental and oral conditions that are rated under 38 C.F.R. § 4.150, Diagnostic Codes 9900 to 9916. Diagnostic Code 9913 applies to service connection claims involving the teeth. Compensation is only paid for loss of teeth due to loss of substance of the body of the maxilla or mandible without loss of continuity. This only applies to bone loss through trauma or disease such as osteomyelitis, and not to the loss of the alveolar process as a result of periodontal disease, since such loss is not considered disabling. See Note following 38 C.F.R. § 4.150, Diagnostic Code 9913. VA regulations distinguish between "replaceable missing teeth" or periodontal disease and teeth lost as a result of "loss of substance of body of maxilla or mandible." Simington v. West, 11 Vet. App. 41 (1998); 38 C.F.R. § 3.381. Replaceable missing teeth may be considered as service connected solely for the purpose of determining entitlement to dental examinations or outpatient dental treatment. However, only the loss of teeth due to the loss of substance of the body of either the maxilla or mandible through trauma or disease such as osteomyelitis is considered compensable and may be rated under the appropriate diagnostic codes. In this case, there is no evidence that the Veteran's service-connected jaw disability resulted in loss of teeth due to the loss of substance of the body of either the maxilla or mandible through trauma or disease such as osteomyelitis. Therefore, any tooth decay/destruction that the Veteran has experienced due to his service-connected jaw disability cannot be separately service connected for compensation purposes.

The representative also argues that the Board must address secondary service connection for tinnitus and a mental health disorder as part of this appeal. The representative acknowledges that the Veteran has already been service connected for tinnitus and a mental health disorder secondary to the service-connected jaw disability, but argues that the Board may award earlier effective dates for the grant of service connection for those disabilities in this decision. In support of that argument, the representative cites to Bailey v. Wilkie, 33 Vet. App. 188, 198-203 (2021). However, the appellant in Bailey wanted the Board to properly compensate a service-connected condition and address reasonably raised complications that were properly part of the scope of that initial claim when it assessed the compensation the appellant should receive. The Court in Bailey found that the Board should have addressed those complications as part of its rating assessment. Bailey describes a careful limit regarding increased rating claims. The rules for assessing increased rating claims must not be conflated with the rules for assigning an effective date for an initial claim. The current case involves determining the appropriate rating for the Veteran's service-connected jaw disability. It does not involve determining the correct effective date for the awards of service connection for tinnitus and major depressive disorder with anxious distress and insomnia disorder even if those disabilities were service connected during the pendency of the increased rating issue on appeal based on their association with the service-connected jaw disability. The effective date for the award of service connection for those disabilities was a downstream issue that the Veteran could have-but did not-appeal from the rating decisions that originally awarded service connection for those disabilities. Therefore, Bailey is not applicable in this case and does not provide an avenue for awarding an earlier effective date for the service-connected tinnitus and mental health disorder.

The representative further argues that the Veteran's service-connected jaw disability is an unlisted condition that is rated by analogy. As such, under Webb v. McDonough, 71 F.4th 1377, 1382 (Fed. Cir. 2023), the exact criteria of Diagnostic Code 9905 need not be met. Furthermore, Diagnostic Code 9905 only accounts for limitation of motion, but the Veteran has other symptoms, including arthritis, pain, crepitus/clicking, and locking of his jaw that may be rated by analogy under other diagnostic codes such as 38 C.F.R. § 4.71a, Diagnostic Code 5258. The Board disagrees that the Veteran's disability has been rated by analogy. Diagnostic Code 9905 pertains to temporomandibular disorder, which is defined as "chronic facial pain associated with dysfunction of some combination of the temporomandibular joint, jaw muscles, and associated nerves. The most common symptoms include facial, neck, and shoulder pain, clicking, or other sounds associated with jaw movement,
9905 only accounts for limitation of motion, but the Veteran has other symptoms, including arthritis, pain, crepitus/clicking, and locking of his jaw that may be rated by analogy under other diagnostic codes such as 38 C.F.R. § 4.71a, Diagnostic Code 5258. The Board disagrees that the Veteran's disability has been rated by analogy. Diagnostic Code 9905 pertains to temporomandibular disorder, which is defined as "chronic facial pain associated with dysfunction of some combination of the temporomandibular joint, jaw muscles, and associated nerves. The most common symptoms include facial, neck, and shoulder pain, clicking, or other sounds associated with jaw movement, limited jaw opening, and locking of the jaw, headache, otalgia, neck and shoulder pain, and dizziness." See Dorland's Illustrated Medical Dictionary 553 (32d ed. 2012). Thus, temporomandibular disorder is a broad term for a condition resulting in the sort of symptoms that the Veteran experiences due to his service-connected jaw disability. Furthermore, the VA examinations show that the service-connected jaw disability is a type of temporomandibular disorder. For example, the November 2025 VA examiner characterized the Veteran's disability a bilateral temporomandibular joint disorder. As such, the disability is not rated by analogy, but rather is rated specifically as a temporomandibular disorder under Diagnostic Code 9905. Because the Veteran's disability is specifically listed, he cannot be rated by analogy under a different diagnostic code. See Copeland v. McDonald, 27 Vet. App. 333 (2015). The Veteran's arthritis, pain, crepitus/clicking, and locking of his jaw are all considered through his rating under Diagnostic Code 9905 for temporomandibular disorder.

Finally, the representative asserts that, pursuant to Morgan v. Wilkie, 31 Vet. App. 162, 167-68 (2019), "once BVA has exhausted schedular alternatives, it is to consider the possibility of an extraschedular rating". However, as discussed above, the Veteran's symptoms are adequately contemplated by his current schedular ratings. Therefore, no discussion of extraschedular ratings is required. See Thun v. Peake, 22 Vet. App. 111 (2008).

Neither the Veteran nor his representative has raised any other issues with regard to the rating for service-connected jaw disability, nor have any other such issues been reasonably raised by the record. See Yancy v. McDonald, 27 Vet. App. 484, 495 (2016); Doucette v. Shulkin, 38 Vet. App. 366, 369-70 (2017).

In summary, the Board finds that the criteria for a rating of 20 percent for bruxism and bilateral articular disc disorder reducing with masticatory myofascial pain have been met from December 19, 2019. However, the criteria for entitlement to ratings in excess of 10 percent prior to December 19, 2019, and 20 percent from that date for bruxism and bilateral articular disc disorder reducing with masticatory myofascial pain have not been met. To the extent that the Veteran seeks ratings higher than those assigned previously or those assigned herein, the evidence for and against the claim is not in approximate balance, but rather weighs against the claim. Because there is not an approximate balance in the weight of the evidence, the doctrine of reasonable doubt is not for application, and the claim must be denied. 38 U.S.C. § 5107(b); Lynch v. McDonough, 21 F.4th 776 (Fed. Cir. 2021).

2. Entitlement to a TDIU prior to July 24, 2017

The Veteran seeks entitlement to a TDIU. The issue was raised as part of the appeal for higher ratings for the service-connected jaw disability. Therefore, the rating period for entitlement to a TDIU is the same as for the rating increase issue. Namely, the rating period is from July 8, 2014, one year prior to receipt of the Veteran's intent to file a claim, through July 23, 2017, the day prior to the current effective date for the award of a TDIU. See 38 C.F.R. § 3.400(o)(2).

Total disability ratings for compensation may be assigned, where the schedular rating is less than total, when a Veteran is unable to secure and follow a substantially gainful occupation as a result of service-connected disabilities. 38 C.F.R. § 4.16(a).

the rating period for entitlement to a TDIU is the same as for the rating increase issue. Namely, the rating period is from July 8, 2014, one year prior to receipt of the Veteran's intent to file a claim, through July 23, 2017, the day prior to the current effective date for the award of a TDIU. See 38 C.F.R. § 3.400(o)(2).

The phrase "unable to secure and follow a substantially gainful occupation" contains both economic and noneconomic components. See Ray v. Wilkie, 31 Vet. App. 58, 73 (2019). The economic component is met when the Veteran is unemployed or marginally employed. Marginal employment generally shall be deemed to exist when the Veteran's earned annual income does not exceed the amount established by the U.S. Department of Commerce, Bureau of the Census, as the poverty threshold for one person. 38 C.F.R. § 4.16(a). Marginal employment includes employment in a protected environment, such as a family business or sheltered workshop, which involves a lower-income position that, due to the Veteran's service-connected disabilities, is shielded in some respect from competition in the employment market. LaBruzza v. McDonough, 37 Vet. App. 111, 123-24 (2024). Consideration shall be given in all claims to the nature of the employment and the reason for termination. 38 C.F.R. § 4.16(a).

The non-economic component of the phrase "unable to secure and follow a substantially gainful occupation" includes consideration of the Veteran's history, education, skill, and training; whether the Veteran has the physical ability (both exertional and non-exertional) to perform the type of activities required by the occupation at issue (e.g., lifting, bending, sitting, standing, walking, climbing, as well as auditory and visual limitations); and whether the Veteran has the mental ability to perform the activities required by the occupation at issue (e.g., memory, concentration, ability to adapt to change, handle work place stress, get along with coworkers, and demonstrate reliability and productivity). Ray, 31 Vet. App. at 73.

The Board is not permitted to consider advancing age or a nonservice-connected disability when determining entitlement to a TDIU. 38 C.F.R. §§ 3.341(a), 4.16, 4.19.

A TDIU does not require a showing of 100 percent unemployability. Roberson v. Principi, 251 F.3d 1378, 1385 (Fed. Cir. 2001). The ultimate question is whether the Veteran is capable of performing the physical and mental acts required by employment, not whether the Veteran can find employment. Van Hoose v. Brown, 4 Vet. App. 361, 363 (1993). In this regard, entitlement to a TDIU is a legal determination, not a medical one. Geib v. Shinseki, 733 F.3d 1350, 1354 (Fed. Cir. 2013). Medical examiners may provide evidence regarding functional and occupational impairment, but the Board must decide whether a Veteran may "secure and follow a substantially gainful occupation" based on all evidence of record. See Delrio v. Wilkie, 32 Vet. App. 232, 243 (2019).

The Veteran had the following service-connected disabilities during the rating period: status-post translocation of left ulnar nerve, left shoulder tendonitis, bruxism and bilateral articular disc disorder reducing with masticatory myofascial pain, and tinnitus.

For the reasons that follow, the Board finds that entitlement to a TDIU is not warranted.

On a September 2022 VA Form 21-8940, Veteran's Application for Increased Compensation based on Unemployability, the Veteran reported that he has a high school education with one year of college and that he last work as network manager until December 30, 2013. He stated that his service-connected jaw disability and tinnitus prevent him from securing or following substantially gainful occupation.

Regarding limitations from the service-connected disabilities, the medical treatment records show that the Veteran is right handed and, accordingly, his service-connected left ulnar nerve and shoulder disabilities affect his minor arm. The Veteran reported at a January 2015 VA treatment visit that his ulnar nerve neuropathy manifests in pain that shoots down the left forearm to the fingertips, numbness, and tingling, but does not result in significant weakness. He reported 1 out of 10 intermittent shoulder pain at a May 2017 VA treatment visit. The September 2015 VA temporomandibular joint conditions examiner determined that the Veteran's service-connected jaw disability did not impact his ability to work. However, the August 2017 VA temporomandibular joint conditions examiner indicated that the Veteran's service-connected jaw disability affects his concentration and that the Veteran cannot drive when he takes medications. The Veteran told a September 2017 VA hearing loss and tinnitus examiner that his tinnitus causes insomnia. The Board finds that because the August 2017 and September 2017 VA examinations were conducted soon after the end of the rating period, the results of those examinations may be applied to the rating period. Accordingly, the Veteran's service-connected left ulnar nerve and left shoulder disabilities limited him to work involving only light lifting of up to 20 pounds occasionally and 10 pounds frequently primarily using only his dominant right upper extremity. For purposes of this decision, the Board defines "occasionally" as up to 2 hours out of an 8-hour workday and "frequently" as up to 6 hours out of an 8-hour workday. The Veteran's service-connected jaw disability and tinnitus limited him to work that does not require prolonged concentration, such as to complete complex multi-step tasks or to address irregularities in work of an inconsistent nature. Thus, he was limited to simple, routine work. His service-connected jaw disability also prevented him from performing work that requires driving.

In summary, the evidence shows that, due to his service-connected disabilities, the Veteran was limited to work involving light lifting, that is simple and routine in nature, and that does not involve driving. Such an occupational profile would still allow for a wide range of light unskilled or semiskilled work, such as inspection work, assembly work, and sorting work, which is simple, routine, and repetitive, involves no more than light lifting, and does not involve driving.

The Board has considered the Veteran's level of education. See 38 C.F.R. § 4.16. The Veteran has a high school education with 1 year of college. Such a level of education is not inconsistent with an ability to perform work of an unskilled or semiskilled nature, such as inspection work, assembly work, and sorting work, which does not require special training and can be learned at the job site.

The Board has also considered the Veteran's work history. The Veteran has a history of working in computer networking and has reported that he has special training in that area. The Board finds that the Veteran's lack of other work prior to and during the rating period would not, in itself, prevent him from transitioning to an unskilled or semiskilled occupation that involves only light lifting and does not require driving.

In summary, the evidence does not show that the Veteran was unable to secure or follow a substantially gainful occupation due to his service-connected disabilities during the rating period. Thus, the Board concludes that the evidence for and against the claim is not in approximate balance, but rather weighs against the claim. Because there is not an approximate balance in the weight of the evidence, the doctrine of reasonable doubt is not for application, and the claim must be denied. 38 U.S.C. § 5107(b); Lynch, 21 F.4th 776.

MICHAEL MARTIN

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board T. J. Anthony, Counsel

The Board's decision in this case is binding only with respect to the instant matter decided. This decision is not precedential and does not establish VA policies or interpretations of general applicability. 38 C.F.R. § 20.1303.

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