Bruxism, which is the involuntary grinding of teeth, might be one of the most overlooked medical conditions among veterans. This is because it is mainly associated with primary conditions such as PTSD, anxiety, and traumatic brain injury rather than as a standalone disorder.
According to Bruxism and Stress Among Veterans With Gulf War Illness, 77.8% of Gulf War illness veterans reported teeth grinding, while 85.2% reported clenching weekly or daily.
However, when you file a VA claim for teeth grinding, you will find that there is no VA rating for bruxism, nor is there any VA diagnostic code specifically reserved for it.
This gap prevents many veterans from pursuing benefits that may relate to bruxism even if there is an established service connection.
But a missing code does not mean a missing path, and knowing how the VA evaluates this condition is the first step to building a claim.
Just 4 Veterans Enterprise is here to provide you with disability benefits and educational services, along with a page that can help you calculate your rating , enabling you to identify which route you can take to obtain a bruxism VA disability rating.
And to thoroughly understand the entirety of the bruxism VA rating, let us explore what it is, how the VA rates it, and the secondary service connection route that you can take for a shot at receiving VA compensation.
What Is Bruxism?
Bruxism is the clenching, grinding, or gnashing of teeth, which typically occurs even without any conscious effort, meaning that those who do it have no idea that they are doing it at all.
Repeated gnashing, grinding, and clenching puts a significant strain on the teeth over time, jaw muscles, and temporomandibular joints (TMJ), which can lead to chronic jaw pain, headaches, and even earaches.
Common symptoms associated with TMJ dysfunction and bruxism include:
- Jaw pain or tenderness during or after chewing
- Facial pain or stiffness
- Clicking, popping, or grating sounds in the jaw
- Jaw locking episodes
- Chronic headaches or migraines
- Ear pain, pressure, or tinnitus
- Difficulty chewing solid foods
- Teeth grinding or clenching (observed by others or identified at dental examination)
- Dental enamel erosion, tooth fractures, or wear
- Tender jaw muscles
- Morning jaw stiffness
- Persistent muscle tightness
- Sleep disturbance
- Reduced mouth opening
- Speech difficulty
While civilians can develop bruxism, veterans face an elevated risk due to conditions frequently associated with military service:
- Post-Traumatic Stress Disorder (PTSD)
- Generalized Anxiety Disorder
- Major Depressive Disorder
- Traumatic Brain Injury (TBI)
These conditions have the potential to carry bruxism as a side effect. There are also certain psychiatric medications that often cause or worsen teeth grinding, medications such as SSRIs and antipsychotics that are commonly prescribed in veterans’ care.
For veterans managing multiple service-connected conditions simultaneously, the compounding effect is significant.
Sleep Bruxism vs. Awake Bruxism
Bruxism falls into two clinically distinct categories, and the difference matters when building a claim.
Awake Bruxism
Awake Bruxism occurs subconsciously during waking hours. Veterans might clench their jaw while concentrating, under duress or stress, or during any heightened emotional states. This behavior occurs even without realizing it.
Because it’s a conscious period, stress management and behavioral awareness can sometimes reduce the severity. Many people with awake bruxism don’t require treatment beyond addressing the underlying trigger.
Sleep Bruxism
The second category of bruxism that happens during sleep and is considerably harder to detect and diagnose.
A veteran can grind through enamel night after night without any awareness that it’s happening. The damage accumulates, and because the grinding occurs involuntarily during an unconscious state, it tends to be more forceful and therefore more dangerous than awake bruxism.
Partners, family members, or fellow service members who share living quarters are often the ones who notice the sound of grinding teeth at night. Their observation can be valuable for buddy statements in disability claims, as it provides a credible account from someone who witnessed your sleep bruxism and can carry evidentiary weight in a VA claim.
Does the VA Rate Bruxism?
The short answer is, not directly.
The VA disability rating for bruxism has no recorded diagnostic code in the VA Schedule of Ratings for Dental and Oral Conditions under 38 CFR § 4.150. The VA officially classifies bruxism as an “unlisted disability” and rates it by analogy.
In amending the dental diagnostic codes, the VA determined that bruxism is best understood as a secondary condition, not a primary one, and that its symptoms are generally contemplated by the underlying condition causing the grinding.
That regulatory position significantly impacts the structure of claims.
The absence of a dedicated code does not close the door on bruxism and TMJ VA rating compensation. When bruxism causes clinical damage, two diagnostic codes become relevant and a veteran coach from Just 4 Veterans Enterprise can walk you through both pathways and identify which route fits your situation.
- DC 9905 — Temporomandibular Disorder
When chronic bruxism progresses to the point of causing jaw dysfunction, clicking, restricted motion, or pain in the temporomandibular joints, the condition can be rated under DC 9905 for Temporomandibular Disorder (TMD). This is the most commonly applicable code for veterans with significant bruxism-related jaw involvement.
- DC 9913 — Loss of Teeth
When years of unchecked grinding result in tooth loss or severe dental destruction, veterans may be rated under DC 9913. This code applies when bruxism is established as a service-connected or secondary service-connected condition and has led to documented tooth loss.
VA Rating Criteria for Bruxism Under DC 9905
DC 9905 rates Temporomandibular Disorder based on inter-incisal range of motion, how far the jaw can open, as well as functional limitations like dietary restrictions due to jaw pain.
| Maximum Unassisted Vertical Opening | Dietary Restriction | VA Rating |
|---|---|---|
| 0 to 10 mm of maximum unassisted vertical opening | ||
| 0–10 mm | With dietary restrictions to all mechanically altered foods | 50% |
| 0–10 mm | Without dietary restrictions to mechanically altered foods | 40% |
| 11 to 20 mm of maximum unassisted vertical opening | ||
| 11–20 mm | With dietary restrictions to all mechanically altered foods | 30% |
| 11–20 mm | Without dietary restrictions to mechanically altered foods | 40% |
| 21 to 29 mm of maximum unassisted vertical opening | ||
| 21–29 mm | With dietary restrictions to full liquid and pureed foods | 40% |
| 21–29 mm | With dietary restrictions to soft and semi-solid foods | 30% |
| 21–29 mm | Without dietary restrictions to mechanically altered foods | 20% |
| 30 to 34 mm of maximum unassisted vertical opening | ||
| 30–34 mm | With dietary restrictions to full liquid and pureed foods | 30% |
| 30–34 mm | With dietary restrictions to soft and semi-solid foods | 20% |
| 30–34 mm | Without dietary restrictions to mechanically altered foods | 10% |
| Lateral excursion range of motion | ||
| 0 to 4 mm | Lateral excursion limitation | 10% |
| Note (1): Ratings for limited interincisal movement shall not be combined with ratings for limited lateral excursion. | ||
| Note (2): For VA compensation purposes, the normal maximum unassisted range of vertical jaw opening is from 35 to 50 mm. | ||
| Note (3): 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: 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. | ||
Regulatory Note: Rating criteria reflect the regulatory language under 38 C.F.R. § 4.150, DC 9905 as of the publication date.
Note: Painful motion alone without limitation = 0%
A Compensation and Pension (C&P) exam for TMD under DC 9905 will center on objective measurement of jaw opening, specifically the maximum distance between the upper and lower incisors without any assistance.
The examiners will also document lateral and protrusive motion and take note of whether pain occurs during motion or at rest. The exam will also evaluate functional impact of eating and speaking.
If you are experiencing this level of condition, please describe your condition on your worst days, rather than your average functioning. If your jaw pain limits what you can eat, that dietary restriction should be clearly documented before the exam; it’s a deciding factor between rating tiers.
The 50% Rating Tier
The highest rating available under DC 9905 is 50%, reached when jaw opening is 0–10 mm and the severity requires a full restriction to mechanically altered foods; provided both criteria are met. Veterans with severe TMD progression should ensure their dietary limitations are documented by a treating provider and clearly described to the C&P examiner.
The TDIU Consideration
Veterans whose TMD significantly impairs their ability to maintain employment, whether due to chronic pain, limited jaw function, or the combination of bruxism with other service-connected conditions, may be eligible for Total Disability Individual Unemployability (TDIU), which provides compensation at the 100% rate regardless of the combined schedular rating.
VA Rating for Tooth Loss Under DC 9913
When bruxism causes significant tooth loss, DC 9913 applies. As of the date of this publication ratings under this code range from 10% to 40%, based on the extent and location of the missing teeth:
| Rating | Criteria |
|---|---|
| 10% | All upper or lower teeth on one side of the arch missing; all lower front teeth missing; or all upper front teeth missing |
| 20% | Loss of teeth involving a full upper or lower arch segment; more extensive loss |
| 30% | More extensive multi-arch loss affecting masticatory function |
| 40% | All teeth missing, where a prosthesis cannot be constructed or is contraindicated |
Two important notes on this code.
First, the prosthetics rule: if a prosthesis, whether dentures, implants, or bridges, can adequately restore the lost teeth, the VA will typically assign a 0% rating. Compensation under DC 9913 is most applicable when dental replacement is not feasible or when existing prosthetics are insufficient.
Second, if a veteran qualifies under both DC 9905 and DC 9913, those ratings are combined under the VA’s standard combined ratings formula; they do not simply add together. Use the rating calculator to calculate your rating and understand what combined compensation might look like.
Conditions Commonly Associated with TMD and Bruxism
Understanding conditions that are commonly associated with, caused by, or aggravated by TMD and bruxism is important for identifying the full scope of potential secondary claims. The table below reflects conditions recognized in the clinical and regulatory literature:
| Level | Condition | VA Rating Basis | Notes |
|---|---|---|---|
| Primary | Temporomandibular Disorder with Bruxism (DC 9905) | Rated under DC 9905 criteria | Jaw dysfunction with teeth grinding |
| Secondary | Chronic jaw pain | Functional impairment evaluation | Persistent pain during jaw movement |
| Secondary | Limited mouth opening | Range-of-motion assessment | Reduced inter-incisal opening |
| Secondary | Dental enamel wear | Bruxism-related dental damage | Tooth grinding may damage teeth |
| Secondary | Jaw locking | Functional impairment assessment | Intermittent restricted jaw motion |
| Secondary | Chronic headaches | Secondary symptom evaluation | Frequently associated with muscle tension |
| Secondary | Facial muscle spasm | Muscular dysfunction assessment | Jaw muscle overuse and fatigue |
| Secondary | Sleep disturbance | Secondary effect of bruxism | Grinding commonly worsens during sleep |
| Secondary | Speech impairment | Functional loss evaluation | Painful or restricted jaw motion |
| Secondary | Difficulty chewing | Mastication impairment evaluation | May require soft-food diet |
| Secondary | Degenerative joint disease | Structural joint pathology | Chronic joint stress may accelerate degeneration |
| Secondary | Anxiety or stress-related symptoms | Chronic pain impact | Stress may aggravate clenching and grinding |
Note: The conditions listed under “Secondary” represent conditions that may be associated with or caused by TMD/bruxism. Each secondary claim requires its own medical nexus establishing causation or aggravation under 38 C.F.R. § 3.310. This table is for educational reference only and does not guarantee any specific rating outcome.
Secondary Service Connection for Bruxism
The VA made it clear that bruxism is fundamentally a secondary condition. A bruxism diagnosis does not close the door on benefits. Secondary conditions are well-established legal pathways that do not require you to prove that the condition began during your service.
Under 38 CFR § 3.310, secondary service connection is granted when a disability is the result of, or is aggravated by, an already service-connected condition. For veterans with bruxism, several common primary conditions open this route.
Bruxism Secondary to PTSD or Anxiety/Depression
An article published in Clinical Oral Investigations reported that those with PTSD also present bruxism as a secondary condition.
The hyperarousal, muscle tension, and psychological stress characteristic of PTSD are believed to drive involuntary clenching and grinding, both awake and during sleep. The same mechanisms are present in generalized anxiety disorder and depression, both of which are frequently service-connected in veterans.
When bruxism is documented as a symptom or consequence of a service-connected mental health condition, it can either contribute to the overall mental health rating or support a separate secondary claim under DC 9905 or 9913, depending on the clinical evidence and the VA adjudication approach.
Bruxism Secondary to Traumatic Brain Injury (TBI)
Traumatic brain injury can disrupt the neurological regulation of muscle activity, including the jaw muscles. Veterans with service-connected TBI sometimes develop bruxism as a result of that neurological disruption, providing a viable pathway for secondary service connection.
Bruxism Secondary to Sleep Apnea
A 2021 BVA decision (Citation No. 21054489) granted a secondary service connection for bruxism after a private physician supported the claim with a controlled clinical trial demonstrating direct causality between sleep apnea and bruxism, evidence the Board found highly probative. This decision illustrates the importance of a well supported nexus opinion.
Sleep apnea fragments and disrupts the normal architecture of sleep and that chronic disruption is a recognized trigger for sleep bruxism. During the disordered breathing episodes characteristic of sleep apnea, the body’s arousal responses can activate jaw muscle activity, causing grinding and clenching.
Therefore, bruxism, secondary to sleep apnea, has been granted in documented VA cases.
Related Reading: Tips to Maximize Your VA Rating for Sleep Apnea and Secondary Conditions
Bruxism Secondary to Medications
Certain medications used to treat service-connected conditions are associated with causing or worsening bruxism. Some of them are as follows:
| Drug Class | Specific Medications | Reported Association |
|---|---|---|
| Antidepressants (SSRIs/SNRIs) | Sertraline (Zoloft), Escitalopram, Venlafaxine (Effexor), Vortioxetine, Citalopram, Paroxetine (Paxil), Fluoxetine (Prozac), Duloxetine (Cymbalta) | Reported in pharmacovigilance literature; percentage figures vary by study |
| Antipsychotics | Ziprasidone, Aripiprazole (Abilify), Olanzapine (Zyprexa), Risperidone (Risperdal) | Reported in case literature |
| Other | Sodium oxybate, Metoclopramide (Reglan) | Signal detected in WHO pharmacovigilance database |
When a veteran can demonstrate that their teeth grinding began or significantly worsened after starting a service-connected medication, this pharmaceutical nexus can support a secondary claim.
There are multiple medical studies supporting this connection, such as:
- Sage Journals: Drug-Induced Bruxism: A Comprehensive Literature Review – Sosa George, Rini Joy, Anitha Roy, 2021
A treating provider’s nexus letter can make a strong piece of evidence.
Reverse Secondary: Bruxism Causing Tinnitus
Severe bruxism can cause tinnitus through the pressure and vibration that jaw clenching transmits to the structures of the inner ear.
If bruxism is established as service-connected or secondary condition, which may lead to tinnitus as an additional secondary condition and potentially increase your compensation, under 38 C.F.R. § 3.310.
Building Your Claim for Bruxism
A successful bruxism claim, whether under DC 9905, DC 9913, or through reverse secondary, depends on three key factors:
- Current Diagnosis. A formal diagnosis of bruxism, TMD, or documented tooth loss from a dentist or oral health provider. The diagnosis needs to be current and clinical, not self-reported.
- Primary Service-Connected Condition. Documentation of the service-connected condition that drives the secondary claim. This means your existing rating decision, service treatment records, and any mental health or TBI documentation that ties your primary condition to service.
- Nexus Evidence. A medical nexus letter, written by a physician, private evaluator, or independent medical examiner that explains the connection between your service-connected condition and your bruxism.
Evidence that can support a claim includes dental records showing ongoing damage from chronic grinding, notes from C&P exams about jaw movement, and buddy statements from individuals who observed sleep bruxism.
Combined Ratings
It’s important to understand that VA ratings do not add; they combine each rating using a formula that applies each successive rating to the remaining “able-bodied” percentage.
For example, a veteran who is already rated at 70% for PTSD and then adds a 20% rating for TMD will not reach a total of 90%; instead, the combined result will be lower.
Related Reading: Understanding VA Math and Combined Ratings | J4V
Get Disability Benefits Education Services
Bruxism exists in a gray zone of the VA rating system, with no dedicated code, a default posture of secondary-only connection, and rating criteria that require clinical documentation most veterans don’t know they need. The veterans who succeed are the ones who understand the regulatory framework and build their evidence accordingly.
Just 4 Veterans Enterprise provides disability benefits educational services that are tailored to situations like this one.
If you want to understand how your bruxism connects to your existing conditions and what evidence you need to make the case, working with a veteran coach is where that process starts.
Visit our VA claims consulting page to learn more about our professional coaching and consultation services. You can also book a free strategy call with our veteran coaches today to ensure your benefits are protected.