Contents
- Introduction
- Rating Tables
- Loss of Function - Gingiva and Loss of Teeth
- Loss of Function - Temporomandibular Joint
- Other Impairment - Temporomandibular Resting Joint Pain
- Loss of Function - Mandible and Maxilla
- Loss of Function - Disfigurement of the Mandible and Maxilla
- Tables
- Table 11.1 Loss of Function - Gingiva and Loss of Teeth
- Table 11.2 Loss of Function - Temporomandibular Joint
- Table 11.3 Other Impairment - Temporomandibular Resting Joint Pain
- Table 11.4 Loss of Function - Mandible and Maxilla
- Table 11.5 Loss of Function - Disfigurement of the Mandible and Maxilla
- Steps to Determine the Dental and Oral Impairment Assessment
Introduction
This chapter provides criteria for assessing permanent impairment from entitled gingiva conditions, loss of teeth, temporomandibular joint dysfunction and loss of function of the mandible and/or maxilla.
Veterans Affairs Canada does not consider loss of teeth to be an assessable disability as the wearing of dentures or a prosthesis will restore an individual's ability to masticate. A nil assessment will be awarded for all entitled loss of teeth conditions regardless of the cause. Bruxism is also assessed at nil.
In complex cases where both a temporomandibular joint condition and a condition of the mandible and/or maxilla are entitled, a rating will be determined on individual merits.
No additional rating is taken from Chapter 14, Gastrointestinal Impairment, for entitled temporomandibular joint conditions or mandible and/or maxilla conditions.
No additional rating is taken from Chapter 22, Skin Impairment for disfigurement due to an entitled condition of the mandible and/or maxilla.
Impairment from malignant dental and oral conditions is rated within Chapter 18, Malignant Impairment. Follow the steps contained within the Malignant Impairment chapter.
Rating Tables
This chapter contains four "Loss of Function" tables and one "Other Impairment" table which may be used to rate entitled dental and oral conditions.
The tables within this chapter are:
Table | Loss of Function | Other Impairment |
---|---|---|
Table 11.1 | Loss of Function - Gingiva and Loss of Teeth | This table is used to establish a rating of nil for impairment from all gingiva conditions, bruxism and loss of teeth. |
Table 11.2 | Loss of Function - Temporomandibular Joint | This table is used to rate impairment from temporomandibular joint function. |
Table 11.3 | Other Impairment - Temporomandibular Resting Joint Pain | This table is used to rate impairment from resting pain in the temporomandibular joint. |
Table 11.4 | Loss of Function - Mandible and Maxilla | This table is used to rate impairment from mandible and/or maxilla function. |
Table 11.5 | Loss of Function - Disfigurement of the Mandible and Maxilla | This table is used to rate impairment from disfigurement of the mandible and/or maxilla. |
Loss of Function - Gingiva and Loss of Teeth
Table 11.1 is used to rate impairment of gingiva conditions, bruxism and loss of teeth. These conditions are assessed at nil.
When entitled gingiva conditions, bruxism and loss of teeth result in permanent impairment of other organ systems, a consequential entitlement decision is required. If awarded, the resulting impairment of that organ system(s) will be rated using the applicable body system specific table(s).
Loss of Function - Temporomandibular Joint
Table 11.2 is used to rate impairment of temporomandibular joint conditions. Only one rating may be selected. If more than one rating is applicable, the ratings are compared and the highest selected.
When entitled temporomandibular joint conditions result in permanent impairment of other organ systems, a consequential entitlement decision is required. If awarded, the resulting impairment of that organ system(s) will be rated using the applicable body system specific table(s).
If non-entitled conditions or conditions rated within another chapter/table of the Table of Disabilities are contributing to the overall impairment, then the Partially Contributing Table (PCT) must be applied to arrive at the rating which is due to the entitled condition(s) rated within this table.
Other Impairment - Temporomandibular Resting Joint Pain
Table 11.3 is used to rate impairment from joint pain that is persistent and unrelenting in the temporomandibular joint(s) when at rest. Only one rating may be selected. If more than one rating is applicable, the ratings are compared and the highest selected. Any applicable rating from this table must be added to the loss of function rating from Table 11.2.
Loss of Function - Mandible and Maxilla
Table 11.4 is used to rate impairment from entitled conditions of the mandible and/or maxilla. Two ratings may be initially selected from Table 11.4, one rating applicable to the loss of function of the mandible and one rating applicable to the loss of function of the maxilla. The ratings for the two individual areas are compared and the highest selected.
When entitled mandible and/or maxilla conditions result in permanent impairment of other organ systems, a consequential entitlement decision is required. If awarded, the resulting impairment of that organ system(s) will be rated using the applicable body system specific table(s).
If non-entitled conditions or conditions rated within another chapter/table of the Table of Disabilities are contributing to the overall impairment, then the Partially Contributing Table (PCT) must be applied to arrive at the rating which is due to the entitled condition(s) rated within this table.
Loss of Function - Disfigurement of the Mandible and Maxilla
Table 11.5 is used to rate impairment from disfigurement of the mandible and/or maxilla. Two ratings may be initially selected from Table 11.5, one rating applicable to the disfigurement of the mandible and one rating applicable to the disfigurement of the maxilla. The ratings for the two individual areas are compared and the highest selected.
Any applicable rating from this table must be added to the loss of function rating from Table 11.4.
Table 11.1 - Loss of Function - Gingiva and Loss of Teeth
A nil assessment will be given from Table 11.1 for all gingiva conditions, bruxism and loss of teeth regardless of whether the teeth can be replaced by prosthetics or not.
Each bullet (•) represents one criterion. In order for a rating to be established for Table 11.1, only one criterion must be met at a level of impairment for that rating to be selected.
Rating | Criteria |
---|---|
Nil |
|
Table 11.2 - Loss of Function - Temporomandibular Joint
Only one rating may be given from Table 11.2 for each entitled condition. If more than one rating is applicable for an entitled condition, the ratings are compared and the highest selected.
Each bullet (•) represents one criterion. In order for a rating to be established for Table 11.2, follow the "ands" and "ors".
Rating | Criteria |
---|---|
Nil |
|
Four |
|
Nine |
|
Thirteen |
|
Table 11.3 - Other Impairment - Temporomandibular Resting Joint Pain
Only one rating may be given from Table 11.3 regardless of whether the entitled condition involves one or both joints.
Each bullet (•) represents one criterion. In order for a rating to be established for Table 11.3, all criteria designated at that rating level must be met.
Rating | Criteria |
---|---|
Nil |
|
Two |
|
Four |
|
Nine |
|
Thirteen |
|
Table 11.4 - Loss of Function - Mandible and Maxilla
Two ratings may be initially given from Table 11.4, one rating applicable to the loss of function of the mandible and one rating applicable to the loss of function of the maxilla. The ratings for the two individual areas are compared and the highest selected.
Each bullet (•) represents one criterion. In order for a rating to be established for either the mandible or the maxilla area for Table 11.4, only one criterion must be met at a level of impairment for that rating to be selected.
Rating | Criteria |
---|---|
Nil | Maxilla |
|
|
Mandible | |
|
|
Four | Maxilla |
|
|
Mandibule | |
|
|
Nine | Maxilla |
|
|
Mandible | |
|
|
Thirteen | Maxilla |
|
|
Mandibue | |
|
Table 11.5 - Loss of Function - Disfigurement of the Mandible and Maxilla
Two ratings may be initially given from Table 11.5, one rating applicable to the loss of function of the mandible and one rating applicable to disfigurement of the mandible and one rating applicable to disfigurement of the maxilla. The ratings for the two individual areas are compared and the highest selected.
Each bullet (•) represents one criterion. In order for a rating to be established for either the mandible or the maxilla area for Table 11.5, all criteria designated at that rating level must be met.
Rating | Criteria |
---|---|
Nil | Maxilla |
|
|
Mandible | |
|
|
Four | Maxilla |
|
|
Mandible | |
|
|
Nine | Maxilla |
|
|
Mandible | |
|
Steps to Determine the Dental and Oral Impairment Assessment
- Step 1: Determine the rating from Table 11.1 (Loss of Function - Gingiva Conditions, Bruxism and Loss of Teeth).
The Medical impairment rating for entitled gingiva conditions, bruxism and loss of teeth is always NIL.
This is the Disability Assessment for for gingiva conditions, bruxism and loss of teeth.
- Step 2: Determine the rating from Table 11.2 (Loss of Function - Temporomandibular Joint). Only one rating is applicable from Table 11.2 regardless if the condition is unilateral or bilateral.
- Step 3: Does the Partially Contributing Table apply? If yes, apply to rating at Step 2.
- Step 4: Determine the rating from Table 11.3 (Other Impairment - Temporomandibular Joint - Resting Joint Pain). Only one rating is applicable from Table 11.3 regardless if the condition is unilateral or bilateral.
- Step 5: Add the ratings at Step 3 and Step 4.
- Step 6: Determine the Quality of Life rating.
- Step 7: Add the ratings at Step 5 and Step 6.
- Step 8: If partial entitlement exists, then apply to the rating at Step 7.
This is the Disability Assessment for temporomandibular joint conditions.
- Step 9: Determine the rating from Table 11.4 (Loss of Function - Mandible and Maxilla). Only one rating is applicable from Table 11.4 regardless if the condition is unilateral or bilateral. If more than one rating is applicable, the ratings are compared and the highest selected.
- Step 10: Determine the rating from Table 11.5 (Loss of Function - Disfigurement of Mandible and Maxilla). Only one rating is applicable from Table 11.4 regardless if the condition is unilateral or bilateral. If more than one rating is applicable, the ratings are compared and the highest selected.
- Step 11: Add the ratings at Step 9 and Step 10 if applicable.
- Step 12: Does the Partially Contributing Table apply? If yes, then apply to rating at Step 11.
- Step 13: Determine the Quality of Life rating.
- Step 14: Add the ratings at Step 12 and Step 13.
- Step 15: If partial entitlement exists, apply to rating at Step 14.
This is the Disability Assessment for mandible and maxilla conditions.