Medication-Related Osteonecrosis of the Jaw (MRONJ)

DC 9913Dental/Oral38 CFR 4.150, DC 9913

Death of jaw bone tissue caused by medications, most commonly bisphosphonates (used to treat osteoporosis) or anti-cancer drugs. This causes exposed bone in the mouth, pain, infection, and difficulty eating.

How the VA rates this condition

The VA rates this condition based on the type and intensity of treatment you require. Higher ratings correspond to more aggressive treatment regimens, such as daily medication, insulin dependence, or the need for ongoing medical management.

Diagnostic code

DC 9913

Rating range

10% – 50%

Rating levels

Rating criteria are defined in 38 CFR 4.150, DC 9913. This guide presents a plain-language summary and is not a substitute for the full regulatory text. Always consult a VSO or VA-accredited attorney for case-specific advice.

Rating Levels

You have severe, extensive jaw bone necrosis requiring major jaw reconstruction, or you have refractory disease that has not responded to multiple surgeries, with severe functional impairment of eating and speaking.

What the VA looks for

Major jaw reconstruction surgery
Refractory disease despite multiple interventions
Severe functional impairment of eating
Speech impairment documented
Chronic pain requiring ongoing management
Significant disfigurement

Common Pitfalls

⚠Not documenting the specific medication that caused the osteonecrosis — if bisphosphonates or anti-cancer drugs were prescribed by VA or military providers, this directly establishes service connection.
⚠Not getting staging documented — MRONJ has defined stages (0-3) and the stage directly correlates to rating severity. Ask your oral surgeon to stage the condition.
⚠Not filing for secondary conditions — tooth loss from MRONJ can be rated separately under DC 9913, and jaw fractures under DC 9904.
⚠Not continuing to document the condition even after surgery — MRONJ has high recurrence rates, and new areas of necrosis support maintained or increased ratings.

Related DBQ Forms

DBQ Dental and Oral Conditions

View evidence checklist →See secondary conditions →

Condition Rating Guides

Understand what the VA looks for at each rating level — loading conditions…

How the VA rates this condition

Diagnostic code

DC 9913

Rating range

10% – 50%

Rating levels

Rating Levels

What the VA looks for

Major jaw reconstruction surgery
Refractory disease despite multiple interventions
Severe functional impairment of eating
Speech impairment documented
Chronic pain requiring ongoing management
Significant disfigurement

Common Pitfalls

⚠Not documenting the specific medication that caused the osteonecrosis — if bisphosphonates or anti-cancer drugs were prescribed by VA or military providers, this directly establishes service connection.

⚠Not getting staging documented — MRONJ has defined stages (0-3) and the stage directly correlates to rating severity. Ask your oral surgeon to stage the condition.

⚠Not filing for secondary conditions — tooth loss from MRONJ can be rated separately under DC 9913, and jaw fractures under DC 9904.

⚠Not continuing to document the condition even after surgery — MRONJ has high recurrence rates, and new areas of necrosis support maintained or increased ratings.