Home › Conditions › Secondary claims › TMJ ← PTSD
A secondary claim is a condition caused or worsened by one the VA has already service-connected (38 CFR 3.310). The causation fight is already half-won — the VA agreed your ptsd came from service; the question is only whether it caused or aggravated the tmj. That's a medical question with a recognized answer.
The connection
Chronic clenching and nighttime grinding (bruxism) are classic physical expressions of hyperarousal, and over years they damage the temporomandibular joint. A dentist documents the wear and the joint dysfunction; the connection to a service-connected mental health condition is the nexus — a pairing raters encounter regularly.
How the VA rates tmj
DC 9905 — Temporomandibular disorder (TMD)
| Rating | Criteria (38 CFR Part 4 wording) |
|---|---|
| 50% | 0 to 10 mm of maximum unassisted vertical opening with dietary restrictions to all mechanically altered foods |
| 40% | 0 to 10 mm without dietary restriction; or 11 to 20 mm with dietary restrictions to all mechanically altered foods; or 21 to 29 mm with dietary restrictions to full liquid and pureed foods |
| 30% | 11 to 20 mm without dietary restriction; or 21 to 29 mm with soft and semi-solid foods; or 30 to 34 mm with full liquid and pureed foods |
| 20% | 21 to 29 mm without dietary restriction; or 30 to 34 mm with soft and semi-solid foods |
| 10% | 30 to 34 mm of maximum unassisted vertical opening without dietary restriction; or lateral excursion range of motion 0 to 4 mm |
Normal maximum unassisted vertical jaw opening is 35 to 50 mm. Ratings for limited interincisal movement are not combined with ratings for limited lateral excursion. A texture-modified diet must be recorded or verified by a physician to count.
Full criteria, exam and evidence guide: VA rating for TMJ. And the anchor: VA rating for PTSD, Depression and Anxiety.
What the claim needs — the three legs
- The anchor: service connection for the ptsd (see how that condition is rated). Not connected yet? File both in the same claim — the VA decides the anchor first, then the secondary against it.
- A current diagnosis of tmj — the VA rates diagnosed conditions. If you only have the symptoms, file them anyway: the C&P exam supplies the diagnosis, and a "no diagnosis" denial is repaired with a supplemental claim that keeps your date.
- The medical link. An opinion stating it is "at least as likely as not" that the ptsd caused or aggravated the tmj. The VA's own C&P examiner supplies this free in most cases; your own doctor can too. A paid independent opinion is the answer to a denial, not the first move.
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See If You Qualify →Frequently asked questions
Can I claim tmj secondary to ptsd?
Yes, if three things hold: the ptsd (or its equivalent) is service-connected, you have a current diagnosis of tmj, and a medical opinion connects the two. The connection described on this page is a recognized pathway raters see regularly.
Do I need to pay for a nexus letter for tmj secondary to ptsd?
Usually not. The VA's own C&P examiner can supply the connecting opinion at your exam for free, and your own treating doctor can also provide it. A paid independent opinion is worth buying only after a denial for lack of nexus — a supplemental claim within one year keeps the original effective date.
What if the primary condition isn't service-connected yet?
File them together in the same claim. The VA decides the primary first and then the secondary against it in the same decision; a secondary filed alone against a condition the VA has not connected fails. Filing both at once under one Intent to File protects the effective date for both.
Last reviewed 2026-09-19.