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If you experienced a back injury during active duty, or an injury that later contributed to back pain, you may be eligible for disability benefits. As with most medical conditions, the VA disability rating for back pain depends on a variety of factors. This guide will break down how the VA rates back pain and spinal disabilities, so you can take the first steps toward making a claim.
Range of Motion Chart for Back Disability VA uses
The general rating formula that is used to rate the conditions listed above is mainly based on range of motion (ROM) measurements. The cervical spine (neck) and the thoracolumbar spine (low back) are rated according to the following criteria:
| Rating | Cervical Spine | Thoracolumbar Spine |
|---|---|---|
| 0% | Flexion ≥45 degrees, OR combined Range of Motion ≥ 340 degrees | Flexion ≥ 90 degrees, OR combined Range of Motion ≥ 240 degrees |
| 10% | Flexion between 30 and 45 degrees, OR combined Range of Motion between 175 and 340 degrees | Flexion between 60 and 90 degrees, OR combined Range of Motion between 125 and 240 degrees |
| 20% | Flexion between 15 and 35 degrees, OR combined Range of Motion ≤ 170 degrees | Flexion between 30 and 65 degrees, OR combined Range of Motion ≤ 120 degrees |
| 30% | Flexion ≤ 15 degrees, OR entire cervical spine is frozen in a favorable position | Not applicable to thoracolumbar spine |
| 40% | Entire cervical spine is frozen in an unfavorable position | Flexion ≤ 30 degrees, OR entire thoracolumbar spine is frozen in a favorable position |
| 50% | Not applicable to cervical spine | Entire thoracolumbar spine is frozen in an unfavorable position |
| 100% | Entire spine is frozen in an unfavorable position | Entire spine is frozen in an unfavorable position |
As you can see, Range of Motion measurements plays a significant role in rating spinal conditions. Because the rating formula is almost entirely based on the VA’s range of motion chart and measurements, it’s important to make sure that a doctor performs a range of motion testing according to the VA’s chart as accurately as possible. Also, the VA requires that all range of motion measurements be taken with a goniometer. If a doctor doesn’t use a goniometer to measure your range of motion, the VA will not consider the results.
In addition to the range of motion measurements, the general rating criteria for spinal involve whether the cervical and/or thoracolumbar spine is frozen in a favorable vs. unfavorable position. A favorable position means the range of motion measurement for flexion or extension is 0 degrees. Unfavorable means any position that is not 0 degrees in flexion or extension.
Understanding Back Pain VA Ratings
Claims involving both the cervical spine and the thoracolumbar spine are rated under the same general rating formula. Below, we compiled all of the current diagnostic codes that are used by the Department of Veterans Affairs in the rating schedule for each of the back disabilities that may qualify for VA disability benefits. Keep in mind that for both, the more medical records or medical evidence that you have, the better chances you receive compensation and pension.
Lumbosacral or Cervical Strain VA Ratings
Lumbosacral or cervical strains are under VA diagnostic code 5237 in the VA rating schedule VA uses. This would be the diagnostic code typically assigned to the veteran experiencing pain in their neck or back.
Spinal stenosis VA Ratings
Spinal stenosis is in the VA rating schedule under diagnostic code 5238 that VA uses. Spinal stenosis is when the spaces in the spine are narrowed and cause pressure on the spinal cord and nerves. Frequently, spinal stenosis is present in the low back but can be present in the cervical spine area as well. Check out our spinal stenosis blog here!
Secondary Conditions Related to Back Pain
Oftentimes, spinal conditions will cause other disabling conditions in a different body part that could qualify a veteran for an additional rating due to secondary service connection. For example, fractured and/or dislocated vertebrae frequently lead to pain and weakness in the arms, hips, shoulders, etc. This could also lead to functional loss if the initial condition and pain is severe enough. People with spinal conditions like Degenerative Disc Disease and more also often change how they walk to compensate for the pain which can lead to even more orthopedic problems like issues with knee and hip problems.
Spinal conditions are also known to sometimes cause nerve problems. One of the most common conditions secondary to spinal conditions is radiculopathy. Radiculopathy is caused by compressed nerves in the spine and results in pain, numbness, tingling, or weakness along the nerve. If radiculopathy is caused by a low back condition, the individuals will feel the symptoms in the lower extremities (thigh, calf, foot). If radiculopathy is caused by a neck condition, the symptoms will be felt in the shoulder and can travel down the arm and into the hand.
If your spinal condition results in the development of a new disability or makes an existing disability worse, remember that you may be entitled to secondary service-connection for the new or aggravated disability. These conditions under the secondary rating disabilities would be rated separately from the primary spinal condition.
What to expect at a C&P Exam for Lower Back and Back Pain
The 2010 Global Burden of Disease study reported that low back pain is now the number one cause of years lost to disability worldwide. Veterans that are seeking compensation for a low back disability are limited, most of the time, to a maximum of 40% rating based on the limitation of motion of their spine. A higher rating is granted only if the thoracolumbar or the entire spine is ankylosed, which occurs when the bones fuse and the joints become stiff, basically, there is no range of motion.
Low back pain has a significant impact on an individual’s ability to work and manage the daily activities of life.
Spondylolisthesis or segmental instability VA Ratings
Segmental instability, also known as spondylolisthesis, is under diagnostic code 5239 that VA uses. This is a condition that causes one bone in your back (a vertebra) to slide forward over the bone below it. The condition can result in the spinal cord or nerve roots being squeezed can cause back pain and numbness, or even weakness in one or both legs.
Ankylosing spondylitis VA Ratings
Ankylosing spondylitis is looked at under diagnostic code 5240 that VA uses. This is a form of spinal arthritis that causes inflammation of the spinal joints and can result in severe, chronic pain. Ankylosing spondylitis can also cause inflammation, pain, and stiffness in the shoulders, hips, ribs, heels, and small joints of the hands and feet.
Spinal fusion VA Ratings
Spinal fusion is a type of surgery that is performed to join two or more vertebrae together so that there is no movement between the two vertebrae. This is rated under diagnostic code 5241. This surgery is often performed in individuals with spondylolisthesis and spinal stenosis.
Vertebral fracture or dislocation VA Ratings
These sorts of fractures are under VA diagnostic code 5235. A vertebral fracture occurs when a vertebra becomes compressed due to trauma. Vertebral fractures are common among veteran’s disability claims due to the physical exertion that most active-duty soldiers experience.
Typically, a vertebral fracture results in symptoms such as limited spinal mobility, and standing/walking will make the pain worse while lying down on the back makes the pain better. A vertebral dislocation is when one of the small vertebrae in the neck is displaced following a traumatic injury to the head or neck. Symptoms of a vertebral dislocation include pain that spread into the shoulder and arms, tingling or numbness in the arm, muscle spasms in the neck, and weakness in the arms. Veterans’ benefits for vertebral fractures can lead to significant VA disability compensation and should not be ignored.
How VA Rates Spinal Arthritis & Back Pain
In order to ensure that you’re getting the most out of your disability claim, you need to understand how the VA rates your condition. Errors are frequently made when rating conditions. The VA not only makes mistakes in evaluating the severity of a condition, but sometimes they evaluate a condition according to the completely wrong rating criteria, even excluding test results.
With this in mind, it’s important to know which spinal conditions are not rated under the general rating formula because your eligibility could be directly impacted. The VA has a separate rating system for these conditions. Some of the conditions included in this category are degenerative arthritis, traumatic arthritis, and rheumatoid arthritis, all of which can be identified by a VA doctor.
The rating system used for arthritis of the spine is the second most common rating system for spine conditions. There are two types of arthritis that are rated under the same rating system; degenerative arthritis, and traumatic arthritis. Rheumatoid arthritis is rated under its own rating system.
VA disability Benefits for Degenerative And Traumatic Arthritis
Degenerative arthritis is the chronic breakdown of the cartilage surrounding the joints. Degenerative arthritis of the spine; sometimes referred to as facet joint osteoarthritis, causes a breakdown of the cartilage between the facet joints in the back of the spine. Lack of cartilage causes pain and limitation of motion.
Traumatic arthritis occurs after an injury, excessive movement, or other physical trauma. Traumatic arthritis causes symptoms similar to other types of arthritis such as pain, inflammation, and build-up of fluid around the affected joint.
Both degenerative arthritis and traumatic arthritis, regardless of the joint affected, are rated under diagnostic code 5003. Depending on what joint is affected, there will be an identifying diagnostic code assigned to the condition. For example, the specific code for degenerative arthritis of the spine is 5242. However, the VA still rates degenerative arthritis of the spine under the criteria listed for diagnostic code 5003. Because there are technically two diagnostic codes associated with one condition, you would see the condition listed on rating decisions as 5242-5003.
What is the diagnostic code for traumatic arthritis?
The diagnostic code for traumatic arthritis is 5010. So if a veteran has traumatic arthritis in his spine, the final diagnostic code would appear as 5010-5003. Think of the first number as an identifying diagnostic code that tells you what joint is affected, while the second diagnostic code tells you the rating system the condition is being rated under.
Keep in mind that arthritis will only be rated under diagnostic code 5003 when the condition does not result in severe enough limitation of motion to be rated under the general rating formula for the spine. If there is decreased range of motion of the cervical or thoracolumbar spine, the condition would be rated according to the general rating formula for the spine that is based on the range of motion measurements. There must be x-rayed evidence of arthritis in the cervical or thoracolumbar joints for the VA to rate a spinal condition under the code for degenerative arthritis.
As mentioned above, many different joints are rated under the rating criteria for degenerative arthritis. This includes the shoulder, wrist, elbow, hip, knee ankle, fingers, toes, spine, and the sacroiliac joint. Some joints are referred to as major joints, while others are referred to as minor joints. The spine is considered as a minor joint. The rating assigned under the rating criteria for degenerative arthritis depends on how many joint groups are affected and whether there is painful motion. If two or more major OR minor groups are affected a 20% rating will be assigned if the arthritis is occasionally incapacitating.
If the arthritis does not cause any episodes of incapacitation, but 2 or more joint groups are involved, then a 10% rating will be assigned. If a veteran only has one joint group affected by arthritis then there must also be painful motion present in order for a rating higher than 0% to be assigned. If there is painful motion, a 10% rating will be assigned. For example, if a veteran has degenerative arthritis of the spine with no other joints affected, and he experiences pain when bending over he will receive a 10% rating.
VA benefits for Rheumatoid Arthritis and Back Pain
Rheumatoid arthritis is a disease that causes the destruction of the joints in the body. Although this type of arthritis is most common in the small joints of the hands and feet, it can occur in any joint. When rheumatoid arthritis affects the spine, it typically occurs in the cervical spine (the neck) rather than the thoracolumbar spine (the low back). Rheumatoid arthritis of the spine leads to neck pain, back pain, and sometimes causes pain to radiate into the arms and legs. Symptoms are similar to the symptoms involved with degenerative arthritis and include pain and swelling of the joints.
The diagnostic code for rheumatoid arthritis is 5002. The VA assigns rating percentages based on the frequency of incapacitating episodes caused by the health condition. The following percentages are available under the rating criteria for rheumatoid arthritis:
- 100% VA rating for Rheumatoid Arthritis: if you are completely incapacitated and are confined to staying in bed
- 60% VA rating for rheumatoid arthritis: if there are severe incapacitating episodes that occur 4 or more times per year
- 40% VA rating for rheumatoid arthritis: if there are incapacitating episodes that occur 3 or more times per year if there is a definite (but not necessarily significant) decrease in health
- 20% VA Rating for rheumatoid arthritis: if there are less than 3 incapacitating episodes per year
It’s possible for rheumatoid arthritis to be rated under diagnostic code 5003 like degenerative and traumatic arthritis. If the condition is not severe enough to meet the above criteria or affect daily life, then the VA rating for back pain/arthritis will be based on specific symptoms. For example, if rheumatoid arthritis of the spine results in pain with motion and can be shown through a medical exam, the condition will be rated according to the criteria set forth in 5003 as described above.
When pursuing a VA disability rating for back pain, it’s important to know your options and seek legal advice whenever necessary. Keep in mind that a veterans disability law firm can work with you to build a claim for a higher rating and to ensure you understand the claims process as well as how a disability evaluation takes place.
