Getting the Most Out of VA Disability Claims Involving the Spine – Part 1
Claims involving the spine, both the cervical spine and the thoracolumbar spine, are rated under the same general rating formula. The following spinal conditions are all rated under the same general rating formula:
- Lumbosacral or cervical strain (diagnostic code 5237): this would be the diagnostic code assigned to a veteran experiencing pain in their neck or back.
- Spinal stenosis (diagnostic code 5238): 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.
- Spondylolisthesis or segmental instability (diagnostic code 5239): this is a condition that causes one bone in your back (a vertebra) to slide forward over the bone below it. This 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 (diagnostic code 5240): 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 (diagnostic code 5241): 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 surgery is often performed in individuals with spondylolisthesis and spinal stenosis.
- Vertebral fracture or dislocation (diagnostic code 5235): A vertebral fracture occurs when a vertebra becomes compressed due to trauma. 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.
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:
| Cervical Spine | Thoracolumbar Spine | |
| 0% | Flexion ≥45 degrees, OR combined ROM ≥ 340 degrees | Flexion ≥ 90 degrees, OR combined ROM ≥ 240 degrees |
| 10% | Flexion between 30 and 45 degrees, OR combined ROM between 175 and 340 degrees | Flexion between 60 and 90 degrees, OR combined ROM between 125 and 240 degrees |
| 20% | Flexion between 15 and 35 degrees, OR combined ROM ≤ 170 degrees | Flexion between 30 and 65 degrees, OR combined ROM ≤ 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, ROM measurements play a huge role in rating spinal conditions. Because the rating formula is almost entirely based on ROM measurements it is important to make sure that a doctor performs ROM testing as accurately as possible. Also, the VA requires that all ROM measurements be taken with a goniometer. If a doctor doesn’t use a goniometer to measure your ROM, the VA will not consider the results.
In addition to the ROM measurements, the general rating criteria for spinal conditions looks at whether the cervical and/or thoracolumbar spine is frozen in a favorable vs. unfavorable position. A favorable position means the ROM measurement for flexion or extension is 0 degrees. Unfavorable means any position that is not 0 degrees in flexion or extension.
Conditions Secondary to Spinal Conditions
Oftentimes, spinal conditions will cause other conditions that can be rated in their own right. For example, fractured and/or dislocated vertebrae can lead to pain and weakness in the arms, hips, shoulders, etc. People with spinal conditions also often change how they walk to compensate for the pain which can lead to knee and hip problems.
Spinal conditions can also 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 symptoms will be felt 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 secondary conditions would be rated separately from the underlying spinal condition.
