What is Spinal Stenosis?
Spinal stenosis is a medical condition in which the passages through which your nerves travel through your spine become narrow or partially blocked. This impinges on the nerves themselves, which can cause pain, tingling numbness, and muscle weakness. In severe cases, it can lead to myelopathy, paralysis, bladder and bowel incontinence or retention, headaches, and other debilitating symptoms.
Stenosis can occur in the spinal column itself, or it can occur within the intervertebral foramen, which are the passages through which your nerve roots branch out laterally through the spine. When these lateral nerve roots become compressed, it can disrupt the signals passing from your brain and spinal column out through the nerve roots to your arms, legs, and other parts of your body – a condition called foraminal stenosis, which can cause radiculopathy.
If your spinal stenosis or foraminal stenosis is service-connected, or if your condition was aggravated because of your military service, you may qualify for VA disability compensation.
Other spinal conditions
Your spinal stenosis may be accompanied by other back conditions, including degenerative disc disease, arthritis, ankylosis or ankylosing spondylitis. This condition causes small bones in your spine to fuse in place to one another, sometimes resulting in significant range-of-motion loss.
VA Disability Ratings for Spinal Stenosis
The VA disability rating system for spinal stenosis is the same general formula as for other similar spinal conditions, including:
- Lumbosacral or cervical strain (diagnostic code 5237) – used to refer to neck or back pain,
- Spondylolisthesis/segmental instability (diagnostic code 5239) refers to a condition that causes vertebrae to slip forward over the vertebrae below it.
- Ankylosing spondylitis (diagnostic code 5240) – a painful type of spinal arthritis
- Spinal fusion (diagnostic code 5241) refers to a surgical technique in which the vertebrae are bolted to each other to restrict movement.
- Vertebral fractures and dislocations (diagnostic code 5235).
If the VA determines your spinal stenosis is service-connected, you will receive a disability rating between 0% and 100%. The rating will largely depend on whether you have lost range of motion as a result of stenosis.
Favorable position means your spine is locked but more or less vertical, so you can still sit at a desk chair, for example. An unfavorable position means your spine is locked in a position that is something other than vertical.
Measuring range of motion
VA physicians will measure your range of motion in six places, using a goniometer. They will have you move, twist, or turn as far as you can without reaching your limit or experiencing significant pain and note the degrees of movement you can manage.
The sum of all these degree measurements together is called the ROM (range of motion) measurement. This metric is used in calculating your VA disability rating.
If your spine is locked in an unfavorable position, you may qualify for a relatively high disability rating – as high as 100%. If your spine is locked, but it’s in a favorable condition, your disability rating may be as low as 30% or 40%
If your back is not frozen, VA doctors will base their assessment on how much range of motion you have left, which they will measure with a goniometer.
To qualify for a 100% rating for stenosis, you would have to have severe ankylosis across your entire spine, locking your spine in an unfavorable condition, unless you have one or more severe secondary conditions.
Spinal Stenosis VA Rating Formula
The general rating formula for spinal stenosis and the other spinal conditions listed above is as follows:
General Rating Formula – Spinal Stenosis and Select Spinal Conditions
|VA Disability Rating%||Cervical Spine (neck)||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 150 and 240 degrees|
|20%||Flexion between 15 and 35 degrees, OR combined ROM ≤ 170%||Flexion between 30 and 60 degrees OR combined ROM of ≤ 120%|
|30%||Flexion measures 15 degrees or less, OR entire cervical spine is frozen in a favorable position.|
|40%||Entire cervical spine is frozen in an unfavorable position.||Flexion measures 30 degrees or less, OR entire thoracolumbar spine is frozen in a favorable position.|
|50%||Entire thoracolumbar spine is frozen in an unfavorable position.|
|100%||Entire spine is frozen in an unfavorable position.|
Total Disability Based On Individual Unemployability
You may also qualify for a 100% rating if your back injury renders you unemployable. This would qualify you for a total disability individual unemployability, as defined by 38 CFR 4.16.
To qualify for the total unemployability disability benefit, you must meet two distinct criteria:
- You cannot do your prior occupation, and;
- You are unable to keep and maintain a job in the greater national economy due to your service-connected disability.
Note that there’s a significant difference in monthly disability benefits between a 40% disability rating and a 100% disability rating. A single veteran with no dependents and a total disability rating of 40% would receive $627.61 per month, as of 2020. The same veteran with a 100% disability rating would receive $3,106.04.
Disability Benefits by Percentage Rating and Dependent Status (As of 2020)
|Dependent status||30% disability rating||40% disability rating||50% disability rating||60% disability rating|
|Veteran alone (no dependents)||435.69||627.61||893.43||1,131.68|
|With spouse (no parents or children)||486.69||696.61||979.43||1,234.68|
|With spouse and 1 parent (no children)||527.69||751.61||1,048.43||1,317.68|
|With spouse and 2 parents (no children)||568.69||806.61||1,117.43||1,400.68|
|With 1 parent (no spouse or children)||476.69||682.61||962.43||1,214.68|
|With 2 parents (no spouse or children)||517.69||737.61||1,031.43||1,297.68|
|Dependent status||70% disability rating||80% disability rating||90% disability rating||100% disability rating|
|Veteran alone (no dependents)||1,426.17||1,657.80||1,862.96||3,106.04|
|With spouse (no parents or children)||1,547.17||1,795.80||2,017.96||3,279.22|
|With spouse and 1 parent (no children)||1,644.17||1,906.80||2,142.96||3,418.20|
|With spouse and 2 parents (no children)||1,741.17||2,017.80||2,267.96||3,557.18|
|With 1 parent (no spouse or children)||1,523.17||1,768.80||1,987.96||3,245.02|
|With 2 parents (no spouse or children)||1,620.17||1,879.80||2,112.96||3,384.00|
Causes of Spinal Stenosis
Causes can include herniated or bulging spinal discs. This occurs when the soft tissue discs between segments of the spine become displaced and are squeezed into the spinal nerve canal or into the ventral nerve roots. Other causes include tumors and lesions, enlargement of facet joints, thickened ligaments, injuries that cause displacement of vertebrae, vertebral fractures, and rheumatoid arthritis, which can cause bone spurs.
Stenosis is most common in the cervical area (the neck) and the lower back (lumbar) area, with lumbar stenosis being the most common form of this condition. Less frequently, stenosis can occur in the upper back (thoracic).
You should see a doctor if you are experiencing severe back pain, weakness, numbness or loss of control of an extremity, “foot drop,” bowel and/or bladder problems, or numbness in your saddle area.
Spinal Stenosis Diagnosis and Treatment
If spinal stenosis is suspected, your doctor may order X-rays, magnetic resonance imaging (MRI), and/or CT or CT myelogram. The latter two will show whether soft tissue may be impinging or invading the spinal cord area.
In many cases, symptoms resolve themselves with rest, physical therapy, exercise, and anti-inflammatories. If these conservative options don’t get results, your doctor may recommend injecting a corticosteroid into your spine, which can give you relief for a few days or weeks.
In severe cases, or where the use of conservative treatment options just isn’t effective for you, you and your doctors may consider surgery.
Your spinal stenosis may cause or contribute to other medical conditions, as well. These complications of stenosis are called secondary conditions, which may qualify you for a higher rating.
Examples of secondary conditions that may arise as complications of stenosis include radiculopathy, neurogenic bladder, and knee and hip problems caused by walking difficulties due to stenosis.
If your service-related stenosis causes a secondary condition, that condition would be rated separately by the VA. It may result in a higher rating, and therefore a greater monthly disability compensation amount.
To collect VA disability compensation benefits, you must show that your spinal stenosis disability claim was caused or aggravated by your military service.
The three elements needed to make a successful service connection claim include:
- Evidence of diagnosis of your spinal stenosis while you were in the military;
- Information about an occurrence or an incident that occurred while you were serving led to the injury or aggravation of this injury;
- Medical nexus – a medical description that connects the diagnosed stenosis with the particular occurrence that is said to lead to it.
When assessing your disability claims, VA examiners will look at your medical records during your time in the military and for a period afterward for evidence of a service connection. There’s no presumptive benefit – the burden is on the veteran to demonstrate a service connection to the stenosis.
Secondary service connection
You may also be able to show your spinal stenosis is service-related via a secondary service connection. That is, your stenosis wasn’t diagnosed at the time, but it likely came about as a result of an injury or illness that has been established as service-connected.
For example: Suppose you were diagnosed with whiplash as a result of a Humvee accident while you were in the service. Later you develop a spinal stenosis in your neck (cervical) area. Your VA doctor may conclude that your spinal stenosis is service-connected because of this pre-existing whiplash and disk herniation.
If your MRIs don’t show a significant stenosis, but you are experiencing severe back pain that still inhibits your ability to work, and you have intervertebral disc syndrome, you may be able to get a higher rating due to incapacitating episodes. These are periods of acute pain severe enough for a doctor to proscribe bed rest.
The VA awards disability ratings for incapacitating episodes as follows:
- 60% – for incapacitating episodes totaling at least 6 weeks during the past 12 months;
- 40% – for incapacitating episodes totaling at least 4 weeks but less than 6 weeks during the past 12 months;
- 20% – for incapacitating episodes totaling at least 2 weeks but less than 4 weeks during the past 12 months;
- 10% – for incapacitating episodes having a total duration of at least one week but less than 2 weeks during the past 12 months.
Your Compensation & Pension Exam
You may be asked to take a compensation & pension exam (C&P exam). At these exams, you can expect your doctor to ask you questions about your background and medical history, evaluate your symptoms and range of motion.
Over time, you will attend additional annual exams at an area SCI Center. These exams are called comprehensive preventive health evaluations (CPHE) or “wellness checks.”
Your doctors will also discuss ongoing treatment and support needs, physical and occupational therapy, and try to identify and treat any worsening symptoms or functions.
Many people with spinal stenosis and other back injuries experience anxiety, depression, and substance abuse problems. You can talk these problems over with your physician, as well. If severe enough, anxiety and depression arising from a service-related condition may also qualify for an additional disability rating.
To continue receiving VA disability benefits, you should be compliant with these exams.
Why you may need a veterans disability attorney
The VA routinely mishandles spinal injury claims. A 2019 Inspector General report found that the VA processed the majority of the 62,500 spinal injury claims decided in the first half of 2018. That is, they get it wrong more than half the time.
Common processing errors include:
- Improper evaluations
- Missed secondary conditions
- Evaluations based on inadequate exams
These mistakes cost veterans at least $5.9 million in payments over the period studied.
If you believe you may have been wrongly denied benefits, you may benefit from the services of a VA disability lawyer. At Hill & Ponton, we have helped thousands of veterans successfully resolve their disability claims with the VA. For a free, confidential, no-obligation evaluation of your case, contact us today.