VA Back Pain and Range of Motion Chart Explained
Category: Veterans Disability Law
If you experience back pain from military service, you may be eligible for VA disability compensation. Benefits will vary based on specific factors about your VA disability. Chronic back pain typically results in a higher rating than acute pain, and a smaller range of motion causes more difficulty than the higher range of motion. Understanding VA disability ratings for back pain is the first step to earning the benefits you deserve.
Understanding VA Back Ratings
Your VA disability rating for back injury or spine injury will depend on which code the condition falls under. Diagnostic codes 5235 through 5243 of 38 CFR § 4.71a, Schedule of Ratings, Musculoskeletal System are dedicated to back and neck pain. Some of which are listed below:
- 5235 – Vertebral fracture or dislocation: When one of the spinal bones, or vertebrae, is damaged or shifted out of position causing discomfort or reduced flexibility.
- 5236 – Sacroiliac injury and weakness: Pain in joints connecting the lower spine and pelvis. When one or both sacroiliac joints are inflamed, veterans may receive a sacroiliitis VA disability rating.
- 5237 – Lumbosacral or cervical strain: This diagnostic code applies to veterans experiencing general pain in their cervical or thoracolumbar spine. This is different from the normal wear and tear of spinal discs. There is no lumbar spondylosis VA rating because it’s not connected to active service.
- 5238 – Spinal stenosis VA disability rating: This occurs when the spaces in the spine become more narrow, putting pressure on spinal nerves and causing pain.
- 5239 – VA disability rating for Spondylolisthesis or segmental instability: A condition that causes a vertebra to slide forward over the bone below it. The spinal cord can be squeezed causing pain and numbness in the back or weakness in one or both legs.
- 5240 – Ankylosing spondylitis disability rating: A form of spinal arthritis that causes joint inflammation and results in severe, chronic back pain. This condition can also cause stiffness in other joints around the body.
- 5241 – VA disability rating for spinal fusion: This is a surgery to remedy other spinal conditions by joining two or more vertebrae together to prevent movement. It can cause difficulties in range of motion although it may reduce pain. There is also a lumbar fusion disability rating for individuals who only get surgery in their lower back.
Diagnostic codes 5242 and 5243 are reserved for arthritis and spinal disc conditions.
VA Range of Motion Chart for Back
The code used for back and spine conditions are primarily based on range of motion (ROM) measurements, thoracolumbar strain, and the range of flexion and extension. Ratings will be decided by how much movement can occur around a joint or body part at a VA C&P exam for back pain. There are two separate rating criteria, one for the cervical spine and one for the thoracolumbar spine.
VA Disability Rating for Cervical Spine
The cervical spine is towards the top, so cervical rating criteria also cover VA disability rating for neck pain or cervicalgia VA rating. Compensation will be decided on the following measurements:
- 0 percent rating: Flexion greater than or equal to 45 degrees, OR a combined ROM greater than or equal to 340 degrees
- 10 percent rating: Flexion between 30 and 45 degrees, OR a combined ROM between 175 and 340 degrees
- 20 percent rating: Flexion between 15 and 35 degrees, OR a combined ROM less than or equal to 170 degrees
- 30 percent rating: Flexion less than or equal to 15 degrees, OR the entire cervical spine is being stuck in a favorable position
- 40 percent rating: The entire cervical spine is stuck in an unfavorable position
- 50 percent rating: This rating does not apply to only the cervical spine
- 100 percent rating: The entire spine will not move and is stuck in an unfavorable position
VA Ratings for Functional Impairment of the Thoracolumbar Spine
The rating chart for thoracolumbar spinal pain is used for primary and secondary conditions to lower back pain. The measurements used for determining compensation are as follows:
- 0 percent rating: Flexion is greater than or equal to 90 degrees, OR a combined ROM greater than or equal to 240 degrees
- 10 percent rating: Flexion between 60 and 90 degrees, OR a combined ROM between 125 and 240 degrees
- 20 percent rating: Flexion between 30 and 65 degrees, OR a combined ROM less than or equal to 120 degrees, the minimum scoliosis percent for a scoliosis VA rating.
- 30 percent rating: This rating cannot be applied to the thoracolumbar spine
- 40 percent rating: Flexion less than or equal to 30 degrees, or the entire thoracolumbar spine is stuck in a favorable position
- 50 percent rating: The entire thoracolumbar spine is stuck in an unfavorable position, also called unfavorable ankylosis of the entire thoracolumbar spine.
- 100 percent rating: The entire spine will not move and is stuck in an unfavorable position
VA Compensation and Pension (C&P) Exams for Back Pain
To help the VA determine VA disability ratings for back pain, a compensation and pension (C&P) exam is usually required. This is where a VA-approved medical professional will perform a comprehensive physical and verbal examination then write their opinion on your condition. The practitioner will assess how far you can bend and flex your joints during the range of motion C&P exam.
While the ROM test is the primary factor in determining VA ratings for back and spine conditions, there are also other portions included in the C&P exams. For example, the VA compensation exam for lower back pain might include a disability benefits questionnaire (DBQ). Back thoracolumbar spine conditions can have a significant effect on an individual’s life, a DBQ allows the veteran to go into detail about how the condition has impacted their life.
Attending a C&P exam with a medical professional can also potentially help you discover the presence of secondary conditions you were unaware of.
VA Secondary Spinal Conditions
The spine can affect every other part of your body. Certain spinal conditions can lead to other conditions that can be claimed for an additional rating. Some injuries to the spine might cause weakness in areas such as the arms, shoulders, or hips. Other spinal conditions cause people to change how they walk, which can lead to leg and knee issues. A common secondary condition to spinal conditions is also nerve damage or issues.
Radiculopathy is a nerve condition caused by compressed nerves in the spine, resulting in weakness, numbness, or pain along the nerve. The VA rating for radiculopathy in the lower back will be based on symptoms felt in their lower limbs, such as feet, calves, or thighs. The VA rating for cervical radiculopathy is determined based on symptoms in the shoulder, arm, and hand.
If a veteran can prove that their service-connected spinal condition was the primary cause of the secondary condition, they may qualify as having a secondary service-connection condition. This allows the veteran to get a separate rating from the spinal condition that could potentially increase monthly compensation.
VA Disability Rating for Arthritis in Back and Spine
Some spinal conditions are rated by a different rating formula. The VA rates conditions such as traumatic arthritis, degenerative arthritis, and rheumatoid arthritis under separate systems. Rheumatoid has its own, while degenerative and traumatic arthritis uses the same formula.
The first type of arthritis with its own rating formula is rheumatoid arthritis. This disease destroys joints in the body. While most common in smaller joints, it can affect any joint. When afflicting the spine, rheumatoid arthritis is less likely to cause lower back pain than chronic neck pain. VA disability ratings are decided through diagnostic code 5002 based on the frequency of episodes that incapacitate those affected. The ratings for rheumatoid arthritis are as follows:
- 20 percent rating: Veteran experiences less than 3 incapacitating episodes in a year
- 40 percent rating: Veteran experiences 3 or more incapacitating episodes in a year and shows a clear decrease in health
- 60 percent rating: Veteran experiences severely incapacitating episodes at least 4 times in a year
- 100 percent rating: Veteran is confined to bed and completely incapacitated
If the rheumatoid arthritis is not severe enough to meet the criteria of diagnostic code 5002, it will be rated according to specific symptoms detailed in code 5003.
Traumatic and Degenerative Arthritis
Traumatic arthritis is joint damage, pain, or inflammation due to an injury. If an individual’s joints begin causing problems after excessive movement or physical trauma, their arthritis will not be considered chronic.
Degenerative arthritis refers to a chronic breakdown of cartilage around joints. The joints between vertebrae are called facets. When facet joints are damaged, veterans experience facet arthropathy. The VA rating for facet arthropathy can contribute to the VA rating for degenerative arthritis of the spine.
Both of these forms of arthritis are rated under code 5003. Each specific joint will also have its own identifying arthritis code. For example, degenerative arthritis of the spine is listed under diagnostic code 5242, meaning decisions regarding degenerative arthritis of the spine will reference the condition as 5242-5003.
Spinal Disc Conditions
Along with degenerative arthritis, diagnostic code 5242 is also used to decide the VA disability rating for degenerative disc disease. This condition refers to back or neck pain caused by the general breakdown of spinal discs. The maximum disability rating for degenerative disc disease VA compensation is 20 percent without any additional secondary conditions. Diagnostic code 5242 covers all degenerative disc diseases other than intervertebral disc syndrome.
Intervertebral disc syndrome is rated under VA diagnostic code 5243. The intervertebral disc syndrome category comprises bulging disc and herniated disc syndrome. A VA disability rating for a bulging disc is given when the fibrous ring on a disc becomes deformed and causes symptoms. This can be as simple as flexibility loss or as severe as nerve pain throughout the body.
A veteran will receive a herniated disc disability rating if a bulging disc is left untreated and the inner nucleus pushes out of the disc into the spinal canal nerves. Both the bulging and herniated disc disability percentage depends on the number of incapacitating episodes the condition brings on.
Proving VA Service Connection for Your Back or Spine Condition
Similar to the majority of VA disability claims, to earn VA disability ratings for back pain you must provide three main pieces of evidence:
- A current diagnosis from a medical professional of the condition you are currently filing a claim for.
- Proof of an inciting event that you believe to have caused the condition you are currently filing a claim for.
- A medical nexus or statement that connects the military event or experience to your current diagnosis. This should be presented as a statement of opinion from a medical professional.
After gathering this information and attending a C&P exam, you will receive a disability rating from the VA in the form of a percentage.
Available VA Benefits for Back Pain or Spinal Conditions
Your assigned VA disability rating for back pain determines the benefits you receive. Based on percentage, you could earn anywhere between a few hundred and a few thousand dollars monthly. On top of monthly financial compensation, certain disabilities are eligible for additional benefits such as clothing allowances. This is money on top of the monthly benefits that allow you to purchase clothing, items, or accessories that may be necessary to continue your everyday life. For example, VA compensation for a back brace, wheelchair, or crutches.
Although it is unlikely to receive a 100 percent VA disability rating for back pain, it is possible to earn full compensation if your condition prevents you from working.
TDIU Benefits for Pain in the Lower Back
TDIU, or total disability based on individual unemployability, occurs when a veteran is unable to work as a direct result of their service-connected disability or condition. If a veteran’s lower back pain prevents them from securing and keeping substantially gainful employment they may be eligible for TDIU benefits paid at a 100 percent disability rate.
Contact Tuley Law Office
Building and presenting a VA disability claim to the VA can be an arduous and difficult process. The veteran’s affairs legal team at Tuley Law Office have the knowledge and skills to guide you through the VA’s dense language and often vague expectations.
If you or someone you know is experiencing back pain as a result of their time in the military, contact us today to schedule a consultation.
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