Back, Neck and Spine Problems
Back disabilities are among the most common problems veterans face coming out of the military. The VA, unfortunately, makes it tough to get a fair rating for back injuries. However, there are strategies for maximizing the compensation you deserve. Knowing the way the VA approaches back and spine disabilities is a good start.
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What follows is a summary of the most common ways the VA rates back conditions. For an even deeper dive into the VA’s rating system, please refer to the VA’s ratings codes.
The VA identifies several specific back conditions in its diagnostic codes is uses to rate disabilities: Vertebral fracture or dislocation (DC 5235), Sacroiliac injury or weakness (DC 5236), Lumbosacral or cervical strain (DC 5237), Spinal stenosis (DC 5238), Spondylolisthesis or segmental instability (DC 5239), Ankylosing spondylitis (DC 5240), Spinal fusion (5241), Degenerative arthritis of the spine (DC 5242), and Intervertebral disc syndrome (DC 5243). However, for many other diagnosed back conditions, including disabling pain, the VA will provide a rating by analogy, where the VA picks the diagnostic code it believes it matches most. Therefore, for all kinds of back sprains, strains, pains, stenosis or narrowing of the spinal canal, herniated, slipped and bulging discs, facet atrophy, degenerative disc disease (DDD), — the VA will most likely seek to apply the following ratings.
Range of Motion Testing
Much of the time, but not always, the VA will rate any medical condition involving your spine based on “range of motion.” This means that the VA will ask you to attend a compensation and pension exam where the examiner will attempt to measure how well you can bend and straighten your back. Range of motion testing does not often produce results higher than 40-percent.
The VA views your back as two different pieces — your neck (cervical spine), and then all of the rest (lumbar and thoracic spine, a.k.a. “thoracolumbar”). Typically you can receive separate ratings for your neck and your thoracolumbar spine.
As with all joints, the VA initially will seek to rate you based on limitation to how you can move the joint. (Section 4.45). But the VA’s regulations instruct it to also consider if your joints have more movement than normal, weakened movement, excess fatigability (gets tired out quickly), incoordination, and pain on movement. The VA considers your cervical spine to be a group of minor joints, and your lumbar spine to be a different group of minor joints.
Thoracolumbar Spine Range of Motion — your middle and lower back.
For the thoracolumbar spine, here are the range-of-motion ratings:
100-percent: Unfavorable ankylosis of the entire spine (thoracolumbar and cervical).
50-percent: Unfavorable ankylosis of the thoracolumbar spine.
40-percent Forward flexion of the thoracolumbar spine of 30 degrees or less.
40-percent Favorable ankylosis of the thoracolumbar spine.
20-percent Forward flexion of the thoracolumbar spine 60 degrees or less.
20-percent Combine thoracolumbar spine range of motion of 120 degrees or less.
20-percent Muscle spasm or guarding resulting in abnormal gait.
20-percent Muscle spasm or guarding resulting in abnormal spinal contour.
10-percent Forward flexion greater than 60 degrees but less than 85 degrees.
10-percent Combined range of motion of 235 degrees or less.
10-percent Muscle spasm, guarding or localized tenderness.
10-percent Vertebral body fracture with loss of at least 50 percent height.
For the range-of-motion ratings, the VA considers a “normal” thoracolumbar spine to be able to bend forward from standing straight (0-degrees) to a bow (90-degrees). That means that if you can bend forward as if to tie your shoes, the VA will probably consider you to have normal range of motion for your lower and middle back.
Ankylosis is a medical term that essentially means frozen permanently. If your back is frozen or locked in place, the VA will consider it frozen “favorably” if it is in a “neutral position,” a.k.a. 0-degrees a.k.a. straightened.
The VA mainly pays attention to how far forward you can bend your back. But it will alternatively look at your back’s combined range of motion, adding up how many degrees your back can flex forward, extend, laterally flex left and right, and rotate left and right.
Cervical Spine Range of Motion — your neck.
For the cervical spine, here are the range-of-motion ratings:
100-percent: Unfavorable ankylosis of the entire spine (thoracolumbar and cervical).
40-percent: Unfavorable ankylosis of the cervical spine.
30-percent: Forward flexion of the cervical spine 15 degrees or less.
30-percent: Favorable ankylosis of the cervical spine.
20-percent: Forward flexion of the cervical spine 30 degrees or less.
20-percent: Combined range of motion 170 degrees or less.
10-percent: Forward flexion of the cervical spine 40 degrees or less.
10-percent: Combine range of motion of 335 degrees or less.
10-percent: Vertebral body fracture with loss of at least 50 percent height.
For the range-of-motion ratings, the VA considers a “normal” cervical spine to be able to bend forward from standing straight (0-degrees) to a nod (45-degrees). That means that if you can bend your neck forward enough to see your toes, the VA will probably consider you to have normal range of motion in your cervical spine.
Ankylosis is a medical term that essentially means frozen permanently. If your neck is frozen or locked in place, the VA will consider it frozen “favorably” if is in a “neutral position,” a.k.a. 0-degrees a.k.a. straightened.
The VA mainly pays attention to how far forward you can bend your neck. But it will alternatively look at your neck’s combined range of motion, adding up how many degrees your back can flex forward, extend, laterally flex left and right, and rotate left and right.
IVDS – Intervertebral Disc Syndrome
If your back has been diagnosed with IVDS, then the VA will also consider, as an alternative to range of motion testing, what your rating should be based upon how often you experience “incapacitating episodes” due to IVDS. It is sometimes easier to get a higher rating using the VA’s IVDS incapacitating episodes formula.
The VA defines an “incapacitating episode” as “a period of acute signs and symptoms due to intervertebral disc syndrome that requires bed rest prescribed by a physician and treatment by a physician” To use the IVDS formula productively, then, you must have been diagnosed with IVDS, seeing treatment from a physician for your IVDS, and prescribed bed rest by your physician.
Here are the ratings under the IVDS formula:
60-percent At least six weeks in the last 12 months of incapacitating episodes.
40-percent At least four weeks in the last 12 months of incapacitating episodes.
20-percent At least two weeks in the last 12 months of incapacitating episodes.
10-percent At least one week in the last 12 months of incapacitating episodes.
Degenerative arthritis of the spine (DC 5003)
The last common method of establishing a rating for a back disability is through the VA’s diagnostic code for degenerative arthritis. If degenerative arthritis is established by X-ray and is accompanied by satisfactory evidence of painful motion, it will be rated no less than 10-percent. (Section 4.59 Painful motion.)
Back disabilities often cause nerve irritation that can cause pain or “pins and needles” in your arms and legs or other neurological conditions, such as loss of bladder control. The VA should rate these conditions separately as secondary to your back condition. Such diagnoses as sciatica, radiculopathy, neuritis or neuropathy related to compression or irritation of your spinal cord are common examples of disabilities the VA will rate separately as conditions secondarily related to back problems.
For example, the sciatic nerve runs from your lower back down each leg. The VA will rate sciatic nerve conditions (such as sciatica, neuropathy, neuritis, and neuralgia) based upon the amount of paralysis and pain or other sensory disturbances. Where there is only sensory impact upon the nerve, the VA will typically rate the condition as “moderate” incomplete paralysis at most. Even though the diagnostic code mentions paralysis, the VA will use the code even if there is only pain present. (Section 4.125 Neuralgia).
Here are the ratings the VA provides for conditions affecting the sciatic nerve (DC 8520):
80-percent Complete paralysis, no active movement possible below the knee, foot dangles.
60-percent Incomplete paralysis, severe with marked muscle atrophy.
40-percent Incomplete paralysis, moderately severe.
20-percent Incomplete paralysis, moderate.
10-percent Incomplete paralysis, mild.
If the pain radiates down both legs or both arms, the VA will provide you a bonus rating called the “bilateral factor.”