Thoracolumbar Spine (Lower and Mid Back)
Thoracolumbar spine conditions are rated under Diagnostic Codes 5235 through 5242 using the General Rating Formula for the Spine based on limitation of range of motion (ROM). The actual diagnosis of the back condition is generally not important for rating purposes. The vast majority of spine conditions are rated based on how far the veteran can bend forward (forward flexion) and total combined range of motion. Examiners and raters are required to consider flare-ups, meaning if the examination does not occur on the veteran's worst day, the examiner must reasonably estimate the impairment on the worst day. Veterans with conditions affecting both their neck and back can receive two separate ratings (one for the neck and one for the back). However, if multiple conditions affect the same section, only one rating per section is allowed.
VA Rating Levels
Forward flexion measures more than 60 degrees but not more than 85 degrees, or combined ROM is between 125 and 235 degrees, or muscle spasm, guarding, or localized tenderness not resulting in abnormal gait.
Forward flexion measures more than 30 degrees but not more than 60 degrees, or combined ROM is 120 degrees or less, or muscle spasm or guarding severe enough to result in an abnormal gait or abnormal spinal contour such as scoliosis, reversed lordosis, or abnormal kyphosis.
Forward flexion of the thoracolumbar spine 30 degrees or less, or the entire thoracolumbar spine is frozen in a favorable position (favorable ankylosis).
The entire thoracolumbar spine is frozen in an unfavorable position (unfavorable ankylosis).
The entire spine (neck through tailbone) is frozen in an unfavorable position (unfavorable ankylosis).
Exam Tips & Key Evidence
- →Your range of motion should reflect your worst days. Make sure to tell the examiner about your flare-ups, because they're required to estimate how limited you are at your worst.
- →If you experience radiculopathy, meaning pain, numbness, or tingling that shoots into your legs, that gets rated separately under nerve damage codes. Each affected leg can receive its own rating.
- →Nerve-related secondary conditions tied to the spine are essentially near-automatic grants unless there's clear evidence against them. Effective dates for these can even go back up to a year before you filed your claim, as long as medical evidence supports it.
- →If you have a herniated disc, bulging disc, or DDD, you may be able to get a higher rating through the incapacitating episodes schedule instead of range of motion. You'll receive whichever one is higher.
- →It's important to know that Degenerative Disc Disease (DDD) is not classified as arthritis and does not qualify for presumptive service connection.
- →Pain with motion on its own is enough to warrant a minimum 10% rating. The same goes for a vertebral body fracture with 50% or more height loss.
Commonly Related Conditions
38 CFR Reference
38 CFR 4.71a, Diagnostic Codes 5235-5242