Back conditions are rated under 38 CFR §4.71a, Diagnostic Codes 5235-5243based primarily on range of motion. Understanding how VA measures and rates spinal conditions—plus claiming secondary conditions—is key to maximizing your rating.
Back Rating Criteria (Range of Motion)
Normal forward flexion is 0-90°. VA rates based on limitation:
| Rating | VA Criteria |
|---|---|
| 10% | Forward flexion greater than 60° but not greater than 85°; OR muscle spasm/guarding not causing abnormal gait |
| 20% | Forward flexion greater than 30° but not greater than 60°; OR muscle spasm causing abnormal gait or spinal contour |
| 40% | Forward flexion 30° or less; OR favorable ankylosis of entire thoracolumbar spine |
| 50% | Unfavorable ankylosis of entire thoracolumbar spine |
| 100% | Unfavorable ankylosis of entire spine |
Alternative: Incapacitating Episodes (IVDS)
If you have Intervertebral Disc Syndrome with incapacitating episodes (bed rest prescribed by a physician):
| Rating | VA Criteria |
|---|---|
| 10% | At least 1 week but less than 2 weeks in past 12 months |
| 20% | At least 2 weeks but less than 4 weeks in past 12 months |
| 40% | At least 4 weeks but less than 6 weeks in past 12 months |
| 60% | At least 6 weeks in past 12 months |
"Incapacitating episode" has a specific VA definition: bed rest PRESCRIBED BY A PHYSICIAN. Staying home on your own doesn't count unless a doctor ordered bed rest.
Key Court Rulings (Know These!)
DeLuca v. Brown
VA MUST consider functional loss due to pain, weakness, fatigability, and incoordination. Pain alone CAN justify a higher rating if it limits function.
Mitchell v. Shinseki
VA must consider additional limitation during flare-ups.
Sharp v. Shulkin
Examiner MUST estimate ROM loss during flare-ups, even if not examined during a flare.
Evidence That Wins
Evidence That Wins
- ✓Range of motion measurements with painful motion starting point documented
- ✓Flare-up descriptions: frequency, duration, additional limitation, triggers
- ✓Functional loss statements: can't bend to tie shoes, can't sit for extended periods
- ✓Lay statements from family about daily limitations
- ✓Work impact documentation
- ✓MRI/X-ray showing disc degeneration, herniation, or stenosis
Evidence That Loses
- ✗ROM measurements only without pain notation
- ✗No documentation of functional loss
- ✗No description of flare-ups
- ✗Diagnosis only without severity
C&P Exam Strategy
- Don't push through pain — Stop bending when pain starts
- Describe flare-ups clearly: "2-3 times per week, lasting 1-2 days, can't bend at all"
- Mention your worst days — Don't describe good days
- Report ALL leg symptoms — Numbness, tingling, shooting pain = radiculopathy
- Describe functional impact — What can't you do because of your back?
Secondary Conditions (CRITICAL!)
Radiculopathy is separately ratable for EACH LEG. If you have shooting pain, numbness, or tingling in your legs, claim radiculopathy as secondary. This can add significant percentage to your combined rating.
Back conditions commonly cause:
- Radiculopathy — Nerve pain in legs (separately rated per leg!)
- Erectile dysfunction
- Bowel/bladder dysfunction
- Depression — Chronic pain affects mental health
- Sleep disturbance
- GERD — From pain medications
Filing Tips
- Get imaging (MRI, X-ray) if possible
- Document ROM with painful motion noted
- Write detailed statement about daily limitations
- Describe flare-ups with frequency and duration
- Claim radiculopathy as secondary if you have ANY leg symptoms
- Consider secondary mental health claim for chronic pain impact