How the VA Rates Back Pain, Herniated Discs, and Degenerative Spine Disease

Serving in the armed forces can be physically demanding. Heavy loads, intense training and challenging conditions take a toll on the body, leading to back pain. If you experience back pain as a result of military service, you may qualify for VA disability benefits. It’s important to understand how the Department of Veterans Affairs evaluates and ranks these conditions to ensure you receive appropriate compensation.

The Foundation of Your Claim: The Diagnostic Code and Service Connection

The VA does not consider the mere presence of a back condition. Instead, it evaluates the functional loss it causes. Most spine conditions are assessed under § 38 C.F.R. § 4.71a of the Schedule of Ratings for the Musculoskeletal System. To successfully claim benefits, it is essential to establish a clear service connection, proving current disability linked to an event, injury or worsening that occurred during military service.

Common service-connected back injuries we see include:

• Herniated or Bulging Discs
• Degenerative Disc Disease
• Sacroiliac Joint Dysfunction
• Spinal Arthritis
• Vertebral Fractures and Misalignments

Understanding the VA’s Rating Formula for Spine Conditions

The VA primarily evaluates spinal disabilities based on one crucial factor: range of motion (ROM). An VA examiner will assess how far you are able to flex and extend your spine forwards, backwards, and laterally. The more restricted your movement, the higher the potential disability rating you may receive.

The general formula for the diagnostic codes for the spine, such as DC 5237 for lumbosacral strains, is as follows:

• Unfavorable Ankylosis: This means your spine is frozen in a fixed position, and ratings for this are highest, ranging from 20% to 100%, depending on whether your neck or back is fixed and in which position it’s frozen.
• Favorable ankylosis: The spine is frozen in a beneficial, upright position, typically resulting in a 40% rating. 
• Limited range of motion: This is the most common pathway, with ratings based on the degrees of limited motion compared to normal ranges, resulting in ratings of 10%, 20%, or 40%.

However, ROM is not the only factor that should be considered when rating. The VA also needs to take into account functional loss due to pain. According to 38 C.F.R. § 4.40, a part that becomes painful when used should be regarded as severely disabled. This means that if your ROM measurements are good, but pain flares up when you move and limits your ability to function, the rater needs to account for this functional loss.

Additional Pathways for Rating Back Conditions

The VA’s system allows alternative rating methods if they provide a higher level of benefit to veterans.

The Formula for Rating Painful Motion

Under 38 C.F.R. § 4.59, if a veteran experiences pain when moving a joint, they are entitled to at least the minimum compensation rate for that joint, which is often 10%. This regulation is critical for veterans whose pain is not fully captured by range of motion measurements.

Rating by Analogy

If your specific condition does not exactly match a standard diagnostic code, the Veterans Affairs (VA) may use “rating by analogy” for a similar condition. For example, if your condition causes symptoms similar to those of nerve damage, it may be rated under codes for peripheral nerves.

Separate Ratings for Radiating Symptoms

Back conditions can often lead to secondary issues, such as sciatica (pain that radiates down the leg). If you experience numbness, tingling, or weakness in your limbs due to nerve involvement, you may be eligible for a separate disability rating for nerves under a different diagnostic code.

Why a Strong Medical Opinion is Crucial

The VA often relies on its own Compensation & Pension (C&P) examinations. However, these examinations can be rushed and may not fully capture the extent of your disability. A valuable tool in your claim is a private, independent medical opinion from your treating physician. This opinion can directly link your current health condition to your military service and provide a more accurate assessment of your functional limitations, addressing the critical elements that the VA rater needs to consider.

Did You Suffer a Back Injury As a Result of Your Service?

If you are a veteran struggling with back pain, herniated discs, or degenerative spine disease, don’t face these challenges alone. Our law firm has extensive experience dealing with complex VA disability claims, and we will work tirelessly to ensure you receive the maximum benefits you deserve.

Contact Veterans Benefits Law Group today at (601) 414-3707 to schedule a free consultation. All consultations are completely free, and we only charge a fee if we win your case. We handle cases on a contingency basis, so you won’t pay anything unless we successfully represent you. Call us now to get started! We proudly serve clients in Jackson, MS and the surrounding areas.