Back Impairments: What Qualifies?
The dangerous and physically demanding tasks commonly performed by members of the U.S. military put servicemembers and veterans at risk of developing orthopedic conditions of the back. Whether your back pain is the result of an acute injury sustained during service or caused by the chronic stress you experienced during training and regular duty, any back conditions caused or worsened by your military service are eligible for service connection and compensation.
Orthopedic conditions affecting the back are compensated differently depending on the degree of disability, so it is incredibly important that you work with a physician to determine the correct diagnosis for your condition and get your symptoms recorded as early as possible. Understanding what is causing your chronic back pain will also help you find the most effective treatment method.
The VA disability rating system separates orthopedic conditions of the spine into those affecting the back (the thoracolumbar spine) and those affecting the neck (the cervical spine). For the purposes of calculating a veteran’s total disability rating, back and neck impairments are treated as separate disabilities, with the exception of unfavorable ankylosis of both segments (which is treated as a single condition). There are a number of different back conditions that are subject to compensation under the VA disability system, including the following:
-Mechanical back pain syndrome
-Facet joint arthropathy (degenerative joint disease of lumbosacral spine)
-Degenerative disc disease
-Foraminal/lateral recess/central stenosis
-Intervertebral disc syndrome
-Ankylosis of thoracolumbar spine
-Ankylosing spondylitis of the thoracolumbar spine
-Vertebral fracture (vertebrae of the back)
Other back conditions may also be subject to service connection and compensation, but make sure to talk to your treating physician and VA examiner in depth about your symptoms, service history, and medical history. This gives you the best chance of receiving the correct diagnosis, treatment, and VA schedular disability rating.
Getting Service Connected for Back Impairments
There is a lot of information you need to provide to the VA when trying to obtain service connection for your back or any other orthopedic condition. Some examples of records you will want to submit to the VA include your service medical records, military personnel files reflecting an in-service accident, diagnosis, or change of duty due to back issues, and any private medical records you have that could help establish a connection between your military service and your back condition. You can also submit sworn declarations from fellow servicemembers, family members, friends, or others familiar with your condition who can help verify that your back issues were caused or made worse by your military service.
As evidenced by the rating schedules below, the only back condition eligible for a 100 percent schedular rating is unfavorable ankylosis (immobility) of the entire spine. Other back impairments have a maximum schedular rating of 60 percent or lower. However, the pain and limited mobility associated with many back impairments can make it all but impossible to perform ordinary daily tasks, including those required to maintain full-time employment. If you are unable to work due to your back condition, getting maximum monthly benefits will usually require a total disability rating based on individual unemployability (a TDIU rating). In addition to your already submitted evidence in the form of service records, medical records, and employment history, additional evidence may be needed to secure a TDIU rating. This could include sworn declarations by vocational experts, opinions from medical professionals, and other documents demonstrating that your service-connected back condition precludes your ability to work. Our attorneys have extensive experience in obtaining TDIU ratings for veterans with back issues and know what type of evidence is necessary to win your claim.
How the VA Rates Back Impairments
Back muscle injuries
Conditions involving injuries to the back muscles are compensated differently depending on the muscle affected and the severity of the impairment. Each group of back and torso muscles have their own schedule.
- Diagnostic Code 5319, Group XIX
Function: Support and compression of abdominal wall and lower thorax; flexion and lateral motions of spine; synergists in strong downward movements of arm (1).
Muscles of the abdominal wall: (1) Rectus abdominis; (2) external oblique; (3) internal oblique; (4) transversalis; (5) quadratus lumborum.
- Severe: 50%
- Moderately Severe: 30%
- Moderate: 10%
- Slight: 0%
- Diagnostic Code 5320, Muscle Group XX
Function: Postural support of body; extension and lateral movements of spine.
Spinal muscles: Sacrospinalis (erector spinae and its prolongations in thoracic and cervical regions).
Cervical and thoracic region:
- Severe: 40%
- Moderately Severe: 20%
- Moderate: 10%
- Slight: 0%
- Severe: 60%
- Moderately Severe: 40%
- Moderate: 20%
- Slight: 0%
- Diagnostic Code, 5321 Group XXI
Muscles of respiration: Thoracic muscle group.
- Severe or Moderately Severe: 20%
- Moderate: 10%
- Slight: 0%
Musculoskeletal Back Conditions
Conditions affecting the thoracolumbar spine such as vertebral fracture, spinal stenosis, ankylosing spondylitis and spinal fusion are all evaluated using the General Rating Formula for Diseases and Injuries of the Spine:
- Diagnostic Codes 5235 to 5243
- Unfavorable ankylosis of the entire spine: 100%
- Unfavorable ankylosis of the entire thoracolumbar spine: 50%
- Unfavorable ankylosis of the entire cervical spine; or, forward flexion of the thoracolumbar spine 30 degrees or less; or, favorable ankylosis of the entire thoracolumbar spine: 40%
- Forward flexion of the cervical spine 15 degrees or less; or, favorable ankylosis of the entire cervical spine: 30%
- Forward flexion of the thoracolumbar spine greater than 30 degrees but not greater than 60 degrees; or, forward flexion of the cervical spine greater than 15 degrees but not greater than 30 degrees; or, the combined range of motion of the thoracolumbar spine not greater than 120 degrees; or, the combined range of motion of the cervical spine not greater than 170 degrees; 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: 20%
- Forward flexion of the thoracolumbar spine greater than 60 degrees but not greater than 85 degrees; or, forward flexion of the cervical spine greater than 30 degrees but not greater than 40 degrees; or, combined range of motion of the thoracolumbar spine greater than 120 degrees but not greater than 235 degrees; or, combined range of motion of the cervical spine greater than 170 degrees but not greater than 335 degrees; or, muscle spasm, guarding, or localized tenderness not resulting in abnormal gait or abnormal spinal contour; or, vertebral body fracture with loss of 50 percent or more of the height: 10%
The exception to this rating schedule is intervertebral disc syndrome (IVDS), which is evaluated using either the General Rating Formula for Diseases and Injuries of the Spine or the Formula for Rating Intervertebral Disc Syndrome Based on Incapacitating Episodes (see below). The VA is required to use whichever scale yields the highest combined rating when all of the Veteran’s disabilities are evaluated together.
Formula for Rating Intervertebral Disc Syndrome Based on Incapacitating Episodes
- Diagnostic Code 5423
- With incapacitating episodes having a total duration of at least 6 weeks during the past 12 months: 60%
- With incapacitating episodes having a total duration of at least 4 weeks but less than 6 weeks during the past 12 months: 40%
- With incapacitating episodes having a total duration of at least 2 weeks but less than 4 weeks during the past 12 months: 20%
- With incapacitating episodes having a total duration of at least one week but less than 2 weeks during the past 12 months: 10%
How To Win Your Back Impairment Claim
The most important evidence you need to have to support your claim is medical evidence. Ideally, this evidence will include documents diagnosing you with a back condition that began in service or was made worse during your military service and detailing the objective findings that show the severity of the condition. These types of records are very important, especially in the event that you receive an unfavorable Compensation and Pension (C&P) exam. Having favorable medical records from your treating physician can help counter the negative C&P exam opinion.
When attending a C&P exam for your back condition, make sure that you are honest with the examiner about your back pain and mobility issues. You want to articulate clearly to the examiner how the pain and swelling (and other symptoms) in your lumbar spine limits your daily life. The examiners who conduct these assessments for the VA are often underpaid, overworked, and under immense time pressure to complete the examination report and return it to the VA, so you may need to repeat yourself several times, but make sure that the examiner knows how severe your back condition is and what sort of limitations it causes you to have in your daily life.
Contact the Veterans Law Office About Your Back Impairments Claim
Our veterans lawyers are experienced in helping veterans obtain service connection for their back and lumbar spine conditions. If you are looking for assistance in getting the compensation you deserve, please contact us at the phone number above or via our Free Case Evaluation form.