If you’re a veteran living with chronic back pain, it affects your daily reality: movement can be excruciating, and even minor tasks can turn into a struggle. Yet when you receive a VA rating decision of 10 or 20 percent for your back injury, it’s hard not to be discouraged because these numbers don’t seem to reflect the severity of what you’re actually experiencing.
You’re not alone in this frustration. Thousands of veterans with debilitating back disabilities find themselves caught in a system where the rating criteria often fail to capture the true impact of their condition. So the question becomes: is your 10 or 20 percent disability rating actually correct, or are you entitled to more?
In this article, we’ll review how the VA rates back disabilities (specifically conditions affecting the thoracolumbar spine) and help you understand whether your current rating accurately reflects your level of impairment. More importantly, we’ll show you what it takes to secure the higher rating you may deserve for your VA claim.
What Is The Thoracolumbar Spine?
When we talk about the thoracolumbar spine, we’re referring to what most people simply call “the back,” or your middle and lower back region. This is where many veterans experience the worst pain and mobility limitations.
The thoracolumbar spine combines two distinct sections: the thoracic spine (your mid-back, consisting of twelve vertebral bodies) and the lumbar spine (your lower back, made up of five vertebral bodies). These seventeen vertebrae work together to support your upper body, protect your spinal cord, and allow you to bend, twist, and move during daily activities.
The VA uses medical terminology when rating spinal conditions. While most of us would refer to neck pain or a neck injury, the VA calls it the cervical spine. We’ll save cervical spine ratings for a future article: today, we’re looking at how to get the proper VA disability rating for your thoracolumbar condition.
How Does the VA Rate My Back Injury?
VA disability ratings come directly from the Code of Federal Regulations (CFR), where each medical condition receives its own “diagnostic code.” For spinal disabilities, the VA uses diagnostic codes between 5235 and 5243, which fall within the spine section of the VA’s rating system and cover a range of diagnoses, including:
Vertebral fracture and dislocation
Lumbosacral or cervical strain
Degenerative arthritis of the spine
Intervertebral disc syndrome
Spinal stenosis
The VA uses the same rating formula for back injuries with Diagnostic Codes 5235 through 5242. This formula applies to both cervical (neck) and thoracolumbar (mid and lower back) conditions. In this article, we’re concentrating on the thoracolumbar portion of that formula: the VA disability ratings that apply to your middle and lower back.
How Can You Get A 40 Percent Rating For Your Thoracolumbar Spine Injury?
The VA diagnostic codes for spinal disabilities center on ankylosis, which means the joint is stiff or won’t move. In other words, the VA rates spinal disabilities based on your lack of mobility or range of motion.
The highest VA rating for a thoracolumbar spinal disability is 50 percent. Most veterans will receive lower ratings, with 40 percent being the next tier down. Understanding how the VA distinguishes between them can help you determine if you’re receiving the correct rating for your back injury.
The 40 Percent Rating
You qualify for a 40 percent rating if your thoracolumbar spine meets one of these two criteria:
Limited Forward Flexion: When you bend forward at the waist, you can’t exceed 30 degrees of spinal movement. To put this in perspective, 30 degrees of forward flexion means you’re severely restricted in your ability to bend. Most people can bend forward 60 to 90 degrees when touching their toes or bending at the waist. If you can only achieve 30 degrees or less, your mobility is substantially impaired.
Favorable Ankylosis: With favorable ankylosis, your entire thoracolumbar spine is frozen in a straight, neutral position (zero degrees). You can’t bend your back at all, but your spine remains upright and aligned in a normal standing position. Even though you’ve lost all mobility in your thoracolumbar spine, the VA considers this “favorable” because your spine is held in a functional position.
The 50 Percent Rating
You qualify for a 50 percent rating if you have unfavorable ankylosis of your entire thoracolumbar spine. This means your spine is frozen in a bent-forward position and you can’t straighten it or move it at all. Your body is permanently locked in a forward bend, which is far more disabling than having your spine frozen in a straight position.
The distinction between favorable and unfavorable ankylosis comes down to your spine’s position: straight and frozen gets you 40 percent, bent and frozen gets you 50 percent. However, qualifying for a 50 percent rating is very difficult because it requires complete immobility in a bent position, which is relatively rare even among veterans with serious back disabilities.
Can You Still Get a 40 Percent Rating or Higher If You Have a Good Range Of Motion?
The VA has one other formula for rating thoracolumbar disabilities. It appears in Diagnostic Code 5243, which covers intervertebral disc syndrome.
Intervertebral disc syndrome can be rated using either the range of motion formula mentioned earlier or a separate formula based on incapacitating episodes. The VA uses whichever option results in the higher rating for all disabilities combined. This means if you have intervertebral disc syndrome, you’re entitled to have your condition evaluated under both formulas, and the VA must assign you the more favorable rating.
Note: In 2021, the VA clarified that Diagnostic Code 5243 should only be applied when there is a diagnosed disc herniation with nerve root compression that results in radiculopathy. If these criteria are not present, the veteran’s service-connected back condition must be evaluated under the General Rating Formula instead of the incapacitating episode formula.
Under the incapacitating episode formula, you qualify for a rating of 40 percent or higher if you’ve had incapacitating episodes with a total duration of over 4 weeks during the last 12 months. The rating increases to 60 percent under this formula if the total duration of your incapacitating episodes reaches 6 weeks or more during the last 12 months.
The VA defines incapacitating episodes as symptoms that require bed rest ordered by a physician. This is a critical detail: your doctor must prescribe bed rest for the time to count as an incapacitating episode. Self-imposed bed rest doesn’t meet the VA’s criteria, even if your pain makes it impossible to function.
Here’s what many veterans don’t realize: the incapacitating episode time doesn’t have to be consecutive. You don’t need one single 4-week period of bed rest. Instead, you add up all the separate periods of physician-ordered bed rest over a 12-month period. If you had one week of bed rest in January, two weeks in April, and another week and a half in September, that totals 4.5 weeks and qualifies you for a 40 percent rating.
Because doctors are usually reluctant to prescribe such extensive bed rest, most veterans receive a more favorable rating using the range of motion criteria (usually 30 degrees or less of forward flexion).
What If I Have Other Symptoms As A Result Of My Back Disability?
The diagnostic codes instruct the VA to rate neurological symptoms as independent conditions. This is important because it means you can receive additional VA disability compensation beyond your back rating if your spinal condition has caused nerve damage or other neurological problems.
Neurological conditions that receive separate ratings include:
Radiculopathy: This addresses the pain, numbness, or tingling that radiates into your arms and legs. When a herniated disc or spinal stenosis compresses a nerve root, you may experience shooting pain down your leg (sciatica) or numbness in your hands and fingers. These symptoms are rated separately from the spine itself.
Bowel or bladder dysfunction: Severe spinal conditions can compress nerves that control your bowel and bladder function. If you experience incontinence, difficulty urinating, or loss of bowel control due to your back disability, the VA rates these symptoms separately.
In other words, if your service-connected back condition has damaged nerves and created secondary symptoms, you’re entitled to separate ratings for each of those neurological conditions. Many veterans don’t realize they can stack these ratings on top of their base spine rating: for instance, if you have a 20 percent rating for degenerative disc disease, you might also receive a 10 percent rating for radiculopathy in the right leg and another 10 percent for radiculopathy in the left leg, substantially increasing your total VA disability compensation
Can You Get To a 100 Percent Rating For a Back Disability?
The diagnostic codes do allow for a 100 percent disability. But you have to show unfavorable ankylosis of the entire spine to qualify for that rating. In other words, both your neck and your back are completely frozen in a bent position. This is an extremely rare condition, and most veterans with serious back disabilities won’t meet this criteria.
A 40 to 60 percent thoracolumbar spine rating means you’re severely limited by your back. You either have a very limited range of motion or you experience incapacitating episodes requiring bed rest for at least four weeks in the last year. Individuals with these limitations often find it difficult to find or maintain employment. When you can barely bend forward, or you’re confined to bed rest multiple times throughout the year, finding a job can be nearly impossible.
We speak to many veterans who have one VA rating of 40 percent or higher and other smaller ratings that bring their total rating up to 70 percent or more. These veterans qualify for TDIU benefits and get paid at the 100 percent level because their disabilities prevent them from finding work. You don’t need to meet the strict anatomical requirements for a 100 percent schedular rating if you can demonstrate that your service-connected disabilities have rendered you unemployable.
Here’s a common scenario: A veteran has a 40 percent rating for degenerative disc disease, a 20 percent rating for knee pain, and a 10 percent rating for tinnitus. That totals 60 percent using VA math. But if that veteran can’t hold down a job because bending, lifting, and standing for extended periods trigger debilitating back pain and bed rest, they qualify for TDIU. Their compensation jumps from the 60 percent rate to the 100 percent rate.
Note: The schedular requirements for TDIU under 38 C.F.R. § 4.16(a) call for a combined rating of 70 percent or more with one disability rated at least 40 percent. However, a veteran in the example above may still qualify for TDIU under 38 C.F.R. § 4.16(b) (extraschedular TDIU) if medical and vocational evidence shows that their service-connected disabilities prevent them from maintaining substantially gainful employment. These extraschedular TDIU cases are possible but difficult, so consulting with an experienced VA disability attorney is recommended in these situations.
Get the VA Rating Your Back Disability Warrants
If you’re living with a back disability that limits your mobility, causes chronic pain, or keeps you in bed rest multiple times a year, you need a VA rating that accurately reflects your condition. Too many veterans accept a 10 or 20 percent rating without realizing they qualify for 40, 60, or even 100 percent through TDIU. You’ve earned these VA benefits through your service, and you shouldn’t settle for less than what your disability warrants.
If your current rating doesn’t match the reality of your back disability, or if you’ve been denied a higher rating despite clear limitations in your range of motion, speak to a VA disability attorney. The appeals system exists for exactly this reason, and with the right medical evidence and legal argument, you can get your rating increased.
At Perkins Studdard, we’ve spent years helping veterans secure the VA disability benefits they’ve earned. We know how the VA rates back disabilities and, more importantly, we know how to build a case that gets results. If you have questions about your VA claim or think you qualify for a higher rating, call us at (770) 285-0548 or contact us online. We offer free consultations for veterans, so reach out today.
Travis Studdard is an attorney who focuses on representing veterans in VA disability compensation claims. He regularly writes about issues that are important to veterans and their families.
You can subscribe to his Veterans Disability channel on YouTube.
Jessica and Travis listened and worked very hard getting us a really great disability payment. Thank you so much for listening and every month we appreciate your time and energy. Thanks againJeannie Brown
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Travis Studdard and his team were always professional and from intake to case resolution, they were extremely pleasant to work with. After working closely with them for roughly six years, they successfully appealed my sleep apnea claim with the VA. At times I thought about giving up, but it was their diligence and confidence in their approach that gave me the ability sustain. There were no surprises, they led me by hand every step of the way. My family and I are truly appreciative for their great work. His team truly cares and it shows. They will fight to the end for veterans. I couldn't be happier with the results.James
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Jason Perkins and his team are so kind, knowledgable and helpful. They were thorough with all my legal needs and made sure my medical needs were taken care of financially. What I most appreciate is that he was always very clear about what was best for my case, but he also always told me I needed to do what was best for me, both mentally and physically. He was always available to answer questions, made sure I understood, and was willing to let me make decisions regarding my case. His ethics are beyond reproach. He would not take a percentage of a payment he did not help me receive. You can trust him. He always made it clear that my mental and physical well-being were more important than any part of my case. Then he would explain what would be best for the case and why, and allow me time to decide. Being in the Worker's Compensation system was an incredibly demeaning experience. I am a strong, educated woman, but when everyone in a system tells you that you are not worthy of the care you have received your entire life, and you instantly become less than to many of those who are suppose to be caring for you, it would weigh on anyone. I am so thankful I had Jason and his team fighting for me, getting me things I never would have imagined would be denied, like a second opinion before surgery, or physical therapy instead of opioids. I cannot imagine trying to handle this experience by myself.Andri Pilgrim
I understand you want your VA claim to be done as quickly as possible. But remember the ultimate goal – to win your VA disability compensation claim.
You may eventually get there on your own, but it may be after a series of decisions by the Regional Office and Board of Veterans Appeals. Sometimes claims are appealed and remanded several times, which can cause a claim to drag on for years. If you are interested in avoiding unnecessary delay in your claim and want to do everything you can to maximize your chances of success, it is probably a good idea for you to consult with an accredited veterans disability attorney.
We would be happy to talk to you. If you would like a free consultation with our Perkins Studdard veterans disability attorneys just click here or give us a call to begin the process.
