Many veterans find VA’s rules for rating back disabilities confusing. Despite having severe impairment and a lot of pain, veterans often find that VA rates their back injuries at 10 or 20 percent.
A lot of veterans feel that this 10 or 20 percent rating is low for how much their back disability affects them. Is that rating correct or should it be higher?
In this article, I will discuss how VA rates back disabilities and the ratings your can receive. I will focus on the thoracolumbar spine.
The thoracolumbar spine is what most people refer to as their back. It is your middle and lower back.
The thoracolumbar spine is actually composed of two parts of the spine:
- The thoracic spine which is made up of twelve vertebral bodies
- The lumbar spine which is made up of five vertebral bodies
The other part of your spine is what we would commonly call your neck. VA chooses to use medical terminology and refers to your neck as your cervical spine. Look for me to discuss how VA rates cervical spine disabilities in future articles.
How does VA rate my back disability?
VA ratings come from VA’s regulations which are published in the Code of Federal Regulations (CFR). Different medical conditions have different “diagnostic codes”.
For disabilities of the spine, VA uses diagnostic codes between 5235 and 5243. These diagnostic codes fall within “the spine” section of VA’s diagnostic codes.
Among other things, these codes cover diagnoses for:
- Vertebral fracture and dislocation
- Lumbosacral or cervical strain
- Degenerative arthritis of the spine
- Intervertebral disc syndrome
- Spinal stenosis
The formula that VA uses to rate back disabilities with a diagnosis code between 5235 and 5242is the same. That formula actually covers both the cervical and thoracolumbar parts of the spine. This article will only focus on the portion of that formula that relates to the thoracolumbar spine.
How can I get a 40 percent rating for my thoracolumbar spine?
The VA diagnostic codes for disabilities of the spine primarily focus on ankylosis. Ankylosis basically means that the joint is stiff or will not move. So, spinal disabilities focus on the lack of mobility or range of motion.
Technically, the highest VA rating for a thoracolumbar spinal disability is 50 percent. To qualify for a 50 percent rating, a veteran would need to have “unfavorable ankylosis of the entire thoracolumbar spine.”
Because of that, qualifying for a 50 percent rating for a thoracolumbar spine disability is very difficult. But, veterans can still qualify for a 40 percent rating for a thoracolumbar disability if they can show one of the following two things:
- Forward flexion of the thoracolumbar spine of 30 degrees or less
- Favorable ankylosis of the entire thoracolumbar spine
Veterans who have less than 30 degrees of flexion at the waist when bending forward can qualify for a 40 percent rating. You have to be quite restricted by your back disability to have less than 30 degrees of flexion at your waist.
The other way you can qualify for the 40 percent thoracolumbar rating is favorable ankylosis of the entire thoracolumbar spine. Ankylosis of the entire thoracolumbar spine means that you cannot bend at all. The difference between favorable and unfavorable ankylosis focuses on the position of your spine.
Favorable ankylosis means that your spine is frozen in a neutral position or zero degrees. So, if your back is straight, but you cannot bend your thoracolumbar spine at all, then that is considered favorable ankylosis and would qualify you for a 40 percent VA disability rating.
If you are bent forward and cannot move your thoracolumbar spine at all, then you should qualify for a 50 percent rating for unfavorable ankylosis.
Can I still get a 40 percent rating or higher if I have good range of motion?
VA does have one other formula that can be used to rate thoracolumbar disabilities. That formula is found in diagnostic code 5243 which covers intervertebral disc syndrome.
VA can rate intervertebral disc syndrome under the range of motion formula mentioned earlier or under a separate formula for incapacitating episodes. VA should use the formula that results in the higher rating for all disabilities combined.
Under the incapacitating episode formula, a veteran can qualify for a rating of 40 percent or higher if the veteran has incapacitating episodes with a total duration of over 4 weeks over the last 12 months. The rating can go as high as 60 percent under this formula if the total duration of the incapacitating episodes is 6 weeks or more over the last 12 months.
VA defines incapacitating episodes as symptoms that require bedrest ordered by a physician. It is important to understand that the incapacitating episode time does not have to be consecutive. A veteran just needs to show a total time of 4 weeks of incapacitating episodes in the last twelve months to get a 40 percent rating.
What if I have other symptoms as a result of my back disability?
VA will rate some conditions caused by your back disability separately. For example, the diagnostic codes instruct VA to rate neurological symptoms separately. Some examples of neurological conditions that could be rated separately include:
- Radiculopathy including pain, numbness or tingling in your arms and legs
- Bowel or bladder symptoms
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.
This would mean that you are bent forward but cannot move any portion of your spine at all. In other words, your thoracolumbar spine does not move and your cervical spine does not move either. That is obviously a very significant limitation.
But, you should keep in mind that you may still be able to qualify for a 100 percent rating for a back disability if your disability makes you unemployable.
A 40 to 60 percent thoracolumbar spine rating means that you are severely limited by your back. You would either have very limited range of motion or incapacitating episodes requiring bedrest at least 4 weeks in the last year. Individuals with these limitations will often find it difficult to find or maintain employment.
I speak to many veterans who have one VA rating of 40 percent or higher and other smaller ratings that brings their total rating up to 70 percent or more. These veterans could often potentially qualify for TDIU benefits and get paid at the 100 percent level because their disabilities prevent them from finding work.