As a veteran, you may have been surprised when your VA disability claim for back pain was denied. Knowing how the back pain VA rating criteria works can help ease any confusion and potentially give you an idea of what to do next so you can start receiving your VA disability benefits.
In this blog post, we’ll be walking through exactly what criteria is used by the VA in determining benefits for military veterans suffering from chronic back pain.
We’ll provide straightforward guidance so you can better understand the VA claim process and know what steps to take to help you get the best possible outcome for your future or current VA disability claim.
Overview of Back Pain VA Rating Criteria
If you’re a veteran who has been diagnosed with back pain, the VA rating criteria you need to know about can be quite confusing. The VA rating for back pain depends upon several factors, such as if the injury was the result of a training injury, traumatic event like a car accident, daily lifting of heavy equipment, or working in an unfavorable position.
Additionally, the VA will try to determine whether your back pain was service connected, before enlistment or happened after military service.
In either case, your primary care or VA doctor may be asked to provide medical evidence that will help you develop a fully developed claim to determine your VA rating for back pain. Some of this evidence includes physical therapy results, x-ray images, MRI scans, physical examination, back surgeries and any other tests required to establish the degree of disability due to back pain.
What is the VA Rating For Back Pain?
The VA offers a range of disability ratings for back pain, depending on the severity. VA disability ratings range from 0% to 100%.
If your VA disability rating is at 100%, then you may be eligible for full disability benefits as well as a monthly VA disability compensation to help with any additional costs due to your service connected back pain.
VA Disability Rating Table
| Description | VA Disability Rating |
|---|---|
| Forward flexion of the thoracolumbar spine greater than 60 degrees but not greater than 85 degrees OR the following:Forward flexion of the cervical spine greater than 30 degrees but not greater than 40 degreesCombined range of motion of the thoracolumbar spine greater than 120 degrees but not greater than 170 degrees but not greater than 335 degreesMuscle spasm, guarding or localized tenderness not affecting gait or spinal contourVertebral body fracture with loss of 50% or more of height | 10% |
| Forward flexion of the thoracolumbar spine greater than 30 degrees but not greater than 60 degrees OR the following:Forward flexion of the cervical spine greater than 15 degrees but not greater than 30 degreesThe combined range of motion of the thoracolumbar spine but not greater than 120 degreesA combined range of motion of the cervical spine not greater than 170 degreesMuscle spasm or guarding severe enough to result in an abnormal gait or abnormal spinal contour (i.e. scoliosis, etc.) | 20% |
| Forward flexion of the cervical spine 15 degrees or less ORFavorable ankylosis of the entire cervical spine | 30% |
| Unfavorable ankylosis of the entire cervical spine ORForward flexion of the thoracolumbar spine 30 degrees or less ORFavorable ankylosis of the entire thoracolumbar spine | 40% |
| Unfavorable ankylosis of the entire thoracolumbar spine | 50% |
| Unfavorable ankylosis | 100% |
Source: CFR Title 38 Chapter 4 Subpart B § 4.71a Schedule for VA rating disabilities
Types of VA Disability Ratings For Back Pain
Everyone experiences pain differently, which is why the Department of Veterans Affairs (VA) has a specific system to evaluate service connected back pain.
The following conditions are listed as diagnostic codes 5235-5243 in the Schedule for Rating Disabilities:
Lumbosacral or Cervical Strain VA Disability Rating criteria
Minor lumbosacral strain (L5-S1) on your lumbar vertebra affects your lower back. It generally impacts much of your daily activities while heavier strains or chronic lumbosacral strain can result in your spine being frozen or locked.
The VA evaluates both the minor to more severe lumbosacral strain VA rating scoring criteria. Cervical strain is even more serious, as it affects muscles and ligaments between the neck and shoulders and can cause difficulty with range of motion in the neck.
Vertebral Fracture Or Dislocation
Vertebral fracture is a spinal misalignment, whether stemming from a fracture or simply being out of position.
Spinal Stenosis
Spinal stenosis is a condition caused by the constriction of delicate nerves and tissue in the spinal column, resulting in pressure on sensitive areas such as your spinal cord.
Sacroiliac Injury And Weakness
Sacroiliac joint injuries can cause painful disruptions in the link between your spine and pelvis.
Spondylolisthesis Or Segmental Instability
Commonly known as a slipped disc, this form of misalignment occurs when one vertebra in the spine unexpectedly slides out of its original place and onto an adjacent one.
Ankylosing Spondylitis
Arthritis can afflict the spine, causing spinal joints to become locked in place.
Degenerative Arthritis, Degenerative Disc Disease
Degenerative arthritis or degenerative disc disease is when the protective discs between vertebrae no longer provide effective cushioning, significant pain and you will lose mobility are likely to follow.
Spinal Fusion
Spinal fusion is a medical procedure that involves connecting two or more vertebrae in the spine, providing relief from chronic back pain and rigidity.
By eliminating motion between these sections of the back, this process can be used to effectively limit long-term discomfort for individuals suffering from certain conditions.
Intervertebral Disc Syndrome
Intervertebral disc syndrome is nerve irritation caused by a misaligned disc fragment has been verified using medical evidence.
How To File A Claim For A VA Disability Rating
If you are experiencing significant pain in your lower back, you may have the option to file a claim for a VA disability rating. The VA Disability Rating System provides compensation for service-connected physical or mental conditions that are disabling in nature.
It’s important to note that lower back pain must be service related to active duty service and medically diagnosed in order to qualify for a disability. To get started, visit your nearest VA office or go to the va.gov website and file for disability compensation using the VA Form 21-526EZ and then submit the necessary documents related to your lower back pain. You can also go to a VA Accredited law group like VetsForever to help you with the process.
“Pro Tip: NEXUS letters are helpful to establish service connection but can be very expensive charging as much as $1,500. A well written personal statement and buddy letters are not only FREE but will help favorably position your claim by having the VA give you a C&P exam to medically evaluate the condition”
From there, the VA will review your claim, the evidence provided, read over the results of the C&P exam and then decide whether to award or deny you disability rating based upon its findings.
What You Need to Know About the Evidence Requirements
Understanding what evidence is necessary for a C&P Exam can be overwhelming. However, it’s important to get it right in order to strengthen your fully developed VA claim and ensure you’re getting all of the benefits that you earned.
In general, the main pieces of evidence that need to be considered are medical evidence, lay evidence, private treatment records, and the C&P Exam report itself.
- Medical evidence includes any records and diagnosis from a medical professional that has examined you.
- Lay evidence is testimony or statements from yourself or people who have seen your disability and can testify to its effects on your life.
- Private treatment records include any evaluation from any source outside of the Veterans Affairs facility, such as a private clinic or doctor’s office.
- C&P Exam report documentation shows assessors’ judgments about your impairments and the final numbers used for rating purposes.
Make sure you have your medical treatment records and lay statements ready before submitting any VA disability claims!
A Step-By-Step Guide to Appealing Your VA Disability Claim Denial
The VA’s disability rating system can be complicated and daunting to navigate, especially if you are appealing your back injury rating. Fortunately, the actual steps are pretty straightforward.
Firstly, any supplemental claim or supplemental statement you submit must include new evidence. It is important to carefully read the VA denial letter. The VA will communicate with you what you need to provide for them to better understand your condition. This is typically stated as they require medical evidence or proof of direct connection to a medical NEXUS or active military service event.
In the event that your supplemental claim is denied, you have the opportunity to request for a Higher-Level Review (HLR). The primary difference between the supplemental claim and the Higher Level Review (HLR) is that no new evidence may be submitted with the HLR. Your claim will then be reviewed by the regional VA accessor and the decision may be changed if there is adequate medical evidence.
The HLR may also uncover an error within the VA process on handling your claim. In that instance, they will automatically resubmit your supplemental claim correcting the error to ensure your claim is handled properly. This does add an additional 4-6 months in the process but if you win your claim you will be compensated to the initial claim submission date.
The most important thing to remember is with perseverance and determination, your appeal may yield a positive result!
Resources to Help You Navigate Your Claim Process Easily
Working through the back pain va rating claim process can be a daunting task, but luckily there are resources to help you navigate it easily. We strongly recommend you talk to a VSO, VA accredited agent, lawyer or law group like VetsForever to help you with the process. There is good information on accredited websites or YouTube videos that can help you through the application steps. These resources can make the process easier and less stressful.
Plus, there are online communities of veterans who have gone through the back pain va rating claim process themselves, so you can receive first-hand accounts from those who have been in your shoes before making your own decisions. With these resources at your disposal, tackling back injury does not need to be a challenge – you may even find yourself feeling confident about navigating the entire process!
Ultimately, if you’re a veteran suffering from back pain, the VA disability rating is an important factor in determining your eligibility for benefits. So it’s important to understand both the medical criteria used to rate your claim and how to appeal if necessary.
We discussed specific examples of VA disability ratings related to back pain, how to file a claim for them, what evidence is needed to support your claim, and how to appeal any denials or low rated back conditions.
Additionally, you may want to investigate secondary conditions related to lower back pain such as radiculopathy va rating or a degenerative disc disease va rating. These secondary disabilities may be an opportunity to continue to increase your general rating formula or overall VA disability score.
Summary
For more information about VA back pain disability rating criteria or help with filing a VA disability claim for one, go to va.gov or visit your local Veterans Service Officer (VSO) or an VA Accredited law group like VetsForever for personalized assistance at every stage of the process!
It’s our hope this blog provides you with some useful disability rating information moving forward as you navigate your own VA disability rating process successfully and finally get your VA disability benefits you have earned!
FAQs
What is the average VA disability rating for back pain?
The average VA disability rating for back pain can vary depending on the severity and type of condition. Generally, lower VA disability ratings (10-30%) may be assigned to minor injuries or conditions that are expected to heal over time with no permanent residual effects. Higher VA disability ratings (50-100%) would indicate more severe cases, such as a spinal cord injury or long-term degenerative condition.
As such, it is important to provide as much evidence as possible when filing a fully developed claim to ensure that your rating accurately reflects the extent of your service connection for your injury or condition.
Ultimately, the VA will evaluate each individual case and assign a disability rating based on the severity of the disability and any residual impairments.
How does the VA measure back pain?
The VA measures back pain based on the evidence provided in support of the claim. Medical records, such as x-rays and MRIs, are particularly useful for establishing a diagnosis and determining the extent of the injury or condition.
Additionally, personal statements and statements from healthcare professionals, supporting family members, friends, or other witnesses can help to corroborate claims and provide additional evidentiary support.
The disability VA ratings are assigned based on an individual’s symptoms including any ongoing discomfort or limitations they may experience due to their disability. Ultimately, the goal is to assign a fair rating that accurately reflects both short-term and long-term impairments and helps ensure veterans receive appropriate care and compensation for their service connected disability.
Is it hard to get VA disability for back pain?
The VA disability process can be complex and difficult to navigate for even the most experienced veterans. However, with the right resources and a thorough understanding of both your medical condition and the criteria used to evaluate claims, it is possible to obtain VA disability benefits for back pain.
It is important to remember that each individual case is unique, so having supportive documentation from healthcare professionals, family members, or other witnesses may help you effectively present your case. Additionally, working with a qualified Veterans Service Officer (VSO) can be extremely helpful in ensuring all requirements are met and all evidence is properly presented.
With their assistance and guidance, you can increase your chances of obtaining an appropriate VA disability rating for your service related back condition.
What kind of back problems qualify for disability?
In order to qualify for VA disability, a back condition must be service connected and adversely affect the veteran’s ability to perform daily activities. This means that it must have been caused by or related to an injury or illness incurred during military service.
Additionally, the condition must be severe enough that it has caused significant impairments, including chronic pain or physical limitations, which have had an impact on daily functioning. Common back conditions eligible for VA disability include spinal cord injuries, herniated discs, degenerative disc disease, sciatica, radiculopathy and scoliosis.
However, specific criteria will vary depending on the type of disability being claimed and can change over time as new evidence is presented.
In any case, having comprehensive medical records and supportive statements from healthcare providers and family members can help to ensure your case is properly evaluated.
How does the VA test for back pain?
The VA testing for back pain typically includes a physical examination, diagnostic imaging (such as X-rays or MRIs), and other tests to accurately diagnose the condition. The VA will also assess the veteran’s medical history, including any previous treatments or medications that have been used to manage their symptoms.
Additionally, psychological tests may be administered in order to determine how the back pain is affecting overall mental health and quality of life. All of this information is then evaluated using set criteria in order to assign a disability rating for back pain that accurately reflects the severity of the impairment and any residual effects it may have on daily functioning.
Ultimately, providing comprehensive evidence is essential for obtaining appropriate VA ratings from the VA for any type of service connected disabilities.