Chronic back pain is a medical condition that the U.S. Department of Veterans Affairs (the VA) recognizes as a compensable disability claim. Depending on the nature and severity of the condition, you can receive a VA disability rating for back pain from 10% up to 100%.
In this article, we cover how the VA rates chronic back pain and how you can apply for veterans benefits if you are suffering from a service-connected back pain disability.
If you need help obtaining a VA rating for back pain, please call Stone Rose Law at (480) 498-8998 to speak with an experienced VA lawyer.
The VA measures your physical health and medical history against disability ratings for musculoskeletal conditions to assign you a pain disability rating.
This schedule refers to ankylosis, a condition characterized by limited or no spinal mobility. Favorable ankylosis occurs when the spine is straight, while unfavorable ankylosis occurs when it is not straight.
Ankylosis can also affect flexion, which measures your ability to bend the spine.
For disability rating purposes, back pain issues can affect two parts of your spine:
The VA evaluates conditions affecting each part of the spine separately. You can receive a disability rating of 10%, 20%, 30%, 40%, 50%, or 100%. These disability ratings can be combined with other disability ratings into a combined disability rating.
The average VA disability rating for back pain is 20%, but this can vary considerably based on your individual symptoms.
For the thoracolumbar spine, this involves forward flexion greater than 60 degrees but no more than 85 degrees, or a combined range of motion greater than 120 degrees but not more than 235 degrees. There’s a degree of flexibility in your back, allowing for forward movement up to about three hand lengths.
For the cervical spine, this rating involves flexion greater than 30 degrees but not more than 40 degrees, or a combined range of motion of greater than 170 degrees but not more than 335 degrees. You can tilt your head forward to about the width of a hand, up to a hand and a half.
Symptoms associated with this rating include muscle spasms, guarding, or localized tenderness that does not result in an abnormal gait or abnormal spinal contour, or vertebral fracture with the loss of 50% or more of the vertebra height.
For the thoracolumbar spine, this involves forward flexion greater than 30 degrees but not more than 60 degrees, or a combined range of motion of the thoracolumbar spine not more than 120 degrees. You can bend forward a bit more, between the length of a ruler and the span of two hands.
For the cervical spine, this rating involves forward flexion of the cervical spine greater than 15 degrees but not more than 30 degrees, or a combined range of motion of the cervical spine not more than 170 degrees. You can tilt your head forward a little, up to about the width of your hand.
Symptoms associated with this rating include muscle spasms, guarding severe enough to result in an abnormal gait, or an abnormal spinal shape.
This rating only applies to back pain affecting your cervical spine. It does not apply to the thoracolumbar spine.
At this rating level, your forward flexion of the cervical spine is 15 degrees or less, or you are experiencing favorable ankylosis of the entire cervical spine. Your neck might have a slight forward tilt.
At this rating level, there is an unfavorable ankylosis of the entire spine, or the ability to flex the lower spine forward 30 degrees or less, or favorable ankylosis of the entire thoracolumbar spine.
Your back may be fixed, but in a slightly more tolerable position. You might have a minimal forward bending ability, no more than the length of a ruler.
In cervical spine injury cases, your neck is stuck in an uncomfortable, fixed position. If combined with a similar condition in your middle back, this could justify a 100% disability rating.
This rating involves complete ankylosis of the thoracolumbar spine. Your back is immobilized in an uncomfortable position, significantly restricting your ability to move freely.
At this rating, you experience complete ankylosis of the spine.
In addition to back pain VA disability ratings for cervical and thoracolumbar spine back pain, you can also receive a VA disability for a lower back pain condition known as Intervertebral Disc Syndrome (IVDS) or total disability benefits based on Total Disability Individual Unemployability, or TDIU.
If you do not qualify for a disability rating based on the range of motion criteria above, you may still be able to receive a disability rating for low back pain if you have intervertebral disc syndrome (IVDS).
IVDS involves the degeneration or damage of spinal cushioning discs. This can lead to herniation, sciatica, and chronic pain. IVDS is often made worse by sitting, bending, or lifting.
The VA can rate IVDS as follows:
Even if you do not qualify for a 100% disability rating for back pain, you may still be able to receive total disability benefits if you are eligible to receive Total Disability Individual Unemployability, or TDIU.
You can receive TDIU benefits in either of two ways: schedular or extraschedular benefits.
To qualify for TDIU benefits, you must meet the following requirements:
Unlike schedular TDIU, which requires you to meet specific disability rating thresholds, the VA can give you extraschedular TDIU when your service-connected conditions are so severe that they still prevent you from keeping substantially gainful employment.
To qualify for extra-schedular TDIU, you must demonstrate that your service-connected disabilities create an exceptional or unusual disability that makes the standard rating schedule inadequate. The VA will review your claim to see if the symptoms of your service-connected conditions are so severe and unique that you can receive extraschedular TDIU.
If your back pain condition is severe enough to require assistance with the activities of daily living, or you cannot leave your house, then you may be able to receive Special Monthly Compensation (SMC).
You can qualify for a back pain VA disability rating if you can show the VA that the following are true:
You apply for VA benefits using VA Form 21-526EZ. Most veterans apply online. You can also mail in your application, or take it to your local VA regional office.
In addition to your 21-526EZ form, you should also include the following supporting documentation:
After you file your claim, the VA may require you to undergo a C&P exam. The purpose of this exam is to give the VA a chance to gather more information about the nature of your claim, so it can decide whether to assign a disability rating for back pain to you and what disability rating that should be.
A VA examiner will conduct your C&P exam. The exam includes a records review, the VA examiner asking you some questions about your symptoms and how they are affecting you, and a medical examination that can include range of motion and other tests. Often, the VA examiner will use a relevant DBQ during the conduct of the C&P exam.
When the C&P exam is complete, the VA examiner will prepare a report for the VA. You are entitled to a copy of this report that you can request or your VA benefits attorney can obtain for you.
Attending a scheduled C&P exam is essential. If you miss the exam for no good reason, this will negatively affect your claim and may result in a claim denial by the VA.
Veteran benefit claims often include claims for more than one disability. Back and neck pain claims are no exception to this general rule. Many kinds of secondary conditions aside from pain can be associated with back injuries. These are secondary claims, and they can contribute to a combined rating for you.
Some conditions that may be secondary to back pain include:
Sometimes the VA will not approve an initial claim for back pain. This can happen because of an incomplete claim, a lack of sufficient supporting evidence, or, in some cases, the VA itself can make an error in processing your claim.
If the VA does not approve your initial claim, you have three options to revive it.
The purpose of a supplemental claim is to give the VA new and relevant evidence to bolster your initial claim to overcome a denial based on lack of sufficient evidence or an incomplete claim.
If you believe that the VA has mistakenly denied your claim, a higher-level review can give a senior VA examiner the opportunity to go over your claim again.
If you have tried a supplemental claim or requested a higher-level review and the VA is still denying your claim, then you can make an appeal to the VA Board of Veterans Appeals. In this formal appeal, you will have a hearing before a VA law judge who will review your claim and any new supporting evidence you present.
Although it is possible to prepare and submit your VA benefits claim by yourself, having an experienced VA benefits lawyer to assist with its preparation can help you in meaningful ways:
At Stone Rose Law, we are board-certified VA claims lawyers who help veterans receive VA disability benefits nationwide. Our VA-accredited attorneys give you affordable, high-quality legal assistance with VA disability claims.
A Stone Rose Law VA disability lawyer can help you prepare your disability claim, monitor your claim status, and consult with you before disability examinations at no cost to you.
If the VA denies your original claim, our VA benefits law firm will help you respond effectively, up to making a formal request for a hearing with the Board of Appeals if necessary.
For more information about how one of our VA disability lawyers can help you with your VA disability compensation claim or appeal, request a free case evaluation consultation at (480) 498-8998 or use our contact form.
