Back Pain VA Rating

If you are a veteran suffering from service-related back pain, you could be eligible for benefits after receiving an accurate back pain VA rating. If your claim for back pain has been denied, VA disability lawyers from our VA benefits law firm can help. 

An Overview of Back Pain

As explained by the National Institute of Health (NIH), back pain is one of the most common medical problems in our country. Back pain can range in severity from a dull, constant ache, to a sudden, sharp pain that can shoot down the leg. 

Causes of Back Pain 

Back pain can be caused by a variety of health issues, including mechanical and structural problems. Degenerative disc disease happens when aging causes a breakdown of the discs between the spine, and can be associated with degenerative diseases like arthritis or spinal stenosis. Spinal stenosis is the narrowing of the spinal canal, placing pressure on the spinal cord and nerves, causing back pain. Experiencing a herniated or ruptured disc causes compression which irritates nearby nerves, causing back pain. 

When the cause of your back pain was service-related, you may qualify for VA disability benefits. 

Types of Back Pain

Back pain ranges from mild to severe and can be a dull pain that can be managed but does not cause cognitive or occupational impairment. Severe back pain requires medication to be managed, and can negatively impact your ability to engage in both recreational activities and work. 

Symptoms of Back Pain

Symptoms of back pain depend upon the severity of the underlying injury and its related conditions. Back pain can manifest as a dull, constant ache that can be managed with medicine, or it can be a sharp pain that comes on suddenly and is difficult to bear. Back pain can be centralized, or may lead to pain that spreads to other areas of your body. 

The NIH recommends that you visit a doctor when you experience: 

• Numbness and tingling 
• Back pain following an injury or fall
• Severe back pain that does not improve after taking medication
• When back pain is experienced with weakness, pain, or numbness in the legs, fever, difficulty urinating, or unintended weight loss

The symptoms that you experience for your back pain will determine how your back pain VA rating is measured through the relevant criteria. 

Back Pain VA Disability Rating Criteria

The VA applies the General Rating Formula for Diseases and Injuries of the Spine under 38 CFR § 4.71a in the evaluation of back conditions, including pain in your lower back. The rating formula takes into account a variety of criteria, namely: 

• Your range of motion 
• The measurement of the amount of movement around a particular joint or body part
• The range of motion includes both flexion or bending, as well as extension or straightening 

The degree to which your functional mobility is impacted is the primary consideration when rating your back pain. The impact the related pain and pain management has upon your life is also factored into your rating to determine what percentage you may be assigned. 

It is important to recognize that rules concerning veteran eligibility for VA disability compensation have recently changed. In the past, it was necessary that you prove that your back pain was due to or linked to a current diagnosis. However, cases such as Saunders v. Wilkie, a 2018 Federal Circuit case, established that pain alone could be identified as contributing to functional impairment and should be considered a disability. It is still necessary for the impairment to rise to the level of causing functional impairment that negatively impacts your ability to earn. 

Rating Percentages Assigned by the VA to Back Pain

The degree to which your back pain alters the physiology of your spine, and impacts your movement, determines your percentage and what benefits you are eligible to receive. A term you’ll see in the percentages is “ankylosis,” which is defined by the National Institutes of Health as “a type of arthritis that causes inflammation in the joints and ligaments of the spine”. The condition impacts the level of pain you experience and also your mobility, and factors largely into how the VA rates your back pain. 

The VA rates back pain based mainly on the degree of impact it has on your spinal function, and the percentages are as follows: 

• 10 percent – the forward flexion of the thoracolumbar spine can be done at greater than 60 degrees, but not greater than 85 degrees; or the forward flexion of the cervical spine is possibly greater than 30 degrees but not over 40 degrees; or, the combined range of motion of the cervical spine is greater than 170 degrees but not over 335 degrees; or muscle spasm, guarding, or local tenderness that is not due to abnormal gait or abnormal spinal contour; or finally vertebral body fracture with loss of 50 percent or more of the height 
• 20 percent – forward flexion of your thoracolumbar spine is over 30 degrees but not greater than 60 degrees; or forward flexion of the cervical spine is greater than 15 degrees but not greater than 30 degrees, or the combined range of motion you exhibit for your thoracolumbar spine is not greater than 120 degrees; or your combined range of motion at your cervical spine is not over 170 degrees; or, muscle spasm or guarding that is severe enough to cause an abnormal gait or abnormal spinal contour 
• 30 percent – forward flexion of your cervical spine of 15 degrees or lower; or favorable ankylosis of your entire cervical spine 
• 40 percent – unfavorable ankylosis of the entire cervical spine; or the forward flexion of your thoracolumbar spine of 30 degrees or lower; or favorable ankylosis of the entire thoracolumbar spine 
• 50 percent – unfavorable ankylosis of the entire thoracolumbar spine 
• 100 percent – unfavorable ankylosis of the entire spine

Even in situations where your back pain does not meet the range of motion criteria that we covered above, you may still be able to qualify for VA disability benefits for your low back pain if you are diagnosed with intervertebral disc syndrome (IVDS) as well. IVDS is rated through VA Diagnostic Code 5243, which instead of focusing on your range of mobility focuses on the number of incapacitating episodes that you experience as a result of your lower back pain. 

The VA defines an incapacitating episode of lower back pain as a period of acute signs and symptoms that require you to engage in physician-prescribed bed rest. 

The VA rates IVDS in the following way: 

• 10 percent – when you experience incapacitating episodes with a total duration of at least a week, but less than 2 weeks over the prior 12 months
• 20 percent – incapacitating episodes with a total duration of 2-4 weeks in the prior 12 months
• 40 percent – incapacitating episodes for a total duration of 4-6 weeks in the past 12 months
• 60 percent – your incapacitating episodes have a total duration of 6 or more weeks in the last 12 months

Determining the origin of your back pain and what type of rating applies to it requires medical attention and assessment. 

Sudden “Flare Ups” Can Limit Mobility and Impact Steady Employment

Lower back pain is also something that is known to flare up, or cause incapacitation as a result of sudden and temporary increases in symptoms. When you experience total incapacitation as a result of back pain, you encounter not only pain but a loss in mobility, which affects you in occupational situations, limiting your ability to earn an income. When that is the case your VA disability benefits increase to address your drop in earning capacity. 

Research published by the National Institutes of Health found that 51% of persons with chronic back pain suffer from flare-ups. When experiencing a flare-up, the patient likely experiences:

• Greater levels of pain intensity 
• Disability 
• The use of opioid medications 
• Other psychosocial impacts 

The potential to experience a painful and debilitating flare-up can influence the behavior of a veteran with chronic back pain and flare-ups, as activities may be avoided to prevent the potential pain.

Filing a VA Disability Back Pain Claim

While you may be able to receive medical treatments at VHA centers before you have applied for VA disability, to collect the full benefits available to you an application is essential. The application may include a Compensation and Pension Exam (C&P Exam) if your initial application does not provide sufficient supporting evidence and medical information. 

You’ll need to file the following forms to apply and support your application with evidence: 

• VA Form 21-526EZ – Application for Disability Compensation and Related Compensation Benefits – This is the essential form that you’ll begin your VA disability claim with, and must be completed accurately, completed, and supported by sufficient evidence for you to receive an accurate back pain VA rating. 
• VA Form 21-4138 – Statement in Support of Claim – this form is used for “buddy statements” in addition to nexus letters, each of which provides you with essential supporting information for your claim. 

The VA is looking for specific information within your application when considering whether or not to approve your claim. It is essential that you completely and accurately fill out your application, and also provide the evidence the VA needs to see a relation between your current diagnosis and your qualifying active military service. 

The Importance of Nexus Letters and Medical Evidence 

It is important to provide sufficient evidence to the VA for you to receive a complete and accurate back pain VA rating. If your claim is denied, or the percentage rating that you receive is lower than you deserve, the appeal process can take years to move through. When you are rated lower than your actual disability, the amount in benefits that you receive may not be enough to cover the medical costs and lost earnings associated with your back pain.

As mentioned above, nexus letters are submitted through VA Form 21-4138, and can provide the opinion of medical professionals who have reviewed your situation in support of your claim. In order to qualify to collect VA disability for back pain, you must:

1. Have a current diagnosis of back pain
2. Your current diagnosis of back pain must be linked to your qualifying active service in the U.S. Armed Forces
3. You must have the opinion of a medical professional that links #1 and #2 above, which our veterans benefits law firm can help align for you through our network of experts 

The medical evidence that you provide with your initial application may also be all that is reviewed by the Board of Veterans Appeals in the event that your initial claim is denied. 

Connect with a VA Disability Lawyer for Help with Your Back Pain VA Rating 

If you or a loved one is suffering from service-related back pain that is limiting social and occupational situations, and your initial claim was denied, reach out now for help with your VA disability claim appeal. Call us at 888-878-9350 or visit our site to schedule a free case evaluation.

FAQs

How do I inform the VA of my back pain and collect disability benefits?

You need to file a completed VA Form 21-526EZ and provide the VA with sufficient medical and supporting evidence to prove your back pain and receive an accurate back pain VA rating. 

What conditions are secondary to back pain? 

Back pain can result in a variety of psychosocial secondary issues including depression, issues with opioid addiction, and secondary health issues due to opioid use, and physical manifestations due to a lack of mobility including an increased risk of diabetes, hypertension, and obesity. 

How does the VA measure back pain? 

The VA measures back pain based largely on the impact it has on your mobility so that your eligibility for disability payments to cover related diminished earning capacity can be measured. Even when you have a diagnosis of 0 percent for a disability, you are eligible for healthcare through the VA, but you need to prove an impact on your earnings ability to collect VA disability payments.