Back pain is one of the leading health problems that veterans face. The nature of military service creates wear and tear on the muscles and bones of the back and spine, leading to chronic conditions later in life. Some back problems caused by service-related activities may not appear until years later.
Some back issues can become debilitating and interfere with a veteran’s ability to work. Pain and limited movement from a condition known as spinal stenosis can lead to significant disability. Veterans who are affected by spinal stenosis may be entitled to disability payments from the VA.
What is Spinal Stenosis?
According to the Mayo Clinic, spinal stenosis is a narrowing of the opening in the spinal canal. The spinal canal runs the full length of the spine and holds the spinal column, also known as the spinal cord. The bones of the spine protect the nerves in the spinal column, but if the bones shift or contract the nerve, the nerves become vulnerable to pinching or friction.
Spinal stenosis can occur anywhere on the spine. Doctors classify the condition based on the location of the narrowing.
If the narrowing occurs in the lower back, it’s called lumbar stenosis. This is the most common form of spinal stenosis.
Symptoms of lumbar stenosis include:
- Back pain
- Numbness or tingling in a foot or leg
- Pain or cramping in one or both legs when you stand for long periods or when you walk
- Weakness in a foot or leg
If the narrowing occurs closer to the neck, it’s called cervical stenosis. Symptoms of cervical stenosis include:
- Difficulty with walking and balance
- Neck pain
- Numbness or tingling in a hand, arm, foot, or leg
- Weakness in a hand, arm, foot, or leg
- In severe cases, bowel or bladder dysfunction (urinary urgency and incontinence)
What Causes Spinal Stenosis?
There are many reasons for spinal stenosis to develop. Due to the physical nature of military service, many veterans are at risk for the conditions that lead to spinal stenosis. Repetitive motions wear on the spine, and service-related injuries to the back are common among veterans. Causes of spinal stenosis include:
Osteoarthritis develops due to damage or wearing away of the protective cartilage inside joints. This can happen as a result of repetitive motion over time. Osteoarthritis of the spine can lead to spinal changes such as bone spurs that cause stenosis.
Injury or inflammation of spinal discs—the padding between vertebrae—can cause spinal stenosis. Disc problems can occur due to trauma or develop due to repeated motion over time. The disks can bulge out from between the vertebrae and cause changes to how the bones are aligned, leading to stenosis.
Ligaments are the tough cords of connective tissue that hold the bones of the spine together. Ligaments can become thicker and toughen over time. These thickened ligaments can bulge into the spinal column and lead to the narrowing of the passage.
Traumatic injuries sustained in combat, training, or other military activity can cause dislocations or fractures in the vertebrae. Spinal fractures and bone fragments may damage the contents of the spinal canal and cause chronic stenosis.
How the VA Rates Spinal Stenosis
The VA considers any back problem that limits movement to be a disability. They determine the scope of the problem by how limited the range of motion is, regardless of the cause of the problem. The VA uses the term “unfavorable ankylosis,” which is required under the VA rating code for the maximum rating. What is unfavorable ankylosis? It is a condition when the entire cervical spine or the entire thoracolumbar spine is fixed in flexion or extension. Favorable ankylosis is when the spine is fixed in the neutral position.
If a veteran has spinal stenosis that affects his or her range of motion, the VA will ask for a medical assessment, which will then be compared to the normal range of motion.
The VA has a set definition for normal range of motion:
For VA compensation purposes, normal forward flexion of the cervical spine is zero to 45 degrees, extension is zero to 45 degrees, left and right lateral flexion are zero to 45 degrees, and left, and right lateral rotation are zero to 80 degrees.
Normal forward flexion of the thoracolumbar spine is zero to 90 degrees, extension is zero to 30 degrees, left and right lateral flexion are zero to 30 degrees, and left and right lateral rotation are zero to 30 degrees. The combined range of motion refers to the sum of the range of forward flexion, extension, left and right lateral flexion, and left and right rotation.
The normal combined range of motion of the cervical spine is 340 degrees and of the thoracolumbar spine is 240 degrees.
Anything less than the normal ranges qualifies a veteran for disability payments. Ratings vary by the severity of the range of motion limits, with severe cases meriting 100% disability and milder cases having lower ratings.
General Rating Formula for Diseases and Injuries of the Spine
|Spinal Stenosis Diagnostic Code 5238 (For diagnostic codes 5235 to 5243 unless 5243 is evaluated under the Formula for Rating Intervertebral Disc Syndrome Based on Incapacitating Episodes):|
|With or without symptoms such as pain (whether or not it radiates), stiffness, or aching in the area of the spine affected by residuals of injury or disease|
|Unfavorable ankylosis of the entire spine||100|
|Unfavorable ankylosis of the entire thoracolumbar spine||50|
|Unfavorable ankylosis of the entire cervical spine; or, forward flexion of the thoracolumbar spine 30 degrees or less; or, favorable ankylosis of the entire thoracolumbar spine||40|
|Forward flexion of the cervical spine 15 degrees or less; or, favorable ankylosis of the entire cervical spine||30|
|Forward flexion of the thoracolumbar spine greater than 30 degrees but not greater than 60 degrees; or, forward flexion of the cervical spine greater than 15 degrees but not greater than 30 degrees; or, the combined range of motion of the thoracolumbar spine not greater than 120 degrees; or, the combined range of motion of the cervical spine not greater than 170 degrees; or, muscle spasm or guarding severe enough to result in an abnormal gait or abnormal spinal contour such as scoliosis, reversed lordosis, or abnormal kyphosis||20|
|Forward flexion of the thoracolumbar spine greater than 60 degrees but not greater than 85 degrees; or, forward flexion of the cervical spine greater than 30 degrees but not greater than 40 degrees; or, combined range of motion of the thoracolumbar spine greater than 120 degrees but not greater than 235 degrees; or, combined range of motion of the cervical spine greater than 170 degrees but not greater than 335 degrees; or, muscle spasm, guarding, or localized tenderness not resulting in abnormal gait or abnormal spinal contour; or, vertebral body fracture with loss of 50 percent or more of the height||10|
Applying for VA Benefits for Spinal Stenosis
Veterans who have a limited range of motion related to spinal stenosis can get disability benefits from the VA if they can prove that the disability is a result of active duty service. Veterans may also be eligible to make a VA claim if military service aggravated a preexisting condition.
In some cases, the VA may help veterans get surgery to treat spinal stenosis. During the months after surgery, veterans are entitled to a 100% disability rating so they can recover from the procedure. After recovery, the VA will re-evaluate their condition.
To qualify for VA disability benefits, veterans need to prove a connection between their military service and their current disability.
First, the veteran must show evidence of a current disability. Veterans will need to be able to show that spinal stenosis compromises their well-being and range of motion. Medical records and “buddy letters” from people who know the veterans are helpful for this part of the application.
Next, veterans must compile evidence that something happened in service. Veterans will need to show an in-service occurrence of something that led to the current disability. The VA will place the most weight on service medical records.
Lastly, veterans need to show a connection between in-service injury, activity, or disease and their current disability. This is called the nexus requirement. The veteran must have evidence establishing that a disabling disease or injury was “incurred coincident with service in the Armed Forces, or if preexisting such service, was aggravated therein.”
If spinal stenosis is due to a traumatic injury that happened during service, the injuries should be documented in in-service treatment records. If the condition arose after service, a doctor should document how service-related activities contributed to the veteran’s current disability.