What Are Va Ratings For Back Pain
The VA ratings for back pain reflect the seriousness of a veterans mobility loss and how much the spine is affected.
Back injuries are rated using the General Rating Formula for Diseases and Injuries of the Spine in the Schedule of Ratings. The ratings consider:
- Degree of flexion
- If the veteran is experiencing unfavorable ankylosis or favorable ankylosis
- If the problem is in the thoracolumbar spine or cervical spine
|Only rated with medical proof of nerve irritation because of a displaced disc fragment|
Vertebral Fracture Or Dislocation Va Ratings
These sorts of fractures are under VA diagnostic code 5235. A vertebral fracture occurs when a vertebra becomes compressed due to trauma. Vertebral fractures are common among veterans disability claims due to the physical exertion that most active-duty soldiers experience.
Typically, a vertebral fracture results in symptoms such as limited spinal mobility, and standing/walking will make the pain worse while lying down on the back makes the pain better. A vertebral dislocation is when one of the small vertebrae in the neck is displaced following a traumatic injury to the head or neck.
Symptoms of a vertebral dislocation include pain that spread into the shoulder and arms, tingling or numbness in the arm, muscle spasms in the neck, and weakness in the arms. Veterans benefits for vertebral fractures can lead to significant VA disability compensation and should not be ignored.
List Of Va Secondary Conditions To Back Pain
Many veterans suffer from various service connected back conditions, which can affect your back.
For example, the following codes from 38 CFR, Part 4, Schedule for Rating Disabilities apply:
- Code 5237: Lumbosacral or cervical straina generic label for back pain
- Code 5238: Spinal stenosisthe spinal column narrows and presses on the spinal cord or nerves
- Code 5239: Spondylolisthesis or segmental instabilitywhen a vertebra slips out of position
- Code 5240: Ankylosing spondylitisan arthritic disease that causes the spinal joints to freeze in place
- Code 5241: Spinal fusionthe vertebrae are surgically fused together
- Code 5235: Vertebral fracture or dislocationthe bones of the spine break or slip out of alignment due to a traumatic event like a car accident. Any generic spinal bone injury would be coded here.
These six back conditions can often lead to pinched or damaged nerve roots, which can cause significant pain known as Radiculopathy.
Radiculopathy is commonly rated as a secondary VA disability claim for secondary service connection due to one or more service connected back conditions.
Note that a veteran is eligible to be rated for both a back condition, and Radiculopathy secondary to lower back pain.
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Types Of Injuries That Can Cause Back Pain
A medical examination will be required to strengthen the claim and increase your chances of approval. Doctors may or may not be able to pinpoint the source of the pain, but its often linked to one of the following:
- Arthritis. Spinal stenosis, or the narrowing of space around the spinal cord, can occur.
- Bulging discs. When the material in the discs in the back rupture or bulge, it can create pressure on the nerves, causing significant pain.
- Osteoporosis. This condition weakens the bone and can lead to fractures.
- Strains. Both ligament and muscle strains can occur from heavy lifting or awkward movements.
You may be experiencing pain from fractures, sprains, strains, herniations, nerve damage, or other injuries.
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How The Veterans Law Group Can Help
If you are a veteran suffering from a back injury or damage to your spine from your service in the military, the Veterans Law Group can help. No matter what the VA disability rating for your back pain might be, we can offer insight into your claim and offer guidance for your next step. If you are unhappy with the VAs decision, an attorney can be your best advocate. Contact us now.
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What Does Va Mean By Incapacitating Episodes
As I mentioned above, veterans can also qualify for a 20 percent VA rating by showing at least 2 weeks of incapacitating episodes in the last year. This applies most often to veterans who have periods where their back flares up or goes out, and they simply are unable to do much of anything. This really takes a toll on veterans and should be factored in by VA.
Fortunately, VA does factor that in. Its another way to rate a spinal condition. Having back pain or some limitations alone will not be enough to qualify for the 20 percent VA rating since VA defines incapacitating episodes.
In VAs rules, incapacitating episodes means signs and symptoms that your doctor says require bedrest that your doctor orders. The good news is that the episodes do not have to be two weeks in a row. You just have to have a total of at least two weeks in the last year.
VAs rules also provide that VA should use whichever method of rating your thoracolumbar spine which provides you with the higher rating. So, if you qualify for a ten percent using range of motion and a 20 percent using incapacitating episodes, then VA should assign you a 20 percent rating.
How To Apply For Va Disability For Back Pain
Before you begin any VA disability claim, consider speaking to a VSO.
You will need to provide medical evidence to support your claim. This evidence can come in the form of a diagnosis from a doctor, medical records and witness statements.
Once you have gathered the necessary documentation, you will need to file a claim with the VA.
To file for benefits, you will need to fill out VA Form 21-0966, Intent to File a Claim for Compensation and/or Pension, or Survivors Pension and/or DIC. You dont need to do this if you plan to file your claim online. Beginning an online application for disability benefits notifies the VA of your intent to file.
Keep in mind, you must submit your VA claim within one year of your effective date.
You can file your claim online or deliver your completed VA Form 21-526EZ, Application for Disability Compensation and Related Compensation Benefits, by mail or in person at your closest VA regional office.
Address mail-in forms to:
PO Box 4444
When applying, you can choose to provide the required supporting documentation for a fully-developed disability claim, which usually yields a quicker decision. Or, you can ask the VA to handle the claim review and gather the needed documents through a standard disability claim.
There is no time limit to file a VA back disability claim. However, its best to start the process when you separate from active duty, if at all possible.
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How Does Va Rate Back Conditions
VA rates most back conditions under 38 CFR § 4.71a, Schedule of Ratings, Musculoskeletal System, General Rating Formula for Diseases and Injuries of the Spine. The criteria are based largely on a veterans range of motion.
Different diagnostic codes within this formula are used to rate different back disabilities. The ratings issued can range from 0 to 100 percent.
Generally, veterans will need to attend a C& P exam to measure how far they can bend forwards, backwards, and side to side, using a goniometer.
VA will then determine the severity of back condition based on the range of motion measurements. When issuing a rating, VA must also take into account functional loss and flare-ups.
Back Pain Va Rating Chart:
- 100% VA Disability for Back Pain: Unfavorable ankylosis of the entire spine
- 50% VA Disability Rating for Back Pain: Unfavorable ankylosis of the entire thoracolumbar spine
- 40% VA Rating for Back Pain: 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
- 30% VA Rating for Back Pain: Forward flexion of the cervical spine 15 degrees or less or, favorable ankylosis of the entire cervical spine
- 20% VA Disability Rating for Back: 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
*If no limitation of range of motion is observed, but the claimant has painful motion, the minimum rating or 10% should be applied.
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Functional Loss Full Definition
Disability of the musculoskeletal system is primarily the inability, due to damage or infection in parts of the system, to perform the normal working movements of the body with normal excursion, strength, speed, coordination and endurance.
It is essential that the examination on which ratings are based adequately portray the anatomical damage, and the functional loss, with respect to all these elements.
The functional loss may be due to absence of part, or all, of the necessary bones, joints and muscles, or associated structures, or to deformity, adhesions, defective innervation, or other pathology, or it may be due to pain, supported by adequate pathology and evidenced by the visible behavior of the claimant undertaking the motion.
Weakness is as important as limitation of motion, and a part which becomes painful on use must be regarded as seriously disabled.
A little used part of the musculoskeletal system may be expected to show evidence of disuse, either through atrophy, the condition of the skin, absence of normal callosity or the like.
Dont Back Down: Reach Out For Help
Chronic back pain often persists through multiple treatments and even surgical intervention. Conditions like failed fusion syndrome can leave patients with unmanageable pain. As a result, they may be unable to return to normal work and leisure activities. In addition to seeking further treatment to combat their pain, these patients often need more than just medical help.
Social Security disability benefits provide that additional assistance. But getting approved for disability benefits for back problems can be challenging, largely because of how difficult it is to measure pain.
Thus, consulting an attorney provides you with a much better chance of getting the aid you need. And doing so before you submit your application could save you from suffering through the months-long appeals process.
An experienced disability lawyer will help you navigate the complex Social Security system. Theyll show the SSA that you will not back down from proving that youre entitled to SSDI or SSI benefits.
At The Law Offices of Jeffrey A. Rabin & Associates, we offer free evaluations of patients cases. We have some of the best disability lawyers in the Chicago area on our team. And we can lead you through every step of the application process.
So call us today at 229-0008 and let us fight to get you the help you deserve.
Va Compensation And Pension Exams For Back Pain
To help the VA determine VA disability ratings for back pain, a compensation and pension exam is usually required. This is where a VA-approved medical professional will perform a comprehensive physical and verbal examination then write their opinion on your condition. The practitioner will assess how far you can bend and flex your joints during the range of motion C& P exam.
While the ROM test is the primary factor in determining VA ratings for back and spine conditions, there are also other portions included in the C& P exams. For example, the VA compensation exam for lower back pain might include a disability benefits questionnaire . Back thoracolumbar spine conditions can have a significant effect on an individuals life, a DBQ allows the veteran to go into detail about how the condition has impacted their life.
Attending a C& P exam with a medical professional can also potentially help you discover the presence of secondary conditions you were unaware of.
How To Win Your Back Impairment Claim
The most important evidence you need to have to support your claim is medical evidence. Ideally, this evidence will include documents diagnosing you with a back condition that began in service or was made worse during your military service and detailing the objective findings that show the severity of the condition. These types of records are very important, especially in the event that you receive an unfavorable Compensation and Pension exam. Having favorable medical records from your treating physician can help counter the negative C& P exam opinion.
When attending a C& P exam for your back condition, make sure that you are honest with the examiner about your back pain and mobility issues. You want to articulate clearly to the examiner how the pain and swelling in your lumbar spine limits your daily life. The examiners who conduct these assessments for the VA are often underpaid, overworked, and under immense time pressure to complete the examination report and return it to the VA, so you may need to repeat yourself several times, but make sure that the examiner knows how severe your back condition is and what sort of limitations it causes you to have in your daily life.
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Temporary Total Ratings Due To Hospitalization
If veterans are hospitalized for over 21 days as a result of their back pain, they can apply for a temporary total rating. Importantly, veterans must apply for this benefit directly as VA will not grant it on its own. Veterans can be granted 100 percent for the rest of the hospitalization period and possibly after, depending on how VA evaluates the back condition following discharge. After discharge, VA will complete an assessment and reassign a rating that reflects the current severity of the veterans back pain.
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Veterans Back Pain Claims
Back pain is a common condition among veterans who have completed active duty service. Chronic back pain can inhibit your ability to maintain employment or meet your own day-to-day needs. Fortunately, you may qualify for disability benefits from the Department of Veterans Affairs if you suffer from service-related back pain.
From acute injuries to repetitive stress syndrome, some forms of back pain will never heal entirely. This is especially true in chronic condition cases that involve nerve damage in the spine. Let an experienced VA benefits attorney advise you on pursuing veterans back pain claims.
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Va Disability Benefits For Back Pain And Conditions
You can receive VA benefits for back pain, even if your doctor hasnt diagnosed you with a specific condition.
Back pain can be a debilitating and chronic condition for a veteran, making it extremely difficult to be gainfully employed. The good news is that VA benefits are available for those suffering from long-lasting back pain, even its not attributed to a known back condition.
If you can link your back pain to your military service or prove that your active duty time worsened a preexisting condition, compensation is available to you.
To receive these benefits, youll have to provide medical records confirming that youve visited a doctor because of your back pain and link your disability to your service.
Heres how youll go about receiving VA benefits for your back pain.
VA claims for a back condition
The most straightforward way to win your VA claim is to have a specific diagnosis of a back condition related to your service. If your doctor documents a back injury that you can trace to your time in the military, the process is pretty simple.
Common back conditions include spinal stenosis, a cervical strain, segmental instability, a vertebral fracture, or ankylosing spondylitis. Some of these disabilities are injuries, while others are degenerative conditions, but they can all receive a medical diagnosis from your doctor.
A VA claim for back pain
How the VA assigns disability ratings
For intervertebral disc syndrome, youre eligible for:
Your employability matters
What Is Medically Determinable Back Pain
The first thing you need to know about qualifying for disability based on back pain is that the Social Security Administration does not typically grant benefits to those with mild, moderate, or intermittent back pain. Despite the fact that the SSA receives millions of applications for back pain-more applications for any other type of illness or injury, in fact-it only grants benefits to individuals with âmedically determinableâ back impairments. This means that, in order to qualify for Social Security disability benefits, youâll need to show that you have an impairment that can be detected and affirmed by a medical professional.
The Social Security Administration has a section on âDisorders of the Spineâ in its Listing of Impairments, which is typically used to determine whether back pain is compensable.
In order to be considered a âdisability,â your back pain must involve, among others, one of the following:
- Herniated discs
- Difficulty walking
- Chronic pain associated with compression of the lumbar spine
This list is not exhaustive you may be required to meet additional criteria in order to qualify for disability for your back pain or spinal condition.
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Getting Service Connected For Back Impairments
There is a lot of information you need to provide to the VA when trying to obtain service connection for your back or any other orthopedic condition. Some examples of records you will want to submit to the VA include your service medical records, military personnel files reflecting an in-service accident, diagnosis, or change of duty due to back issues, and any private medical records you have that could help establish a connection between your military service and your back condition. You can also submit sworn declarations from fellow servicemembers, family members, friends, or others familiar with your condition who can help verify that your back issues were caused or made worse by your military service.