The Spine

Topics:

How to Rate a Spine Condition
General Rating Formula
Spinal Conditions
Secondary Conditions
Arthritis
The Sacroiliac and Lumbosacral Joints
The Coccyx (Tailbone)
Intervertebral Disc Syndrome
DBQs for the Spine
Principles that Apply

Reminder: The VA will give a Military Disability Rating for each service-connected condition a service member has, but the DoD will only rate service-connected conditions that make a service member Unfit for Duty.

 


How to Rate a Spine Condition

It is really difficult to decide how best to rate a spine condition, but the basic rule of thumb is to rate it under the code that would give the highest rating. Always start first with the General Rating Formula (below). This is always the main rating system for any spine condition, and any other rating system should only be used if it gives a higher rating. There are, of course, a few exceptions that are discussed below.

Also note that the cervical spine and the thoracolumbar spine are to be rated as two separate conditions except when both are frozen in an unfavorable position.

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General Rating Formula

There is one general rating formula for any condition of the spine that is used in the majority of cases. We’ll discuss this general formula first, and then address exceptions.

The general formula is based primarily on range of motion (ROM). The images below show a normal ROM for the cervical and thoracolumbar spines.

military disability ratings for spine conditions

military disability ratings for spine conditions

Below is a chart of the general rating formula. A few points to know:

– If the spine is frozen and cannot move at all, it is considered favorable if it is frozen at 0° for flexion or extension. If it is frozen at any other place in flexion or extension, then it is considered unfavorable.
– To get the combined ROM, add all the measurements together: left rotation, right rotation, flexion, extension, right lateral flexion, and left lateral flexion. The normal combined measurements for the cervical spine is 340°, and the thoracolumbar spine is 240°.
– All measurements are rounded to the nearest 5 (8° rounds up to 10°, 7° rounds down to 5°, etc.)

Rating

Cervical Spine

Thoracolumbar Spine

100%

Entire spine frozen in an unfavorable position.

50%

 

Entire thoracolumbar spine frozen in an unfavorable position.

40%

Entire cervical spine frozen in an unfavorable position.

Flexion measures 30° or less.
-OR-
Entire thoracolumbar spine frozen in a favorable position.

30%

Flexion measures 15° or less.
-OR-
Entire cervical spine is frozen in a favorable position.

 

20%

Flexion measures more than 15° but not more than 30°.
-OR-
Combined ROM is 170° or less.

Flexion measures more than 30° but not more than 60°.
-OR-
Combined ROM is 120° or less.

10%

Flexion measures more than 30° but less than 45°.
-OR-
Combined ROM is between 175° and 340°.

Flexion measures more than 60° but less than 90°.
-OR-
Combined ROM is between 125° and 240°.

0%

Flexion measure 45° or more.
-OR-
Combined ROM measures 340° or more.

Flexion measures 90° or more.
-OR-
Combined ROM measures 240° or more.


military disability ratings for spine conditionsNOTE: It is important that your physician records correct and thorough measurements for any back condition. The measurements should be measured with a goniometer. If possible, make sure your physician records the range of motion for EVERY direction. As shown in the above images, there should be 6 total measurements taken for both the cervical and thoracolumbar spines. THIS IS VITAL TO A PROPER AND FAIR RATING!!!!! Too often physicians do not record these important measurements properly, and then the service member’s condition is not appropriately rated.

Another note on rating a spine condition based on ROM: There are some very rare circumstances where a physician can declare that a limited ROM is normal for an individual and thus not ratable. This is very rare and only happens if the physician can provide significant evidence that the ROM is normal for a particular individual.

There are a few more rating options under this general formula that only come into play if the ROM is not restricted enough to warrant a higher rating:

– If there is an abnormal spine contour (like scoliosis), or if you have muscle spasms, or if you guard your spine movements enough that you walk abnormally, then the condition is rated 20%. Proof of the abnormal spine contour or abnormal walk must be noted by the physician in an exam, not just with radiological evidence.
– If there are muscles spasms and guarding present that do not interfere with the way you walk, it is rated 10%.
– A 10% rating is also given if there is a compressed (fractured) vertebra that has lost 50% or more of its height.
– Finally, if there is pain with motion, then the rating must be at least 10%.

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Spinal Conditions

What the physicians call a spine condition is not terribly important unless it is one of the exceptions discussed later on this page. Since the majority of spine conditions are all rated on the General Rating Formula, it rarely makes a difference what the condition is called.

Here are the spine condition names and codes:

  • Code 5237: Lumbosacral or cervical strain—a generic label for back pain
  • Code 5238: Spinal stenosis—the spinal column narrows and presses on the spinal cord or nerves
  • Code 5239: Spondylolisthesis or segmental instability—when a vertebra slips out of position
  • Code 5240: Ankylosing spondylitis—an arthritic disease that causes the spinal joints to freeze in place
  • Code 5241: Spinal fusion—the vertebrae are surgically fused together
  • Code 5235: Vertebral fracture or dislocation—the 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.

When coding a condition, the physicians will try to choose the best description of the condition, but again, the coding really only matters if the condition qualifies for one of the exceptions.

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Secondary Conditions

Many times spinal conditions have other conditions that contribute to the severity of the spinal condition. For example, many spine conditions also cause radiculopathy. These secondary conditions can sometimes be independently ratable.

Remember that the DoD will ONLY rate conditions that make a soldier Unfit for Duty. In the case of secondary spinal conditions, however, the secondary condition does NOT have to be independently unfitting to be ratable. All it has to do is contribute to making the spinal condition unfitting. So, if the primary condition is spinal stenosis which causes a secondary condition of radiculopathy down the left leg by pushing on a nerve, then the radiculopathy would be independently ratable since the amount of pain it creates significantly contributes to the inability of a service member to perform his job.

If a secondary condition exists, it will be rated by the criteria for that condition, so see those conditions pages for rating information (i.e. see the nerve pages for radiculopathy).

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Arthritis of the Spine

The second most common rating system for spine conditions is under arthritis.

Code 5242: Degenerative arthritis of the spine is used when the limitation of motion is not severe enough to warrant a rating under the general rating formula. This condition is rated as degenerative arthritis, code 5003.

The final code for any spine condition rated as degenerative arthritis will look like this: 5242-5003. The first four-digit code defines the condition as a spine condition, and the second four-digit code tells how it is rated. See the Analogous Ratings page for more information on using hyphenated codes.

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The Sacroiliac and Lumbosacral Joints

military disability ratings for spine conditionsCode 5236: The sacroiliac joint and lumbosacral joint are rated together as though they are one entity (see principle §4.66). They are most commonly rated under arthritis, but can cause significant limitation of motion in the low back or hips and thus can also be rated under these symptoms.

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The Coccyx

Code 5298: The only condition of the tailbone that is rated under this code is surgical removal. Very simply, if the tailbone hurts following the surgery, it is rated 10%. If it doesn’t hurt, it’s rated 0%.

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Intervertebral Disc Syndrome

Code 5243: Intervertebral disc syndrome is when a disc in the spine is dysfunctional. It can deteriorate, herniate, etc. This condition can either be rated under the general rating formula or based on incapacitating episodes (below), whichever will give the higher rating. Now, if a disc in the cervical spine has this syndrome and another disc in the thoracolumbar spine also has it, then both the cervical spine and the thoracolumbar spine can be separately rated.

Formula for rating on Incapacitating Episodes:

If within the last year you were on bed rest prescribed by your physician for 6 weeks or more, then it is rated 60%. If within the last year you were on bed rest for 4 to 6 weeks, it is rated 40%. Two to 4 weeks is rated 20%, and 1 to 2 weeks is rated 10%.

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DBQs for the Spine

The following Disability Benefits Questionnaires (DBQs) are used for spinal conditions: Cervical Spine DBQ and Thoracolumbar Spine DBQ.

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Principles that Apply

Painful Motion: If pain is present with motion, then the minimum rating must be given.

The Joints: When rating arthritis, the vertebrae are considered minor joints.

Pyramiding: A single condition can only be rated once! However, if a nerve condition or other condition exists that is additional to the spine condition (not simply caused by it), then it can also be rated.

Probative Value: If two exams record the condition differently, the exam with the most thorough data and performed by the most qualified person in that specialty will be the exam the rating is based on.

A Tie Goes to the Veteran: If there are two equally strong exams with conflicting information, or if the condition can be equally rated under two different codes, then the one that gives the highest rating will be assigned. Every conflict should be resolved in favor of the higher rating.

Accurate Measurements: It is essential that the necessary information to rate your condition is recorded by the physician in your exam. All ranges of motion should be measured with a goniometer. With the information on this page, you should know what needs to be measured and recorded. Make sure this happens correctly to ensure that you receive a proper rating.

Hospital or Convalescent Ratings: Some conditions require periods of hospitalization or constant medical care (at-home nurse, etc.). Any condition that requires this is rated 100% during this intensive treatment. Once it ends, then the 100% rating will continue for a certain period. This period is 3 months unless another length (6 months, 1 year, etc.) is directly specified in the condition ratings. Some patients may need more time to recover than others, so the physician or Rating Authorities can lengthen this time period if they see fit.

Please see the Musculoskeletal Principles and the VASRD Principles pages for further guidance.

For muscle conditions, see The Torso and Neck Muscles and The Buttock, Hip and Thigh Muscles pages. For spinal cord and nerve conditions, see The Central Nervous System, Nerves of the Upper Back and Arms, and Nerves of the Low Back and Legs pages.

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