Let’s start with the good news.
In April 2018, it was determined by the Federal Circuit that the VA must award disability benefits for pain due to military service. Previously, pain without an underlying diagnosis was awarded compensation. This had been the de facto determination according to the Court of Appeals for Veteran Claims. Thankfully, that is no longer the case.
Today, because of the Federal Circuits decision, veterans may receive disability benefits that began during their military service even without an actual diagnosis. This decision has helped a number of veterans get benefits or even increase their disability rating.
Back pain for Veterans
Spine impairment is one of the leading causes of disability among veterans. Because most of those serving in the military frequently carry and lift heavy loads or engage in quick shifting and running in the line of duty, there is repeated stress and trauma on the joints which affect the health of the spine.
Fortunately, this fact has become more recognized by the VA and those creating policies for the VA. However, it is still important you know how to communicate your pain in order to receive the best possible benefits. Understanding the rules the VA uses to determine disability ratings for back pain will be helpful as you pursue help.
VA benefits for back pain
First of all, although it is now possible to receive benefits for pain incurred during your time in service without a diagnosis, it is not guaranteed. A current diagnosis is always recommended if possible to obtain. In addition to your current diagnosis, you will need to include a NEXUS letter and DBQ to partner with your medical evidence and in turn, prove your service-connected. Without these outside documents, you are significantly decreasing your chance of winning.
In determining benefits, the VA refers to the back as the “thoracolumbar spine”. This is the term used to reference middle or lower back pain. The VA considers upper back pain in the same category as neck pain. Therefore, anything above middle or lower back pain will be referred to as the “cervical spine” and falls under a different rating system.
The thoracolumbar spine is composed of two parts of the spine; the thoracic (twelve vertebrae) and the lumbar (5 vertebrae). These are the two areas that will be examined in order to determine benefits for any back pain.
Range of motion for back pain
The VA most often uses the General Rating Rating Formula for Diseases and Injuries of the Spine to evaluate back disabilities. Their rating is determined most commonly by assessing your range of motion. Their formula looks at the flexion at the waist and determines if it is limited by injury.
According to the VA, flexibility must be fairly limited to even get a 20 percent disability rating. This will be determined on whether there is forward flexion greater than 30 degrees but less than 60 degrees. Meaning that if you are significantly limited in your ability to bend at the waist, you might qualify for the 20 percent rating. Usually, previous diagnoses from doctors or therapists will be used to determine this.
The range of motion method of determining your VA benefits rating generally will end up as one of the following:
- 100%– entire spine affected by unfavorable ankylosis (the abnormal stiffening and immobility of a joint due to fusion of the bones)
- 50%– the entire thoracolumbar (middle and lower) spine affected by unfavorable ankylosis
- 40%– the entire cervical (upper) spine affected by unfavorable ankylosis; or, forward flexion of the thoracolumbar spine 30 degrees or less; or, favorable ankylosis of the entire thoracolumbar spine
- 30%– favorable ankylosis of the entire cervical spine; or, forward flexion of the cervical spine 15 degrees or less
- 20%– 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
- 10% – 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
Of course, a limited range of motion is not the only way to get a rating for a disabled back. It is also possible to obtain at least a 20 percent rating if you are regularly experiencing muscle spasms severe enough to develop an abnormal walking gait. They will also check you for the following abnormal spinal contours:
- abnormal kyphosis (abnormal rounding of the upper back)
- scoliosis (a sideways curvature of the spine)
- or reversed lordosis (abnormal straightening of the spine).
Intervertebral Disc Syndrome
Also considered is intervertebral disc syndrome, which is the condition wherein there is degeneration of one or more of the bones making up the spine. IVDS may receive the following ratings:
- 60% – a total duration of at least 6 weeks during the past 12 months with incapacitating episodes
- 40% – incapacitated at least 4 weeks but less than 6 weeks during the past 12 months
- 20% – incapacitated at least 2 weeks but less than 4 weeks during the past 12 months
- 10% – incapacitated at least one week but less than 2 weeks during the past 12 months
Finally, it is also possible to get benefits for osteoarthritis in the back. Veterans suffering from this will have bone spurs in their vertebra. These painful bony deformities develop over time, meaning the original injury that caused them may have occurred during service but taken years to manifest. Veterans with bone spur often experience:
- Herniated Discs: issues with the cushion between the vertebrae, also called a slipped disc or ruptured disc.
- Bulge Discs: usually in the lower back
- Compressed Discs: the weakening of the disc walls
If you have been diagnosed with any of these issues as a veteran, immediately report it to your local VA. By getting these symptoms documented you will be greatly helping your future VA claim!
If you have any questions for me, reach out here! Don’t allow back pain to prevent you from doing the things that you love!