How to Get a Sacroiliitis VA Disability Rating

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Do you qualify for a sacroiliitis VA disability rating? We can help guide you in the right direction!

Sacroiliitis generally presents as lower back pain but can exhibit differently from person to person. 

As a veteran, you put significant stress on your body while serving in the military and deserve the appropriate compensation.

But how much are you owed when you qualify for a sacroiliitis VA rating?

In this post, we’ll examine sacroiliitis VA disability ratings. We’ll also break down how to file a VA claim and get service connected for your sacroiliitis.

Let’s take a closer look.

What is Sacroiliitis?

Sacroiliitis is a painful condition affecting one or both sacroiliac joints, which sit where your lower spine and pelvis meet. 

Generally, these joints act as shock absorbers, helping decrease stress on your pelvis and spine. However, if one or more of these joints becomes inflamed, you’ll likely experience discomfort and mobility issues. 

Speaking with a medical professional about your condition is vital because sacroiliitis can lead to permanent joint damage if left untreated. 

Symptoms of Sacroiliitis

• Lower back pain 
• Stiffness 
• Hip pain
• Limited range of motion
• Fatigue 
• Fever

Sacroiliitis VA Disability Ratings

The VA rates sacroiliitis at 10%, 20%, 30%, 40%, 50%, and 100% under diagnostic codes 5235 through 5243 of 38 CFR § 4.71a, General Rating Formula for Diseases and Injuries of the Spine.

Your sacroiliitis VA disability rating will depend on the severity, frequency, and duration of symptoms, including Limitation of Range of Motion (ROM) and Painful Motion. 

How to Get Service Connected for Sacroiliitis

Veterans suffering from sacroiliitis because of their military service should know how to prove a service connection and file a VA disability claim.

To receive a sacroiliitis VA disability rating, you must meet the following requirements:

1. A current medical diagnosis of sacroiliitis 
2. An in-service event, injury, illness, or aggravation
3. A medical nexus (or link) between the current diagnosis and the in-service event, injury, or illness (can be a Nexus Letter)

5 Steps to Filing a VA Claim for Sacroiliitis

To file a VA claim to receive a VA rating for sacroiliitis, use the following five steps:

1. Gather Documentation: Collect medical records showing current diagnosis, test results, service records, and other evidence, such as Medical Nexus Letter or Independent Medical Opinion (IMO) linking your sacroiliitis to your military service.
2. Complete VA Form 21-526EZ: Fill out this form to apply for disability compensation. Include details about your exposure, symptoms, and how it affects your daily life.
3. Submit Your Claim: Send the completed form and supporting documents to the VA regional office handling your claim. You can submit it online through the VA website, by mail, or in person.
4. Undergo Examinations: The VA might schedule you for medical examinations to evaluate the extent of your sacroiliitis.
5. Await the Decision: The VA will review your claim, considering the evidence provided.

The VA will notify you of their decision regarding your eligibility for a sacroiliitis VA disability rating, including VA benefits and compensation.

Compensation and Pension Exam for Sacroiliitis

Sacroiliitis is difficult to diagnose because it’s often mistaken for other lower back conditions, so you’ll likely be required to attend a compensation and pension (C&P) exam. 

Your C&P exam is the opportunity to show the VA how your condition affects your life. While honesty is important, you don’t want to exaggerate or lie about your condition. 

This is the #1 VA C&P Exam Tip

This is the #1 VA C&P Exam Tip!

VA Back Ratings

You’ll be assigned an appropriate diagnostic code depending on your specific diagnosis. 

Here’s an overview of some of the diagnostic codes (DC) regarding back ratings. 

• DC 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.
• DC 5236 – Sacroiliac injury and weakness: Pain in the joints connecting the pelvis and lower spine. 
• DC 5237 – Lumbosacral or cervical strain: A generic label for back pain.
• DC 5238 – Spinal stenosis VA disability rating: The spinal column narrows and presses on the spinal cord or nerves.
• DC 5239 – Spondylolisthesis or segmental instability: When a vertebra slips out of position.
• DC 5240 – Ankylosing spondylitis: An arthritic disease that causes the spinal joints to freeze in place.
• DC 5241 – Spinal fusion: The vertebrae are surgically fused together.
• DC 5242 – Degenerative arthritis, degenerative disc disease: a condition in which pain is caused by a disc that wears down.
• DC 5243 — Intervertebral disc syndrome: a common condition characterized by the breakdown (degeneration) of one or more of the discs that separate the bones of the spine (vertebrae), causing pain in the back or neck and frequently in the legs and arms.

General VA Rating Chart for the Back Pain

General Rating Formula for Diseases and Injuries of the Spine	VA Rating
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%

If you don’t qualify for the range of motion listed above, you may qualify for a back pain VA rating if you have intervertebral disc syndrome, found under diagnostic code 5243

Formula for Rating Intervertebral Disc Syndrome Based on Incapacitating Episodes	VA Rating
With incapacitating episodes having a total duration of at least 6 weeks during the past 12 months	60%
With incapacitating episodes having a total duration of at least 4 weeks but less than 6 weeks during the past 12 months	40%
With incapacitating episodes having a total duration of at least 2 weeks but less than 4 weeks during the past 12 months	20%
With incapacitating episodes having a total duration of at least one week but less than 2 weeks during the past 12 months	10%

Sacroiliitis and TDIU

If you receive a sacroiliitis VA disability rating of less than 100%, you may still qualify for the maximum VA rating if your condition prevents you from maintaining substantially gainful employment. 

If you qualify for total disability based on individual employability, you’ll receive a rate equivalent to a 100% VA disability rating.  

Sacroiliitis VA Disability Rating (FAQs) Frequently Asked Questions  

What is the VA disability rating for sacroiliac joint dysfunction?

The VA rates sacroiliac joint dysfunction at 10%, 20%, 30%, 40%, 50%, and 100%, depending on the severity, frequency, and duration of your symptoms. 

What is the maximum sacroiliitis VA disability rating?

The maximum sacroiliitis VA rating is 100%. 

What medical evidence is required for a VA disability claim for sacroiliitis?

To help you get the highest possible sacroiliitis VA rating, you should provide the following:

• Medical records showing the current diagnosis of sacroiliitis
• Nexus Letter
• Independent medical opinions (IMOs)
• Test results
• Buddy statements (optional)

NEED MORE ASSISTANCE?

Most veterans are underrated for their disabilities and, therefore, not getting their due compensation. At VA Claims Insider, we educate you on how to take control of the claims process so you may get the rating and compensation you’re owed by law. If you’ve filed your VA disability claim and have been denied or have received a low rating—or you’re unsure how to get started—reach out to us!

Our process takes the guesswork out of filing a VA disability claim and supports you in building a fully developed claim (FDC)—so you can increase your rating FAST! Take advantage of a FREE VA Claim Discovery Call. Learn what you’ve been missing—so you can FINALLY get the disability rating and compensation YOU DESERVE!