VA math → how VA rates a back or neck strain

How VA rates a back or neck strain

VA rates lumbosacral or cervical strain (a common back or neck rating) under diagnostic code 5237 using the General Rating Formula for Diseases and Injuries of the Spine in 38 CFR 4.71a. The level (10, 20, 30, 40, 50, or 100 percent) turns mostly on your measured range of motion, or on ankylosis (a spine segment fixed in place), and it applies whether or not you have pain.

38 CFR § 4.71a · DC 5237

What the rating schedule says

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; 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

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; 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

30%Forward flexion of the cervical spine 15 degrees or less; or, favorable ankylosis of the entire cervical spine

40%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

50%Unfavorable ankylosis of the entire thoracolumbar spine

100%Unfavorable ankylosis of the entire spine

How the regulation is applied

Rated with or without pain

The General Rating Formula for the Spine is applied with or without symptoms such as pain (whether or not it radiates), stiffness, or aching in the affected area (38 CFR 4.71a). The rating turns on measured motion and ankylosis, not on pain by itself.

Nerve problems are evaluated separately

Any associated objective neurologic abnormalities, including but not limited to bowel or bladder impairment, are evaluated separately under an appropriate diagnostic code (38 CFR 4.71a, Note 1). Radiculopathy down the leg, for example, is evaluated on its own and then combined.

One formula for the whole spine group

This same formula evaluates diagnostic codes 5235 to 5243, so a strain, arthritis, or a vertebral fracture in the spine are read against the same range-of-motion and ankylosis levels (38 CFR 4.71a).

How this combines with your other ratings

VA does not add your ratings together, it combines them by remaining efficiency, so any single rating rarely changes your combined number as much as simple addition would suggest. See how VA combines ratings, or use the combined-rating calculator.

Related terms

Combined evaluation Diagnostic code

This explains what the rating schedule says. It is educational, not claims assistance: only a VA-accredited representative may help with the preparation, presentation, or prosecution of a claim (38 CFR 14.629). We do not advise how to obtain or increase a rating, and we determine nothing about any specific claim.

Decode your rating letter →Browse the glossary