Getting VA Disability for Back Pain: What Veterans Can Expect

Disabling service-connected back pain is common among veterans. In fact, back and spine conditions consistently rank in the top five most frequently claimed service-related disabilities each year.

However, getting a proper VA disability rating for back pain can be extremely frustrating and challenging. Even if you experience chronic pain that makes gainful employment challenging or even impossible, you may still be given a low rating after your initial compensation and pension (C&P) exam.

But an unfavorable initial rating doesn’t necessarily mean you’re out of options. In this post, our veterans disability lawyers take a closer look at how the VA determines disability ratings for back pain, and ways you might be able to increase your rating.

How Does the VA Determine Disability Ratings for Back Pain?

C&P Exams Are Common in Back-Related Disability Claims

Once you file a disability benefits claim, the VA will often schedule a C&P exam. During your appointment, you will meet with a doctor and other healthcare professionals who will gather information about your back pain. This often involves both an interview and a physical examination.

After the exam, the doctor will write a report that summarizes their findings and send it to the VA. Based on this report and other information in your file, the VA will assign your disability rating.

Doctors Focus on Range of Motion During C&P Exams

When it comes to evaluating disability benefits for back pain, the VA uses a rating formula that is heavily based on range of motion, which is a measurement of how much you can move a joint or muscle. Doctors are required to use a tool called a goniometer at your C&P exam to assess your back’s mobility, and might not focus as much on other significant back symptoms.

This has some obvious disadvantages for veterans. First, range of motion is only one aspect of back pain and functional loss. Veterans who experience significant pain, but still have good or even complete range of motion, often feel that the VA disability system undervalues their level of disability.

Second, VA ratings can be very strict, with a 100% rating only available in very severe cases that involve not just the back, but the neck as well.

Many veterans with significant functional loss, pain, and difficulty working might initially only obtain a 10 or 20 percent rating. In fact, the average VA disability rating for back pain is only 10 percent.

How to Get a 100% Disability Rating for Back Pain

To obtain a 100% VA disability rating for a spinal problem, you’ll need to show that your “entire spine is frozen in an unfavorable position.” Let’s break this down a bit more:

• Entire spine: Both your lower and middle back (thoracolumbar spine) and your neck (cervical spine). If you have some movement in one or the other, you will not qualify for a 100% rating.
• Frozen: You have essentially no range of motion in your spine.
• Unfavorable position: Your spine is fixed in a curved or non-neutral position. If your spine is fixed in a neutral position (0 degrees), this is considered “favorable” ankylosis and would only qualify for a lower disability rating.

This is a tough standard to hit, and it requires a severe level of functional loss.

That’s why most veterans with service-related back pain who do qualify for 100% VA disability ratings often do so by combining their VA disability rating for back pain with other related conditions, or through total disability based on individual unemployability (TDIU). We’ll discuss both options later.

General Rating Formula for Disability Ratings for Back and Neck Pain

Assuming you still have some range of motion in your thoracolumbar spine or cervical spine, you will be assessed a lower rating based on the VA’s rating table. Both sections of your spine will be rated independently.

For the thoracolumbar spine (main part of the back):

• 50% Rating: The entire thoracolumbar spine is frozen in an unfavorable position.
• 40% Rating: Frozen in a favorable position, or forward flexion is less than 30 degrees.
• 20% Rating: Forward flexion between 30 and 60 degrees, or combined range of motion (forward flexion, extension, left and right flexion, left and right rotation) 120 degrees or less.
• 10% Rating: Forward flexion between 60 and 85 degrees, or combined range of motion between 125 and 240 degrees.

For the cervical spine (neck):

• 40% Rating: The entire cervical spine is frozen in an unfavorable position (unless the thoracolumbar spine is also frozen in an unfavorable position, in which case the two conditions combine for a 100% overall rating).
• 30% Rating: Frozen in a favorable position, or forward flexion is less than 15 degrees.
• 20% Rating: Forward flexion between 15 and 30 degrees, or combined range of motion is less than 170 degrees.
• 10% Rating: Forward flexion between 30 and 45 degrees, or combined range of motion is less than 340 degrees.

The VA also considers the “painful motion” principle when it comes to back pain. In short, this means that if you experience pain during movement, you should still qualify for the minimum rating (10%) even if your range of motion is normal.

As you can see, though, the rating table can be particularly harsh. For example, most veterans who have severe (but not total) stiffness and pain in their lower back are probably incapable of working. But they’d only qualify for VA benefits at a 40% disability rating under the general formula if they have no other issues with their neck or elsewhere.

Proving a Service Connection

To get VA benefits, it’s not enough to simply be a disabled veteran. You need to show that your disability was the result of an injury, illness, or other event that occurred during your service.

That may be easier said than done. Back pain is one of the most common chronic pain conditions experienced by American adults. Surveys show that between 10 percent and 33 percent of adults report back pain to their doctors. And back pain can have many causes, including trauma, wear and tear from daily life, and the aging process.

So, proving that your back pain is connected to your military service can be challenging, particularly if the condition is degenerative and your severe symptoms developed long after your retirement from the service. To prove the connection, you must have:

• A current diagnosis (such as intervertebral disc syndrome, spinal stenosis, or vertebral fracture) or evaluation of disability from a medical professional.
• An identifiable in-service event or injury that you believe caused your back pain. Examples might include training injuries, combat injuries, a car accident, or even repetitive stress from the nature of your military work.
• A “medical nexus,” or in other words, a way to link the in-service event to your current diagnosis, enough that a physician would conclude that your current disability is as likely as not to be directly connected to your service than not.

This may require you to collect extensive medical records (both from during and after your time in the military), service records, or even recorded statements from those you served with who witnessed the event.

RELATED POST: Was Your VA Disability Claim Denied? Here’s What You Should Do Next – Truman Law

What to Do If Your Rating Is Denied or Too Low

If you believe that your rating is too low, either because it was determined incorrectly, or because you believe your VA disability benefits don’t accurately reflect the severity of your disability, you may have several options available.

Appeal Your VA Disability Ruling

If you believe the VA made an error in assessing your rating—for example, denying that your disability is service-connected, or applying a lower rating than you deserve according to the formula—you can appeal it (if you file within one year of the date on your denial letter).

Hiring an experienced VA Disability attorney can make a huge difference to ensure your case is as well prepared as possible.

 

Combine Your Back Pain With Related Conditions

Many veterans with back pain also deal with other, related conditions that may also qualify for a VA disability rating.

For example, back and spine problems often lead to secondary conditions like nerve damage, pain, and weakness in other areas of the body—such as the neck, arms, hips, or shoulders. Common examples include radiculopathy (pinched spinal nerves that cause weakness and tingling elsewhere in the body) and even bowel or bladder syndromes.

Conditions with a secondary service connection may be rated separately by the VA and added to the rating for your primary condition. Even if the secondary condition did not develop until after you left the service, the VA will still award disability benefits if there is a service-connected primary condition that caused it.

Apply for Total Disability Based on Individual Unemployability (TDIU)

This is the route that many veterans with service-connected back pain go when the VA rates for their back pain simply don’t align with their real-life experience.

TDIU provides VA disability compensation at 100% rating if the veteran can prove that a service-connected condition renders them unable to obtain or maintain gainful employment, even if the combined rating for all their VA disability claims doesn’t add up to 100 percent.

A VA Disability Attorney Can Help

Filing a VA disability claim, or appealing an unfair ruling, can be a time-consuming and frustrating processes. Veterans can wait months or even years to get a favorable result, depending on whether several appeals must be made.

An experienced attorney will know what kinds of medical records and other documents will be required to prove your case, and can navigate the confusing VA disability process on your behalf. They’ll also be knowledgeable about whether you might be eligible for additional benefits from additional or related conditions.

You do not have to fight alone.

Count on the Colonel

Attorney Karl Truman and his team are fierce advocates for disabled veterans. Karl served for 28 years in the Army Reserves, retiring as Lieutenant Colonel.

These cases are personal for us. We understand the struggles that veterans and their loved ones face and the frustration of dealing with the VA. You served your country honorably, and you shouldn’t have to fight so hard to get the benefits you deserve.

Whether you need help filing your back pain claim with the VA, or you’ve just received a ruling you disagree with and are considering your options, contact our team today or call us at (502) 222-2222. Our VA disability attorneys are happy to provide a free case evaluation, discuss your legal options, and advise you on your next steps.

The content provided here is for informational purposes only and should not be construed as legal advice on any subject.