VASRD Schedule of ratings—musculoskeletal system - The Spine

Jason Perry

Jason Perry

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The Spine​


Rating​

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General Rating Formula for Diseases and Injuries of the Spine

(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​

Note (1): Evaluate any associated objective neurologic abnormalities, including, but not limited to, bowel or bladder impairment, separately, under an appropriate diagnostic code.​

Note (2): (See also Plate V.) For VA compensation purposes, normal forward flexion of the cervical spine is zero to 45 degrees, extension is zero to 45 degrees, left and right lateral flexion are zero to 45 degrees, and left and right lateral rotation are zero to 80 degrees. Normal forward flexion of the thoracolumbar spine is zero to 90 degrees, extension is zero to 30 degrees, left and right lateral flexion are zero to 30 degrees, and left and right lateral rotation are zero to 30 degrees. The combined range of motion refers to the sum of the range of forward flexion, extension, left and right lateral flexion, and left and right rotation. The normal combined range of motion of the cervical spine is 340 degrees and of the thoracolumbar spine is 240 degrees. The normal ranges of motion for each component of spinal motion provided in this note are the maximum that can be used for calculation of the combined range of motion.​

Note (3): In exceptional cases, an examiner may state that because of age, body habitus, neurologic disease, or other factors not the result of disease or injury of the spine, the range of motion of the spine in a particular individual should be considered normal for that individual, even though it does not conform to the normal range of motion stated in Note (2). Provided that the examiner supplies an explanation, the examiner’s assessment that the range of motion is normal for that individual will be accepted.​

Note (4): Round each range of motion measurement to the nearest five degrees.​

Note (5): For VA compensation purposes, unfavorable ankylosis is a condition in which the entire cervical spine, the entire thoracolumbar spine, or the entire spine is fixed in flexion or extension, and the ankylosis results in one or more of the following: difficulty walking because of a limited line of vision; restricted opening of the mouth and chewing; breathing limited to diaphragmatic respiration; gastrointestinal symptoms due to pressure of the costal margin on the abdomen; dyspnea or dysphagia; atlantoaxial or cervical subluxation or dislocation; or neurologic symptoms due to nerve root stretching. Fixation of a spinal segment in neutral position (zero degrees) always represents favorable ankylosis.​

Note (6): Separately evaluate disability of the thoracolumbar and cervical spine segments, except when there is unfavorable ankylosis of both segments, which will be rated as a single disability.​

5235 Vertebral fracture or dislocation​

5236 Sacroiliac injury and weakness​

5237 Lumbosacral or cervical strain​

5238 Spinal stenosis​

5239 Spondylolisthesis or segmental instability​

5240 Ankylosing spondylitis​

5241 Spinal fusion​

5242 Degenerative arthritis of the spine (see also diagnostic code 5003)​

5243 Intervertebral disc syndrome​

Evaluate intervertebral disc syndrome (preoperatively or postoperatively) either under the General Rating Formula for Diseases and Injuries of the Spine or under the Formula for Rating Intervertebral Disc Syndrome Based on Incapacitating Episodes, whichever method results in the higher evaluation when all disabilities are combined under §4.25.​






Formula for Rating Intervertebral Disc Syndrome Based on Incapacitating Episodes​

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​

Note (1): For purposes of evaluations under diagnostic code 5243, an incapacitating episode is a period of acute signs and symptoms due to intervertebral disc syndrome that requires bed rest prescribed by a physician and treatment by a physician.​

Note (2): If intervertebral disc syndrome is present in more than one spinal segment, provided that the effects in each spinal segment are clearly distinct, evaluate each segment on the basis of incapacitating episodes or under the General Rating Formula for Diseases and Injuries of the Spine, whichever method results in a higher evaluation for that segment.​

 
Jason,
I just got my range of motion done and was read at 68% for forward flexion of my lumbar spine. I believe this qualifies me for 10% rating. Go figure if I would have had 60% I would have had 20% rating. Does this make sense according to the VASRD Schedule of ratings chart?

Thank you!
 
OverqualifiedNavy said:
Jason,
I just got my range of motion done and was read at 68% for forward flexion of my lumbar spine. I believe this qualifies me for 10% rating. Go figure if I would have had 60% I would have had 20% rating. Does this make sense according to the VASRD Schedule of ratings chart?

Thank you!
Click to expand...


It makes sense because you can move more. If you could move less then you would qualify for more of a percentage.
 
I just received a rating of 20% from the VA and have been reading and
trying to understand their reasoning. My C&P exam put my limitation for
bending forward at 32 degrees. While burning over 2 degrees costing me
40% Service Connection I read the entire General Rating Formula For Disease
and Injuries to the Spine and found NOTE(4). NOTE(4) clearly states that all
measurement of motion MUST be rounded to the nearest 5 degrees.
To me this clearly means 32 degrees must be rounded back to 30 degrees
which means my service connection should be 40% and my backpay should
also be at 40% not 20%.

I have sent a Notice of Disagreement to the VA pointing out this error but
have not yet received a response. I need advice on how to proceed.


CASE UPDATE 9-13-09
DRO said I was absolutely correct about using note(4). They rounded 32 degrees
forward motion back to 30 degrees and awarded me 40% service connection and
quickly sent back pay for 40%. They say no need for 50% extra schedular rating
since I am "retired on social security disability". They seem to think being disabled
is the same as being retired.Go figure!!
 
jdh_72457,

Welcome! Good for you for educating yourself and identifying the correct issue. I would also look at whether the examiner appropriately accounted for limitation of motion due to pain, fatigue, weakness, etc.

Sounds like you are on the right track, though! Next is to either request DRO review or get Statement of the Case.

Best of luck!
 
If i had a disectomy at L4-L5 in 2000 and entered Active Duty 4 years later, and in 2009 injured my back and had a spinal fusion of L5-S1 will that affect anything if i'm placed on a MEB?? I still have radiating pain down my leg but its 10x better then before the surgery. I just want to make sure if something does come of this I will still qualify for either medically retired or VA disability
 
This all still confuses me. I just came back from 3 months of convelescent leave due a 2nd back surgery. The first surgery was a disc fusion at L5-S1 and that surgery made me worse. After seeing another doctor a year later, he said it never healed. I just had a 2nd surgery to fix the problem and now 3 months later I am still worse off again than before. I am in severe pain and no one seems to know why. A MEB was started on me but has been on hold to see if this second surgery would fix the problem. It didn't, so the board will start back up. The pain is in my lower back but is so severe that I cannot move whatsoever without it hurting. I cannot sit, stand, or walk for any lenghth of time. The pain does radiate down into my hips as well. If I am medically retired, am I only looking at 30-40% retirement/disability?

This whole process scares the crud out of me, but there is no way I can do my job and much of anything without constantly being in pain all day long. I am an active duty MSgt with 15 years in.

Any advise would be greatly appreciated.

Glenn
 
ATCavi8or said:
This all still confuses me. I just came back from 3 months of convelescent leave due a 2nd back surgery. The first surgery was a disc fusion at L5-S1 and that surgery made me worse. After seeing another doctor a year later, he said it never healed. I just had a 2nd surgery to fix the problem and now 3 months later I am still worse off again than before. I am in severe pain and no one seems to know why. A MEB was started on me but has been on hold to see if this second surgery would fix the problem. It didn't, so the board will start back up. The pain is in my lower back but is so severe that I cannot move whatsoever without it hurting. I cannot sit, stand, or walk for any lenghth of time. The pain does radiate down into my hips as well. If I am medically retired, am I only looking at 30-40% retirement/disability?

This whole process scares the crud out of me, but there is no way I can do my job and much of anything without constantly being in pain all day long. I am an active duty MSgt with 15 years in.

Any advise would be greatly appreciated.

Glenn
Click to expand...

Sorry to hear about your pain, I hope they find the cause. I highly doubt they will PDRL you while your in the condition you are in. I would expect them to put you on TDRL which can last up to five years while you become stable for rating. If they do place you on TDRL, the minimum rating is 50% which means you get the retirement benefits while on it. I would get to the VA right away, and get started with them to get your VA rating. I would also build your case for your MEB. I know extreme pain can tax your reserves, take a deep breath. See if you can get a loved one to be there through it, and as you go through it ask your questions here as you encounter them. when you read all these stories you'll become quickly overwhelmed with issues you may never experience. Understanding your rights, the process and the lingo is the most important thing.
 
Hello-

I am currently going through a board for L5/S1 radiculopathy with nerve involvement. My MRI and EMG were normal, but I continue to have symptoms. I was evaluated for ROM at Walter Reed and had horrible results (11 degrees for forward flexion). The VA doctor evaluated my ROM based on a visual guestimate. When I did my VA claim, I only got 20%, even after an appeal. To me it looks like I'm >30% according to the VASRD. Am I missing something? What other objective data is used when determining the ruling? I plan to get another VA ruling again after the MEB is done.
Thank you for your help.
 
Ok, here it goes, I just had a c&p done. My case started in 2003 when I was ADSEP'd from the Navy, been fighting the VA since. Here is the modified copy of my latest C&P.

I got copies of my complete C-file from the VA. The c&p exam I had in 2004, the doctor stated that my back pain was more likely than not related to my service in the Navy. But I was denied service connection because there was not an official diagnosis, just stated back pain.

I also had a C&P exam on 16 Mar 2012, where the Dr. states that my Ankylosing Spondylitis is more likely than not related to my service. The following is a breakdown of the dr notes from the recent C&P:

Bilateral Hip Condition:

R hip flexion : 20
R hip extension: 5
L hip flexion : 20
L hip extension : 5

Painful motion begins at 5 on both
Abduction lost beyond 10 degrees yes (Both)
Adduction limited - can not cross legs yes (Both)

Rotation limited - Veteran cant toe-out more than 15 degrees yes (Both)

Patient in severe pain, repetitive use ROM not completed

Functional loss of hip and thigh - yes (Both)

Less movement than normal, Weakened movement, Excess fatigability, pain on movement, instability of station, disturbance of locomotion, interference with sitting, standing, and or weight-bearing these are all marked for both Hips.

localized tenderness or pain to palpitation for joints/soft tissue of either hip (yes - Both)

Muscle strength test -
Hip Flexion 4/5 on both
Hip abduction and hip extension 3/5 on both

Images were taken, degenerative arthritis is documented in both hips, and Ankylosing Spondylitis seen on x-ray results.

Cervical spine condition:

ROM:
forward flexion ends: 20
painful motion: 15

extension ends : 5
painful : 5

right and left lateral flexion ends : 5
painful motion : 5

right and left lateral rotation ends: 10
painful : 10

did not do repetitive ROM test, too much pain

Functional loss:

less movement than normal, weakened movement, excess fatigability, pain on movement, interference with sitting, standing, weight bearing

localized tenderness - yes



reflex exams:
biceps : 1+ (both)
triceps : 0 (both)
brachioradials : 1+ (both)

sensory all normal

x-rays show Ankylosing Spondylitis


Thoracolumbar spine condition:

forward flexion : 10 - ends with pain
extension - 10 - ends with pain

right lateral / left lateral flexion : 5 - ends with pain

right / left lateral rotation : 10 - with pain

did not complete repetitions

Functional loss: yes
less movement than normal, excess fatigability, instability of station, disturbance of locomotion, interference with sitting, standing, and/or weight bearing

Localized tenderness ; yes

guarding / muscle spasm of thoraculumbar spine (
yes, abnormal gait

Muscle strength : Hip flexion; knee extension;ankle plantar flexion; ankle dorsiflexion ; great toe extension - all 4/5 on both

reflexes : knee and ankle ; 0 - both sides

all sensory normal

Radiculopathy yes: l/r lower extremity ; moderate (both) paresthesias and or dysesthesias ; moderate (both)

nerve roots involved: L2/L3/L4 (both)(femoral nerve) ; L4/L5/S1/S2/S3 (sciatic nerve) (both)

severity of radiculopathy and side affected : Moderate - Both

Intervertebral disc syndrome and incapacitating episodes, yes to both

Images: Ankylosing Spondylitis and Scoliosis noted on thoracic and lumbar spine x-ray results

Pain and decreased ROM affect the veterans ability to work

Medical opinion of VA Examiner:

patient was diagnosed with Ankylosing Spondylitis in April 2011, However, symptoms began in 2001, during his enlistment. This is clearly supported when reviewing his medical records. The veteran was seen on multiple occasions for his ongoing back pain, but never officially diagnosed until recently.

The veteran's condition (back, bilateral hip) is at least as likely as not incurred in or caused by his military service.



Sorry this is so long, but I wanted to get an accurate opinion, and to do so, I have to give the full picture.

Do you have an opinion on what I may get as far as service connection goes? A best case scenario will be fine.
_________________________
Losing is NOT an OPTION! Never give up hope, because A.S. never gives up! Always remember, stand as tall and proud as you can, no matter who you are, you are SOMEONE!
 
If service connected, the lower spine will be at least 40%. You would have to look the rest up in the VASRD but every joint with any limited motion due to ankylosing spondylitis at all would get a minimum 10% rating per major joint/set of minor joints per the rating criteria of VASRD DC 5002.

Mike
 
Thank you Sir!
 
Well reading all of this is pretty much freaking me out. I just had my QTC apointments completed last week. I have not heard anything back yet nor expect to for 2-4 weeks but.. My back condition is really messed up. I can not bend backwards at all, I can not lay on my back. I can bend forward, and to the left and right downwards, but i can not bear much more than 30 pounds and if i twist with any weight or bent in a certain position i get bad pains., and numbness in my left foot. I am a Blackhawk crew chief from the army and Got injured during a deployment. MRI's show 2 bulged discs, my 2 lowest. The army says that I will just have to live with this pain for the rest of my life. Ive been to pain management to get spine shots and they did nothing for me. And they stopped there. The only thing they are doing for me now is Physical therapy.

I guess my question actually is... I wont get rated on how I am affected, just on my range of motion? If this is true then i can expect to get absolutely nothing!
 
You have identified the issue with evaluations- they are supposed to include the impact of things such as pain on use, fatigue, incoordination, and flares in evaluating you. If they just measure your ability to move through the range of motion you will get an erroneous measurement for rating purposes.
 
Well, I assumed that they would consider all of those as well. But you know what they say about those who assume. So we will see! Thanks for the feedback!
 
Quick question, posted in another forum but this one seems appropriate. What if you RoM doesn't start from a standing position? I ask because in my condition (undifferentiated spondyloarthropathy), the range of motion before an increase in pain is from a bent over position towards my toes. With my fingers about 8 inches from the ground to when I touch my toes I'm alright. If I raise any higher, then pain increases dramatically. Yet I was rated at 81 degrees mobility. This particular test, if required to start from a standing upright position, paints an inaccurate picture of my mobility, because standing upright I'm already outside of my RoM. Thanks for any help you can provide.
 
I'm confused as to how you can get down there without pain though? Wouldn't it hurt on the way down so in reverse sort of?
 
Yes it hurts all of the time, there is no time it DOESN'T hurt. It's a matter of degree. There are things the increase pain. I take serious pain medications which keeps the pain level between about a 6-8, unless I'm doing something to aggravate it, like standing or walking more than a few minutes. Even sitting up straight increases the pain, I have to sit 'slumped' or with a leg up to force my back into the right position. That's sort of my point, by just being in a standing position, I'm already aggravating the lower back.
 
If your pain increases when you begin to bend, stop, that should be your ROM. If you are pretty much going to your toes, you are showing a good to go ROM. Stop once the pain increases and make sure the doc giving you the ROM understands that you are stopping at the point the pain increases.
 
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