VA Disability Ratings for Back Pain - Veteran.com (2023)

FAQs

VA Disability Ratings for Back Pain - Veteran.com? ›

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.

The VA rates back pain based on how much of the spine, or range of motion, is affected. “In addition to range of motion scores and medical findings like ankylosis, the VA has to consider the severity of a veteran's functional loss,” said Cecilia Ton, a VA-certified disability benefits lawyer.

The veteran's service-connected back disability is currently evaluated under 38 C.F.R. § 4.71a, Diagnostic Codes 5295- 5293. Lumbosacral strain is assigned a disability rating in the Schedule under Diagnostic Code 5295. Severe lumbosacral strain is given a 40 percent rating.

You can file for a rating increase if your pain has worsened, or you can also apply for total disability based on individual unemployability (TDIU). TDIU requires that you have one condition with at least a 60% rating or two disabilities that add up to 70%.

Tracing back pain to an injury or event that occurred during a person's active duty service is the simplest way to establish a nexus. This can be done by referencing military service records. For many former servicemembers, injuries during strenuous training exercising are the cause of their chronic back pain.

A 40 percent rating is the maximum schedular rating for limitation of motion of the lumbosacral spine under Diagnostic Code 5292. The Board has considered rating the veteran's low back disability under all potentially applicable diagnostic codes to determine whether a more favorable rating is warranted.

To qualify for Social Security Disability Insurance (SSDI) or Supplemental Security Income (SSI) benefits, chronic back pain sufferers must prove they have a medically determinable impairment. Additionally, the impairment must last or be expected to last for a minimum of one year.

If the veteran can demonstrate that the original disability caused lower back problems, the VA might award secondary benefits due to disability from the knee arthritis. Veterans can file a secondary claim whenever an additional disability appears.

On most days, the veteran is unable to bend forward more than 60 degrees. However, when experiencing a flare-up, the veteran is unable to bend more than 30 degrees. Therefore, during the flare-up, the veteran's back condition becomes much more disabling than 10 percent.

Arthritis of the back will be rated at 10 or 20 percent based upon the number of joints/joint groups affected and the level of incapacitation. VA requires that limitations of motion be confirmed by observations such as swelling, muscle spasms, or evidence of painful motion.

What is the average VA rating for degenerative disc disease? ›

The VA generally rates degenerative disc disease between 10 and 20%, depending on the number of joints affected.

What Is the Maximum Disability Rating for Degenerative Disc Disease? Despite how much pain the condition causes, the maximum VA disability rating for degenerative disc disease, as mentioned above, is typically 20 percent. However, there are a few ways veterans can increase their DDD VA rating.

Unlike other disabilities, erectile dysfunction is not given a rating schedule but instead, uses the following to determine compensation: Code 7520 Partial removal of the penis. This gives a rating of 30%.

What not to say at a C&P exam. The most vital thing not to do at your claim exam is to pretend your symptoms aren't as bad as they are. It's not the time to play tough. You don't want to exaggerate your symptoms, but you should be honest about how bad they are and exactly how they impact your life.

Imaging and Blood Tests

Most people do not need additional testing; however, sometimes doctors order tests to rule out a specific cause for your pain or to confirm a cause for your back pain.

Tinnitus. Tinnitus, otherwise known as “Ringing-in-the-Ear-Syndrome” is by far the #1 easiest VA disability to claim. Tinnitus is when you experience ringing, hissing, buzzing, or other noises in one or both of your ears.

Veterans receive either a 10% or 20% rating depending on the severity of their symptoms and the number of joints affected. A 20% rating requires that two or more major joints or two or more groups of minor joints have occasional incapacitating episodes.

Once you turn 55, you are typically "protected" and will no longer have to attend an exam to prove that your condition has not changed unless there is reason to suspect fraud. This is sometimes called the 55-year rule.

The VA doesn't have a specific diagnostic code for chronic pain, but it does pay benefits for veterans who experience it. Therefore, VA disability benefits for chronic pain are based on the symptoms or impairments that result from your pain.

What Is the Most Approved Disability? Arthritis and other musculoskeletal system disabilities make up the most commonly approved conditions for social security disability benefits. This is because arthritis is so common. In the United States, over 58 million people suffer from arthritis.

How much disability is chronic back pain? ›

How VA Rates Back Pain Disability. VA disability ratings for back pain go from 10% to 100% depending on how severe your symptoms are, including your range of motion and pain frequency and level. Claims involving both the cervical spine and the thoracolumbar spine are rated under the same general rating formula.

If your chronic back pain is preventing you from performing the essential duties of your job, you may qualify for long-term disability (LTD). Chronic back pain is a common symptom. Spine injuries and other medical conditions can cause severe back pain.

Some secondary conditions resulting from back pain include: Radiculopathy. Radiculopathy occurs when the nerves in the lower back are compressed. This can cause a range of symptoms such as sharp pain that shoots and radiates in the lower back down into the legs, weakness, and numbness.

Sleep apnea and back pain are commonly experienced together. Although medical experts don't believe that one condition causes the other, the two health issues are found as co-symptoms often enough that the relationship between back pain and sleep apnea deserves to be explored.

Here are some common physical secondary conditions to back pain: Paralysis. Erectile dysfunction. Sciatic nerve damage.

A 20 percent rating is assigned for diastolic pressure that is predominantly 110 or more, or systolic pressure predominantly 200 or more. A 40 percent rating is assigned where diastolic pressure is predominantly 120 or more. A 60 percent rating is assigned where diastolic pressure is predominantly 130 or more.

At the C&P exam, the VA practitioner will check the ROM for your affected joint using a goniometer. This is an instrument used to measure precise angles. In this case, it would be used to measure the precise degrees of motion that you experience around a joint.

Limitation of Flexion of the Knee (Diagnostic Code 5260)

This is the most common knee problem eligible for VA disability benefits, with ratings that typically range from 10% to 30%.

§ 4.115a, urinary frequency is to be rated as follows: Daytime voiding interval between 2 and 3 hours, or, awakening to void 2 times per night, warrants a 10 percent disability rating. Daytime voiding interval between 1 and 2 hours, or, awakening to void 3 to 4 times per night, warrants a 20 percent disability rating.

Common Secondary Conditions to Knee Pain

Limitation of flexion or extension of the knee, which have diagnostic codes 5260 and 5261, respectively. Instability of the knee, diagnostic code 5257. Ankylosis of the knee, diagnostic code 5256. Total knee replacements, diagnostic code 5055.

How do I prove arthritis for VA disability? ›

To establish a service connection for arthritis, a veteran must prove that the condition was a result of an event that occurred during service, such as an in-service injury or overuse of a joint during a service-related task that caused the condition to develop.

Degenerative disc disease can be a challenging condition to prove as disabling to insurance companies. While the debilitating pain of degenerative disc disease is very real, pain is considered a “subjective” symptom. Your insurance company will want objective medical evidence to back up your disability claim.

The osteoarthritis disability ratings are either 10% or 20% depending on the following symptoms: 10%: a veteran has degenerative arthritis in two or more major joints or two or more groups of minor joints seen with X-ray evidence. through X-ray evidence) along with occasional incapacitating exacerbations.

The veteran's degenerative disc disease of the lumbar spine at L4-5 and L5-S1 is rated as 40 percent disabling pursuant to 38 C.F.R.

A few examples of these secondary conditions or complications are radiculopathy, myelopathy, urinary incontinence and/or frequency along with mental health conditions as well.

The secondary condition has a disability rating of 30%.

Veterans who use PDE-5 inhibitors for ED are limited to four doses per month through VA pharmacy benefits.

Under Diagnostic Code 7831, for alopecia areata, a noncompensable rating is assigned with loss of hair limited to the scalp and face. A 10 percent rating is warranted with loss of all body hair.

Your VA rating for insomnia can be between 0% and 100% depending on the severity of your symptoms and if you can prove the insomnia is service-connected.

#1 Q: What is a VA claim exam, also known as a Compensation and Pension (C&P) exam? If you've filed a claim with the U.S. Department of Veterans Affairs (VA) for disability compensation or pension benefits, VA may ask you to go to an examination as part of the claim process.

How do I ace the C&P exam? ›

You could get a favorable decision under these conditions: The C&P exam went well, meaning you completed all questions, and the exam report was declared veteran-friendly. The attending physician reviewed all medical records and stated as such in their exam report.

A Computerized Axial Tomography scan (a CT or CAT scan) or a Magnetic Resonance Imaging test (an MRI) may be required. These tests are more effective than X-rays at showing the soft tissues in your spine, and can help to identify problems such as a bulging disc or a herniated disc.

Using Adjectives – Adjectives provide the most accurate description because they give doctors a better idea of what your pain feels like, even from an outside perspective. Some adjectives you can use are burning, stinging, stiff, sore, radiating, and aching to paint the picture for your spine surgeon accurately.

Tracing back pain to an injury or event that occurred during a person's active duty service is the simplest way to establish a nexus. This can be done by referencing military service records. For many former servicemembers, injuries during strenuous training exercising are the cause of their chronic back pain.

Seek treatment and obtain medical evidence to support the claim. One of the most important factors in obtaining an increased VA disability rating is providing medical evidence that supports the veteran's claim. This medical evidence can include records from military service, private doctors, and VA medical centers.

Veterans can file a Priority Processing Request using VA Form 20-10207 to ask VA to address their claim in a more expedient manner. In order to be eligible, veterans must submit documentation, if not already on file, indicating that they meet one of the following criteria: Experiencing extreme financial hardship.

If you have chronic back pain, and it has prevented you from working for at least 12 months, you may be eligible for Social Security Disability benefits. However, few claims for chronic back pain are approved, and applying for Social Security Disability benefits is a long process that can take months to years.

Tinnitus. Tinnitus, otherwise known as “Ringing-in-the-Ear-Syndrome” is by far the #1 easiest VA disability to claim. Tinnitus is when you experience ringing, hissing, buzzing, or other noises in one or both of your ears.

How far back is back pay for disability? ›

The maximum SSDI will provide in back payments is 12 months. Your disability would have to start 12 months before you applied to receive the maximum in SSDI benefits.

Retroactive SSI benefits may be paid from the month after the Protective Filing Date (PFD) and Retroactive SSDI benefits may be paid from the established date of onset of disability plus the 5-month waiting period.

Arthritis of the back will be rated at 10 or 20 percent based upon the number of joints/joint groups affected and the level of incapacitation. VA requires that limitations of motion be confirmed by observations such as swelling, muscle spasms, or evidence of painful motion.

The VA uses the following criteria to rate hypertension: 60% rating is given if your diastolic pressure is 130 or higher. 40% rating is given if your diastolic pressure measures between 120 and 129. 20% rating is given if your diastolic pressure is 110-119, or your systolic pressure is 200 or higher.

VA automatically presumes that certain disabilities were caused by military service. This is because of the unique circumstances of a specific Veteran's military service. If a presumed condition is diagnosed in a Veteran within a certain group, they can be awarded disability compensation.

Yes, a veteran can receive disability for high blood pressure, either as a primary disability or with a secondary connection to another medical issue that's service related.