VA Diagnostic Code 5235Vertebral fracture or dislocation

Vertebral Fracture or Dislocation — VA Disability Rating (Diagnostic Code 5235)

Body System: Musculoskeletal System Regulation: 38 CFR § 4.71a Rated Under: General Rating Formula for Diseases and Injuries of the Spine

What This Condition Is

A vertebral fracture or dislocation involves a break or displacement affecting one or more of the bones (vertebrae) that make up your spine. Because the spine is central to movement, posture, and nerve function, injuries here can affect how far you can bend, how you stand and walk, and — in some cases — other body systems connected to the spinal nerves.

The VA evaluates this condition under the General Rating Formula for Diseases and Injuries of the Spine. Ratings are based largely on how much motion you retain in the affected part of your spine (the cervical/neck segment and the thoracolumbar/mid-and-lower-back segment), on whether the spine has become fixed in place (ankylosis), and on related factors like muscle spasm, guarding, or fracture severity. There is also a separate pathway for rating based on incapacitating episodes.

Available Rating Levels

Ratings Based on Motion, Ankylosis, and Related Findings

Ratings Based on Incapacitating Episodes (Over the Past 12 Months)

What the VA Looks For

• Range of motion measurements. For VA purposes, normal forward flexion of the cervical spine is 0 to 45 degrees, and normal forward flexion of the thoracolumbar spine is 0 to 90 degrees. The VA also measures extension, left and right lateral flexion, and left and right lateral rotation, then adds them together for a "combined range of motion." Normal combined range of motion is 340 degrees for the cervical spine and 240 degrees for the thoracolumbar spine. Each measurement is rounded to the nearest five degrees.

• Ankylosis (fixation of the spine). Favorable ankylosis means a spinal segment is fixed, including in a neutral (zero-degree) position. Unfavorable ankylosis means the entire cervical spine, entire thoracolumbar spine, or entire spine is fixed in flexion or extension and results in specific problems — such as difficulty walking due to a limited line of vision, restricted mouth opening and chewing, breathing limited to diaphragmatic respiration, gastrointestinal symptoms from pressure of the costal margin on the abdomen, dyspnea or dysphagia, atlantoaxial or cervical subluxation or dislocation, or neurologic symptoms from nerve root stretching.

• Muscle spasm, guarding, and spinal contour. The examiner notes whether muscle spasm, guarding, or localized tenderness is present, and whether it is severe enough to cause an abnormal gait or an abnormal spinal contour such as scoliosis, reversed lordosis, or abnormal kyphosis.

• Fracture severity. A vertebral body fracture with loss of 50 percent or more of its height is specifically recognized in the rating criteria.

• Separate segments, separate evaluations. The thoracolumbar and cervical spine segments are evaluated separately — except when there is unfavorable ankylosis of both segments, which is rated as a single disability.

• Associated neurologic problems. Any objective neurologic abnormalities linked to the spine injury — including, but not limited to, bowel or bladder impairment — are evaluated separately under an appropriate diagnostic code.

• Individual considerations. In exceptional cases, an examiner may determine that a person's range of motion should be considered normal for that individual — due to factors such as age, body habitus, or neurologic disease not caused by a spine disease or injury — as long as the examiner provides an explanation.

This information summarizes the VA rating criteria for Diagnostic Code 5235 under 38 CFR § 4.71a. It is provided for general educational purposes and describes how the VA structures ratings for this condition.