VA Diagnostic Code 5236Sacroiliac injury and weakness
Rated from 10% to 100% under § 4.71a. Here is what the VA requires at each level.
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What each rating requires
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- 100%
Unfavorable ankylosis of the entire spine
- 50%
Unfavorable ankylosis of the entire thoracolumbar 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
- 30%
Forward flexion of the cervical spine 15 degrees or less; or, favorable ankylosis of the entire cervical spine
- 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
- 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
- 60%
With incapacitating episodes having a total duration of at least 6 weeks during the past 12 months
- 40%
With incapacitating episodes having a total duration of at least 4 weeks but less than 6 weeks during the past 12 months
- 20%
With incapacitating episodes having a total duration of at least 2 weeks but less than 4 weeks during the past 12 months
- 10%
With incapacitating episodes having a total duration of at least one week but less than 2 weeks during the past 12 months
General rating formula
General Rating Formula for Diseases and Injuries of the Spine
Notes on this code
These notes are part of the regulation. They change how the levels above are applied.
- 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.
Sacroiliac Injury and Weakness (VA Diagnostic Code 5236)
Musculoskeletal System · Rated under 38 CFR § 4.71a
What This Condition Is
Sacroiliac injury and weakness affects the joint area of the lower back and pelvis. For VA compensation purposes, it is evaluated under the General Rating Formula for Diseases and Injuries of the Spine, the same framework the VA uses to rate spinal conditions. Because it falls under this general formula, its rating levels are described in terms of spinal range of motion, ankylosis (a spine fixed in one position), muscle spasm and guarding, vertebral fractures, and—when applicable—incapacitating episodes.
How the VA Measures Your Spine
The VA compares your measured range of motion against established norms. According to the rating schedule:
- Thoracolumbar spine (mid and lower back): normal forward flexion is 0 to 90 degrees, extension 0 to 30 degrees, left and right lateral flexion 0 to 30 degrees each, and left and right rotation 0 to 30 degrees each. Normal combined range of motion is 240 degrees.
- Cervical spine (neck): normal forward flexion is 0 to 45 degrees, extension 0 to 45 degrees, left and right lateral flexion 0 to 45 degrees each, and left and right rotation 0 to 80 degrees each. Normal combined range of motion is 340 degrees.
The "combined range of motion" is the sum of all these movements. Each measurement is rounded to the nearest five degrees. In exceptional cases—due to factors like age or body habitus that are not caused by the spine condition—an examiner may explain that your range of motion is normal for you even if it differs from these numbers.
Available Rating Levels
The rating schedule provides two sets of criteria. One is based on range of motion, ankylosis, and related findings; the other is based on incapacitating episodes over the past 12 months.
Based on Range of Motion and Ankylosis
| Rating | What the criteria describe |
|---|---|
| 100% | Unfavorable ankylosis of the entire spine |
| 50% | Unfavorable ankylosis of the entire thoracolumbar spine |
| 40% | Unfavorable ankylosis of the entire cervical spine; or forward flexion of the thoracolumbar spine at 30 degrees or less; or favorable ankylosis of the entire thoracolumbar spine |
| 30% | Forward flexion of the cervical spine at 15 degrees or less; or favorable ankylosis of the entire cervical spine |
| 20% | Forward flexion of the thoracolumbar spine greater than 30 but not greater than 60 degrees; or forward flexion of the cervical spine greater than 15 but not greater than 30 degrees; or combined thoracolumbar range of motion not greater than 120 degrees; or combined cervical range of motion not greater than 170 degrees; or muscle spasm or guarding severe enough to cause an abnormal gait or abnormal spinal contour such as scoliosis, reversed lordosis, or abnormal kyphosis |
| 10% | Forward flexion of the thoracolumbar spine greater than 60 but not greater than 85 degrees; or forward flexion of the cervical spine greater than 30 but not greater than 40 degrees; or combined thoracolumbar range of motion greater than 120 but not greater than 235 degrees; or combined cervical range of motion greater than 170 but not greater than 335 degrees; or muscle spasm, guarding, or localized tenderness not resulting in abnormal gait or spinal contour; or vertebral body fracture with loss of 50 percent or more of the height |
Based on Incapacitating Episodes (Past 12 Months)
| Rating | Total duration of incapacitating episodes |
|---|---|
| 60% | At least 6 weeks |
| 40% | At least 4 weeks but less than 6 weeks |
| 20% | At least 2 weeks but less than 4 weeks |
| 10% | At least 1 week but less than 2 weeks |
What the VA Looks For
- Range of motion measurements, especially forward flexion and combined range of motion for the affected spinal segment, compared against the normal values above.
- Ankylosis, and whether it is favorable or unfavorable. Unfavorable ankylosis means the entire spinal segment is fixed in flexion or extension and results in one or more issues 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. Fixation of a spinal segment in the neutral (zero-degree) position always represents favorable ankylosis.
- Muscle spasm, guarding, or localized tenderness, and whether it is severe enough to cause an abnormal gait or an abnormal spinal contour.
- Vertebral body fracture with loss of 50 percent or more of the height.
- Incapacitating episodes and their total duration over the past 12 months.
- Associated neurologic abnormalities, including but not limited to bowel or bladder impairment. Per Note (1), these are evaluated separately under an appropriate diagnostic code.
A note on how segments are rated: The thoracolumbar and cervical spine segments are evaluated separately, except when there is unfavorable ankylosis of both segments, in which case they are rated together as a single disability.
This information is drawn from the VA rating schedule under 38 CFR § 4.71a for Diagnostic Code 5236. It is provided for general informational purposes and does not predict any individual outcome.
These criteria are a rendering of § 4.71a, diagnostic code 5236. The official version is the one that governs your rating.
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