VA Diagnostic Code 5237Lumbosacral or cervical strain
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.
Lumbosacral or Cervical Strain (VA Diagnostic Code 5237)
Understanding how the VA rates back and neck strain under the General Rating Formula for Diseases and Injuries of the Spine.
Musculoskeletal System · Diagnostic Code 5237 · 38 CFR § 4.71a
What This Condition Is
Lumbosacral or cervical strain refers to strain affecting the lower back (thoracolumbar spine) or the neck (cervical spine). The VA evaluates this condition using the General Rating Formula for Diseases and Injuries of the Spine.
Under this formula, the VA generally looks at how far you can move your spine (range of motion), whether your spine is fixed in place (ankylosis), and related signs such as muscle spasm, guarding, tenderness, or abnormal spinal contour. Where applicable, ratings may also be based on incapacitating episodes over the past 12 months.
Normal Range of Motion (for VA Compensation Purposes)
To understand the rating levels, it helps to know what the VA considers normal:
- Cervical spine (neck): forward flexion 0–45°, extension 0–45°, left and right lateral flexion 0–45°, left and right lateral rotation 0–80°. Normal combined range of motion is 340°.
- Thoracolumbar spine (lower back): forward flexion 0–90°, extension 0–30°, left and right lateral flexion 0–30°, left and right lateral rotation 0–30°. Normal combined range of motion is 240°.
The combined range of motion is the sum of forward flexion, extension, left and right lateral flexion, and left and right rotation. Each measurement is rounded to the nearest five degrees.
Available Rating Levels
The VA assigns a percentage rating based on the criteria that best fit your condition.
General Rating Formula (Range of Motion & Ankylosis)
| Rating | What the VA Looks For |
|---|---|
| 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° or less; or favorable ankylosis of the entire thoracolumbar spine |
| 30% | Forward flexion of the cervical spine 15° 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°; or forward flexion of the cervical spine greater than 15° but not greater than 30°; or combined range of motion of the thoracolumbar spine not greater than 120°; or combined range of motion of the cervical spine not greater than 170°; 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° but not greater than 85°; or forward flexion of the cervical spine greater than 30° but not greater than 40°; or combined range of motion of the thoracolumbar spine greater than 120° but not greater than 235°; or combined range of motion of the cervical spine greater than 170° but not greater than 335°; or muscle spasm, guarding, or localized tenderness not resulting in abnormal gait or abnormal spinal contour; or vertebral body fracture with loss of 50% or more of the height |
Rating Based on Incapacitating Episodes (Past 12 Months)
| Rating | What the VA Looks For |
|---|---|
| 60% | Incapacitating episodes having a total duration of at least 6 weeks during the past 12 months |
| 40% | Incapacitating episodes having a total duration of at least 4 weeks but less than 6 weeks during the past 12 months |
| 20% | Incapacitating episodes having a total duration of at least 2 weeks but less than 4 weeks during the past 12 months |
| 10% | Incapacitating episodes having a total duration of at least one week but less than 2 weeks during the past 12 months |
Important Notes the VA Applies
- Associated neurologic abnormalities — Any associated objective neurologic abnormalities, including but not limited to bowel or bladder impairment, are evaluated separately under an appropriate diagnostic code.
- Unfavorable ankylosis — 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 (0°) always represents favorable ankylosis.
- Separate segment 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.
- Individualized normal range of motion — 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, an individual's range of motion should be considered normal for that person even if it doesn't conform to the standard normal values — provided the examiner supplies an explanation.
This information is drawn from the VA rating schedule at 38 CFR § 4.71a for Diagnostic Code 5237 and is provided for general educational purposes.
These criteria are a rendering of § 4.71a, diagnostic code 5237. The official version is the one that governs your rating.
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