VA Diagnostic Code 5240Ankylosing spondylitis
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.
Ankylosing Spondylitis (VA Diagnostic Code 5240)
Understanding how the VA rates ankylosing spondylitis under § 4.71a.
What This Condition Is
Ankylosing spondylitis is a condition affecting the musculoskeletal system, specifically the spine. For VA compensation purposes, it is evaluated under Diagnostic Code 5240 using the General Rating Formula for Diseases and Injuries of the Spine.
Because the spine has distinct segments, the VA generally evaluates the thoracolumbar (mid- and lower-back) segment and the cervical (neck) segment separately — except when there is unfavorable ankylosis of both segments, in which case they are rated as a single disability (Note 6).
How the VA Measures Your Spine
The VA compares your range of motion against defined "normal" values (Note 2):
- Cervical spine (neck): normal forward flexion is 0–45 degrees; the normal combined range of motion is 340 degrees.
- Thoracolumbar spine (mid/lower back): normal forward flexion is 0–90 degrees; the normal combined range of motion is 240 degrees.
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 (Note 4).
About ankylosis (Note 5): Unfavorable ankylosis means the entire cervical spine, entire thoracolumbar spine, or entire spine is fixed in flexion or extension and results in one or more effects such as difficulty walking due to a limited line of vision, restricted opening of the mouth 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 a neutral position (zero degrees) always represents favorable ankylosis.
Available Rating Levels
The General Rating Formula uses these levels, based on range of motion, ankylosis, spasm/guarding, or vertebral fracture:
| 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 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 but not greater than 60 degrees; or forward flexion of the cervical spine greater than 15 but not greater than 30 degrees; or combined range of motion of the thoracolumbar spine not greater than 120 degrees; or 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 but not greater than 85 degrees; or forward flexion of the cervical spine greater than 30 but not greater than 40 degrees; or combined range of motion of the thoracolumbar spine greater than 120 but not greater than 235 degrees; or combined range of motion of the cervical spine greater than 170 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 |
Rating Based on Incapacitating Episodes
This condition may alternatively be rated based on incapacitating episodes over the past 12 months:
| Rating | What the VA Looks For |
|---|---|
| 60% | Incapacitating episodes with a total duration of at least 6 weeks during the past 12 months |
| 40% | Incapacitating episodes with a total duration of at least 4 weeks but less than 6 weeks during the past 12 months |
| 20% | Incapacitating episodes with a total duration of at least 2 weeks but less than 4 weeks during the past 12 months |
| 10% | Incapacitating episodes with a total duration of at least 1 week but less than 2 weeks during the past 12 months |
Additional Things the VA Considers
- Associated neurologic abnormalities (Note 1): Any objective neurologic abnormalities — including, but not limited to, bowel or bladder impairment — are evaluated separately under an appropriate diagnostic code.
- Individualized "normal" range of motion (Note 3): In exceptional cases, an examiner may determine that a range of motion is normal for a particular individual — due to factors such as age, body habitus, or neurologic disease not caused by a spine disease or injury — even if it does not match the standard values, provided the examiner supplies an explanation.
This information reflects the VA rating schedule under 38 CFR § 4.71a for Diagnostic Code 5240 and is provided for general educational purposes.
These criteria are a rendering of § 4.71a, diagnostic code 5240. The official version is the one that governs your rating.
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