VA Diagnostic Code 5242Degenerative arthritis, degenerative disc disease other than intervertebral disc syndrome (also, see either DC 5003 or 5010)

Degenerative Arthritis & Degenerative Disc Disease of the Spine (VA Diagnostic Code 5242)

Musculoskeletal System · 38 CFR § 4.71a · Rated under the General Rating Formula for Diseases and Injuries of the Spine

Understanding the Condition

Diagnostic Code 5242 covers degenerative arthritis and degenerative disc disease of the spine, other than intervertebral disc syndrome. These conditions affect the vertebrae and discs of the spine and can limit how far you are able to move your neck (cervical spine) and mid-to-lower back (thoracolumbar spine).

The VA evaluates this condition using the General Rating Formula for Diseases and Injuries of the Spine. Ratings are based primarily on measured range of motion, the presence and type of ankylosis (a spine that has become fixed in one position), and related findings such as muscle spasm, guarding, or vertebral fracture. (Related codes: for arthritis findings, see also DC 5003 or 5010.)

For reference, the VA measures spinal motion against these normal ranges:

• Cervical spine: forward flexion 0–45°, extension 0–45°, left/right lateral flexion 0–45°, left/right lateral rotation 0–80° (combined normal range of motion: 340°).
• Thoracolumbar spine: forward flexion 0–90°, extension 0–30°, left/right lateral flexion 0–30°, left/right lateral rotation 0–30° (combined normal range of motion: 240°).

Available Rating Levels

The General Rating Formula uses the following levels:

Rating Based on Incapacitating Episodes

Where applicable, the condition may instead be evaluated on incapacitating episodes over the past 12 months:

What the VA Looks For

When rating this condition, the VA considers the following important rules and definitions:

• Separate evaluation of neurologic abnormalities (Note 1). Any associated objective neurologic abnormalities — including, but not limited to, bowel or bladder impairment — are evaluated separately under an appropriate diagnostic code.

• Measured range of motion (Notes 2 & 4). Range of motion is compared against the normal values listed above, and each measurement is rounded to the nearest five degrees. The combined range of motion is the sum of forward flexion, extension, left and right lateral flexion, and left and right rotation. The normal ranges for each component are the maximum used when calculating the combined range of motion.

• Individualized normal ranges (Note 3). In exceptional cases, an examiner may state that — because of age, body habitus, neurologic disease, or other factors not caused by disease or injury of the spine — a particular individual's range of motion should be considered normal, even if it does not match the standard values. If the examiner provides an explanation, that assessment will be accepted.

• Favorable vs. unfavorable 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 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 from 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 the neutral position (zero degrees) always represents favorable ankylosis.

• Separate segment evaluations (Note 6). 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.

This information summarizes VA rating criteria for Diagnostic Code 5242 under 38 CFR § 4.71a and is provided for general educational purposes only.