VA Diagnostic Code 5243Intervertebral disc syndrome
Rated from 10% to 60% under § 4.71a. Here is what the VA requires at each level.
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Summary
Assign this diagnostic code only when there is disc herniation with compression and/or irritation of the adjacent nerve root; assign diagnostic code 5242 for all other disc diagnoses. Evaluate intervertebral disc syndrome (preoperatively or postoperatively) either under the General Rating Formula for Diseases and Injuries of the Spine or under the Formula for Rating Intervertebral Disc Syndrome Based on Incapacitating Episodes, whichever method results in the higher evaluation when all disabilities are combined under § 4.25.
What each rating requires
The VA assigns the highest level your evidence actually supports. Read up the stack until your records stop matching.
- 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
Notes on this code
These notes are part of the regulation. They change how the levels above are applied.
- Note (1): For purposes of evaluations under diagnostic code 5243, an incapacitating episode is a period of acute signs and symptoms due to intervertebral disc syndrome that requires bed rest prescribed by a physician and treatment by a physician.
- Note (2): If intervertebral disc syndrome is present in more than one spinal segment, provided that the effects in each spinal segment are clearly distinct, evaluate each segment on the basis of incapacitating episodes or under the General Rating Formula for Diseases and Injuries of the Spine, whichever method results in a higher evaluation for that segment.
Intervertebral Disc Syndrome (Diagnostic Code 5243)
Musculoskeletal System · 38 CFR § 4.71a
Understanding This Condition
Intervertebral disc syndrome affects the discs that sit between the bones of your spine. Under the VA rating schedule, Diagnostic Code 5243 applies specifically when there is disc herniation with compression and/or irritation of the adjacent nerve root. For all other disc diagnoses, the VA uses Diagnostic Code 5242 instead.
This condition can be rated whether it is evaluated before or after surgery (preoperatively or postoperatively).
How the VA Rates It
The VA has two possible methods for evaluating intervertebral disc syndrome:
- The General Rating Formula for Diseases and Injuries of the Spine, or
- The Formula for Rating Intervertebral Disc Syndrome Based on Incapacitating Episodes
The VA uses whichever method results in the higher evaluation when all disabilities are combined under § 4.25.
Rating Levels Based on Incapacitating Episodes
When rated on incapacitating episodes, the following levels are available:
| Rating | What It Reflects |
|---|---|
| 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 |
What the VA Looks For
A specific definition of "incapacitating episode." For evaluations under Diagnostic Code 5243, an incapacitating episode is a period of acute signs and symptoms due to intervertebral disc syndrome that requires bed rest prescribed by a physician and treatment by a physician. (Note 1)
Distinct effects across spinal segments. If intervertebral disc syndrome is present in more than one spinal segment — and the effects in each segment are clearly distinct — the VA evaluates each segment separately. For each segment, it uses either the incapacitating episodes method or the General Rating Formula, whichever results in a higher evaluation for that segment. (Note 2)
This information is drawn directly from the VA rating schedule under § 4.71a. It is provided for general educational purposes and is not legal advice.
These criteria are a rendering of § 4.71a, diagnostic code 5243. The official version is the one that governs your rating.
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