---
title: "DC 5239 - Spondylolisthesis or segmental instability"
diagnostic_code: "5239"
body_system: "Musculoskeletal System"
cfr_section: "§ 4.71a"
canonical: "https://veteranai.co/va-rating-schedule/musculoskeletal/5239-spondylolisthesis-or-segmental-instability"
source: "https://www.ecfr.gov/current/title-38/section-4.71a"
updated: "2026-07-21T19:57:25.244083Z"
---

# DC 5239 - Spondylolisthesis or segmental instability

Rated under § 4.71a. Body system: Musculoskeletal System.

General Rating Formula for Diseases and Injuries of the Spine

## Rating criteria

| Rating | Criteria |
| --- | --- |
| 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 |

## Notes

- 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.

# Spondylolisthesis or Segmental Instability (Diagnostic Code 5239)

*Musculoskeletal System · 38 CFR § 4.71a*

## Understanding the Condition

Spondylolisthesis or segmental instability affects the spine, where a vertebra shifts out of position or a spinal segment becomes unstable. The VA evaluates this condition under the **General Rating Formula for Diseases and Injuries of the Spine**, which is based on how the condition limits your range of motion, causes ankylosis (fixation of the spine), or results in incapacitating episodes.

The VA rates the **thoracolumbar spine** (mid-to-lower back) and the **cervical spine** (neck) as separate segments — except when both segments have unfavorable ankylosis, in which case they are rated as a single disability (Note (6)).

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

## Available Rating Levels

The VA may assign one of several rating levels based on your specific symptoms and measurements.

### Ratings Based on Range of Motion and Ankylosis

| Rating | What It Reflects |
|--------|------------------|
| **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 |

### Ratings 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

When rating spondylolisthesis or segmental instability, the VA evaluates:

- **Forward flexion measurements** of the cervical and/or thoracolumbar spine, measured in degrees.
- **Combined range of motion**, defined as the sum of forward flexion, extension, left and right lateral flexion, and left and right rotation (Note (2)).
- **Ankylosis** — whether the spine is fixed, and whether that fixation is favorable or unfavorable.
- **Muscle spasm, guarding, or localized tenderness**, and whether these affect gait or spinal contour.
- **Vertebral body fractures** with loss of height.
- **Incapacitating episodes** and their total duration over the past 12 months.
- **Associated neurologic abnormalities**, which are rated separately.

### Key Definitions the VA Uses

**Normal ranges of motion (Note (2)):**
- *Cervical spine:* 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:* 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°.

**Unfavorable ankylosis (Note (5)):** A condition in which the entire cervical spine, entire thoracolumbar spine, or entire spine is fixed in flexion or extension, resulting 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.

**Measurement notes:** Each range of motion measurement is rounded to the nearest five degrees (Note (4)). 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 resulting from a spine injury — provided the examiner supplies an explanation (Note (3)).

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*This information is drawn from the VA rating schedule under 38 CFR § 4.71a for diagnostic code 5239. It is provided for general educational purposes and does not guarantee any particular rating or outcome.*

Source: https://www.ecfr.gov/current/title-38/section-4.71a