VA Claim for Neck or Back Pain – How Do I File?
“Your back pain is a 10/10? Here’s some motrin. You will be fine.” Sound familiar? I, like many of you, have an injury that causes neck and back pain. Military service is very hard on your health, and spinal injuries that result in neck or back pain are the sixth most common VA claim. Today, we will take you through the steps to file a VA claim for back or neck pain.
My spinal injury that created the neck and back pain came from an on duty accident. My buddy has severe neck pain from the hatch of his armored vehicle slamming against him. Your pain and injury can come from a variety of causes, but the VA will treat it all the same. It will come down to ROM (range of motion) and painful motion.
The VA will rate using Diagnostic Code 5237 within the 38 CFR Part 4 when you file a claim for a spinal injury. Ultimately, this is the “Bible” of VA disability. You need to study it, and understand how the VA rater is scoring your disabilities during a C&P Exam. In theory, the VA can rate your back or neck pain as high as 100%.
How Will The VA Rate My Claim For Back or Neck Pain?
The following section of the 38 CFR Part 4 will be used for most back or neck claims. In short, the VA determines how much the back or neck injury is affecting ROM relating to the spine:
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 of more of the height.”
So The VA Will Rate Me 100% For My Back Or Neck Pain?
They can. However, that is very unlikely. The VA will typically rate spinal injuries, back pain, and neck pain at 10% or 20% per claim. As a result, we do not consider these claims as being high value. The VA typically rates PSTD claims at 50% or 70%, and these claims are high value.
However, that does not mean that you should skip on filing a claim for back or neck pain. These disabilities are the base to secondary claims, and ultimately they are a way to avoid pyramiding. As a result, they are very important.
Pyramiding – Spread Them Out with Secondary Claims
The law forbids the VA from awarding two disability ratings for the same symptoms. As a result, it is very important that you use a variety of VA claims. Too many veterans overly focus on their most severe or most painful disability. I get it. My neck pain takes me out of commission several times a year, and it makes life difficult.
I am currently rated at 20% for neck, and I do not qualify for an increase. However, my neck pain radiates into my arms. The medical community calls this “radiculopathy,” and I have secondary claims for secondary radiculopathy. A secondary claim is an injury or illness that is aggravated by a service connected disability. These secondary claims are your work around for beating pyramiding. The VA can only give me 20% for my neck, but the radiculopathy in each arm is its own claim.
As a result, secondary claims increase my neck rating from 20% to 50% through secondary radiculopathy claims. What does your back or neck pain aggravate? Do you have radiculopathy, altered gate, knee pain, etc.? You need to spend some time researching what secondary conditions you need to add to your VA claim for neck or back pain.
File A Winning VA Claim For Back and Neck Pain
When you file your VA claim for back or neck you will need three key things:
1) A current disability diagnosis
2) Proof that the disability occurred on active duty (service-connection)
3) “Nexus” (Proof that the current disability is continuation of the active-duty injury)
Prep For Success Before You File A VA Claim
It is imperative that you have a medical diagnosis for back or neck pain before you file your VA claim for back or neck pain. The VA will immediately deny claims lacking a diagnosis. In addition, you need to show that your injury occurred on active duty (service-connection). Your C-File is where you need to start looking for that information.
Finally, the “nexus” is the piece that links your current disability with your active duty injury. You need to prove the military is responsible for this injury. The best way to show nexus is to routinely seek care for your injuries. What if you do not have good medical evidence? That would be the time to investigate if you need a nexus letter.
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