This guide covers how the VA actually rates back or neck pain under diagnostic code 5237 / 5242 / 5243 — the criteria the rater applies, the evidence that carries weight, and the related conditions veterans most often leave unclaimed. It's the same playbook our own case managers work from.
How the VA rates it
Thoracolumbar: 40% = forward flexion ≤30° · 20% = >30° but ≤60°, OR muscle spasm/guarding severe enough to cause abnormal gait or abnormal spinal contour · 10% = >60° but ≤85°. Rated WITH OR WITHOUT pain — measured motion governs. Cervical: 30% = ≤15° · 20% = >15–30° · 10% = >30–45°.
Honest ceiling: 40% at forward flexion of 30° or less.
The evidence that wins
Service connection: In-service injury (STR entry, or buddy statement if never reported).
Medical opinion (nexus): Needed if no contemporaneous record or a treatment gap.
Secondary conditions veterans miss
Conditions that commonly develop because of this one can be service-connected on top of it:
- Radiculopathy secondary to spine — EACH extremity rated separately — the biggest miss in the business
- Depression secondary to chronic pain — Restarts the entire MH tree
- Opposite-side joints from compensation gait
Filing it right the first time
Most denials on back or neck pain claims trace to the same failures: the evidence never addressed the actual rating criteria, the connection to service was asserted instead of supported, or the C&P exam went sideways because nobody prepared for it. A complete file — records, statements written to the criteria above, and honest exam preparation — is the difference.
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