How to Get VA to Grant a Spinal Fusion Disability Rating

How to Get VA to Grant a Spinal Fusion Disability Rating

Back pain disability claims are common among veterans. Traumatic injury or wear and tear on the spine during military service can cause chronic back pain, often leaving veterans with limited mobility, ongoing pain, and an inability to work.

The VA recognizes back pain as a disability, including back problems requiring spinal fusion surgery. Veterans who cannot work due to military service-related back problems may be eligible for monthly VA benefits. The VA determines the amount of these benefits based on the severity of the range of motion impairment.

Spinal Fusion Surgery

Spinal fusion surgery is a decades-old treatment used for certain types of back pain. In a spinal fusion operation, doctors combine bone grafts and medical screws to fuse two or more vertebrae together. The technique stabilizes the vertebrae to prevent friction between them. Newer alternatives to fusion surgery involve replacement of damaged spinal discs with artificial disc implants.

Spinal fusion treats several back problems, including:

Degenerative disk disease

Spinal disks are thick layers of rubber-like tissue that sit between the vertebrae. Over time, the disks can wear down, allowing the bones to shift. As a result, bones can grind against each other or shift and pinch nerves within the spinal column.

Herniated disk

A herniated disk is a spinal disk bulging out between two vertebrae. The condition is often a result of degenerative disk disease or spinal injuries.

Spondylolisthesis

Spondylolisthesis is any misalignment of the vertebrae. It can be caused by other back conditions or injury and results in pain and limited mobility.

Spinal stenosis

Spinal stenosis occurs when the opening in the middle of the vertebra shrinks. The condition is often caused by shifting vertebrae or inflammation. The smaller opening can pinch or compress the nerves of the spinal column, leading to pain, tingling, or numbness.

Scoliosis

Scoliosis refers to an abnormal curvature of the spine. It can be congenital or result from spinal injury.

Fractured vertebra

Fractured vertebra refers to any break in the bones of the spine, often resulting from injury or a pre-existing back condition.

Spinal fusion is most effective when doctors can identify the exact source of back pain. Surgery can reduce pain significantly, but not all veterans who undergo spinal fusion have ideal results. Back pain can return after surgery, or new back problems can develop.

How the VA Rates Spinal Fusion

The VA considers any back problem limiting the normal range of motion a disability. The technical term the VA uses is "unfavorable ankylosis," which means any unnatural spine alignment.

The VA considers a "normal combined range of motion" as 340 degrees for the neck (cervical spine) and 240 degrees for the back (thoracolumbar spine). A veteran's "combined range of motion" is calculated by adding up four individual range of motion measurements (forward flexion, extension, left and right lateral flexion, left and right rotation) for that region of the spine.

Normal range of motion measurements:

Cervical spine

  • forward flexion: 0-45 degrees
  • extension: 0-45 degrees
  • left and right lateral flexion: 0-45 degrees
  • left and right lateral rotation: 0-80 degrees

Thoracolumbar spine

  • forward flexion: 0-90 degrees
  • extension: 0-30 degrees
  • left and right lateral flexion: 0-30 degrees
  • left and right lateral rotation: 0-30 degrees

The VA calculates the amount of disability compensation according to how significantly a spine condition affects the range of motion.

Rating General Rating Formula for Diseases and Injuiries of 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 no 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.

Applying for VA Benefits for Back Problems and Spinal Fusion

Veterans with a limited range of motion related to back pain caused or aggravated by military service may be eligible for VA disability benefits, including financing of spinal fusion surgery.

During the three months of post-surgery recovery time, eligible veterans are entitled to a 100% disability rating. After recovery, the VA will re-evaluate the condition to schedule a rating based on improving range of motion.

To qualify for VA disability benefits, veterans must establish a link between military service and current health conditions. To demonstrate the service connection, a veteran must satisfy three essential criteria:

  1. Evidence of a current disability
  2. Evidence of in-service injury or disease
  3. Evidence of a connection between in-service injury or disease and the present disability (medical nexus)

Relevant injuries may be documented in the service treatment records. But service treatment records frequently lack corroboration of back or spine incidents. In this case, veterans should try to obtain alternative evidence such as buddy statements by witnesses to the injury.

In other cases, an injury to the back is in the service records, but the discharge exam is negative for any ongoing back disability. Here, veterans often face an uphill battle to win service connection for back disabilities.

If back pain started after service, a doctor should write an expert opinion showing how service-related activities contributed to the current disability.

We have won many cases with less-than-ideal evidence, but it takes a top-notch legal strategy and established medical experts to win hard-to-prove cases with weak evidence.

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