Lumbosacral Strain — VA Disability Rating Criteria (DC 5237)
Diagnostic Code 5237 · 38 CFR §4.71a
What Is It?
Lumbosacral strain is an injury to the muscles, tendons, or ligaments of the lower back. It is one of the most commonly claimed VA disability conditions. Veterans develop lower back problems from carrying heavy equipment, rucking, parachute landings, vehicle vibrations, heavy lifting, and the general physical demands of military service. The VA rates lumbosacral strain under the General Rating Formula for Diseases and Injuries of the Spine, which applies the same criteria to most spinal conditions. The rating is based primarily on range of motion measurements, with additional consideration for muscle spasm, abnormal gait, and spinal contour abnormality.
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. DC 5237 covers cervical strain as well as lumbosacral strain, so this step is available where the cervical segment is the disability at issue — but it is cervical-only, which is why a purely lumbosacral claim moves from 20 percent to 40 percent. |
| 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. |
Evidence Needed
Range of motion measurements of the thoracolumbar spine are the primary evidence. The C&P examiner measures forward flexion, extension, bilateral lateral flexion, and bilateral rotation using a goniometer. Medical records documenting back injuries during service, imaging (X-rays, MRI of the lumbar spine), and treatment records showing ongoing back problems are important. Evidence of associated radiculopathy (nerve pain radiating into the legs) should be documented separately because it receives its own rating. Document any incapacitating episodes that required bed rest prescribed by a physician, as the alternative IVDS formula may yield a higher rating.
C&P Exam Tips
The examiner will measure your range of motion in six directions: forward flexion, extension, left and right lateral flexion, and left and right rotation. Normal combined ROM for the thoracolumbar spine is 240 degrees. Be honest — do not push through significant pain. When the examiner asks about flare-ups, describe the additional limitation clearly. If your back spasms cause you to walk with an altered gait, demonstrate or describe that. The examiner should note whether muscle spasm or guarding is present. If you have radiating pain into your legs, describe it in detail — this should trigger a separate peripheral nerve evaluation. Mention if you use a back brace, cane, or other assistive device.
How to File
File on VA Form 21-526EZ listing lumbosacral strain as the claimed condition. Describe the in-service events that caused or contributed to your back condition. If you also have radiculopathy (radiating nerve pain), claim it separately — it is rated under the peripheral nerve diagnostic codes and can significantly increase your combined rating. Include imaging studies, treatment records, and descriptions of how the condition affects daily activities. A VSO can ensure all related conditions are properly listed.
Common Mistakes
The most common mistake is not claiming radiculopathy as a separate condition. Many veterans with back conditions have associated nerve pain radiating into one or both legs, which is rated separately and can add significantly to the combined rating. Another mistake is not describing flare-ups and their impact on ROM during the C&P exam — the VA is required to consider this under the DeLuca principles. Veterans also sometimes fail to mention incapacitating episodes requiring bed rest, which could qualify for a higher rating under the alternative IVDS formula.
Frequently Asked Questions
What is the combined range of motion for the thoracolumbar spine?
The combined ROM is the sum of forward flexion, extension, right lateral flexion, left lateral flexion, right rotation, and left rotation. Normal combined ROM is 240 degrees. The VA uses this combined measurement as one of the criteria for determining the rating level.
Can I get separate ratings for my back and for nerve pain in my legs?
Yes. The General Rating Formula for Diseases of the Spine specifically states that associated objective neurological abnormalities, including radiculopathy, should be evaluated separately under the appropriate diagnostic code. Claiming radiculopathy in each affected leg in addition to the back condition itself is proper and can substantially increase your combined rating.
What is ankylosis?
Ankylosis is the immobility or fixation of a joint. For the spine, favorable ankylosis means the spine is fixed in a neutral (upright) position. Unfavorable ankylosis means the spine is fixed in a flexed or other non-neutral position. Ankylosis of the entire thoracolumbar spine warrants a 50% rating, and ankylosis of the entire spine warrants 100%.