VA Disability Rating for Vertebral Fracture or Dislocation

Diagnostic Code 5235 · 38 CFR §4.71a

What Is It?

DC 5235 covers the residuals of a fractured or dislocated vertebra. The code carries no percentages of its own. Like every spine code from 5235 through 5243, it is evaluated on the General Rating Formula for Diseases and Injuries of the Spine, which measures what the spine can still do rather than what the imaging shows. There is one exception, and most veterans filing this claim have never heard of it. The formula's 10 percent step can be met by "vertebral body fracture with loss of 50 percent or more of the height" — on its own, as an alternative to every range-of-motion measurement in that row. It is the only criterion in the entire formula that names this diagnostic code's own injury, and it does not depend on how the back moves on the day of the exam. A veteran whose compression fracture flattened a vertebra by half meets it on the X-ray. If that is your imaging, say so in the claim and make sure the measurement is in the record, because an examiner focused on degrees of flexion will not think to write it down. The formula applies "with or without symptoms such as pain (whether or not it radiates), stiffness, or aching in the area of the spine affected by residuals of injury or disease." Pain is built into the percentages rather than added on top of them, which is why the evaluation turns on measured motion, on ankylosis, and on muscle spasm or guarding — not on how much the back hurts. What pain does affect is the measurement itself: under 38 CFR 4.59 an actually painful joint is entitled to at least the minimum compensable rating for that joint, and range of motion is supposed to be measured to the point where pain begins. Veterans reach this code from vehicle and aircraft accidents, falls, parachute landings, blast injuries, and the compression fractures that follow them years later. It also covers osteoporotic compression fractures where those are service connected.

Rating Criteria

Evidence Needed

• Imaging that states the percentage of vertebral body height lost. A radiology report saying "mild compression deformity" does not establish the 10 percent criterion; one saying "approximately 50 percent loss of anterior vertebral body height at L1" does. If your existing films were never measured that way, ask for a re-read rather than a new injury.
• Range of motion measured in degrees for all six planes of the affected segment — forward flexion, extension, left and right lateral flexion, and left and right lateral rotation. The combined figure the formula uses is the sum of those six.
• Documentation of muscle spasm, guarding, or localized tenderness, and specifically whether it is severe enough to produce an abnormal gait or an abnormal spinal contour such as scoliosis, reversed lordosis, or abnormal kyphosis. That distinction is the entire difference between the 10 and 20 percent steps.
• Service treatment records covering the injury event, plus any post-service records showing continuity. A parachute or vehicle accident entry, an aid station note, or a flight physical mentioning back pain all serve.
• A separate neurological examination if there is radiating pain, numbness, weakness, or bowel or bladder change. Note (1) requires associated objective neurologic abnormalities to be evaluated separately under their own diagnostic codes, so these are additional evaluations rather than part of the spine percentage.
• Records of what treatment has been tried — bracing, injections, physical therapy, fusion or other surgery — and what the result was.
• Lay statements describing flare-ups: how often, how long, and what the back will not do during one. Range of motion measured on a good day undercounts the disability, and the record is where that gets corrected.

C&P Exam Tips

• Bring the imaging report with the height-loss measurement and hand it to the examiner. This is the single highest-value thing you can do at this exam, because that one line reaches 10 percent independent of every measurement the examiner is about to take.
• Do not push through pain during range of motion testing. The examiner is supposed to record where pain begins, and a veteran who forces an extra 15 degrees is documenting a spine they do not actually have.
• Make sure all six planes get measured and recorded in degrees. A note that says "decreased lumbar range of motion" is not usable in the formula.
• Ask whether muscle spasm or guarding was observed, and whether it changed your gait or the shape of your spine. Those are separate findings from tenderness, and the higher step requires the gait or contour change.
• Report radiating symptoms by limb and by area — which fingers or toes are numb, which movements are weak. Note (1) evaluations for radiculopathy are separate ratings, and they are commonly missed when the veteran only says "my back hurts."
• Describe flare-ups concretely: frequency, duration, what triggers them, and what you cannot do while one is happening. Ask that the examiner estimate your additional loss of motion during a flare.
• If both the neck and the low back were injured, make sure both segments are examined. Note (6) directs that thoracolumbar and cervical segments be evaluated separately unless there is unfavorable ankylosis of both.
• Mention bowel or bladder changes if you have them, even if they feel unrelated and embarrassing. They are named in Note (1) and in the unfavorable-ankylosis definition.

How to File

File on VA Form 21-526EZ and name the injured vertebra and segment — "compression fracture, L1, thoracolumbar spine" rather than "back condition." Attach the imaging report and quote the height-loss figure if it is there, because that criterion sits inside the 10 percent row and is easy for a rater working from range-of-motion numbers to pass over. Claim the neurological residuals separately and by name. Note (1) to the General Rating Formula directs that associated objective neurologic abnormalities, including but not limited to bowel or bladder impairment, be evaluated separately under an appropriate diagnostic code. Radiculopathy down one leg is its own evaluation under DC 8520 and it combines with the spine percentage rather than being folded into it. If the neck and the low back were both injured, file for both. Note (6) directs separate evaluations of the thoracolumbar and cervical segments except where there is unfavorable ankylosis of both, in which case the two are rated as a single disability. And if imaging shows disc herniation with compression or irritation of the adjacent nerve root, DC 5243 may fit better than 5235 — the schedule now reserves 5243 for that specific finding and sends all other disc diagnoses to DC 5242.

Common Mistakes

Assuming the rating tracks the severity of the fracture. It does not — it tracks measured motion, ankylosis, spasm and guarding, plus the one height-loss criterion. A badly comminuted fracture that healed with good motion can evaluate lower than a mild one that did not. Letting the height-loss criterion go unmentioned. It is a complete, self-sufficient path to 10 percent sitting inside a row otherwise full of degrees, and nothing prompts an examiner to look for it. Expecting 30 percent for a low-back injury. The 30 percent step is written for the cervical spine only; a thoracolumbar claim moves from 20 to 40. Accepting a range-of-motion measurement taken on a good day without any flare-up discussion in the record. Not claiming radiculopathy, bladder changes, or bowel changes separately. Note (1) makes those additional evaluations, and a veteran who describes them only as part of "back pain" usually gets them absorbed into the spine percentage instead. Treating pain as the argument. The formula applies with or without pain, so the persuasive material is degrees, spasm, gait, contour, and the imaging measurement.

Frequently Asked Questions

My X-ray says I lost half the height of a vertebra but my back moves fine. Is that ratable?

Yes. The 10 percent row of the General Rating Formula lists "vertebral body fracture with loss of 50 percent or more of the height" as an alternative criterion, joined to the range-of-motion criteria by "or." Meeting any one of the listed criteria meets the row. Make sure the imaging report states the percentage of height lost, and point the examiner and the rater to that sentence directly.

Why is there no 30 percent rating for my lumbar fracture?

Because the 30 percent step is written entirely in terms of the cervical spine — forward flexion of the cervical spine 15 degrees or less, or favorable ankylosis of the entire cervical spine. A thoracolumbar disability moves from the 20 percent step to the 40 percent step, which requires forward flexion of 30 degrees or less or favorable ankylosis of the entire thoracolumbar spine. It is a real gap in the formula, not an error in your decision.

Does pain increase the rating?

Not directly. The formula is expressly applied with or without symptoms such as pain, stiffness, or aching, so those symptoms are already priced into each percentage. Pain matters in a different way: under 38 CFR 4.59 an actually painful joint is entitled to at least the minimum compensable rating, and range of motion should be measured to the point where pain begins rather than to the point where movement stops.

Can I get a separate rating for numbness going down my leg?

Yes, and you should claim it by name. Note (1) to the General Rating Formula directs VA to evaluate any associated objective neurologic abnormalities separately under an appropriate diagnostic code. Lower-extremity radiculopathy is usually evaluated under DC 8520 for the sciatic nerve. That evaluation combines with the spine percentage rather than replacing it.

What counts as unfavorable ankylosis?

Note (5) defines it narrowly. The segment must be fixed in flexion or extension, and the fixation has to produce at least one of a specific list of consequences: difficulty walking from a limited line of vision, restricted mouth opening and chewing, breathing limited to diaphragmatic respiration, gastrointestinal symptoms from costal margin pressure, dyspnea or dysphagia, atlantoaxial or cervical subluxation or dislocation, or neurologic symptoms from nerve root stretching. A segment fused in neutral position — zero degrees — is always favorable ankylosis, no matter how rigid it is.

I had a spinal fusion. Is that rated under this code?

Spinal fusion has its own diagnostic code, 5241, but every spine code from 5235 through 5243 is evaluated on the same General Rating Formula, so the criteria and the percentages are identical. What changes is the label. What matters far more than which of those codes is assigned is what the post-fusion measurements show and whether the fused segment counts as favorable or unfavorable ankylosis under Note (5).