Spinal Cord, Malignant Neoplasm — VA Rating (DC 8021)
Diagnostic Code 8021 · 38 CFR §4.124a
What Is It?
DC 8021 covers malignant tumors of the spinal cord — primary spinal cord cancers such as ependymoma, astrocytoma, and glioblastoma when they arise in the cord rather than the brain, and metastatic tumors that have spread to the cord from another primary site. The clinical course typically involves progressive neurological deficits below the level of the tumor — weakness, sensory loss, bowel and bladder dysfunction — with the diagnosis established by MRI followed by biopsy or resection, and treatment combining neurosurgery, radiation, and chemotherapy. 38 CFR §4.124a opens the neurological schedule with a bracketed instruction: disability from the diseases it lists "may be rated from 10 percent to 100 percent in proportion to the impairment of motor, sensory, or mental function," referring the rater to the appropriate body system of the schedule for each manifestation. Inside the 8000–8025 block the schedule prints either a single flat percentage, a single minimum rating, or no percentage at all — there is no severity ladder anywhere in it. A Note closing the block adds two conditions: the minimum ratings for residuals require ascertainable residuals, and when a rating above the minimum is assigned, the diagnostic codes used as the basis of that evaluation must be cited alongside the code identifying the diagnosis. DC 8021 prints two figures and no ladder between them: 100 percent for the malignant tumor, and a minimum rating of 30 once the evaluation moves to residuals. The Note attached to the code is the part most often misstated: the 100 percent "will be continued for 2 years following cessation of surgical, chemotherapeutic or other treatment modality," and only at that point, if the residuals have stabilized, is the rating made on neurological residuals according to symptomatology. Two years, not six months — the six-month clock in §4.124a belongs to the brain-vessel codes DC 8007 through 8009 and to hematomyelia at DC 8012.
Rating Criteria
| Rating | Criteria |
|---|---|
| 100% | Malignant neoplasm of the spinal cord. The Note under DC 8021 continues this rating for 2 years following cessation of surgical, chemotherapeutic, or other treatment modality; at that point, if the residuals have stabilized, the rating is made on neurological residuals according to symptomatology. Surveillance imaging without active treatment does not restart the clock; a recurrence that requires new treatment does. |
| 30% | Minimum rating, once the evaluation moves to residuals. The schedule prints no steps between 30 and 100 for this code — §4.124a's preamble instead sets the range at 10 to 100 percent in proportion to the impairment of motor, sensory, or mental function, with partial loss of use of an extremity rated by comparison with the mild, moderate, severe, or complete paralysis of peripheral nerves. The Note closing the 8000–8025 block requires ascertainable residuals for this minimum, and requires that any rating above it cite the diagnostic codes used as the basis of evaluation. |
Evidence Needed
MRI of the spinal cord showing the tumor is foundational. Pathology from biopsy or resection confirms the malignancy, the tumor type, and the grade. Treatment records — operative notes, radiation oncology summaries, chemotherapy regimens, immunotherapy administration — establish the date active treatment ceased, which is what starts the two-year clock, so the last treatment date needs to be unambiguous in the record. Serial post-treatment imaging documents recurrence or progression. Once the two years elapse, the evidence that sets the percentage is the residual workup: strength and sensation by nerve distribution below the tumor level, bowel and bladder function, and any requirement for aid and attendance. Service records establishing an exposure history support the nexus where an environmental cause is the basis for service connection.
C&P Exam Tips
During active treatment and for the two years afterward, the diagnosis and the treatment timeline are what matter; make sure the record shows the exact date the last surgical, chemotherapeutic, or other treatment ended. After that, the exam shifts to characterizing residuals, and each deficit should be documented individually in the terms its own code uses — which limb, which nerve distribution, what strength grade, what the bowel and bladder function is. Bring all pathology reports, treatment summaries, surveillance imaging, and the neurology findings. If the residuals include loss of use of a limb, bowel or bladder dysfunction, or the need for aid and attendance, request an SMC evaluation explicitly.
How to File
File VA Form 21-526EZ listing spinal cord malignant neoplasm under DC 8021 and reference 38 CFR §4.124a. Attach the MRI, pathology, all treatment records with the last treatment date clearly identified, and post-treatment surveillance imaging. If the nexus runs through a recognized exposure, cite the applicable presumptive regulation and attach the exposure documentation. As the two-year period approaches its end, file the residual evidence so the transition is made on a current picture rather than an outdated one, and request SMC evaluation when functional losses justify it.
Common Mistakes
Believing the 100 percent runs six months after treatment ends. Under DC 8021 it runs two years — the six-month figure in §4.124a belongs to the brain-vessel codes and to hematomyelia, not here. Filing without complete treatment records, which leaves the date active treatment ceased unclear and the two-year clock unanchored. Letting the transition to residuals happen on stale evidence. Not requesting an SMC evaluation when severe residuals justify it.
Frequently Asked Questions
How long does the 100 percent rating last after treatment ends?
Two years. The Note under DC 8021 in 38 CFR §4.124a reads that the rating "will be continued for 2 years following cessation of surgical, chemotherapeutic or other treatment modality. At this point, if the residuals have stabilized, the rating will be made on neurological residuals according to symptomatology." Active treatment means surgery, chemotherapy, radiation, immunotherapy, or other antineoplastic therapy; surveillance imaging alone does not extend the period. The same two-year Note appears at DC 8002 for malignant brain tumors. Some other codes in §4.124a do use a six-month clock — DC 8007 through 8009 for brain vessel events and DC 8012 for hematomyelia — which is where the six-month figure gets borrowed from by mistake.
What happens to the rating after the two years?
If the residuals have stabilized, the rating is made on the neurological residuals according to symptomatology, with a minimum of 30 percent. There are no schedule steps printed between 30 and 100 for this code; §4.124a's opening instruction sets the range at 10 to 100 percent in proportion to the impairment of motor, sensory, or mental function, and directs that partial loss of use of a limb be rated by comparison with the mild, moderate, severe, or complete paralysis of the relevant peripheral nerves. The Note closing the 8000–8025 block requires ascertainable residuals for the minimum and requires that any rating above it cite the codes used as the basis of evaluation.
What happens if the tumor recurs?
A recurrence that requires new active treatment restarts the 100 percent period, and the two-year continuation runs again from the cessation of that treatment. Any reduction from 100 percent is a rating reduction, so the procedural protections in 38 CFR §3.105(e) — notice, a period to respond, and the opportunity for a hearing — apply before the change takes effect.