◢ Musculoskeletal • 38 CFR § 4.71a, DC 5237
Lumbosacral Strain (Lower Back)
Lower back conditions are rated under the General Rating Formula for Diseases and Injuries of the Spine. The rating depends on forward flexion measured in degrees and the presence of muscle spasm, abnormal gait, or ankylosis. Critically, the VA must consider flare-ups and pain on motion under the DeLuca v. Brown precedent — the static measurement on exam day is not the whole story.
Rating tiers under 38 CFR § 4.71a, DC 5237
The VA rates lumbosacral strain (lower back) at these schedular tiers. Most veterans land at the middle tiers — extreme tiers require correspondingly extreme documentation.
Forward flexion of thoracolumbar spine greater than 60 but not greater than 85 degrees, or muscle spasm not resulting in abnormal gait.
Forward flexion greater than 30 but not greater than 60 degrees, or muscle spasm severe enough to result in abnormal gait or abnormal spinal contour.
Forward flexion 30 degrees or less, or favorable ankylosis of entire thoracolumbar spine.
Unfavorable ankylosis of the entire thoracolumbar spine.
Unfavorable ankylosis of the entire spine.
Evidence the C&P examiner needs
Build the record before the exam. Walk in with documentation, walk out with a stronger rating.
- 01
Back DBQ from VA or private orthopedist with goniometer measurements
- 02
Service treatment records showing in-service back complaint or injury
- 03
Imaging (X-ray or MRI) showing structural pathology
- 04
Lay statement detailing flare-up frequency, duration, and triggers
- 05
Pain journal documenting bad days vs good days over 60-90 days
- 06
Statement on functional loss — what you can no longer do (lift over X pounds, sit longer than X minutes, sleep on back)
Secondary conditions to file alongside
These conditions frequently develop as a consequence of lumbosacral strain (lower back) and are often missed. Each can be filed as a secondary claim and add to your combined rating.
Radiculopathy (sciatica)
Rated separately under DC 8520 for each lower extremity, 10-80% per side. Often added to a back claim and can produce a higher combined rating than the back alone.
Erectile dysfunction (secondary to back nerve impingement)
L5-S1 nerve compression can support an ED secondary claim with proper neurology nexus.
Depression (secondary to chronic pain)
Chronic pain conditions support secondary mental health claims when the pain demonstrably impairs quality of life.
Common mistakes that lower the rating
- 01
Stretching before the C&P exam to perform better — this artificially raises your range of motion and lowers your rating
- 02
Not requesting flare-up consideration — explicitly tell the examiner about flare-ups; the regulation requires it to be assessed
- 03
Failing to file radiculopathy as a separate condition — back pain alone is usually 10-20%; back + bilateral radiculopathy can push combined ratings to 50% or higher
Pro tip
Bring a witness to your C&P exam who can confirm your typical limitations. The examiner sees you for 30 minutes; your spouse or buddy has watched you for years. A signed witness statement filed within 7 days of the exam carries strong weight.
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Source: 38 CFR Part 4 (VA Schedule for Rating Disabilities) and VA M21-1 Adjudication Procedures Manual. This guide explains the regulation; it is not legal advice and does not substitute for an accredited VA claims agent or VSO. Find a free VSO at va.gov/ogc/apps/accreditation.