Back Pain / Lumbosacral Strain (Thoracolumbar Spine)
Diagnostic Code 5237 • 38 CFR § 4.71a (General Rating Formula — Spine)
Often grouped with DC 5235–5243; ratings follow range of motion, IVDS episode rules, or ankylosis criteria—not the label on your intake form.
Primary DC (strain)
5237
Scope: This guide focuses on the thoracolumbar (low/mid-back) region typical of lumbosacral strain claims. The cervical spine uses different ROM columns—do not mix neck and low-back numbers from your exam sheet.
Thoracolumbar Spine — Rating Snapshot (2026)
Live 38 CFR § 4.71a General Rating Formula for Diseases and Injuries of the Spine (current as of 8/27/2026). Thoracolumbar flexion greater than 30° but not greater than 60° is 20%, not 30%. The 30% row in this formula is cervical-only. This formula has no 0% row. Amounts below are 2026 VA compensation rates, veteran alone, no dependents—add dependents separately.
Unfavorable ankylosis of the entire spine
Official General Rating Formula
$3,938.58/mo
base
Unfavorable ankylosis of the entire thoracolumbar spine
Not 40%
$1,132.90/mo
base
Forward flexion of the thoracolumbar spine 30 degrees or less; or, favorable ankylosis of the entire thoracolumbar spine
Unfavorable entire-thoracolumbar ankylosis is 50%
$795.84/mo
base
Forward flexion of the thoracolumbar spine greater than 30 degrees but not greater than 60 degrees; or, combined thoracolumbar ROM not greater than 120 degrees; or, muscle spasm or guarding severe enough to result in an abnormal gait or abnormal spinal contour
Official 20% thoracolumbar paths (cervical alternates omitted here)
$356.66/mo
base
Forward flexion of the thoracolumbar spine greater than 60 degrees but not greater than 85 degrees
Official 10% thoracolumbar flexion band (other official 10% alternates omitted here)
$180.42/mo
base
The 30% evaluation in this formula is cervical-only (forward flexion of the cervical spine 15 degrees or less; or, favorable ankylosis of the entire cervical spine). There is no 30% thoracolumbar flexion band and no 0% row. IVDS (DC 5243) may instead be rated on incapacitating episodes with prescribed bed rest; the VA assigns the method that is appropriate and often the higher evaluation when rules allow. eCFR § 4.71a.
Complete regulatory criteria, CFR citations, and official rating notes
Three Compensation Scenarios (VA Combined Math)
Combined ratings use VA math—not straight addition. The largest single rating is taken first; each additional rating is a percentage of what remains until the next tier (then rounded to the nearest 10%).
40% Spine + Radiculopathy + Tinnitus
Illustrative: 40% + 20% + 10% typically land near the 60% band → about $1,435.02/mo (2026, veteran alone).
20% Spine + 50% Sleep Apnea (Secondary)
Combined
60%
Monthly (approx.)
$1,435.02/mo
20% + 50% combines to 60% under standard VA math—not 70%.
30% Spine + Bilateral Knees + Depression
Combined % depends on exact ratings and bilateral calculation—often pushes into the 70–90% range when multiple musculoskeletal and mental health ratings are present.
Use the Rating Calculator with your actual decision percentages.
Evidence That Moves Spine Claims
Goniometer ROM on exam
C&P should record flexion/extension with a goniometer. Ask that flare-ups and repeated motion (DeLuca factors) be considered.
Imaging & specialist notes
MRI/CT when clinically indicated; ortho or PM&R notes tying findings to functional limits.
Radiculopathy documentation
If you have leg pain, numbness, or weakness, exams should address nerve findings—may support a separate rating in addition to the spine.
IVDS episodes (if applicable)
For episode-based IVDS, the regulation generally requires prescribed bed rest by a physician—not self-directed rest alone.
Lay statements
Spouse/employer statements on lifting limits, missed work, and how bad days differ from good days.
Common Secondary Conditions (Grid)
Chronic lumbar strain alters gait and load—often supporting secondary claims when a nexus is documented:
🦵 Hip / knee strain
Commonly discussed5252 / 5260 • Altered gait and compensation patterns
🦶 Foot / ankle
Sometimes discussed5271 • Weight shift from lumbar guarding
🧠 Depression / anxiety
Commonly discussed9434 / 9400 • Chronic pain and activity loss
😴 Sleep apnea
Sometimes discussed6847 • Weight, meds, pain-sleep cycle
🤕 Migraines
Sometimes discussed8100 • Cervicogenic / tension patterns
❤️ Hypertension
Sometimes discussed7101 • Pain, stress, medication effects
Secondary Condition Mapper (Founding Pass) — map from your primary SC conditions.
Filing Timeline (Typical)
Organize STR & post-service records
Pull DD-214, STRs, imaging, therapy notes.
File claim (21-526EZ)
List spine condition; mention radicular symptoms if applicable.
C&P musculoskeletal exam
Ensure goniometer ROM; describe flare-ups.
Decision / rating
Often several months; review for separate nerve evaluations.
Appeal or secondary claims
File neuropathy, hips/knees, mental health as supported.
What Gets You Higher Spine Ratings
10% → 20% (thoracolumbar)
- Thoracolumbar flexion greater than 30° but not greater than 60°, combined ROM not greater than 120°, or spasm/guarding causing abnormal gait or contour (official 20% row).
- The 30% row in this formula is cervical-only: forward flexion of the cervical spine 15 degrees or less; or, favorable ankylosis of the entire cervical spine.
Toward 40%
- Flexion ≤30° on credible exam—or ankylosis criteria if applicable.
- Strong IVDS episode pattern if rated under that method.
Separate evaluations
Radiculopathy and mental health ratings stack under VA math (not pyramiding the same symptom twice)—raising total compensation even when the spine % stays flat.
Common Mistakes
Mixing cervical and lumbar ROM
Neck flexion numbers do not rate your low back.
No goniometer / one quick measurement
Misses painful motion and functional loss rules.
Ignoring radiculopathy
Leg symptoms may be a separate rating if documented.
Expecting IVDS ‘stacking’
IVDS methods are alternatives—VA picks supported higher when rules allow.
FAQs
▸ Is DC 5237 the only code for my back?
No—the VA may use 5235–5243 (strain, post-surgical states, IVDS, stenosis, etc.) depending on findings. DC 5237 often appears for lumbosacral/cervical strain, but the rating still follows the spine formulas in § 4.71a.
▸ Does painful motion guarantee 10%?
§ 4.59 requires consideration of painful motion; practical outcomes depend on exam quality and how findings align with the diagnostic code. Always review your C&P for accurate segment and motion planes.
▸ Can I work with a 40% back rating?
Yes—schedular ratings are not an earnings test. TDIU has separate rules if you cannot work due to service-connected disabilities.
▸ Where is the official regulatory text?
See the DC reference below and 38 CFR § 4.71a in the eCFR for the exact rating criteria and notes.
Diagnostic Code Reference & Tools
Schedule Deep Dive (Flexion & Official Table)
Quick check: does your low-back rating match your exam?
Use your C&P or treatment exam and look at forward flexion of the thoracolumbar spine (low / mid-back bend). Compare that number to the table—this is only one part of the full rating schedule, but it is the part many veterans read first.
Low back forward flexion → common flexion-based tier
| If your forward flexion is… | Often lines up with* |
|---|---|
| 30° or less | 40% |
| 31° to 60° | 30% |
| 61° to 85° | 20% |
| 86° to 90° | 10% |
*“Often lines up with” means the flexion part of the schedule. The same percentage can also be reached other ways (combined motion, ankylosis, etc.). Your decision must match the full regulatory row—not this table alone.
Different path, same “20% neighborhood”
Even if flexion is not in the 61°–85° band, you might still fall in the 20% range if the examiner documents severe muscle spasm or guarding that causes an abnormal gait or abnormal spinal contour, when that language matches the schedule.
Disc syndrome (IVDS) — second way to rate
If you have IVDS, the VA may rate using bed rest prescribed by a physician during flare-ups (incapacitating episodes) instead of, or in addition to comparing, ROM. They generally use whichever method the evidence supports and that results in the appropriate combined evaluation under the rules—not an automatic extra percentage.
Neck vs low back: Cervical (neck) flexion uses different degree cutoffs. Use the thoracolumbar row on your exam for low-back claims. Social posts often mix up the 30% and 20% flexion bands—trust your ROM sheet and 38 CFR § 4.71a, not a screenshot.
Educational only—not a promise of an increase. Talk with a VA-accredited representative about your file.
Official VA rating criteria — General Rating Formula for Diseases and Injuries of the Spine
Live 38 CFR § 4.71a General Rating Formula (current as of 8/27/2026). There is no 30% evaluation for thoracolumbar flexion. The 30% row in this formula is cervical-only: forward flexion of the cervical spine 15 degrees or less; or, favorable ankylosis of the entire cervical spine. Unfavorable ankylosis of the entire thoracolumbar spine is 50%, not 40%. This formula has no 0% row.
| Rating | VA criteria (eCFR text) | Segment |
|---|---|---|
| 100% | Unfavorable ankylosis of the entire spine. | Entire spine. |
| 50% | Unfavorable ankylosis of the entire thoracolumbar spine. | Thoracolumbar. |
| 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. | Thoracolumbar flexion ≤30° or favorable entire-thoracolumbar ankylosis. Unfavorable entire-thoracolumbar ankylosis is 50%. |
| 30% | Forward flexion of the cervical spine 15 degrees or less; or, favorable ankylosis of the entire cervical spine. | Cervical-only. Not a thoracolumbar flexion band. |
| 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. | Thoracolumbar flexion >30° not >60° is 20%, not 30%. |
| 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. | Thoracolumbar flexion >60° not >85° is 10%. |
Source: 38 CFR § 4.71a — https://www.ecfr.gov/current/title-38/chapter-I/part-4/subpart-B/subject-group-ECFRd3005f7d828ea7b/section-4.71a (current as of 8/27/2026).
IVDS & related (summary)
For qualifying IVDS claims, the VA may rate under general spine ROM or the episode formula— typically whichever is supported and appropriate under the notes to § 4.71a.
Service connection — common paths
Direct service connection
An in-service injury or illness (lifting, falls, MVAs, blast, etc.) with evidence of a current chronic spine disability may support direct service connection when the record ties them under VA’s standard of proof.
Secondary service connection
A service-connected condition elsewhere (for example knee, ankle, or foot) can theoretically contribute to or aggravate a spine condition when competent medical evidence supports that relationship.
Secondary conditions sometimes pursued with thoracolumbar spine / back conditions
The list below describes common secondary claim theories discussed with accredited representatives—not automatic benefits. Whether a secondary is granted depends on evidence, including medical nexus opinions where needed.
Often argued when imaging or exams suggest nerve-root involvement with leg symptoms; requires medical evidence linking radicular signs to the spine.
May be raised when providers document neurologic or medication-related links; highly fact-specific.
Chronic pain can factor into mental-health claims; mental disorders are rated on their own criteria under § 4.130.
Some veterans connect pain, weight change, or sleep fragmentation; apnea needs its own medical theory of causation.
Altered gait or compensation is sometimes argued as contributing to lower-extremity conditions; opinions and records matter.
“Commonly discussed,” “Sometimes discussed,” and “Less often discussed” describe how often these theories appear in educational materials. They are not a prediction of approval. Use accredited help for your specific file.
Already service-connected for something else?
If you are already service-connected for a lower-body condition, a spine disability may be claimed as secondary when competent medical evidence supports aggravation or causation (not automatic).
Altered gait from knee disability is a common secondary theory for back symptoms.
Biomechanical alignment issues may be argued as aggravating lumbar strain.
Hip pathology can change posture and loading on the spine when medically supported.
Limping or instability may be tied to compensatory back stress in some records.
⚠️ Important Disclaimer
This page provides general educational information based on public VA regulations and VA.gov resources. It is not legal or medical advice, and My Claim Packet is not a VA-accredited representative. Any worksheets or draft documents produced by the tools must be reviewed for accuracy and are not filed with VA for you. Ratings and service connection are decided case-by-case from the individual record. Consult a VA-accredited VSO, claims agent, attorney, or qualified clinician for help with your situation, and verify current rules using the linked official source.