VA Secondary Conditions to Back Pain
Overview of Back Pain
Back pain is one of the most common orthopedic issues experienced by adults in the United States. It often leads to missed work, is a leading cause of disability worldwide, and can result in a variety of secondary conditions. Symptoms of back pain can vary, including:
- Shooting pain
- Aching pain
- Burning or stabbing sensations
- Cramps or spasms
Back pain may be exacerbated with bending, twisting, lifting, standing, or walking. Generally, back pain will gradually improve with home treatment and self-care within a few weeks. However, individuals with back pain should see a doctor if the pain:
- Persists past a few weeks
- Is severe and does not improve with rest
- Spreads down one or both legs, especially if the pain extends below the knee
- Causes weakness, numbness, or tingling in one or both legs
- Is accompanied by unexplained weight loss
Importantly, back pain often develops without an identifiable cause; however, common conditions linked to back pain include:
- Muscle or ligament strains – repeated heavy lifting or a sudden awkward movement can strain back muscles and spinal ligaments
- Bulging or ruptured disks – soft material inside a disk can bulge or rupture and press on a nerve, causing pain
- Arthritis – can lead to a narrowing of the space around the spinal cord (i.e., spinal stenosis)
- Osteoporosis – vertebrae can develop fractures causing pain
When diagnosing back pain, doctors will examine the individual’s back and assess their ability to sit, stand, walk, and lift their legs. The examiner may also ask the individual to rate their pain on a scale of zero to ten and talk about any impact it has on their level of functioning. Finally, the examiner may complete one or more tests, such as an X-ray, MRI, blood tests, bone scans, and nerve studies.
Common treatments for back pain include the following:
- Over-the-counter pain relievers (e.g., Advil, Motrin IB, Aleve)
- Muscle relaxants
- Topical pain relievers
- Physical therapy
- Cortisone injections
- Implanted nerve stimulators
Generally, surgery is reserved for very severe cases of back pain.
Service Connection for Back Pain
Many veterans suffer from back pain following their military service. Chronic back pain can limit your ability to work, earn a living, and even perform basic activities, such as bathing and dressing. If you can establish service connection for your back condition, you might be eligible to receive VA disability benefits. Service connection is the acknowledgment by VA that a veteran’s current health condition (i.e., back pain) is related to their military service. Importantly, there are many types of service connection, including direct and secondary service connection.
Direct Service Connection for Back Pain
In order to establish direct service connection for conditions related to back pain, veterans must show evidence of the following:
- A current diagnosis of back pain or a back condition;
- An in-service event, injury, or illness; and
- A medical nexus (i.e., link) between the current, diagnosed back pain/condition and the in-service event, injury, or illness
However, it is important to note that there is an exception to the first element of service connection involving a current diagnosis. In April 2018, the Court of Appeals for the Federal Circuit held in Saunders v. Wilkie that VA must award disability benefits for pain due to military service. This means that if a veteran has pain related to their time in service, but does not have an underlying medical diagnosis, they can still receive VA disability benefits. With regard to back conditions, this ruling is beneficial as many veterans experience back pain stemming from their time in service, but do not have a diagnosis that serves as a cause for the pain. Nonetheless, veterans will typically need medical documentation from a healthcare professional indicating that their back pain is related to their service.
Secondary Service Connection for Back Pain
Veterans can also be service-connected for back conditions that are not directly related to service. A secondary service-connected disability is a disability that resulted from a condition that is already service-connected. Here, veterans must provide medical evidence linking their back pain to their already service-connected condition.
The nexus between your primary condition and your secondary condition must be clearly established in order to be granted secondary service connection. For example, if a veteran has a service-connected knee condition that causes them to favor one side when walking, they might develop an altered gait. This uneven shift in weight may then contribute to complications and pain in their back. In that way, the veteran’s back pain is due to their service-connected knee condition, and therefore warrants secondary service connection.
Importantly, back pain can also cause secondary conditions for which service connection may be possible.
Secondary Conditions Caused by Back Pain
Oftentimes, back pain will cause other conditions, and these subsequent conditions may qualify for service connection on a secondary basis, as described above. Common examples of secondary conditions related to back pain include the following:
Cervical Radiculopathy Secondary to Back Pain
Cervical radiculopathy is when a veteran has a pinched nerve in their neck. When there is pressure on a nerve in the neck, a veteran can experience radiculopathy in their shoulders, arms, hands, and fingers. The type of pain can vary from numbness, tingling or burning, and can also range in severity from mild to severe.
Thoracic Radiculopathy Secondary to Back Pain
Thoracic radiculopathy occurs when a nerve in the upper back is pinched, and people may experience pain in their chest or torso area. This is the least common type.
Lumbar Radiculopathy Secondary to Back Pain
Lumbar radiculopathy is a common condition among veterans. This occurs when a nerve in the lower portion of the back is pinched, and it can cause numbness and tingling in the hips and legs. Incontinence can also occur as a result.
Arthritis of the Back Secondary to Back Pain
Degenerative arthritis of the back occurs when cartilage between joints erodes over time resulting in joint stiffness, limited mobility, and pain. This type of arthritis usually takes place in weight-bearing joints (e.g., back, hips, knees). Arthritis of the spine is a breakdown of the cartilage of the joints and discs in the neck and back.
Depression Secondary to Back Pain
Depression is a serious mental health condition that affects the way a person thinks, feels, and acts. Symptoms of depression tend to include the following: persistent feelings of sadness, worthlessness, and hopelessness; lack of motivation or interest in activities that usually derive pleasure; difficulty sleeping and concentrating; irritability; decreased energy; fatigue; and changes in appetite resulting in weight loss or weight gain. If a veteran suffers from debilitating back pain, it is possible that they will develop depression due to the chronic pain and limitations on activities of daily living.
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