Getting Veterans (VA) Disability for Back Pain Injury
Chronic back pain can limit a person’s ability to work, earn a living, and even perform basic activities, such as bathing and dressing. Unfortunately, many veterans suffer from back pain following their military service.
If you are suffering from a back injury or pain as a result of your military service, you may be eligible to receive disability benefits from the Department of Veterans Affairs (VA).
How to Establish Service Connection for Back Pain or Injury
Service connection is the acknowledgment by VA that a veteran’s current health condition is related to their military service. There are several ways in which veterans can establish service connection for their back pain, including the following:
Direct Service Connection
Generally, to establish direct service connection, veterans must show that their diagnosed medical condition or injury resulted from a specific event in their military service. Therefore, veterans must show evidence of the following three things:
- A current diagnosis of a back condition;
- An in-service event, injury, or illness; and
- A medical nexus (i.e., link) between the current, diagnosed back condition and the in-service event, injury, or illness.
VA typically requires an opinion from a medical expert stating that your back injury likely resulted from an in-service event. VA will likely schedule a Compensation and Pension (C&P) exam to fulfill this nexus element.
Secondary Service Connection
Veterans can also be service connected for back conditions on a secondary basis. This means that the back condition is the result of an already service-connected condition.
To prove secondary service connection, veterans must provide medical evidence linking their back pain to their already service-connected condition.
For example, a veteran has a service-connected hip condition that causes them to favor one side when walking, resulting in an altered gait. This uneven shift in weight then contributes to back pain. In this case, the veteran’s back pain is caused by their service-connected hip condition and therefore warrants secondary service connection.
Can I Qualify for Disability Benefits for Back Pain without a Diagnosis?
In April 2018, the Court of Appeals for Federal Circuit ruled 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. Essentially, the Court concluded that disability “refers to the functional impairment of earning capacity, not the underlying cause of said disability.”
Regarding 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.
VA Disability Ratings for Back Pain
VA rates back conditions under 38 CFR § 4.71a, Schedule of Ratings, Musculoskeletal System. The criteria are based largely on a veteran’s range of motion and functional loss.
Generally, veterans will attend a Compensation & Pension (C&P) examination and the examiner will use a goniometer to measure how far they can bend forward, backward, and side to side. VA will use these range of motion measurements to determine the severity of a veteran’s back condition.
However, the C&P examiner should also consider the functional loss caused by the veteran’s back condition, as evidenced by pain during motion. For example, a veteran might be able to bend forward 85 degrees but start to experience pain at 55 degrees.
In this case, the veteran should receive a disability rating that is consistent with both the range of motion measurements and the functional limitations caused by their back pain.
Presence of Flare-ups
In addition to range of motion measurements and functional loss, VA examiners should also address the presence of flare-ups. If a veteran experiences flare-ups of back pain, they may be eligible for a higher disability rating.
For example, say a veteran is granted service connection for a back condition and receives a 10 percent disability rating. On most days, the veteran is unable to bend forward more than 60 degrees. However, when experiencing a flare-up, the veteran is unable to bend forward more than 30 degrees. Therefore, during the flare-up the veteran’s back condition becomes much more disabling than 10 percent. As such, VA should assign a disability rating in accordance with this additional loss.
In a 2017 Court of Appeals for Veterans Claims (CAVC) case, Sharp v. Shulkin, the Court decided that examiners must offer an opinion on how the veteran could be functionally limited during a flare-up, even if the examination is not being performed during a flare-up.
If an examiner fails to do so, then the examination is inadequate for VA rating purposes and a new examination may be warranted. If the examiner is unable to provide an opinion, they must prove they have considered all the evidence available before arriving at that conclusion.
Overall, VA’s consideration of functional loss and flare-ups accounts for how a veteran’s back condition actually impacts their daily life, making up for the otherwise very mechanical application of the rating schedule.
How to Challenge an Unfavorable C&P Examination
As mentioned above, C&P examinations are incredibly important in relation to how VA rates back pain. If you disagree with your VA examiner’s report, you can submit an argument and evidence to the contrary.
For example, you can submit a lay statement outlining the severity of your symptoms, either generally or specifically in relation to the examiner’s findings. You can also consider getting a private medical opinion to refute the negative C&P examination.
If the VA examiner failed to address any of the factors mentioned above, such as functional loss and flare-ups, you can argue that the examination is inadequate. You can also argue against the adequacy of an examination if the examiners fail to provide rationale for their conclusions, or if they do not address all theories of service connection (e.g., direct, secondary).
Since VA will not automatically send you a copy of your C&P exam, it is important to request a copy from your local VA Regional Office. This way you can thoroughly review the report to ensure it accurately represents the severity of your back condition.
How Much Can I Receive in VA Disability for Back Pain?
Generally, the more disabling your back condition, the more compensation you will receive. VA will assign a disability rating ranging from 0 to 100 percent based on the level of severity. Your disability rating then determines the monetary amount you will receive.
As mentioned above, range of motion is the primary criterion VA uses to assign disability ratings to back pain disabilities. For example, VA assigns a 100 percent disability rating for a veteran with unfavorable ankylosis of the entire spine, while it only assigns a 10 percent disability rating for a veteran with forward flexion between 60 and 85 degrees.
As of December 1st, 2023 the VA disability rate benefit amounts are as follows:
- 0 percent disability rating: $0.00 per month
- 10 percent disability rating: $171.23 per month
- 20 percent disability rating: $338.49 per month
- 30 percent disability rating: $524.31 per month
- 40 percent disability rating: $755.28 per month
- 50 percent disability rating: $1,075.16 per month
- 60 percent disability rating: $1,361.88 per month
- 70 percent disability rating: $1,716.28 per month
- 80 percent disability rating: $1,995.01 per month
- 90 percent disability rating: $2,241.91 per month
- 100 percent disability rating: $3,737.85 per month
Importantly, with a disability rating of 30 percent or higher, you may also be eligible to receive additional compensation for qualifying dependents.
Secondary Conditions to Back Pain
There are several common disabilities associated with back pain that a veteran can claim secondary to their service-connected back condition. These include:
- Radiculopathy secondary to back pain – a condition caused by a pinched nerve root in either the cervical, thoracic, or lumbar spine.
- Gastrointestinal issues secondary to back pain – may result from taking serious medication for back pain.
- Depression secondary to back pain – may occur because the veteran can no longer do all the activities they used to do.
However, it is important to note that veterans must avoid pyramiding when applying for secondary service connection. Pyramiding is the VA term for rating the same disability, or same manifestation (i.e., symptom) of a disability, twice. In other words, veterans cannot get two disability ratings for the same symptom.
Temporary Total Ratings Due to Hospitalization
If a veteran is hospitalized for over 21 days as a result of their back pain, then they can apply for a temporary total (i.e., 100 percent) rating. Importantly, veterans must apply for this benefit directly as VA will not grant it on its own.
Veterans can be granted 100 percent disability for the rest of their hospitalization period and possibly after, depending on how VA evaluates the back condition following discharge. After discharge, VA will complete an assessment and reassign a rating that reflects the current severity of the veteran’s back pain.
TDIU for Back Pain
Veterans who are unable to secure and follow substantially gainful employment as a result of their back pain injury may be eligible for Total Disability based on Individual Unemployability (TDIU)https://cck-law.com/benefits/individual-unemployability-tdiu/. If granted, veterans will be compensated at the 100 percent level even if their combined schedular rating does not come to 100 percent.
To qualify, veterans must submit evidence specifically highlighting how their back condition precludes employment.
Was Your Claim for Back Pain Denied?
If VA denied your claim for back pain, Chisholm Chisholm & Kilpatrick LTD may be able to help. Our VA disability attorneys have helped many veterans win VA disability, and we may be able to put our vast resources to work for you. Call our office today at 800-544-9144 for a free case evaluation.
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