Reference: 38 CFR 4.71a

Back (Thoracolumbar Spine): Rating Criteria

The published percentage tiers and what separates them

Percentage Guides

Understanding Your Percentage

Select a pathway to see what the published criteria ask about, what records may clarify it, and what should not be assumed.

0%

Next: 10%

A 0% criteria pathway can apply when enough detail is available to review the thoracolumbar criteria but no compensable level is shown by those facts.

What separates the next level: The 10% pathway begins when a listed motion, tenderness, spasm, guarding, or vertebral-fracture criterion is documented.

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Official CFR language
38 CFR 4.31 provides a 0 percent evaluation when a diagnostic code does not list a 0 percent level and the requirements for a compensable evaluation are not met.
Qualification explanation
RatingScope uses this educational pathway only when the record details are sufficient. Missing or unclear motion and examination findings belong in a needs-more-detail state, not an assumed 0% pathway.
Examples
Measured forward flexion and combined motion are outside the compensable ranges reviewed by RatingScope.; The available findings do not document qualifying ankylosis, gait or contour effects, localized tenderness, or qualifying vertebral height loss.; Enough structured information is present to review the current General Rating Formula pathway.
Medical evidence
Thoracolumbar range-of-motion measurements; Back DBQ or clinical examination findings; Findings about ankylosis, spasm, guarding, gait, contour, tenderness, and fracture
Functional impact examples
Symptoms may still be present even when no compensable threshold is shown.; A 0% criteria pathway does not mean the condition is unimportant.
Common misconceptions
0% is not a denial prediction.; Missing measurements are not proof that the criteria are absent.; A diagnosis can be documented even when the supplied findings do not show a compensable pathway.
Related topics
sufficient detail; noncompensable pathway; missing measurements
Source context
38 CFR 4.31 and 4.71a; 5235-5243; Current General Rating Formula educational pathway.

10%

Next: 20%

The 10% level includes several alternatives: a mild limitation in measured motion, certain tenderness or muscle findings without abnormal gait or contour, or qualifying vertebral-body height loss.

What separates the next level: The 20% pathways use greater motion limitation, combined motion of 120 degrees or less, or spasm or guarding severe enough to produce abnormal gait or spinal contour.

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Official CFR language
The General Rating Formula lists thoracolumbar forward flexion greater than 60 degrees but not greater than 85 degrees; combined thoracolumbar motion greater than 120 degrees but not greater than 235 degrees; 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 height.
Qualification explanation
Any one listed pathway can explain the 10% level. The record should identify the actual measurement or examination finding rather than relying on pain or diagnosis alone.
Examples
Forward flexion is measured at 75 degrees.; Combined thoracolumbar motion is measured at 200 degrees.; Localized tenderness is documented without abnormal gait or spinal contour.
Medical evidence
Back DBQ initial range-of-motion section; Clinical findings about tenderness, spasm, guarding, gait, and contour; Imaging or examination evidence of vertebral-body height loss when applicable
Functional impact examples
Pain with movement documented during the examination; Difficulty bending even though the measured motion remains above the 20% threshold; Localized tenderness that does not alter gait or contour
Common misconceptions
Pain does not automatically identify a particular percentage.; A diagnosis name does not replace the measured or observed finding.; Tenderness without abnormal gait or contour is different from the 20% spasm-or-guarding pathway.
Related topics
forward flexion; combined range of motion; localized tenderness; vertebral fracture
Source context
38 CFR 4.71a; 5235-5243; Current General Rating Formula educational pathway.

20%

Next: 40%

The 20% level can be described by forward flexion from greater than 30 through 60 degrees, combined motion of 120 degrees or less, or spasm or guarding that causes abnormal gait or spinal contour.

What separates the next level: The clearest motion distinction from 40% is forward flexion: greater than 30 through 60 degrees at 20%, compared with 30 degrees or less at 40%. Favorable ankylosis of the entire thoracolumbar spine is also a 40% pathway.

Review CFR criteria, examples, and evidence
Official CFR language
The General Rating Formula lists thoracolumbar forward flexion greater than 30 degrees but not greater than 60 degrees; combined thoracolumbar motion not greater than 120 degrees; or muscle spasm or guarding severe enough to result in abnormal gait or abnormal spinal contour.
Qualification explanation
The motion and spasm-or-guarding routes are alternatives. A veteran does not need to satisfy every listed route, but the specific route should be supported by documented findings.
Examples
Forward flexion is measured at 45 degrees.; Combined thoracolumbar motion totals 110 degrees.; An examiner documents guarding that causes an abnormal gait.
Medical evidence
Back DBQ range-of-motion measurements; Examination notes about muscle spasm or guarding; Gait and spinal-contour findings
Functional impact examples
Reduced bending documented during the examination; Guarded movement that alters gait; Additional loss of motion documented after repeated use or during flare-ups
Common misconceptions
A 20% path does not require both limited motion and abnormal gait.; MRI wording alone does not establish the measured-motion pathway.; Pain intensity by itself does not turn a 20% measurement into 40%.
Related topics
20 vs 40; forward flexion; combined range of motion; abnormal gait; abnormal spinal contour
Source context
38 CFR 4.71a; 5235-5243; Current General Rating Formula educational pathway.

40%

Next: 50%

The 40% level can be described by thoracolumbar forward flexion of 30 degrees or less or by favorable ankylosis of the entire thoracolumbar spine.

What separates the next level: The flexion boundary between 20% and 40% is 30 degrees. The 50% level requires unfavorable, rather than favorable, ankylosis of the entire thoracolumbar spine.

Review CFR criteria, examples, and evidence
Official CFR language
The General Rating Formula lists thoracolumbar forward flexion of 30 degrees or less, or favorable ankylosis of the entire thoracolumbar spine.
Qualification explanation
A qualifying flexion measurement and favorable thoracolumbar ankylosis are separate paths to the same level. RatingScope keeps the actual documented finding visible so the explanation does not drift between those paths.
Examples
Forward flexion is measured at 30 degrees.; Forward flexion is measured below 30 degrees.; An examiner documents favorable ankylosis of the entire thoracolumbar spine.
Medical evidence
Back DBQ forward-flexion measurement; Repeated-use or flare-up degree value when documented; Exam findings identifying the region and position of ankylosis
Functional impact examples
Marked difficulty bending documented alongside the degree measurement; Additional motion loss documented after repeated use; The entire thoracolumbar spine fixed in a neutral position
Common misconceptions
Severe pain alone does not substitute for a qualifying measurement or ankylosis finding.; Limited motion is not automatically ankylosis.; A surgery history does not automatically identify the 40% pathway.
Related topics
20 vs 40; forward flexion 30 degrees; favorable ankylosis; functional loss
Source context
38 CFR 4.71a; 5235-5243; Current General Rating Formula educational pathway.

50%

Next: 100%

The 50% level is tied to unfavorable ankylosis of the entire thoracolumbar spine.

What separates the next level: Favorable thoracolumbar ankylosis is a 40% pathway. The 100% level requires unfavorable ankylosis of the entire spine, not only the thoracolumbar region.

Review CFR criteria, examples, and evidence
Official CFR language
The General Rating Formula lists unfavorable ankylosis of the entire thoracolumbar spine.
Qualification explanation
The record should identify ankylosis of the entire thoracolumbar region and describe it as unfavorable. Restricted motion or prior fusion should not be silently converted into this finding.
Examples
A DBQ documents unfavorable ankylosis involving the entire thoracolumbar spine.; The examination identifies both the affected region and unfavorable position.; The cervical spine is not documented as part of the ankylosis finding.
Medical evidence
Back DBQ ankylosis section; Clinical examination describing the fixed position; Treatment or surgical records that clarify anatomy without replacing the examination finding
Functional impact examples
The thoracolumbar region is fixed in an unfavorable position; The record describes functional consequences associated with the fixed position; Ordinary measured-motion testing may not apply when the region is fixed
Common misconceptions
Very limited motion is not automatically unfavorable ankylosis.; Spinal fusion surgery does not automatically establish unfavorable ankylosis.; The 50% pathway does not require unfavorable ankylosis of the cervical spine.
Related topics
unfavorable ankylosis; thoracolumbar spine; spinal fusion
Source context
38 CFR 4.71a; 5235-5243; Current General Rating Formula educational pathway.

100%

Highest listed pathway

The highest General Rating Formula level is tied to unfavorable ankylosis of the entire spine.

What separates the next level: The 50% pathway is limited to unfavorable ankylosis of the entire thoracolumbar spine. The 100% pathway extends the finding to the entire spine.

Review CFR criteria, examples, and evidence
Official CFR language
The General Rating Formula lists unfavorable ankylosis of the entire spine.
Qualification explanation
The documented finding must involve the entire spine, including the cervical and thoracolumbar regions, and identify the ankylosis as unfavorable.
Examples
An examination documents unfavorable ankylosis of both cervical and thoracolumbar regions.; The DBQ identifies the entire spine as fixed in an unfavorable position.; The finding is not based only on pain, restricted motion, or one fused segment.
Medical evidence
Back and neck examination findings; DBQ ankylosis findings identifying the entire spine; Clinical records describing the fixed position and associated effects
Functional impact examples
The entire spine is fixed in an unfavorable position; The record describes effects associated with the fixed position; Both cervical and thoracolumbar regions are included in the finding
Common misconceptions
A 100% back pathway is not based on pain severity alone.; Unfavorable thoracolumbar ankylosis alone describes the 50% pathway, not this level.; Multiple diagnoses do not replace the required ankylosis finding.
Related topics
entire spine; unfavorable ankylosis; cervical and thoracolumbar
Source context
38 CFR 4.71a; 5235-5243; Current General Rating Formula educational pathway.

Diagnostic Code 5243 comparison tool

Compare the two IVDS evaluation formulas

Intervertebral disc syndrome (DC 5243) is evaluated under whichever formula results in the higher evaluation: the General Rating Formula for Diseases and Injuries of the Spine, or the separate Formula for Rating IVDS Based on Incapacitating Episodes. Enter documented findings for each formula below to see both results side by side. This is an informational comparison, not a submission. Nothing entered here is saved or sent anywhere.

General Rating Formula findings

Incapacitating episodes findings

An incapacitating episode is a period of acute signs and symptoms due to IVDS requiring bed rest prescribed by a physician and treatment by a physician.

General Rating Formula

0%

No General Rating Formula criterion reviewed here is documented as met.

Incapacitating Episodes

0%

No incapacitating episodes, or not documented

Both formulas currently show the same result from the findings entered. This comparison covers only the two DC 5243 formulas above; it does not include DC 5235-5242, DC 5244, combined ratings math, or any other disability.

Compare your full back records

Measurement Guide

How thoracolumbar range of motion is described

These are examination terms and normal reference values from the published schedule. They are not instructions for measuring yourself. A clinician uses a goniometer and records the relevant degree values and functional context.

Forward flexion

Bending forward at the waist.

Normal reference: 0 to 90 degrees for the thoracolumbar spine.

Why it matters: Forward flexion has direct thresholds in the 10%, 20%, and 40% pathways.

Extension

Leaning backward from a neutral position.

Normal reference: 0 to 30 degrees for the thoracolumbar spine.

Why it matters: Extension contributes to the combined range-of-motion total used in the 10% and 20% pathways.

Left and right lateral flexion

Bending the torso to each side.

Normal reference: 0 to 30 degrees on each side.

Why it matters: Both side-bending measurements contribute to combined range of motion.

Left and right rotation

Turning the torso to each side.

Normal reference: 0 to 30 degrees on each side.

Why it matters: Both rotation measurements contribute to combined range of motion.

How an examination adds context

Goniometer
A goniometer is the measurement tool used to record joint and spine motion in degrees. The documented number matters more than an informal description such as limited bending.
Repeated-use testing
An examination may record whether repeated movement causes additional loss of motion or function. RatingScope uses only the degree values and findings actually documented.
Flare-ups
The record may describe added limitation during flare-ups, including an additional degree value when supported by the examination record. RatingScope does not invent a value when one is absent.
Functional loss
Pain, weakness, fatigability, incoordination, and interference with movement may add context. They do not become a hidden score; the relevant documented functional loss must remain traceable.
NextEvidence & DBQWhat documentation clarifies the criteria

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