Public rules

Back and thoracolumbar spine — public rules, in plain words

See which thoracolumbar words the spine formula uses, so you can check your exam notes against them.

This page shows the general rating formula for the spine in 38 CFR 4.71a. Diagnostic codes 5235 to 5242 use that formula. The thoracolumbar spine is the mid and low back. The same formula also has lines for the neck (the cervical spine). This guide points out the thoracolumbar words. It is education and organizing only. It is not your rating. We do not say you have a back condition. You review the words and you submit. We do not file.

Last reviewed 2026-10-16.

The lines below match the General Rating Formula for Diseases and Injuries of the Spine in 38 CFR 4.71a. Current text checked October 16, 2026. Diagnostic code 5243 (intervertebral disc syndrome) can use this formula or a separate formula based on incapacitating episodes, whichever method results in the higher evaluation when all disabilities are combined under 38 CFR 4.25. This page quotes the general formula. It does not pick a method for you. Not medical advice.

What we help you do

We help you review your documents against the published rating criteria. Rating criteria are the public rules VA published. This is education and organizing. It is not a promise of a rating. We do not decide the claim.

Official sources

Why the papers have to say it

A VA exam is a short visit. Write how often something happens, how long it lasts, and how it stops normal life, only if that is true. If those facts are not in the papers you send, the exam may not have them. We do not write them for you.

Published levels (38 CFR 4.71a, general rating formula for the spine)

CFR means the Code of Federal Regulations. DC means diagnostic code. Those are public rule numbers.

Published: Unfavorable ankylosis of the entire spine — 100% in the rule book.

Ankylosis means the spine is fixed and does not move. Note (5) says unfavorable ankylosis is fixation in flexion or extension with one or more listed problems, such as trouble walking because of a limited line of vision. Fixation in a neutral position (zero degrees) is favorable ankylosis, not unfavorable. This page does not say your spine is fixed.

Published: Unfavorable ankylosis of the entire thoracolumbar spine — 50% in the rule book.

This 50 percent line is the thoracolumbar spine only: the whole mid and low back fixed in an unfavorable position, as Note (5) defines that word. It is not a pain score.

Published: 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 — 40% in the rule book.

For the mid and low back, this line is forward flexion (bending forward) of 30 degrees or less, or favorable ankylosis of the entire thoracolumbar spine. The neck part of the same sentence is a different segment. The degrees come from an exam or treatment notes. This page does not measure you.

Published: Forward flexion of the cervical spine 15 degrees or less; or, favorable ankylosis of the entire cervical spine — 30% in the rule book.

This 30 percent line is about the neck, not the thoracolumbar spine. It is in the same formula, so it is quoted here. It is not a low-back level.

Published: 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 — 20% in the rule book.

For the mid and low back, this line includes forward flexion greater than 30 degrees but not greater than 60, or a combined range of motion not greater than 120 degrees, or muscle spasm or guarding severe enough to change the way you walk or the shape of the spine. Note (2) says the normal combined range for the thoracolumbar spine is 240 degrees. Combined means the sum of forward flexion, extension, left and right side bend, and left and right rotation. Note (4) says to round each measurement to the nearest five degrees.

Published: 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 — 10% in the rule book.

For the mid and low back, this line includes forward flexion greater than 60 degrees but not greater than 85, or a combined range greater than 120 but not greater than 235, or spasm, guarding, or tenderness that does not change gait or spinal shape, or a vertebral fracture that lost 50 percent or more of the height. Note (2) says normal forward flexion of the thoracolumbar spine is 0 to 90 degrees.

38 CFR 4.71a, Schedule of ratings—musculoskeletal system (spine)

What the rule is about — only what you actually have

Exam or treatment notes that list range of motion in degrees, when those notes exist. The rule reads the numbers. A pain word alone is not a degree.
The formula’s opening line says the ratings apply with or without pain (whether or not it radiates), stiffness, or aching. Pain can be present at any level. It does not by itself pick the level.
Note (6) says to evaluate the thoracolumbar spine and the cervical spine separately, except when both are in unfavorable ankylosis. That is a published instruction. It is not advice to file two claims.
A statement in your own words about what you can and cannot do, only if it is true. We do not write it.

Other conditions

Note (1) says to evaluate any associated objective neurologic abnormalities, including bowel or bladder impairment, separately, under an appropriate diagnostic code. That is the rule book’s own instruction. It is not a finding that you have a nerve condition, and it is not advice to claim one. The sciatic-nerve guide quotes diagnostic code 8520.

Questions if a statement leaves these out

Questions only. They do not make up a fact. They do not write the statement.

Do your records list forward flexion of the thoracolumbar spine in degrees? Copy only a number that is already written down.
Do the records list the other motions (extension, side bending, and rotation) so a combined range can be added? Only if those numbers exist.
Do the records describe muscle spasm or guarding, and whether it changes how you walk or the shape of the spine? Only if that is written.
Do the records say any part of the spine is fixed (ankylosis)? If they do not, do not guess.

Check your own statement against this rule

The statement review lines your own words up with the published words on this page and shows which of those words your statement speaks to and which are not mentioned yet. It asks questions. It does not add a symptom, a test result, or a date.

Common questions

Which part of the spine formula is the low back?

The thoracolumbar lines. Normal forward flexion is 0 to 90 degrees. The 40 percent line includes forward flexion of 30 degrees or less, or favorable ankylosis of the entire thoracolumbar spine. The 50 percent line is unfavorable ankylosis of the entire thoracolumbar spine. The 20 and 10 percent lines also name thoracolumbar ranges. The 30 percent line in this formula is the neck.

Does back pain by itself pick the level?

No. The formula says the ratings apply with or without pain, stiffness, or aching. The levels turn on ankylosis, measured motion, spasm or guarding, or a vertebral fracture with loss of height, as each line is written.

Is this page medical advice?

No. This page shows VA's published rule in plain words. It is education and organizing only. It is not medical advice, not a diagnosis, and not a rating. You review the words. You, or a free accredited representative, submit to VA.

Forms you can open

There is no back-only form on VA’s additional-forms page. The disability application is VA Form 21-526EZ. You fill it out and send it. We do not send it.

Application for disability benefits

VA Form 21-526EZ. Application for Disability Compensation and Related Compensation Benefits.

There is no separate form for this condition. This is the disability application. You fill it out and send it to VA. We do not send it.

You fill this out and send it to VA. We do not fill it in with your records. We do not send it. We do not make a packet that is ready to file.

Signed in? The forms list only helps you keep track. It does not fill a form. It does not send it.