
Cervical / Thoracic / Lumbosacral Strain
Overstretching or tearing of the muscles, tendons and ligaments that hold a spinal region together. This is the most commonly granted spine diagnosis in the VA system, and it is the one most often under-rated, because examiners treat it as "just a muscle pull" instead of measuring what it actually does to your motion.
A strain is the diagnosis the VA hands out most and rates least. There is no scan that shows a strained muscle, no blood test, no fracture line. The entire evaluation is built from how far you can move, how much it hurts when you do, and whether the examiner can feel muscle spasm or guarding, a finding that alone can carry you from 10% to 20% without a single extra degree of lost motion. If your examiner skipped palpation, they destroyed half your evidence.
The Diagnostic Codes
Conditions Rated In Back, Neck & Spine
These are the codes the VA will actually stamp on a decision in this group. The code you are granted under decides which formula is used, and that decides your percentage. Spinal Strain is highlighted below.
DC 5237

Cervical / Thoracic / Lumbosacral Strain
Overstretching or tearing of the muscles, tendons and ligaments that hold a spinal region together. This is the most commonly granted spine diagnosis in the VA system, and it is the one most often under-rated, because examiners treat it as "just a muscle pull" instead of measuring what it actually does to your motion.
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DC 5242

Degenerative Disc Disease (DDD) / Degenerative Arthritis of the Spine
The discs between your vertebrae are shock absorbers made mostly of water. Under years of compressive load they dry out, flatten and crack. The vertebrae then sit closer together, the joints grind, and the body lays down bone spurs. It does not heal. It only progresses.
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DC 5243

Herniated Disc / Intervertebral Disc Syndrome (IVDS)
The disc wall ruptures and the nucleus pushes into the spinal canal, pressing directly on a nerve root. This is the spine condition that produces the most dramatic nerve symptoms, sciatica, arm pain, foot drop, bladder dysfunction, and it is the only one that has its own alternative rating formula based on incapacitating episodes.
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DC 5238

Spinal Stenosis
The spinal canal narrows, from bone spurs, thickened ligaments, bulging discs, or all three, and the spinal cord or nerve roots run out of room. Stenosis is progressive, it does not reverse, and the hallmark symptom is neurogenic claudication: leg pain and weakness that gets worse when you walk and better when you lean forward.
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DC 5235

Vertebral Fracture
A vertebral body cracks under force, a blast, a fall, a parachute landing, a vehicle rollover. The fracture may heal, but the vertebra never returns to its original height, and the mechanical consequences, altered load distribution, accelerated degeneration at adjacent levels, and progressive kyphosis, last the rest of your life.
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DC 5240

Ankylosing Spondylitis
An inflammatory autoimmune disease that fuses the vertebrae together over time. The spine literally turns into a single rigid column of bone. Unlike every other spine condition on this page, ankylosing spondylitis is not caused by mechanical wear, it is a disease process. But military service can trigger it, and the VA recognizes it.
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Before Anything Gets Rated
What The VA Is Actually Looking For, And What Service Connection Really Means
Before the VA ever opens the rating schedule, it asks one question: is this disability the government’s responsibility? That is what “service connection” means. It is not a diagnosis, it is not sympathy, and it is not a reward for having served. It is a legal finding that a current, diagnosed disability is linked to something that happened to you in uniform. Percentages come later. If service connection is not established, there is nothing to rate and the claim is denied, no matter how bad the spinal strain is.

For Spinal Strain Specifically
For a spinal strain claim, the VA needs a current diagnosis of cervical, thoracic, or lumbosacral strain written by a clinician, not just a complaint of back or neck pain, and a documented in-service event that caused or aggravated it: a fall, motor vehicle accident, heavy lifting duty, airborne operations, prolonged load-bearing, or any trauma recorded in your service treatment records. Most spinal strain claims are won direct service connection under the Shedden/Caluza framework: current diagnosis, in-service event, and a nexus linking the two, usually through a C&P examiner's opinion or a private nexus letter. Under DC 5237 and 38 CFR §4.71a, the rating is driven almost entirely by range of motion measurements, the presence of muscle spasm or guarding on palpation, and whether those findings worsen with repetitive use, which is why an examiner who skips palpation or fails to test motion after repetition has produced an inadequate exam you can challenge. M21-1, Part III, Subpart iv, Chapter 4, Sections A–B (Musculoskeletal Conditions) requires the C&P examiner to document spasm, guarding, and the effect of flare-ups on functional loss, and when that documentation is missing, the rater is supposed to return the exam, but in practice they often rate low instead.
The three elements the VA must find. All three. Every time.
These come out of Caluza v. Brown and Shedden v. Principi, and they are the checklist a rating officer works through on your file. Miss one and the claim fails on that element alone.
A current, diagnosed disability
A doctor has to have written a diagnosis in a medical record, cervical or lumbosacral strain. Symptoms by themselves are not a disability the VA can rate. Saunders v. Wilkie held that pain causing functional impairment can be a disability, but you still need a clinician to document it as diagnosed and impairing. The diagnosis must exist now, during the claim period, not only years ago.
An in-service event, injury, illness or aggravation
Something in service had to have happened, an injury, an exposure, a documented sick call, or steady wear over a career. It does not have to be one dramatic moment and it does not have to be spelled out in your service treatment records: buddy statements, unit records, performance evaluations and your own competent lay testimony can establish it.
A medical nexus linking the two
A qualified medical opinion that says the current diagnosis is at least as likely as not related to the in-service event. That phrase matters: at least as likely as not means 50 percent or better. Under 38 C.F.R. §3.102, when the evidence is evenly balanced, the benefit of the doubt goes to you and the claim must be granted.
The five ways service connection is established
Most veterans only know the first one. The other routes are lower-effort paths to the same grant, and the secondary route is the one most often left on the table.
Direct, 38 C.F.R. §3.303(a)
The injury or disease began in service and never went away. The classic route: three elements, one nexus opinion.
Chronicity and continuity, §3.303(b)
A chronic condition shown in service, plus continuity of the same symptoms from separation to now, can establish the link without a formal nexus opinion. Your own testimony about symptoms you can observe is competent evidence.
Presumptive, §3.307 and §3.309
Certain chronic diseases are presumed service connected if they manifest to a compensable degree within a set window after separation. You do not have to prove causation at all.
Secondary, §3.310(a) and (b)
A disability proximately due to, or aggravated by, an already service-connected condition is itself service connected. This is how the radiculopathy, altered gait, and secondary depression that spinal strain produces get on the rating sheet.
Aggravation of a pre-service condition, §3.306
If you entered service with a condition and service made it permanently worse, the increase is compensable. The VA must rebut the presumption of soundness by clear and unmistakable evidence, a bar it frequently fails to meet.
VA medical care, 38 U.S.C. §1151
An additional disability caused by VA treatment, surgery, or a failure to diagnose is compensated as if it were service connected.
The bottom line, there is no way around this
No diagnosis, no rating. It has to be chronic. It has to cause impairment.
Without a diagnosis, the VA will not rate your claim.
If your records show only 'back pain' or 'neck pain' without a clinician writing the word strain or an equivalent structural diagnosis, the VA will treat it as a symptom, not a ratable disability, and deny the claim for lack of a current diagnosis. Veterans lose this element constantly because sick-call entries from service say 'low back pain, ibuprofen given' and nothing more, leaving no diagnosis to connect to. You need a current treating physician or a private examiner to write the diagnosis explicitly before you file or before your C&P exam.
The condition must be chronic.
A single documented episode of back pain that resolved and was never treated again is not a chronic disability, the VA will call it acute and transient and assign zero percent or deny outright. Chronicity for spinal strain means a documented treatment history showing the condition has persisted or recurred: follow-up appointments, physical therapy referrals, imaging ordered because pain continued, or a physician's note stating the condition is chronic. The longer the gap between your last treatment and your filing date, the harder the rater will push the argument that the condition resolved.
It must cause actual impairment.
Under DC 5237 and 38 CFR §4.1 and §4.10, a spinal strain that causes no measurable loss of motion, no documented spasm or guarding, and no functional impairment will be rated zero percent, service-connected but compensated at nothing. The zero-percent trap is common when veterans have a diagnosis and a nexus but show up to the C&P exam on a good day, move normally, and the examiner records full range of motion with no spasm, that exam becomes the entire evidentiary record and the rater has no basis to go above zero. Functional loss from pain, flare-ups, and fatigability must be documented in the exam or through a separate statement to avoid this outcome.
What this means for you before you file: Before you file, get a current clinical note that names the diagnosis, documents restricted motion or spasm, and ties the condition to your service, and if your C&P exam report does not mention palpation findings, repetitive-use testing, or the effect of flare-ups, submit a written request to return the exam as inadequate before the rating decision issues. Under Colvin v. Derwinski, the VA cannot substitute its own medical judgment for your treating cardiologist, challenge any rating decision that contradicts specialist findings without an equally qualified rebuttal.
The Percentages
Rating Schedule, Spinal Strain, Diagnostic Code 5237
Reproduced verbatim from 38 CFR §4.71a. Strain is rated under the General Rating Formula that applies to every spine condition except IVDS incapacitating-episode ratings. The percentages below are the same whether the strain is cervical, thoracic, or lumbosacral, but the degree thresholds differ by segment (cervical thresholds are tighter because normal cervical flexion is only 45°, vs. 90° for the thoracolumbar spine).

100%
Unfavorable ankylosis of the entire spine.
50%
Unfavorable ankylosis of the entire thoracolumbar spine.
40%
Unfavorable ankylosis of the entire cervical spine; or forward flexion of the thoracolumbar spine 30° or less; or favorable ankylosis of the entire thoracolumbar spine.
30%
Forward flexion of the cervical spine 15° or less; or favorable ankylosis of the entire cervical spine.
20%
Forward flexion of the thoracolumbar spine greater than 30° but not greater than 60°; or forward flexion of the cervical spine greater than 15° but not greater than 30°; or the combined ROM of the thoracolumbar spine not greater than 120°; or the combined ROM of the cervical spine not greater than 170°; 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.
10%
Forward flexion of the thoracolumbar spine greater than 60° but not greater than 85°; or forward flexion of the cervical spine greater than 30° but not greater than 40°; or combined ROM of the thoracolumbar spine greater than 120° but not greater than 235°; or combined ROM of the cervical spine greater than 170° but not greater than 335°; or muscle spasm, guarding, or localized tenderness not resulting in abnormal gait or abnormal spinal contour; or vertebral body fracture with loss of 50% or more of height.
Service Connection
Advice from the Advocate
This is where I stop explaining the rules and tell you how I would build your Spinal Strain claim if you were sitting across my desk. Read the causation notes below twice. The VA will not connect the dots for you, even though 38 CFR 3.159 says it has a duty to assist. Your job is to put the in-service event, the current diagnosis and the medical link on paper, then make the examiner deal with all three.

The advocate's notes on causation, Spinal Strain
The separate arguments that decide this code: where the VA will attack, the regulation that answers it, and the evidence that closes the gap.
1Where the VA attacks first, the missing sick-call entry
The most common denial on a strain claim is not a medical opinion, it is a records argument: there is no line in your service treatment record showing you hurt your back, so the VA concludes it never happened. That is not the law. Under 38 CFR §3.303(a) an injury may be established by lay evidence, and the Federal Circuit held in *Buchanan v. Nicholson* that the absence of contemporaneous medical records cannot be the sole reason to reject a veteran's account. What beats the silence in the file is your own detailed statement of the event and a buddy statement from someone who watched you get hurt or watched you stop being able to do the job.
2The intervening-injury trap, the off-duty car wreck
An off-duty car wreck does not kill your claim. If service already weakened the region, an everyday event that would not have hurt an uninjured back is evidence of the underlying service-connected condition, not a replacement for it. And under 38 CFR §3.310(b) a post-service event that permanently worsens a service-connected back is aggravation, which is compensable at the level of additional disability. The mistake veterans make is to volunteer the wreck as the cause. It is not the cause. It is the thing your already-damaged back could not absorb.
3The route most strain claims should be filed on, continuity of symptomatology
You do not always need a doctor to draw a line from 1998 to today. Under 38 CFR §3.303(b) a chronic condition noted in service, followed by continuous symptoms since, establishes service connection on its own. That means your own timeline matters: when the pain started, that it never fully stopped, what you took for it, what you stopped doing because of it. A statement covering every year between discharge and today is frequently stronger evidence than a nexus letter written by a physician who met you last month.
Exposure & Aggravation
How Spinal Strain Happens In Service, And How It Gets Worse

The VA wants an in-service event, and most veterans think that means one dramatic injury. It does not. Years of duty that wore the body down count too, and under 38 CFR 3.306 a condition service made worse can still be connected. Find yourself in the list below, then put that duty in writing with dates, units and names. The board only weighs what you put on paper.
How veterans pick this up in uniform, Spinal Strain
Spinal strain rarely announces itself with one dramatic moment. It is built by what service asked of your body over months and years, heavy rucks, body armor, casualty drags, and the whole-body vibration of every vehicle you rode in. Once the muscles and ligaments are damaged, they do not fully recover, and every post-service year under load makes them worse. The rating compensates the damage as it lives today, not as it happened then.
- Infantry (11B), Combat Engineer (12B) and Cavalry Scout (19D): ruck marches under 60 to 100 pounds, repeated for years. The load rides directly on the lumbar spine.
- Motor Transport Operator (88M), Heavy Equipment Operator (12N) and every truck and bus driver: eight to fourteen hour shifts of whole-body vibration, plus climbing in and out of a high cab hundreds of times a week.
- Combat Medic (68W) and Hospital Corpsman (HM): lifting and carrying casualties, dragging litters, and moving patients who cannot help you move them.
- Aviation maintenance and ordnance (15-series, 2A-series, AD/AM ratings, 6531): overhead work on airframes, loading ordnance, and working folded double inside a fuselage or wheel well.
- Supply, logistics and food service (92Y, 92G, 3051, CS): repetitive lifting of cases and pallets, unassisted, all day, every day.
- Every MOS: body armor and plate carriers, load-bearing equipment, and the buddy-drag, litter-carry and casualty-evacuation tasks trained over and over.
Who is most prone to it
Anyone who carried weight for a living. Junior enlisted in load-bearing jobs get hit hardest, because they carry the most and report it the least, the sick-call culture means the injury almost never makes it into the record when it happens.
The Symptoms
What Spinal Strain Actually Feels Like
Read this list the way the examiner will. Every symptom you live with but never report is a symptom the VA treats as if it does not exist. The rating schedule pays for how Spinal Strain affects your daily life and your work, so the details matter. Check off what matches your day, tell your doctor in those words, and make sure it lands in your treatment record before the exam.

- Aching or burning pain across the affected region that worsens through the day
- Stiffness in the morning that takes 30 to 60 minutes to loosen
- Muscle spasm, a hard, ropey band the examiner can feel
- Guarding, you unconsciously hold the region rigid to avoid pain
- Pain that flares hard after sitting, standing, driving or lifting
- Abnormal gait or abnormal spinal contour caused by the spasm itself
- Tenderness the examiner can reproduce by pressing along the paraspinal muscles
- Loss of motion at the end range, the last few degrees simply are not there
- Headaches that start at the base of the skull when the strain is cervical
- Pain that wakes you when you roll over, and stiffness that is worst the first hour of the day
- Fatigue in the region after light activity, long before the rest of you is tired
- Flare-ups lasting days after ordinary tasks, mowing, driving, carrying groceries
How this one is rated
Rated on the General Rating Formula for Diseases and Injuries of the Spine under 38 CFR §4.71a. Your percentage is driven by measured forward flexion, combined range of motion, and, critically, whether muscle spasm or guarding is severe enough to produce an abnormal gait or abnormal spinal contour. That last finding alone is worth 20%.
What you are measured against
Cervical normal motion: 45° flexion, 45° extension, 45° left/right lateral flexion, 80° left/right rotation, combined 340°. Thoracolumbar normal: 90° flexion, 30° extension, 30° left/right lateral flexion, 30° left/right rotation, combined 240°. Every degree lost is measured with a goniometer, on both segments if both are claimed.
Each One On Its Own Page
Secondary Conditions, Aggravated or Caused by a Current Service-Connected Condition
Under 38 CFR §3.310(a), a disability that is proximately due to a service-connected condition is service-connected in its own right, and under §3.310(b), so is any additional disability caused when a service-connected condition aggravates a problem you already had. Each condition below is a separate evaluation with its own diagnostic code and its own percentage. They do not fold into the spinal strain rating, they stack on top of it. A veteran who claims only the primary condition leaves these ratings on the table.

Radiculopathy, the nerves the strain compresses
A strained spine does not stay in the muscles. Over time the region shortens, the disc spaces narrow, and the nerve roots get pinched. Under §3.310(a) every nerve that fires because of a service-connected spinal condition is a separate rating, sciatic (DC 8520) for the legs, cervical radiculopathy for the arms. Report every tingling, numbness, and shooting pain down a limb.

The altered gait and the joints it destroys
A spine that hurts changes how you walk, and the body pays for it everywhere else. The knees take uneven load, the hips compensate, and the opposite side of the spine overworks. Under §3.310(a) each downstream joint condition is separately claimable as secondary to the service-connected strain, and each carries its own rating.

Depression, sleep loss, and the work the spine ends
Chronic pain that never lets up produces depression, anxiety, and insomnia, all separately ratable under the mental health schedule at §4.130. And a spine that cannot tolerate sitting, standing, or lifting is a straight line to TDIU under §4.16, the disability that makes you unemployable. Document every job task the spine has taken away.
Accredited Claims Agent #45147
Ready To Get This Rated Correctly?
You have read how the VA rates Spinal Strain. Now the question is whether your file proves it. We represent veterans on a No Win, No Fee basis: 20% Direct-Pay paid by the VA from back pay, or 30% High-Complexity, and you owe nothing for representation if your rating does not increase. If you only need the roadmap, the Mission 5 Brief is a separate $750 flat fee. You bring the records, we build the argument.
Back, Neck & Spine, In Detail
Back, Neck & Spine, Service Connection In Depth
Here is each claimable condition in this group on its own terms, what it is, what service did to it, and what the VA requires before it will connect it.

Cervical / Thoracic / Lumbosacral Strain
A strain is the diagnosis the VA hands out most and rates least. There is no scan that shows a strained muscle, no blood test, no fracture line. The entire evaluation is built from how far you can move, how much it hurts when you do, and whether the examiner can feel muscle spasm or guarding, a finding that alone can carry you from 10% to 20% without a single extra degree of lost motion. If your examiner skipped palpation, they destroyed half your evidence.
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Degenerative Disc Disease (DDD) / Degenerative Arthritis of the Spine
The word "degenerative" makes VA examiners want to blame your age. Your job is to show the wear started in uniform. The occupational medicine literature on axial load, whole-body vibration and disc degeneration is clear, a career of parachute landings, tracked-vehicle jolts, and heavy rucking does not produce the same disc profile as a desk career, and it should not be rated the same way. Age is a factor in everyone; it is not an explanation.
Read the full Degenerative Disc Disease page
Herniated Disc / Intervertebral Disc Syndrome (IVDS)
A herniated disc is rated two ways and the VA must give you the higher one. The General Rating Formula rates on range of motion, and the Incapacitating Episodes Formula under DC 5243 rates on the total weeks of doctor-prescribed bed rest in the past 12 months. Most veterans do not know the second formula exists, and even fewer track the bed-rest weeks that would trigger it. Six weeks of prescribed bed rest in a year is worth 60%, regardless of how far you can bend.
Read the full Herniated Disc / IVDS page
Spinal Stenosis
Stenosis is the slow squeeze. The canal narrows over years, and the symptoms creep up until one day you realize you cannot walk a city block without stopping to lean on something. The classic sign, the "shopping cart" posture, leaning forward for relief, is so distinctive that clinicians name it. The VA rates stenosis on range of motion under the General Formula, but the real value in the claim lives in the nerve roots being compressed and the secondary conditions that compression produces.
Read the full Spinal Stenosis page
Vertebral Fracture
A vertebral fracture changes the geometry of the spine permanently. Even a "healed" compression fracture leaves the vertebra shorter, shifts the load to the levels above and below, and starts a cascade of degeneration that was not happening before the fracture. The General Rating Formula gives a baseline 10% for loss of 50% or more of vertebral body height, but the real value is in the downstream conditions the fracture sets off.
Read the full Vertebral Fracture page
Ankylosing Spondylitis
Ankylosing spondylitis is the spine condition that goes straight to the top of the schedule. When the spine fuses, favorable or unfavorable ankylosis, the rating is 30% to 100% depending on how much of the spine is involved and what position it fused in. The disease is progressive, it does not reverse, and the VA cannot rate a fused spine on range of motion it no longer has. The rating reflects the anatomical reality.
Read the full Ankylosing Spondylitis pageThe C&P Exam
What To Expect At The Spinal Strain Exam
This is the encounter your rating is built on. The examiner has a checklist and a limited window, what follows is exactly what happens in that room, so none of it surprises you.
Clinical Section, What To Expect at the Exam
The Strain Examination, Diagnostic Code 5237
What gets measured, what gets missed, and why a strain exam is decided by a goniometer and a pair of hands on your back.
A strain claim is won or lost on the goniometer and on the muscle exam. There is no imaging finding that rates a strain, the entire evaluation is built from how far you can move, how much it hurts when you do, and whether the examiner can feel spasm or guarding. If your neck and your low back are both claimed, the examiner must complete two separate worksheets and measure two separate segments.
Condition
Spinal Strain, DC 5237
Governing questionnaire
VA Form 21-0960M-14, Back (Thoracolumbar Spine) Conditions, and/or 21-0960M-13, Neck (Cervical Spine) Conditions
Click the form number to open the official questionnaire on VA.gov.
01In The Room
What happens during the exam
The tests and maneuvers for this condition
- Palpation of the paraspinal musculature for spasm and for guarding, this is the finding that carries a strain from 10% to 20% when it produces an abnormal gait or an abnormal spinal contour.
- Observation of gait across the room, and of spinal contour for scoliosis, reversed lordosis or abnormal kyphosis.
- Localized tenderness, documented by level.
- Where pain begins in the arc of motion, under §4.59 the point pain starts, not the point you stop, is what matters.
What gets measured, and to what number
Cervical spine, six planes, goniometer
Forward flexion 0–45°, extension 0–45°, left and right lateral flexion 0–45° each, left and right lateral rotation 0–80° each. Normal combined range of motion is 340°.
Thoracolumbar spine, six planes, goniometer
Forward flexion 0–90°, extension 0–30°, left and right lateral flexion 0–30° each, left and right lateral rotation 0–30° each. Normal combined range of motion is 240°.
Rounding
Every measurement is rounded to the nearest five degrees before it is applied to the formula.
Repetitive use
Three repetitions in each plane, then the range is measured again. Additional loss after repetition is what the rater uses.
02Orientation
What to expect during this exam
What makes this exam different from every other C&P exam
1There is no image that proves a strain
Every other spine condition has something a radiologist can point at. A strain does not. An MRI of a badly strained back can read completely normal, and examiners regularly treat a normal MRI as evidence that nothing is wrong. The entire evaluation is built from measured motion and from what the examiner can feel with their hands, which means an examiner who skips palpation has destroyed half your evidence.
2The 20 percent finding is a muscle finding, not a motion finding
You can reach 20 percent on this code without losing a single degree of extra motion, if muscle spasm or guarding is severe enough to produce an abnormal gait or an abnormal spinal contour. That is a finding the examiner makes by watching you walk and by feeling the paraspinal muscles. It is the most commonly skipped high-value step in the entire strain exam.
3Neck and back are two separate exams
If you claimed both a cervical and a thoracolumbar strain, they are two different segments, two different worksheets and two different ratings that later combine. An examiner who measures only the lumbar spine has left an entire rating off your claim, and the C-file will show one set of measurements where there should be two.
See it before you sit in the room


03Preparation
Know your symptoms and secondary factors
What the report must actually say about spinal strain, dc 5237
- The degree at which pain begins in each plane, separately from the endpoint.
- Whether spasm or guarding is present, and whether it results in abnormal gait or abnormal spinal contour.
- An estimate in degrees of additional functional loss during a flare-up, or a clear statement of why that estimate cannot be given.
- That measurements were taken with a goniometer in both active and passive motion, weight-bearing and non-weight-bearing.
Pain level, frequency, lost work and functional loss, how to say them

Say where the pain starts in the arc of motion
Under 38 CFR §4.59, the point where pain begins in the arc is the legally relevant point, not the point where you stop. If pain starts at 40° of flexion but you push through to 70°, the examiner should record 40° as the onset. Say it out loud: "the pain starts here", and freeze so the degree is captured.
Repeat this for every plane, flexion, extension, lateral flexion left and right, rotation left and right.
"The pain starts right here, at about 40 degrees, before I hit the end of the motion."

Describe the morning stiffness and how long it takes to loosen
Stiffness that takes 30 to 60 minutes to loosen every morning is a hallmark of a chronic strain and differentiates it from an acute injury. The examiner needs a time duration, "I am stiff for about an hour every morning", not just "I am stiff sometimes." That duration goes into the flare-up analysis.
Include what you do to loosen up, hot shower, stretching, medication, and whether it fully resolves or just becomes tolerable.
"Every morning I am locked up for about 45 minutes. I need a hot shower and ibuprofen before I can move."

Report spasm and guarding, the 20% finding
Muscle spasm or guarding severe enough to produce an abnormal gait or abnormal spinal contour is a separate 20% pathway that does not require losing a single extra degree of motion. The examiner has to feel the spasm with their hands and watch your gait across the room. Tell them: "my back locks up and I walk crooked when it spasms." That sentence triggers the palpation they might otherwise skip.
Describe the episodes: how often the spasm hits, how long it lasts, and what triggers it.
"When the spasm hits, my whole back locks to one side and I cannot stand up straight. It happens two or three times a week."

Quantify your flare-ups in degrees and days
The examiner is required to estimate additional functional loss during a flare-up, in degrees, under *DeLuca v. Brown* and *Mitchell v. Shinseki*. If they do not ask, volunteer it: "On a flare-up day I lose about 30 extra degrees of flexion, and it happens three or four times a month." Give them the raw material to make the estimate.
A flare-up log, dates, triggers, severity, duration, is the strongest evidence you can bring.
"I flare up three or four times a month. On those days I lose about half my forward bend, maybe 30 degrees, and it lasts two to three days."

State whether both neck and back are claimed
Cervical and thoracolumbar strain are two separate segments, two separate worksheets, and two separate ratings. An examiner who measures only the lumbar spine has left an entire rating off your claim. Say it at the start of the exam: "I am claiming both my neck and my low back." Confirm the examiner has both DBQ forms open.
If only one segment is claimed but the other is symptomatic, say so, it may warrant a separate filing.
"I am claiming both my cervical spine and my thoracolumbar spine. I want to make sure both worksheets are completed."
Secondary conditions to raise in the same appointment
Every secondary condition laid out in the Secondary Conditions section above belongs in this same appointment. Name each one out loud, tell the examiner how the primary condition caused it or made it worse, and ask that it be noted in the report. Under 38 CFR 3.310, a secondary condition the examiner never hears about is a secondary condition the VA never rates. Bring your list on paper so nothing gets left in the parking lot.
What to expect at this specific exam
- Do not take extra pain medication before the exam to get through it. You will be measured on the range that medication gives you, and that number goes in the record as your baseline.
- Write down, before you go, how many degrees of motion you lose on a bad day and how many bad days a month you have. The examiner is required to estimate flare-up loss and will often ask you for the raw material.
- Tell the examiner where the pain STARTS in the movement, not just where you have to stop. Under 38 CFR §4.59 the onset of pain in the arc is the legally relevant point.
- If both your neck and your low back are claimed, say so out loud at the start and confirm the examiner has both worksheets open.
04The Protocol
What procedures are required during the exam
These are not courtesies. Each comes out of the regulation or out of binding case law. Take this list in with you and tick them off as they happen.

01Goniometer range of motion, six planes, both segments
38 C.F.R. §4.71a
The examiner measures forward flexion, extension, lateral flexion left and right, and rotation left and right, with a goniometer, not by eyeball. If both cervical and thoracolumbar are claimed, all twelve measurements (six per segment) must be taken. An estimated measurement is a challengeable measurement.
The goniometer reading IS the rating. Without it, the examiner is guessing, and a guess can be challenged as inadequate under 38 CFR §4.2.

02Palpation of the paraspinal muscles
38 C.F.R. §4.71a
The examiner must feel the muscles along both sides of the spine for spasm and guarding. This is not optional, it is the only way to document the finding that carries a strain from 10% to 20% without any additional loss of motion. A report that says "no spasm noted" without documenting that palpation was performed is inadequate.
Spasm or guarding severe enough to produce an abnormal gait or abnormal spinal contour is a 20% finding, the highest-value muscle finding in the entire spine schedule.

03Repetitive-use testing, three reps in each plane
38 C.F.R. §§4.40, 4.45
The examiner bends you through each plane three times and then re-measures. Additional loss of motion after repetition is documented separately, and it is the functional loss that separates a compensable strain from a non-compensable one under §§4.40 and 4.45.
Repetitive-use loss captures the fatigue, weakness, and incoordination that do not show up on a single cold measurement. Skipping it means the rating reflects your best moment, not your daily reality.

04Gait and spinal contour observation
38 C.F.R. §4.71a
The examiner watches you walk across the room and inspects your standing posture from behind. They are looking for scoliosis, reversed lordosis, or abnormal kyphosis, findings that prove the spasm or guarding is severe enough to deform your posture. This observation is the bridge to the 20% muscle-spasm criterion.
Abnormal gait or abnormal spinal contour caused by spasm is the key qualifier for the 20% level. Without the observation documented, the rater cannot apply it.
05The Standard
What makes an exam adequate
Read your exam report against these. An exam that fails the standard is legally inadequate, and an inadequate exam is something you challenge rather than accept.
The range of motion has to be MEASURED, not estimated
38 CFR §4.46 states that the use of a goniometer in the measurement of limitation of motion is indispensable in examinations conducted within the Department of Veterans Affairs. An examiner who eyeballs your bend and writes a number has not complied with the regulation. This is the most common defect in a spine exam and it is the easiest one to spot from the chair.
Joints must be tested in every required condition
Under Correia v. McDonald, a joint examination for pain must, wherever possible, record active motion, passive motion, motion in weight-bearing and motion in non-weight-bearing, and where relevant, the range of the opposite undamaged joint. An exam that records one set of numbers and stops is incomplete on its face, and that incompleteness is grounds to challenge it.
Flare-ups have to be addressed, not dodged
Under Sharp v. Shulkin, when a veteran describes flare-ups, the examiner is obligated to estimate the additional loss of motion during a flare based on all the available evidence, including your own account of it. "I cannot opine without resorting to mere speculation" is not automatically acceptable; the examiner has to have actually sought the information first and explained why an estimate is impossible.
Repetitive use and functional loss must be factored in
Sections 4.40 and 4.45, and the DeLuca line of cases, require that pain, weakness, fatigability, incoordination and lack of endurance after repeated use be considered, and expressed in additional degrees of lost motion where that is feasible. Your rating is supposed to reflect what you can do on the fifth repetition and on a bad day, not just the first careful bend of the morning.
Neurological findings must be separately documented
Note (1) to the General Rating Formula requires that any associated objective neurologic abnormality be evaluated separately under an appropriate diagnostic code. If your leg symptoms were mentioned in the narrative but never tested and never assigned, the exam did not do what the schedule requires of it.
The examiner must review the record when the question requires it
Where a medical opinion on cause, aggravation or a secondary relationship was requested, the examiner is expected to review the relevant evidence and give a reasoned explanation. A bare conclusion, "less likely than not related to service" with no reasoning attached, carries little weight, and an opinion with no rationale is challengeable.
The examiner has to be qualified for the body system
The VA may use its own clinicians or a contract vendor. Either way, the examiner is expected to have the competence to evaluate the system being examined. If a spinal exam with a neurological component was performed by someone who never tested a reflex, that is a problem worth raising.
The exam has to be CURRENT
A rating is supposed to reflect your condition now. An exam performed before a documented worsening, or years before the decision, may not support the current evaluation, and you can request a new one on that basis.
06Afterward
What happens after your exam is complete
The examiner writes the report and submits it, it is reviewed for completeness, and only then does the claim move toward a rating decision. Here is what actually controls the clock.

The examiner writes and submits the report
Days 1–5 after the exam
The examiner compiles the history, the physical findings, the measurements and any testing into the questionnaire, adds any requested medical opinion, and submits it. Contract vendors typically have a turnaround requirement measured in days, not weeks.
Nothing about your claim moves while this is happening, and nothing you do speeds it up. What matters is that the report is written from notes taken in the room, which is exactly why what you said, and how the examiner recorded it, is already locked in by the time you get to your car. Request your copy now rather than later.

Quality review, and the request for clarification
Days 3–30
The report is reviewed for completeness. If it is internally inconsistent, missing a required field or missing the opinion the VA asked for, it goes back for correction or a second opinion. This is the single most common cause of a claim appearing to stall after the exam.
Understand what a finished exam actually means: it means the appointment happened, not that your claim is ready for a decision. If the reviewer finds a blank range-of-motion field, an opinion that does not answer the question that was asked, or findings that contradict each other, the file goes back out for more information. That is a normal quality control step, not a rejection of your claim, and it is not a sign that you did something wrong, but it does add weeks, and it is the reason so much of what you read online sounds like the system is broken.

Your status tracker moves backward, and it is usually not bad news
Any time after the exam
The online tracker shows eight steps. Veterans watch it reach step 7 or 8, then find it back at step 3 or 4 a week later. That regression almost always means one thing: the file went back for additional information, most often a returned or clarified exam.
This is the number one thing veterans panic about, and it is misread constantly. The tracker is not a countdown, it is a location marker. When the VA decides it needs one more piece of evidence, a corrected exam, a clarifying medical opinion or an outstanding record, the claim is routed back to the evidence gathering step and the bar redraws itself where the file physically is. It does not mean a denial. It does not mean your case was thrown out or restarted. It does not erase anything already in the file, and it does not change your effective date. What it does mean is that something in the record was not good enough to decide on yet, which is worth knowing, because if the weak link is the exam, this is the window where a corrective statement or a private opinion from your own doctor does the most good.

Evidence gathering closes
Varies
Before anyone rates your claim, the file has to be built. This is the stretch where the Regional Office pulls together everything the decision will rest on: your service treatment records, your VA medical records, any federal records, the C&P exam report, and any private records it has requested on your behalf. The claim sits here until the VA is satisfied the record is complete enough to decide, which is exactly why a status tracker can appear to stall or slide backward at this step. You are not powerless while it sits here. Anything you put into the file yourself lands the day you send it, and every relevant record you add now is one less thing the rater can later say was missing.
A VA request to a private provider is a letter that may or may not be answered, and the VA will wait on it for weeks before moving on, sometimes without ever getting a response. A record you walk in yourself, or upload through your claim, is in the file the day you send it. So do not sit and wait to be asked. If you know a treatment record, an imaging report, a surgical note or a buddy statement exists and it matters, send it now, with a VA Form 21-4138 statement that explains in plain words what the document is and what it shows. This is also the window where a corrective statement or a private medical opinion from your own doctor does the most good, before the rater has locked in a decision, not after. Once the evidence gathering step closes, the file goes to a rating specialist, and your chance to shape the record cheaply and quickly closes with it.

Rating decision and promulgation
Typically several weeks after the last piece of evidence lands
This is the stage where your evidence finally becomes a number. A rating specialist, not the examiner, and not a doctor, takes everything in the file and applies the rating schedule to it: the exam findings, your range-of-motion measurements, your lay statements, your private records and any medical opinions. They assign a diagnostic code to each condition, pull a percentage from the schedule, set your effective date, and either grant, deny or defer each issue. The decision is then reviewed and authorized, promulgation is simply the VA’s word for making it official, and the decision letter and code sheet are generated and mailed. Where an award is made, payment follows the effective date rules, and back pay is calculated to that date.
Read the code sheet, not just the percentage. It names the diagnostic code used, the exact measurements relied on and the effective date assigned, and that is where most mistakes live. This is a human being reading a file under a production quota, and the two things that go wrong most often are a rater using the pre-repetition range-of-motion numbers instead of the worst-case figures §4.59 and §4.40 require, and a claimed condition being decided on a thin record or quietly left out. Check whether painful motion was accounted for, whether your radiculopathy was rated separately under Note (1) or folded into the spine rating, and whether every condition you claimed was actually addressed. A decision you do not read is a decision you cannot challenge, and the deadline to challenge it starts the day the letter is dated, not the day you understand it.

C&P examination is the decision letter
The day it lands in your mailbox
The envelope holds two different documents: the narrative decision letter, and the code sheet. Together they are the single most important piece of paper in your claim, because every deadline, every appeal option and every dollar of back pay is set by what is printed on them, not by what you were told at the exam.
Most veterans read one thing on that letter: the percentage. Then they either celebrate it or get angry at it, and file it in a drawer. That is the mistake. The percentage is the conclusion; the reasons section is the reasoning, and the reasoning is what you attack. It tells you which diagnostic code the rater used, which range-of-motion figures they relied on and which they ignored, whether painful motion under §4.59 was accounted for, whether your neurological findings were rated separately under Note (1) or folded into the spine rating, which conditions were decided, which were deferred, and which were never addressed at all. It also assigns your effective date, which controls back pay. A rating that looks low is very often not a disagreement about how bad your neck is, it is a rater who used the pre-repetition numbers, or missed the radiculopathy, or rated one side and not both. You cannot see any of that from the percentage. Do not go by the percentage alone, and do not decode it by yourself if you are not sure what you are looking at, have someone who reads these for a living read it with you before the clock runs out. You have one year from the date on that letter to file a Higher-Level Review (VA Form 20-0996), a Supplemental Claim (VA Form 20-0995) or a Board appeal, and the deadline runs from the date printed on the letter, not the date you opened it. Bring it to this office and we will go through it line by line, at no cost, and tell you plainly whether it is right.
What normal looks like: 30 to 60 days for a simple claim, longer for a complex one
After your exam you should expect some kind of notification from the VA, a decision, a request for more information, or a notice that another exam has been scheduled. For a straightforward, single-issue claim that often lands within 30 to 60 days. But 30 to 60 days is a rough guide, not a rule, and it is not a ceiling. A claim with several conditions, a toxic-exposure or presumptive question, a returned exam, or missing records routinely takes 90 days or more, and that alone does not mean anything is wrong, the more moving parts your case has, the longer the VA takes to work it. Inside the window that is normal for a case like yours, silence is expected and there is nothing to fix, and a tracker that jumps backward is normal too.
What matters is not a fixed number of days, it is whether the claim is still moving and whether you can get a straight answer about where it is. Once you are well past what is normal for a case like yours and the VA either goes silent or cannot tell you what the claim is waiting on, stop waiting. That is usually where the real trouble hides, an exam that came back twice, a records request that was never answered, a claimed condition that got dropped, or a file sitting in the wrong queue. Call the VA at 800-827-1000, ask specifically what the claim is waiting on and who it is assigned to, and write down the answer. If you cannot get a straight answer, or the answer tells you the exam is the problem, that is the moment to bring it to this office rather than sitting on it for another three months. Problems raised early get fixed inside the claim. Problems discovered in a denial letter get fixed on appeal, and that costs you a year.
Other things that control the clock
Six things decide how long you wait, and none of them are visible from the tracker alone.

The average is a moving number
Check it at the source, not second-hand
The VA publishes an average days-to-complete figure for disability claims that moves month to month; check the current number on the VA’s own claim status page rather than relying on any second-hand figure. In practice, most veterans see a decision somewhere between roughly three and eight months from the date the claim was filed, with the exam usually falling in the middle of that window.

The exam is not the last step
Three stages still sit in front of you
The exam is not the last step. The clock does not start at the exam and it does not stop there either, the claim still has to clear evidence gathering, the rating decision and authorization.

A returned exam is the invisible delay
The reason a tracker slides backward
A returned or clarified exam is the most common invisible delay, and it is why a tracker can slide backward. Expect some contact from the VA within 30 to 60 days of the exam. Past 60 days with nothing at all, call and ask specifically what the claim is waiting on.

30 to 60 days is a guide, not a deadline
A complex case can take 90 days or more
Thirty to sixty days is a rough average for a simple, single-issue claim, not a hard rule and not a ceiling. A claim with several conditions, a presumptive or toxic-exposure question, a returned exam, or missing records can easily take 90 days or more, and that alone does not mean anything is wrong. Watch whether the claim is still moving, not the calendar. Only when it stalls well past what is normal for a case like yours, and no one can tell you what it is waiting on, should you stop waiting, call 800-827-1000 and ask what the claim is waiting on and who it is assigned to.

Watch your status yourself, in one of three places
Weekly, not daily
Check your own status in one of three places: your VA.gov claim status page, the VA Health and Benefits mobile app, or by calling 800-827-1000. Check it weekly, not daily. And understand exactly what a status check can tell you: if a decision is posted in your account, it is live; if it is not posted, it is not ready. That is the whole rule. This is not something your representative or your attorney can speed up, we see the same thing you see, at the same time, and calling us to ask does not move it. Calling the VA to ask for an update does not move it either. Watch it yourself, weekly, and the moment a decision posts, bring it to us.

Your decision letter arrives, read it, then start the appeal clock
What to do the day it lands in your mailbox
The decision letter is the finish line of the claim and the starting line of the appeal, and the moment it arrives, a one-year clock starts running. Read it the same day. Find the combined rating, the percentage assigned to each condition, and the effective date, because the effective date controls how far back your back pay reaches. Then request a copy of your C&P exam report so you can see whether the rater used your real range-of-motion numbers or ignored the radiculopathy. If any part of the decision is wrong, a low rating, a denied condition, or a bad effective date, you have three appeal lanes, and you must choose one within one year of the date printed on the letter: a **Higher-Level Review (VA Form 20-0996)**, where a senior reviewer re-decides on the same evidence; a **Supplemental Claim (VA Form 20-0995)**, when you have new and relevant evidence such as a private DBQ or your own range-of-motion exam; or a **Board Appeal (VA Form 10182)** to a Veterans Law Judge. Miss that one-year deadline and the decision becomes final. You can still file again later, but you lose the original effective date, and that lost time is lost back pay you never get back. Bring the letter to this office before the year runs out and we will read it with you, line by line, at no cost.
07Remedy
How to report a bad exam
Where this exam goes wrong
The single most common defect in a strain exam is a range of motion recorded on a good day with no flare-up estimate at all. A clean 80° of flexion recorded at 9 a.m. after you sat in a waiting room is not the same spine you live in at hour ten of a shift, and the examiner is required to say so.

Write it down the moment you get to your car
Date, start time, end time, the examiner’s name and credentials, the vendor, every test that was performed, and every test that was not. A contemporaneous note written the same day is evidence. A memory reconstructed four months later is not.

Get the exam report and the questionnaire
Request a copy through VA.gov, through a written request to the Regional Office, or by calling 800-827-1000. You cannot challenge what you have not read. Compare it line by line against what actually happened in the room.

Name the defect specifically, with the citation
Never write "the exam was unfair." Write "no goniometer was used, contrary to 38 CFR §4.46" or "flare-ups were reported and not addressed, contrary to Sharp v. Shulkin" or "repetitive use testing was not performed, contrary to 38 CFR §4.40 and DeLuca." A specific, citable defect is what forces action.

Submit a statement asking for a new examination
VA Form 21-4138, Statement in Support of Claim, filed through VA.gov or mailed to the Evidence Intake Center. State the defect, cite the authority, and request a new or supplemental examination. Do this BEFORE the decision if the claim is still open, it is far easier than undoing a decision afterward.

Report examiner conduct separately
If the problem is behavior rather than methodology, you were rushed out, dismissed, never touched, or treated with hostility, file a complaint with the VA facility’s Patient Advocate, or with the vendor directly for a contract exam, and copy the Regional Office. Conduct complaints and adequacy challenges are two different tracks and you can run both.

If a decision has already issued, pick the right lane
A Higher-Level Review (VA Form 20-0996) argues the VA erred on the evidence it had, the right vehicle when the exam was inadequate on its face. A Supplemental Claim (VA Form 20-0995) is the vehicle when you are adding new and relevant evidence, such as your own private range-of-motion examination or a completed DBQ from your treating provider.

Put your own measurements on the table
A private examination with full goniometric measurements, or a DBQ completed by your own provider, creates a conflict in the evidence that the VA has to resolve, and under 38 CFR §3.102 reasonable doubt is resolved in your favor.
End of clinical section
Spinal Strain, DC 5237
See It Before You Sit In The Room
Lower Back Strain, Causes & Symptoms
Veritas Health
Low Back Pain, What You Need to Know
DocMikeEvans
The Questions Veterans Actually Ask
Spinal Strain Claims, Frequently Asked Questions
Straight answers to the questions that decide spinal strain claims, the ratings, the separate evaluations, and the exam mistakes that cost veterans money. Read every answer with your own file open. If an answer depends on a record you do not have yet, that is the next thing to request, from your doctor, your unit or the VA itself.
Spinal Strain is evaluated under DC 5237 using the General Rating Formula for Diseases and Injuries of the Spine. The highest rating under the General Formula is 100% for unfavorable ankylosis of the entire spine, but for a strain specifically the practical ceiling most veterans reach is 40% (forward flexion of the thoracolumbar spine 30° or less) or 30% (forward flexion of the cervical spine 15° or less). The critical jump from 10% to 20% can be achieved purely through a spasm/guarding finding without losing additional motion, if the examiner documents it.
Every condition in Back, Neck & Spine




