Last updated: October 2026
If your lower back has bothered you since service, you're in good company. Years of rucks, heavy lifting, and long hours in vehicles add up, and plenty of us got out with a back that never fully recovered. The frustrating part is that VA doesn't rate how much your back hurts. It rates how far you can move and what ends up in your records.
That's workable once you know what VA looks for. This guide covers how VA rates lumbosacral strain, how to get it service-connected, the evidence that makes a difference, what happens at the exam, the conditions worth claiming alongside your back, and when TDIU (Total Disability based on Individual Unemployability, which pays at the 100% rate when your service-connected conditions keep you from working) may apply.
Lumbosacral Strain at a Glance
Diagnostic code: Diagnostic Code (DC) 5237 under 38 CFR 4.71a, rated with the General Rating Formula for Diseases and Injuries of the Spine, which covers DCs 5235 through 5243.
Ratings available for the lower back: 10%, 20%, 40%, 50%, and 100%. The 50% and 100% levels require ankylosis, meaning the spine is frozen in place, so most strains are rated between 10% and 40%.
Ways to get service connection: Direct, meaning an in-service injury or event caused it, or secondary, meaning another service-connected condition caused or worsened it, like a bad knee that changed how you walk.
Key evidence: Range-of-motion measurements in degrees, notes on painful motion, spasm, and guarding, a record of your flare-ups, and a nexus, which is a medical opinion linking your back to service.
Main exam: The Compensation and Pension (C&P) exam, a medical evaluation VA orders for your claim. The examiner completes the Back (Thoracolumbar Spine) Conditions Disability Benefits Questionnaire, VA Form 21-0960M-14. A Disability Benefits Questionnaire (DBQ) is a standard form that tells the examiner what to record.
Official rating criteria: Read the full criteria on eCFR.
How the VA Defines Lumbosacral Strain
Lumbosacral strain is an injury to the muscles, tendons, or ligaments of the lower back. VA rates it under the musculoskeletal system, with the rest of the spine conditions in 38 CFR 4.71a.
VA rates the spine by function, not by diagnosis. Whether your doctor calls it a strain, degenerative arthritis, or disc disease, the same General Rating Formula applies. VA looks at how far you can bend forward, your total range of motion, whether muscle spasm or guarding changes how you walk or stand, and whether your spine is ankylosed.
The formula's own notes set normal motion for the thoracolumbar spine (the middle and lower back): flexion, or bending forward, from 0 to 90 degrees; extension, or bending backward, from 0 to 30 degrees; lateral flexion, or bending to each side, from 0 to 30 degrees; and rotation, or twisting to each side, from 0 to 30 degrees. Add all six movements and you get your combined range of motion, which is 240 degrees when normal. Each measurement is rounded to the nearest 5 degrees.
A doctor diagnoses a strain through a physical exam, your history, and imaging if needed. For rating purposes, though, the numbers that matter come from a goniometer, a protractor-like tool with two arms, either at your C&P exam or in your treatment records. Under 38 CFR 4.46, VA treats those goniometer measurements as essential.
One heads-up if you read the regulation yourself: some levels describe the neck (the cervical spine), not the lower back. The 30% level, for example, applies only to the neck. For a lower back claim, look for the words "thoracolumbar spine."
How the VA Rates Lumbosacral Strain
Here's a plain-language overview of the levels that apply to the lower back:
| Rating | What it generally means |
|---|---|
| 10% | Forward bending of more than 60 but no more than 85 degrees, or combined motion of more than 120 but no more than 235 degrees, or muscle spasm, guarding, or localized tenderness that doesn't change your walk or spinal shape, or a vertebral fracture with at least 50% loss of height |
| 20% | Forward bending of more than 30 but no more than 60 degrees, or combined motion of 120 degrees or less, or spasm or guarding severe enough to cause an abnormal walk or spinal curve, like scoliosis, reversed lordosis, or abnormal kyphosis |
| 40% | Forward bending of 30 degrees or less, or the entire thoracolumbar spine fixed in a favorable position |
| 50% | The entire thoracolumbar spine fixed in an unfavorable position |
| 100% | The entire spine fixed in an unfavorable position |
Read the full rating criteria on eCFR.
To make this concrete, say an examiner measures your forward flexion at 70 degrees, extension at 20, each side bend at 20, and each rotation at 25. Your combined motion is 180 degrees. Both your flexion and your combined motion fall in the 10% range. If your flexion drops to 55 degrees on a later exam, that alone can support 20%.
A few related rules matter for backs:
Pain and painful motion. The formula applies with or without pain, so pain on its own doesn't move you up a level. Painful motion still counts, though. Under 38 CFR 4.59 and Burton v. Shinseki (2011), actually painful motion can support at least the minimum compensable rating, 10% for the spine, even when your motion is otherwise normal. Under 38 CFR 4.40 and DeLuca v. Brown (1995), VA must also consider motion you lose to pain, weakness, fatigue, or poor coordination, including after repeated use and during flare-ups. Mitchell v. Shinseki (2011) adds that the pain has to actually limit what you can do.
Medication. Under Jones v. Shinseki (2012), VA can't consider how medication improves your symptoms unless the rating criteria mention medication, and the spine formula doesn't. Ingram v. Collins (2025) applied that rule to conditions rated on range of motion, like backs. Tell the examiner what your motion and pain are like when your medication wears off.
Disc disease can be rated a second way. If your condition includes intervertebral disc syndrome (IVDS), VA can also rate it under DC 5243's separate formula based on incapacitating episodes, and uses whichever method gives you the higher rating.
Nerve problems get their own ratings. The spine formula's notes say nerve problems tied to your back, like radiculopathy in your legs or bowel and bladder problems, are rated separately under their own codes, not folded into your back percentage.
Ratings can be staged. If your back got worse partway through your claim, VA can assign different ratings for different time periods. In one 2025 Board of Veterans' Appeals decision, a veteran's back was rated 10% for one period and 40% from a later date. Board decisions aren't precedential, meaning they apply only to the case decided, but they show how the rule works in practice.
If you have more than one service-connected condition, VA combines your ratings with a combined ratings table under 38 CFR 4.25, not by simple addition. My VA disability calculator walks through that math and current pay amounts.
Getting Lumbosacral Strain Service Connected
Back claims follow the ordinary rules for orthopedic conditions. There's no special evidence standard, so your job is to build a clear, well-documented file.
Direct Service Connection
Direct service connection under 38 CFR 3.303 means your service caused the condition. VA looks for three things: a current diagnosis, an in-service event or injury, and a nexus between the two.
Think about what happened to your back while you were in. Maybe you fell during a ruck march, hurt yourself lifting gear, or were in a vehicle accident. Repetitive strain counts too. Years of loading pallets or carrying heavy packs can wear down a back without one dramatic injury. If you went to sick call, those service treatment records are gold.
If you didn't, lay evidence can fill the gap. Lay evidence means statements from you and people who saw what happened or saw how you changed. Under Buchanan v. Nicholson (2006), VA can't reject them just because there's no medical record from the time. If you hurt your back in combat, 38 CFR 3.304(d) goes further: VA accepts your own statement about the injury when it fits the circumstances of your service.
The nexus opinion needs to meet VA's standard of "at least as likely as not," which means a 50% chance or better that your back condition is related to service.
Secondary Service Connection
Secondary service connection under 38 CFR 3.310 means a condition that's already service-connected caused your back condition or made it worse.
For lower back strain, the most common path is altered gait. If you have a service-connected knee, hip, or foot condition, you've probably spent years shifting your weight or limping to protect it, and that puts extra stress on your lower back. A doctor who explains that chain in a nexus opinion can turn a back claim that failed as a direct claim into a grant. This works even if your back problem started after service. What matters is the medical link to the condition that's already connected.
Presumptive Service Connection
A presumptive condition is one VA assumes is linked to service based on where or when you served, like certain burn pit or Agent Orange conditions. Lumbosacral strain isn't on any of those lists, so you'll prove it through the direct or secondary path.
Evidence That Strengthens Your Claim
Back ratings come down to measurements and documentation. A real condition with thin records often gets a lower rating than it deserves. These pieces make the biggest difference:
Range-of-motion measurements. Goniometer readings in degrees for each direction. A note that says your motion was "limited" gives VA nothing to apply the formula to, so ask your doctor to measure and record actual numbers.
Painful motion and flare-ups, in writing. Make sure your records note where in each movement your pain starts, how often flare-ups happen, how long they last, and what you can't do during them.
Muscle spasm, guarding, and gait findings. Notes describing an abnormal walk or an abnormal spinal curve can support 20% even without severe motion loss.
Lay statements. A buddy who was there when you hurt your back lifting a generator can describe it. A spouse can describe how you can't pick up your kids anymore or how you sleep in a recliner on bad nights. Use VA Form 21-10210 for these statements, and keep them specific and observable.
A nexus letter. An opinion from a VA or private provider linking your current diagnosis to service, or to your service-connected knee or hip, using the phrase "at least as likely as not." The strongest letters show the doctor reviewed your records and explain the medical reasoning.
A treatment timeline. Records that show your back problems from service to now, not just one recent diagnosis. Chiropractor visits, physical therapy, and urgent care trips all help show continuity.
My Personal Statement Workbook includes a printable guide you can hand to a spouse or buddy writing a statement about what they've seen.
For help finding records and working with your doctors, see my guide to gathering medical evidence for your claim.
What to Expect at Your C&P Exam
The exam is built around the Back (Thoracolumbar Spine) Conditions DBQ, which the examiner fills out and sends to a rater, the VA employee who reviews your whole claims file and decides your claim. My post on what to expect at your C&P exam covers scheduling and general preparation.
The center of the exam is range-of-motion testing. The examiner uses a goniometer to measure how far you can bend forward, backward, and to each side, and how far you can twist each way. Active motion is how far you move on your own; passive motion is how far the examiner can move you. Under Correia v. McDonald (2016), a joint exam should test both, along with weight-bearing and non-weight-bearing motion where that applies.
A complete exam should also cover:
Pain on motion: where in each movement your pain begins.
Repetitive use: whether your motion drops after you repeat the movement several times.
Flare-ups: how your back works on your worst days.
Spasm and guarding: whether your muscles tighten up and whether that changes your walk or posture.
Nerve symptoms: numbness, tingling, or shooting pain into your legs, and any bowel or bladder changes.
Don't push through pain to look tough. Plenty of us were trained to do exactly that, but at this exam it works against you. Stop when the pain stops you, and tell the examiner when it starts.
Describe your flare-ups in detail, too. Your exam is one snapshot, and you might be having a decent day. Explain how often your bad days happen, how long they last, and what they look like, for example: "Two or three times a month I can't bend to tie my shoes for about four days." Under Sharp v. Shulkin (2017), an examiner can't refuse to estimate your flare-up limits just because you aren't having one at the exam.
A symptom journal kept over several weeks makes those answers specific. My C&P Exam Prep Workbook includes a Joints & Spine insert with flare-up worksheets and a daily symptom log.
Common Reasons Lumbosacral Strain Claims Are Denied
Most back denials and low ratings come down to a few gaps:
No link between your current back and service. VA needs an in-service event plus a medical opinion connecting it to your current diagnosis. Without the nexus, a real injury can still be denied.
No range-of-motion measurements. Without actual degree readings, VA can't apply the rating formula.
Pain and flare-ups never written down. If no record captures your painful motion or your bad days, VA is left with "normal" findings, even when your condition is real.
An incomplete C&P exam. When an examiner skips repetitive-use testing or doesn't address flare-ups, the report understates how limited you are. That can make the exam inadequate, which you can challenge.
These claims are often close calls. When the evidence for and against you is about evenly balanced, VA must give you the benefit of the doubt under 38 CFR 3.102 and Gilbert v. Derwinski (1990).
The fix depends on what's missing. A new nexus letter usually means a Supplemental Claim (VA Form 20-0995). An inadequate exam VA relied on may be a better fit for a Higher-Level Review (VA Form 20-0996). VA's decision reviews page explains each option.
Secondary Conditions Linked to Lumbosacral Strain
Your back may not be the only condition to claim. Secondary conditions run in both directions.
Conditions often claimed as secondary to a back strain:
Radiculopathy. Nerve pain, numbness, or tingling down one or both legs. Each leg gets its own rating, separate from your back. In one Board decision, a veteran was granted radiculopathy in both legs as secondary to a service-connected lumbosacral strain, based on a VA physician's opinion.
Bowel or bladder problems. When nerve involvement from your spine causes them, they're also rated separately.
Depression and anxiety. Living with chronic pain takes a toll, and a mental health condition caused or worsened by your back can be claimed as secondary.
Conditions your back may be secondary to: a service-connected knee, hip, or foot condition that changed the way you walk or stand.
Two conditions work differently than you might expect:
Disc disease and arthritis in the same back aren't separate secondary claims. VA rates them together with your strain under the same spine formula, because rating the same symptoms twice breaks the pyramiding rule in 38 CFR 4.14.
Obesity can't be service-connected on its own. Under VA General Counsel Precedent Opinion 1-2017, weight gain caused by a service-connected condition can be an "intermediate step" toward another condition, for example a back that limits activity, leading to weight gain that worsens your knees, as one Board decision explains.
Claim each secondary condition separately and by name. If you don't claim radiculopathy in each leg, VA may not rate it.
When TDIU May Apply
TDIU applies when your service-connected conditions keep you from holding a substantially gainful job, even if your combined rating is lower than 100%, under 38 CFR 4.16.
Schedular TDIU, meaning you meet VA's standard rating thresholds, requires one service-connected disability rated 60% or more, or two or more with a combined rating of 70% and at least one rated 40% or more. A lumbosacral strain alone rarely reaches 60%, because the levels above 40% require a frozen spine.
The shared-cause rule changes the math. Disabilities from a common cause count as one disability for these thresholds. So a back rated 40% plus radiculopathy in each leg can reach the 60% level together once VA combines them, because all three come from your back.
If you don't meet the thresholds but still can't work, VA can refer your case for extraschedular TDIU under 4.16(b), meaning consideration outside the standard thresholds. You apply with VA Form 21-8940. Back injuries rule out a lot of jobs, especially physical ones, so if that sounds like your situation, my TDIU eligibility guide covers how to apply and what evidence VA looks for.
Conclusion
Your back rating depends on measurements and documentation, not on your diagnosis or an MRI. Your file needs to show your bad days, not just the decent one you might have at your exam. Get your range of motion measured and recorded, keep a flare-up journal, collect statements from people who see how your back affects you, and claim every secondary condition by name.
You don't have to build this alone. A VSO, or Veterans Service Organization, has accredited representatives who help with claims at no cost, and a VSO is often my first suggestion to clients. Find an accredited representative near you, then start your flare-up journal this week so it's ready before your exam.
Wondering how this applies to your condition? Every veteran's situation is a little different. Schedule a free consultation to talk through what you've read and get connected with a VSO who can help with your claim.
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