Claims evidence · Neck and cervical spine
Neck and cervical spine — what the rating actually turns on
Most flyers print one line per rating level. The regulation gives you three separate ways to reach 10 percent and three separate ways to reach 20 percent. I am printing all of them, because the short version stops people from filing.
Read this first. Nothing on this page is a VA form and I am not VA. A
DBQ — a Disability Benefits Questionnaire — is a medical exam form VA uses to collect detailed
information about a condition so a rater can decide the claim. The only neck form VA accepts is the
Neck (Cervical Spine) Conditions Disability Benefits Questionnaire, revision 2024-08-22, free at
benefits.va.gov/compensation/docs/Neck_Conditions_Cervical_Spine.pdf.
If you need a form number to request it from a provider, look the title up yourself at
va.gov/find-forms. I am not printing a form number here
because I could not confirm one on a VA page that displays it, and a wrong number sends you in circles.
VA will not pay or reimburse what a private provider charges to fill out a DBQ.
Where these numbers come from. The rating criteria below are the General Rating Formula
for Diseases and Injuries of the Spine at 38 CFR 4.71a. That is the regulation a VA rater applies
to your neck. I quote it at full breadth on purpose. If a page you read somewhere else lists only one
route to a rating level, that page is not wrong about the route it printed — it is just missing the
others, and the ones it left out are the ones that get people paid.
What a normal neck measures
Six motions. These are the normal figures VA uses — not your figures, the baseline.
| Motion | Normal range |
|---|---|
| Forward flexion (chin toward chest) | 0 to 45 degrees |
| Extension (head back) | 0 to 45 degrees |
| Right lateral flexion (ear toward shoulder) | 0 to 45 degrees |
| Left lateral flexion | 0 to 45 degrees |
| Right rotation (turning head) | 0 to 80 degrees |
| Left rotation | 0 to 80 degrees |
| Combined range of motion | Add all six. A normal neck totals 340 degrees. |
Combined range of motion is just the six numbers added together. It matters because it is its
own separate route to a rating. Two rating levels can be reached on the combined number alone, with no
reference to your flexion at all.
Note (4) of the regulation — the rounding rule. Every range of motion measurement is rounded to
the nearest five degrees. So 32 degrees of flexion is recorded as 30, and 33 is recorded as 35. That
one rounding step can move you across a rating line. If your exam report shows an odd number that was
never rounded, say so in writing.
38 CFR 4.46 requires the examiner to measure with a goniometer — a hinged protractor for
joints — and report your actual range of motion. Eyeballed or estimated numbers are not what the
regulation asks for.
★ Know the baseline before you read your report.
Forward flexion0 to 45 degrees
Right rotation0 to 80 degrees
Combined range of motion340 degrees
Four ways to reach 10 percent
You need any ONE of these. Not all of them. Any one.
- Forward flexion of the cervical spine greater than 30 degrees but not greater than 40 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.
Read route 3 again. Muscle spasm, guarding, or localized tenderness earns 10 percent
with no loss of motion at all. If the examiner presses on your neck, you are tender, and they
write it down, that finding by itself meets the criterion. A veteran with a nearly normal range of
motion and documented tenderness is not a zero.
Route 4 is the one nobody tells vehicle-accident veterans. A vertebral body fracture that cost
50 percent or more of the bone's height earns 10 percent on the fracture alone. If you were in a
vehicle accident, a fall or a blast on active duty, find the imaging. The percentage of height loss
is a measurement a radiologist can report off your films.
★ Tenderness alone is compensable. File.
Three ways to reach 20 percent
Any ONE of these three gets 20 percent. You do not need the flexion number.
- Forward flexion of the cervical spine greater than 15 degrees but not greater than 30 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.
Here is what the short version costs a veteran. Say your forward flexion is 35 degrees. By the
flexion route that is 10 percent, and most flyers stop there. But if your six motions add up to 160
degrees, route 2 puts you at 20 percent — twice the rating — on a number the flexion route
never looks at. Add your six measurements up yourself.
Route 3 is a finding, not a measurement. Abnormal spinal contour means the shape of the spine
itself is wrong: scoliosis is a sideways curve, reversed lordosis means the normal inward neck curve
has flattened or gone the other way, abnormal kyphosis is a forward hunch. Abnormal gait means
the way you walk is affected. If your provider has ever written any of those words, the finding
supports 20 percent regardless of what your degrees measured that day. Do not let it sit on the page
as a checkbox marked "muscle spasms."
★ Add your six numbers. Then read route 3.
The ladder does not stop at 40
The same General Rating Formula runs all the way to 100 percent.
| Rating | Criterion |
|---|---|
| 30% | Forward flexion of the cervical spine 15 degrees or less; or, favorable ankylosis of the entire cervical spine |
| 40% | Unfavorable ankylosis of the entire cervical spine |
| 50% | Unfavorable ankylosis of the entire thoracolumbar spine (the mid and lower back — listed here so you can see the whole formula, since the same table rates your back) |
| 100% | Unfavorable ankylosis of the entire spine |
Ankylosis means the joint is fixed — it does not move. The difference between favorable and
unfavorable is the difference between 30 and 40 percent for the neck, and it gets decided on one
checkbox. So here is the definition the provider is supposed to be using.
The full regulation definition of unfavorable ankylosis (Note 5) is on the Degenerative Disc Disease ratings page. Fixation in neutral position is always favorable ankylosis.
If your exam says "unfavorable" or "favorable" with no explanation, that box was guessed. Ask
for the finding that supports it. Ten percent of a rating is money every month for the rest of your
life.
★ 40 percent is not the ceiling.
The ladder does not stop at 40
Doing the arithmetic yourself
Numbers off a typical neck exam, run through the criteria.
Flexion 35 · extension 30 · right lateral flexion 25 · left lateral flexion 20
· right rotation 45 · left rotation 40.
- Flexion 35 degrees falls in "greater than 30 but not greater than 40" — that is 10 percent.
- Combined: 35 + 30 + 25 + 20 + 45 + 40 = 195 degrees. That falls in "greater than 170 but not greater than 335" — also 10 percent.
- Both figures land at the same place: 10 percent.
- Neither reaches 20 percent, which needs flexion of 30 degrees or less, or combined motion of 170 degrees or less, or severe spasm or guarding causing abnormal gait or abnormal spinal contour.
Now look at how close it is. This veteran needs 25 more degrees of loss on the combined number to
reach 20 percent — or one finding of abnormal spinal contour, which needs no degrees at all. That is
why the spasm and contour question has to actually get asked at the exam.
★ Add your own six. Do not wait to be told.
What the examiner is required to test
An exam missing these can be held inadequate, which means a re-exam and a delay.
- Active motion — you move your own neck
- Passive motion — the examiner moves it for you
- Weight-bearing and nonweight-bearing motion, tested for pain in both
- Range of motion after repetitive use — re-measured after at least three repetitions
- Whether there is pain on rest and non-movement
- Whether the pain causes functional loss — that is the question VA's current form asks
Flare-ups. How to describe them so the examiner records them is on the Describing Symptoms to VA page.
★ Ask what was tested. In writing.
What pain does and does not buy
For the cervical spine, an actually painful neck should not come back below the 10 percent minimum (38 CFR 4.59), but pain by itself is not functional loss. Your job at the exam is to make the examiner record the range of motion the pain actually costs you. The full explanation is on the Describing Symptoms to VA page, and the exam rules are on the C&P Exam Cheat Sheet.
★ Show the loss, not just the hurt.
Radiculopathy is rated separately
Numbness, tingling, weakness or shooting pain down the arms is not part of the neck rating.
Note (1) of 38 CFR 4.71a: VA must evaluate any associated objective neurologic abnormality —
including upper-extremity radiculopathy — separately, under its own diagnostic code, in addition
to the rating for the neck itself.
A documented radiculopathy that never got its own rating is money left on the table, every month,
going back to your effective date. If your records show reduced motor strength, reduced reflexes,
decreased sensation in a dermatome, or an EMG or nerve conduction study confirming radiculopathy, and
your decision letter shows one rating for the neck and nothing else — that is the first thing to
challenge.
What to look for in your own records: motor strength graded out of 5 · reflex findings
· sensory testing by dermatome (the skin area one nerve root serves) · EMG or nerve
conduction study results · the words radiculopathy, radicular, or nerve root.
The levels for each arm nerve and radicular group are on Nerve damage VA ratings.
★ One neck rating is rarely the whole claim.
The other rating path: incapacitating episodes
A cervical disc condition (intervertebral disc syndrome) can be rated on doctor-ordered bed rest instead of degrees of motion, and VA must use whichever method pays more. The episode table and the definition of an incapacitating episode are on the Degenerative Disc Disease ratings page. Ask your doctor to write any bed-rest order down.
★ Ask your doctor to write the rest order down.
Headaches and dizziness from your neck
These belong in their own claims, not as checkboxes inside the neck exam.
Headaches caused by a service-connected neck condition can be claimed as a separate service-connected
condition — secondary service connection, 38 CFR 3.310(a) — and rated under diagnostic code
8100, which reaches 50 percent for very frequent completely prostrating and prolonged
attacks productive of severe economic inadaptability.
Fifty percent for headaches can be worth more than the neck rating itself. If cervicogenic headaches
sit inside your neck exam as a checked box and nothing else, you may be leaving the largest single
piece of the claim on the table.
How VA rates attack frequency, what "prostrating" means and how to keep a headache log are on the Describing Symptoms to VA page.
Dizziness works the same way. If rapid head movement makes you dizzy, get it diagnosed and
claim it as secondary to the neck. Do not let it live as a symptom note.
★ Every symptom with its own name deserves its own claim.
The exam, and the reschedule rule almost nobody knows
Go to the exam. If you truly cannot, move fast — the window is narrow.
The one-time reschedule rule (within 5 days), what a missed exam costs you, and travel reimbursement are on the C&P Exam Cheat Sheet. Call the number on your appointment letter right away.
At the exam, describe your life, not just your neck. What you cannot lift. How long you can sit
at a computer or drive before you have to stop. What you gave up. How bad the flare-ups get and how
often. The examiner records what you tell them and what they observe — silence in that section costs
you.
VA's page on claim exams:
va.gov/disability/va-claim-exam
★ Call today.
The paperwork that makes an exam stick
A DBQ is one piece. Alone it often sits there doing nothing.
- Lay statements — how to get them into the file is on the Describing Symptoms to VA page (VA Form 21-10210).
- Private treatment records — VA Form 21-4142 and 21-4142a are how you authorize VA to get records from a private provider. Without that authorization a private DBQ can sit unsupported in your file.
- Service records showing the injury or the onset — the accident report, the sick call slip, the profile.
- Imaging and testing — MRI, X-ray, EMG or nerve conduction studies.
VA's list of evidence needed:
va.gov/disability/how-to-file-claim/evidence-needed
Before you pay a private provider to fill out a DBQ, know two things. VA will not reimburse
that charge. And VA may decide your claim from records already on file, without an exam at all, under
its Acceptable Clinical Evidence process. Spend the money knowing that.
Watch out for anyone pushing a DBQ at you for a fee. VA publishes the public DBQ forms free at
benefits.va.gov/compensation/dbq_publicdbqs.asp,
and VA's own fraud-prevention fact sheet on DBQs is worth ten minutes of your time.
★ Free forms. Paid help is where the risk is.
Make sure your provider has the right version
Old DBQ layouts still circulate online, and they ask questions VA stopped asking.
VA's current Neck (Cervical Spine) Conditions DBQ (rev. 2024-08-22) runs seventeen
sections, including separate sections for Muscle Strength Testing, Reflex Exam, Sensory Exam,
Radiculopathy, Ankylosis, Other Neurologic Abnormalities, Intervertebral Disc Syndrome and Episodes
Requiring Bed Rest, Assistive Devices, Remaining Effective Function of the Extremities, and Diagnostic
Testing.
An older layout with ten or eleven sections is out of date. It asks "at what point does pain begin"
instead of the weight-bearing, nonweight-bearing and functional-loss questions VA now uses. A provider
handed an old form produces a report keyed to criteria VA no longer asks about — which means a re-exam
and months of delay, not just a thin report.
Download the current PDF straight from VA and hand your provider that file:
benefits.va.gov/compensation/docs/Neck_Conditions_Cervical_Spine.pdf.
Check the revision date on the form before the appointment.
★ Right form, first try.
The clock starts the day the decision is mailed
Two of the three review lanes have a one-year limit, and filing a Supplemental Claim inside that year protects your effective date. The lanes, forms and deadlines are on the Help Your Own Claim page. VA's supplemental claim page: va.gov/decision-reviews/supplemental-claim.
★ Never give up. Just do not sit on it.
If the neck is keeping you from working
There is a benefit for that, and a neck claim is exactly where people miss it.
If your neck condition and its related conditions keep you from holding substantially gainful
employment, ask about Total Disability based on Individual Unemployability (TDIU), which pays at
the 100 percent rate even when your combined rating is lower.
- You may qualify with one service-connected disability rated 60 percent or more; or
- two or more service-connected disabilities with at least one rated 40 percent and a combined rating of 70 percent or more.
- Apply on VA Form 21-8940. VA Form 21-4192 is the one your employer completes.
Cannot lift what you used to. Cannot sit at a computer or drive for long. Missing days when it flares.
Write all of it down — that is the record TDIU is decided on.
★ A low rating is not the end of the road.
Who can help you, and what they may charge
I am not an accredited representative. I do not prepare or represent VA claims. Accredited VSO representatives are free. Who may charge a fee, and when, is on the Help Your Own Claim page.
★ Free help exists. Use it first.
A neck does not have to be fused to be rated as fixed
The 30 and 40 percent levels are written as "ankylosis." A court has said that can be met on function alone.
The rule. In Chavis v. McDonough, No. 18-2928 (U.S. Court of Appeals for Veterans Claims,
decided April 16, 2021), the Court held that the ankylosis requirement in the spine's General Rating
Formula can be met by the functional equivalent of ankylosis. The Court's words:
applying 38 CFR 4.40 and 4.45 permits an evaluation based on ankylosis "if a claimant's functional
loss is consistent with that contemplated by ankylosis." In plain language: if pain, weakness, tiredness
or flare-ups leave the neck working as if it were fixed, the rater has to consider that, even when no
bone is fused.
What the two regulations say. 4.40: "Weakness is as important as limitation of motion, and a
part which becomes painful on use must be regarded as seriously disabled." 4.45 lists the factors:
less movement than normal, weakened movement, excess fatigability, incoordination, and pain on movement.
Those are the things the examiner is supposed to be measuring and writing down.
The limit. Not every painful neck is a fixed neck. The evidence has to show loss of function so
severe that it looks like ankylosis. Pain by itself is not enough. And the
Note (5) definition of unfavorable ankylosis linked earlier on this page is still the yardstick
for the 40 percent level.
What helps show it.
- Your flare-up history: how often, how long, what the neck will not do during one.
- The estimated range of motion during a flare-up or after repeated use, which VA's form asks the examiner to give.
- The exam findings themselves, and any brace, collar or other device you are told to use.
- Lay statements from people who see it lock up or become unusable (VA Form 21-10210).
★ Ask the examiner: does my neck work like a fixed one on a bad day?
Other conditions that can be claimed as secondary to the neck
Headaches and arm nerve damage are covered above. These four are the rest of the usual list, with the real rating tables.
The rule for all of them. 38 CFR 3.310(a): a disability "proximately due to or the result of a
service-connected disease or injury shall be service connected." Paragraph (b) covers a condition
that was already there and that your service-connected neck made worse. VA describes this as filing "a
claim for a new disability that's linked to a service-connected disability you already have."
It is not automatic. You need a current diagnosis and a medical opinion, from a doctor, linking it
to the neck. I am not saying a neck condition causes any of these in your case. That is a medical question for
your provider.
| Condition | Rating levels in VA's schedule |
|---|---|
| Shoulder — limitation of arm motion (code 5201) | Arm raised only to shoulder level: 20% either arm. Only midway between side and shoulder: 30% dominant arm, 20% other arm. Limited to 25 degrees from the side: 40% dominant, 30% other. Other shoulder codes (5200 ankylosis, 5202 humerus, 5203 collarbone and shoulder blade) go higher or lower. |
| Jaw (TMJ) — limited opening (code 9905) | Measured as how far the jaw opens, in millimeters. 30 to 34 mm: 10% (20% on soft foods, 30% on liquid or pureed foods). 21 to 29 mm: 20% (30% soft, 40% liquid or pureed). 11 to 20 mm: 30% (40% with diet limits). 0 to 10 mm: 40% (50% with diet limits). Side-to-side movement of 0 to 4 mm: 10%. The diet must be recorded or verified by a physician. |
| Vertigo — peripheral vestibular disorder (code 6204) | 10% occasional dizziness. 30% dizziness and occasional staggering. VA requires objective findings supporting the diagnosis before any compensable rating. |
| Sleep apnea (code 6847) | 0% documented but no symptoms. 30% persistent daytime sleepiness. 50% requires a breathing machine such as CPAP. 100% chronic respiratory failure or tracheostomy. There is no 10 percent level. |
Which arm is "dominant"? Under 38 CFR 4.69, handedness is decided from the evidence of record or by
testing at the VA exam. Only one hand counts as dominant.
Sleep apnea is a medical diagnosis made by a sleep study. Do not claim it, or any of the others, on the theory
that it sounds related. Get the diagnosis first, then ask your doctor in writing whether the neck condition
caused or worsened it.
★ Diagnosis, then the doctor's link, then the claim.
Where to call and where to go
Numbers below were read on VA's own pages.
- VA benefits (claims, exam appointments, status): 800-827-1000, Monday to Friday, 8:00 a.m. to 9:00 p.m. Eastern.
- VA health care: 877-222-8387, Monday to Friday, 8:00 a.m. to 8:00 p.m. Eastern.
- Veterans Crisis Line: dial 988, then press 1. Any hour.
- Hearing or speech difficulty: dial 711 for the relay service.
- Questions about this page: Veteran's Strategic Solutions LLC, 785-579-9071.
Places to go:
types of claims and when to file ·
how to file a claim ·
file online (VA Form 21-526EZ) ·
how ratings are combined ·
VA contact page
★ Call, write it down, keep the date.
Where each fact on this page comes from
- Neck rating formula, shoulder codes 5200-5203, Notes (4) and (5): 38 CFR 4.71a
- Functional loss and the joints: 38 CFR 4.40, 4.45, and 4.59
- Functional equivalent of ankylosis: Chavis v. McDonough, No. 18-2928, Court of Appeals for Veterans Claims
- Dominant hand: 38 CFR 4.69
- Jaw: 38 CFR 4.150, code 9905 (also govinfo)
- Vertigo: 38 CFR 4.87, code 6204 (also govinfo)
- Sleep apnea: 38 CFR 4.97, code 6847 (also govinfo)
- Secondary service connection: 38 CFR 3.310 and VA: types of claims
- Phone numbers: va.gov/contact-us and va.gov/disability/about-disability-ratings
★ Check me. It is your claim.
What I would do this week
In this order.
- Get a copy of your last neck exam report and your decision letter.
- Add your six range-of-motion numbers together. Compare the total to 335 and to 170.
- Check the rounding. Any odd number on the report should have been rounded to the nearest five.
- Search the report for: tenderness, spasm, guarding, abnormal contour, scoliosis, kyphosis, lordosis, gait.
- Search for: radiculopathy, numbness, tingling, dermatome, EMG. If it is there and not separately rated, that is your claim.
- Check whether weight-bearing, nonweight-bearing, passive motion and three repetitions were tested at all.
- Check whether a flare-up range of motion was estimated.
- If you have headaches or dizziness from the neck, start a log today and file them as secondary.
- Ask your doctor whether bed rest was ever prescribed, and get the dates in writing.
- If your decision is under a year old and something above is missing, pick your review lane and file before the year runs.
★ Ten steps. Most of them are free.
My word on it. I bring the truth, simple and to the point. I have nothing left in this
world but my word, so I will not print a figure I cannot stand behind. Where I could not confirm
something — a form number, in this case — I told you so instead of guessing. If you find an error on this
page, call me and I will fix it.