Lumbar spine — what you can and cannot claim on top

What a secondary claim actually requires

• A diagnosis and a nexus — a current diagnosis, plus a written provider opinion that your service-connected spine condition caused or aggravated it. The full mechanics, including the aggravation baseline, are at vsgsolutions.org/secondary-conditions.
• One claim per condition. File on VA Form 21-526EZ (va.gov/find-forms/about-form-21-526ez).

Do not claim these on top of your spine rating

38 CFR 4.14 bars rating the same problem twice under a second name. VA calls it pyramiding. These four are automatic denials — and each has a better door.

• Degenerative arthritis of the spine / degenerative disc disease. That is diagnostic code 5242, rated under the very same General Rating Formula that already produced your spine rating. Instead: degenerative arthritis of a different joint — knee, hip — caused or worsened by your back or your altered walk is a real secondary claim.
• Sacroiliac joint dysfunction. Diagnostic code 5236, also inside the spine series 5235–5243, also under the same formula. Instead: if sacroiliac pain is cutting down how far your back bends, file a claim for an increase on the spine rating.
• Muscle spasms. Spasm is already written into the spine criteria — 10 percent for "muscle spasm, guarding, or localized tenderness not resulting in abnormal gait or abnormal spinal contour." Instead: see the increase panel below.
• Gait abnormality. Abnormal walk is a criterion at the 20 percent level of the spine formula — "muscle spasm or guarding severe enough to result in an abnormal gait or abnormal spinal contour such as scoliosis, reversed lordosis, or abnormal kyphosis." Instead: if you are rated under 20 percent and your spasm causes a documented abnormal gait, that is an increase. And an altered gait is the reason you argue a hip, knee, ankle or foot secondary — it is the theory, not the claim.

File an intent to file first. Today.

This is the single cheapest thing on this page and the one most people skip.

Nerve damage is rated separately — and foot drop is 80 percent

Note (1) to the spine formula requires objective neurologic abnormalities to be rated separately under their own code and combined with your spine rating. They are not swallowed by it.

Nerve signs that belong in your record

Every one of these is a reason to ask whether a nerve rating is missing. Say them out loud at the exam and to your doctor, and make sure they are written down.

• Numbness or tingling in a leg or foot
• Burning or shooting pain down the leg
• Weakness, or a leg giving out
• Foot slapping, tripping or falls (foot drop)
• Front-of-thigh weakness or numbness
• Urgency, leakage or trouble emptying your bladder; bowel leakage

What backs up a nerve rating

• The exam itself. The Back (Thoracolumbar Spine) exam form has a radiculopathy section (which nerve roots, right or left, and whether the symptoms are constant pain, intermittent pain, paresthesias or numbness) and a separate section on other neurologic abnormalities such as bowel or bladder problems. Read your exam report against it.
• Imaging and nerve testing. The form asks whether imaging was done. It also says electromyography (EMG) is rarely required to diagnose radiculopathy in the appropriate clinical setting, so do not assume a missing EMG sinks a claim, and do not assume you need to pay for one.
• Assistive devices. The form asks whether you use a cane, brace, crutches, walker or wheelchair as a normal way of getting around. Tell the examiner if you do.
• A lay statement. You, or someone who sees you every day, can describe the falls, the weakness, the numbness and the leakage on VA Form 21-10210, or on plain paper. No special training is required to write one.
• Pad use and treatment history matter directly for bladder and bowel, because those ratings are written around how often pads are changed and whether a bowel program works.

The levels for the other leg nerves are on Nerve damage VA ratings.

Low back, mid back and neck: what VA rates together and apart

• Mid back and low back go together. The spine formula treats them as the thoracolumbar spine, so mid-back stiffness and spasm are part of that one rating, not a separate one.
• The neck is rated on its own. Note (6) says to evaluate the thoracolumbar and cervical segments separately, except when both are unfavorably ankylosed (fused in a bad position), which is rated as a single disability. A service-connected neck condition can carry its own rating, and nerve trouble in the arms is an associated neurologic abnormality under Note (1).
• Look for every line. In your decision letter, count what VA actually rated: spine, neck, right leg, left leg, bladder or bowel. Do not stop at the back percentage. If a line you have symptoms for is not there, that is a claim to file with evidence, not a mistake to accept.

Claim the diagnosis, not the symptom

There is no diagnostic code for "knee pain" or "lower extremity pain." File the condition your provider names. How to word symptoms, and why pain still counts, is at vsgsolutions.org/describing-symptoms-to-va.

Chronic pain does not stay in your back

• Depression, anxiety and chronic sleep impairment secondary to chronic spine pain are filed like any other secondary. How they are rated and how to word them: vsgsolutions.org/secondary-conditions and vsgsolutions.org/describing-symptoms-to-va.
• Sleep apnea is separately ratable under DC 6847. That one needs a sleep study.

Erectile dysfunction: the 0 percent that pays

Diagnostic code 7522 is "Erectile dysfunction, with or without penile deformity," and it is rated 0 percent by rule. That is the expected outcome, not a loss.

When the back itself is worse: file for an increase

• Spasm now causing an abnormal gait or abnormal spinal contour, and you are rated below 20 percent — that is the 20 percent criterion. File for an increase.
• Intervertebral disc syndrome, DC 5243, has a second scoring method: the Formula for Rating IVDS Based on Incapacitating Episodes, counted over the past 12 months — at least 1 but under 2 weeks 10%; at least 2 but under 4 weeks 20%; at least 4 but under 6 weeks 40%; at least 6 weeks 60%. VA must rate you under whichever method gives the higher number.

TDIU — paid at 100 percent without a 100 percent rating

Total Disability based on Individual Unemployability, 38 CFR 4.16. If service-connected conditions keep you from holding substantially gainful work, VA can pay you at the 100 percent rate.

• That matters here. Under 4.16(a), a lumbar spine rating plus radiculopathy in both legs, all flowing from the same spine pathology, can be treated as one disability. Combined to 60 percent that way, you meet the single-disability test without ever reaching a 70 percent combined rating.
• The other TDIU routes, including 4.16(b) extraschedular referral, are at vsgsolutions.org/conditions-that-combine-to-100.

Three review lanes, and a one-year clock

Supplemental Claim, Higher-Level Review and Board Appeal, with forms, deadlines and the one-year effective-date rule, are at vsgsolutions.org/appeal-a-va-decision. VA's own pages: va.gov/decision-reviews/supplemental-claim and va.gov/decision-reviews/higher-level-review.

You do not have to pay anyone to file

• An accredited Veterans Service Organization representative will help you prepare and file a claim at no charge. Not a discount — no charge.
• An accredited attorney or claims agent may charge a fee, but only after VA issues its initial decision on the claim. The fee rules are at vsgsolutions.org/conditions-that-combine-to-100.
• Anyone charging you to file an original claim before a decision exists is outside the rules. Walk.

Where to call and where to go

• VA benefits (claims, decisions, status): 800-827-1000, Monday through Friday, 8:00 a.m. to 9:00 p.m. ET.
• VA health care (get the exam findings and nexus letter into your medical record): 877-222-8387, Monday through Friday, 8:00 a.m. to 8:00 p.m. ET.
• Veterans Crisis Line: 988, then press 1.
• How to file a VA disability claim
• Evidence VA accepts
• The Back (Thoracolumbar Spine) exam form (see what your examiner was asked)
• VA Form 21-10210, Lay/Witness Statement