Inside the exam room
1. You will be asked when your back problem started and what treatment you have had. Explain trouble sitting, standing, bending, or lifting.
2. You will be asked to bend forward while standing. The examiner measures how far you bend. Tell them when pain starts and where you must stop. Do not force painful movement. Say if standing or bending is unsafe.
3. You will also be asked to bend backward, bend to each side, and turn each way. The examiner measures each direction and may repeat movements if safe, then check leg strength, reflexes, and feeling. Explain what changes after activity or on worse days. Point out pain, numbness, or weakness going into either leg.
The examiner measures joint movement with a goniometer (angle-measuring tool).
How VA rates back condition
The examiner measures how far you bend forward, lean back, bend to each side, and turn to each side. VA can use the forward bend or all six measurements added together. One side-bend alone does not set a rating. Compare your recorded measurements with the rules below. Other exam results may matter too. Source: 38 CFR 4.71a (2025 edition) .
Middle and lower back (thoracolumbar) full movements listed in VA’s guide: bending forward (forward flexion) 0-90 degrees; leaning backward (extension) and left/right side-bending (lateral flexion) 0-30 each; left/right rotation 0-30 each. Six-direction total: 240 degrees.
What each rating percentage means
Match the whole description with your exam and records. A single symptom or illustration does not decide your rating.
| Rating | What the rule requires |
|---|---|
| 10% | Bending forward greater than 60 through 85 degrees; OR all six back movements total greater than 120 through 235 degrees; OR muscle spasm, protective tightening (guarding), or tenderness without changed walking or spinal shape; OR a broken spinal bone that has lost at least half its height. |
| 20% | Bending forward greater than 30 through 60 degrees; OR all six back movements total 120 degrees or less; OR muscle spasm or protective tightening severe enough to change how you walk or the shape of your spine. |
| 40% | Bending forward 30 degrees or less; OR the entire middle and lower back fixed in a position the clinician classifies as favorable ankylosis. |
| 50% | The entire middle and lower back fixed bent forward or backward, with the additional effects required by the rule (unfavorable ankylosis). A clinician must assess this. |
| 100% | The entire spine fixed bent forward or backward, with the additional effects required by the rule (unfavorable ankylosis). A clinician must assess this. |
Check these details in your records
The examiner uses a condition form called a Disability Benefits Questionnaire (DBQ). Compare these items with your own records and explain what actually happens in daily life.
- A clinician's records show bending forward (forward flexion) greater than 60 degrees, through 85 degrees10%
- A clinician's records show combined middle and lower back (thoracolumbar) motion greater than 120 degrees, through 235 degrees10%
- A clinician's records show bending forward (forward flexion) greater than 30 degrees, through 60 degrees20%
- A clinician's records show combined middle and lower back (thoracolumbar) motion 120 degrees or less20%
- A clinician's records show bending forward (forward flexion) 30 degrees or less40%
What may happen in the exam room
- The examiner may ask you to move the joint, then move it for you. They may check it with and without weight on it when safe. Follow their directions and tell them when something hurts.
- The examiner checks strength, pain, and what changes after doing the movement several times. One result alone does not decide the diagnosis.
What the measurements tell you
- The examiner records all six movements separately. If a measurement is missing, do not assume it is normal.
- Standing straight does not show that your back is stuck in that position. The examiner must check whether it is fixed in place (ankylosis).
Questions the examiner may cover
- How often do flare-ups occur, how long do they last, and how do they change bending, sitting, standing, or lifting?
- What changes after repeated use? Are symptoms different on the day of the exam?
Questions to expect
Where does bending stop, and what changes after activity or a flare?
Explain: Describe pain onset, the movement you cannot finish, flare frequency and duration, and limits after lifting, sitting or standing. The examiner measures or estimates degrees.
Rating connection: VA compares forward flexion and the combined six movements with the percentage rows. Pain onset and the final movement limit are different findings.
Do spasms change your walking, and do symptoms travel into either leg?
Explain: Describe the walking change, affected side, numbness, weakness and falls. Identify existing examinations or prescribed aids.
Rating connection: Abnormal gait or spinal contour from guarding or spasm can meet a different spine pathway. Separately documented nerve impairment uses the affected nerve rule.
Your answer outline
On a usual day, I can [activity and approximate duration or amount]. After [repeated activity], [what changes]. When symptoms are worse, [specific difference]. This happens about [frequency] and lasts [duration]. [What helps and what remains difficult].
Mark approximate dates and counts as estimates.
My notes: ________________________
Service connection records
1. How is this connected to your service?
For a direct claim, identify your current disability, what happened in service, and evidence linking them. Being on active duty or orders alone does not prove that link.
- Write the 5 Ws and how: who was there; what happened; when; where; why you were there; how the problem began. Add duty status, treatment, witnesses, and records. Mark uncertain dates as estimates.
- Guard or Reserve: find your orders, dates, duty type, and any line-of-duty records. Active duty, training, and drills have different rules.
- Secondary condition: it may start after service. Identify the service-connected condition and evidence that it caused or worsened this problem. A medical opinion may help explain the link.
- Started before service? Record what changed during service. Presumptive condition? Check the required diagnosis and service history; qualifying claims do not require separate proof of a link.
- Already service connected and seeking an increase? Focus on what has worsened and the records showing it.
If you do not know the cause, say so. Do not guess a medical connection.
Explain what changes in daily life
Describe both what you can do and what becomes difficult. Include how often it happens and how long it lasts.
- Use your own examples of effects on sitting, walking, lifting, and daily tasks. Explain the range of typical and flare-up functioning.
Common mistakes to avoid
- Describe a usual day and a worse day, including how often symptoms get worse and how long that lasts. Do not make your symptoms sound better or worse than they are.
- Keep taking medicines as prescribed unless your health care provider tells you otherwise. If a movement hurts or feels unsafe, tell the examiner and follow their directions.
Records to get ready before the exam
- Your treatment records, movement measurements already recorded by a health care provider, and medicine list.
- Notes about daily tasks, what changes after repeating them, and worse periods. Send personal records through VA’s official channels.
Preparation notes
- Use the picture to understand the measurement. At the exam, follow the examiner’s directions and do not force unsafe movement.
- Explain where pain starts, where movement stops, and what changes after repeated activity or during worse periods.
- VA reviews your whole record, including whether the condition is linked to service. The highest box you check here does not decide your rating.
Pain, repeated use, and worse periods
Tell the examiner where pain begins and how far you can move. Those may be different points. Pain alone does not set a percentage. Explain what becomes harder after repeating an activity or during worse periods (flare-ups). The examiner uses your records and description to estimate those changes, and explains if there is not enough information to do so.
Could one health problem have caused another?
A condition VA has already linked to your service may cause another health problem or make it worse. VA calls this secondary service connection. Having both conditions does not prove the link. Your records need to show a current diagnosis and explain how the first condition or its treatment affected the second.
- Start with your records. Find the current diagnosis, the condition VA already linked to service, and evidence from someone qualified to explain the connection.
- Ask about cause and worsening. Did the first condition or its treatment cause the new disability, or make an existing disability worse? These are different questions. The rules call them causation under 38 CFR § 3.310(a) and aggravation under § 3.310(b). If both are raised by your records, the medical opinion should address both; answering only the cause question may not be enough (El-Amin).
- If treatment may be involved, collect the dates. List the medicine or surgery prescribed for the condition VA linked to service, the side effect, and the new diagnosis. Bring pharmacy records and dates when treatment started or stopped. A provider must explain the connection in your case; taking a medicine alone does not prove it.
- If weight gain may be involved, ask how it fits. Weight gain or obesity can be a step between the first condition and another diagnosed disability under VAOPGCPREC 1-2017. Obesity itself does not receive a VA disability rating.
- You do not need absolute certainty. VA uses the “at least as likely as not” standard and the reasonable-doubt rule under 38 CFR § 3.102. Ask a VA-accredited representative how the evidence applies to your claim.
- The same symptom cannot be counted twice. This is the rule against pyramiding in 38 CFR § 4.14. Mental-health diagnoses generally share one § 4.130 rating when they affect the same work and social abilities. Trouble sleeping may be a symptom rather than a separate disability.
- Check whether VA already assumes a link to service. Some conditions qualify based on where or when you served. These are called presumptive conditions. Examples can include chronic rhinitis, chronic sinusitis, hypertension after qualifying herbicide exposure, and type 2 diabetes. Sleep apnea (OSA) is not a PACT Act presumptive. Check eligibility before seeking a medical opinion about the link.
- An exam form and a medical opinion do different jobs. A Disability Benefits Questionnaire (DBQ) records the diagnosis and how severe it is. It may not explain why it is linked to service, often called a nexus. A VA-accredited veterans service organization (VSO) can help you file at no charge.
If another prescribed treatment may have caused a problem, ask your health care provider to record what happened and explain the connection in your case.
Sources: 38 CFR § 3.310 · 38 CFR § 4.14 · VA-accredited representatives
Other health problems to ask about
Use these notes to ask your provider about problems you already have. Your records must explain the connection. VA decides whether the condition is linked to service.
A nerve problem caused by a back condition may receive a separate rating if its effects are different from those already counted. The records must identify the nerve problem.
Each affected arm or leg may receive a separate rating when the records show its own nerve problem and effects.
Bladder or bowel problems may receive a separate rating when diagnosed, confirmed by medical findings, and linked to the spine. New loss of bladder or bowel control needs urgent medical attention.
Bring records showing a change in how you walk or put weight on a leg. A provider must explain whether the back condition caused the diagnosed hip or knee problem or made it worse.
Bring records of prescribed anti-inflammatory pain medicine (NSAID) for the back. A provider must explain any link to diagnosed GERD.
If you have been diagnosed with depression, ask your provider whether ongoing pain or limits on daily life caused it or made it worse.
Being less active and gaining weight do not prove a link to sleep apnea. A provider must explain the whole chain leading to diagnosed OSA in your case.
Bring records of prescribed opioid pain medicine. A provider must explain any link to diagnosed ED.
Choose the related health problems you want to discuss. Your preparation packet will include the notes you select and the full condition guides available for them.