Inside the exam room
1. You will be asked about your neck problem, treatment, and worse days. Explain trouble reading, driving, or looking up.
2. You will be asked to look down, look up, tilt to each side, and turn each way. The examiner measures each direction. Tell them about pain or a movement you cannot safely do.
3. The examiner may repeat movements if safe and check arm strength, reflexes, and feeling. Explain what changes after activity or on worse days. Point out symptoms in either arm or hand.
The examiner measures joint movement with a goniometer (angle-measuring tool).
How VA rates neck condition
The examiner measures looking down, looking up, tilting to each side, and turning to each side. VA can use the downward bend or all six added together. Looking up or tilting to one side alone does not set a rating. Use the neck rules below; the lower-back rules use different angles. Source: 38 CFR 4.71a (2025 edition) .
Neck (cervical) full movements listed in VA’s guide: bending the head forward (flexion), looking up (extension), and tilting the head to either side (lateral flexion) 0-45 degrees; each rotation 0-80 degrees. Six-direction total: 340 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 the head forward greater than 30 through 40 degrees; OR all six neck movements total greater than 170 through 335 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 the head forward greater than 15 through 30 degrees; OR all six neck movements total 170 degrees or less; OR muscle spasm or protective tightening severe enough to change how you walk or the shape of your spine. |
| 30% | Bending the head forward 15 degrees or less; OR the entire neck fixed in a position the clinician classifies as favorable ankylosis. |
| 40% | The entire neck 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 the head forward (forward flexion) greater than 30 degrees, through 40 degrees10%
- A clinician's records show combined neck (cervical) motion greater than 170 degrees, through 335 degrees10%
- A clinician's records show bending the head forward (forward flexion) greater than 15 degrees, through 30 degrees20%
- A clinician's records show combined neck (cervical) motion 170 degrees or less20%
- A clinician's records show bending the head forward (forward flexion) 15 degrees or less30%
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 bending down, looking up, and the total movement separately. A 30-degree downward bend matches the listed 20% neck rule; the lower-back rule uses 40% at that angle.
- Tell the examiner about symptoms in your arm or hand. A health care provider must check their cause; one symptom or checkbox does not decide a separate diagnosis or rating.
Questions the examiner may cover
- How do symptoms affect looking down, turning your head, desk work, or driving?
- What happens during flare-ups and after repeated use, compared with your usual function?
Questions to expect
What can you no longer do when looking down, up, sideways or turning?
Explain: Describe checking traffic, reading and overhead work, plus flare duration and changes after repeated use. The examiner records all six measurements.
Rating connection: Forward flexion or combined motion determines the movement pathway. A side tilt alone does not carry its own percentage.
Do symptoms travel into the arms or fingers?
Explain: Identify each side, the path, numbness, weakness, dropped objects and relevant treatment.
Rating connection: Nerve findings are assessed separately from neck movement; the nerve and loss of function determine the applicable rule.
Your answer outline
When I [task involving head movement], I notice [actual symptom]. After about [time or repetition], I [change or stop the task]. This occurs [frequency]. [What helps], and I can still [activity].
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.
- Describe frequency, duration, and effects on daily life in your own words. Do not infer a nerve diagnosis or headache relationship from a checkbox.
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 may receive a separate rating when its effects are different from those already counted. The records must identify the nerve problem. For a neck condition, describe symptoms in your arm or hand. Use the diagnosed nerve or nerve group in your records to choose the matching arm guide. A neck level on an imaging report alone does not identify the nerve rating.
Each affected arm may receive a separate rating when its own nerve problem and effects are shown in the records. For a neck condition, describe symptoms in your arm or hand. Use the diagnosed nerve or nerve group in your records to choose the matching arm guide. A neck level on an imaging report alone does not identify the nerve rating.
If a headache disorder is diagnosed, ask your provider to explain any connection.
Bring records showing how you hold or move your body differently to protect a painful area. Ask your provider whether that caused this problem or made it worse.
A provider needs to diagnose this problem separately and explain the connection.
Bring records of prescribed anti-inflammatory pain medicine (NSAID) for the neck. A provider must explain any link to diagnosed GERD.
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.