Crisis?Call 988, press 1Text 838255Chat with the Veterans Crisis Line (opens in a new window)

Skip to content
Helping The Brave, because no brave fights alone
← All exam guidesClaim Navigator

Get ready for your exam

Back (lower or mid back)

Back (thoracolumbar spine: mid and low back)

What it is

Your back is the stack of bones from below your neck to your tailbone; VA rates it mostly by how far you can bend forward, the total of all your back motions, or (for a disc problem) how many weeks a doctor put you on bed rest.

Normal movement (what VA counts as normal)

  • Forward flexion0 to 90°
  • Extension (lean back)0 to 30°
  • Left lateral flexion (side bend)0 to 30°
  • Right lateral flexion0 to 30°
  • Left lateral rotation (twist)0 to 30°
  • Right lateral rotation0 to 30°
  • Combined (all six added)240°

VA's code numbers for this: 5235, 5236, 5237, 5238, 5239, 5240, 5241, 5242, 5243

What the examiner will do

  • The examiner asks how and when the problem started, what treatment you have had, and how it affects work and daily life.
  • They ask about flare-ups: how often, how long, what sets them off, and what you cannot do during one.
  • They measure how far you can move the joint yourself (active motion) with a goniometer. They should note where pain begins.
  • They move the joint for you (passive motion). They test it with weight on it and without weight on it. They compare it to your other side if that side is healthy. (Correia v. McDonald, 2016; 38 CFR 4.59.)
  • They have you repeat each motion at least 3 times, then measure again (repetitive-use testing).
  • They check strength, muscle loss (atrophy), tenderness, and whether the joint is stuck (ankylosis).
  • They look at X-rays or other imaging, or order them.
  • They ask about braces, canes, or other devices and how often you use them.
  • Nerve checks: reflexes, feeling (light touch), strength in the legs, and a straight-leg raise test for nerve pain.
  • Questions about disc problems and any bed rest a doctor prescribed in the past 12 months.
  • Questions about bowel or bladder problems tied to the spine.

The examiner fills out a form called a DBQ. You can read it ahead of time: Back (Thoracolumbar Spine) Conditions DBQ (updated 2024-12-20) (opens VA's site).

The rating levels, in plain words

VA rates most joints by how far they move. The less you can move, the higher the level.

Forward flexion (bend forward)

  • Up to 85°

    10%

    Can you bend forward more than 60 degrees but not more than 85 degrees (almost normal; fingertips near the knees or lower)? That is 10%.

    Rule: 38 CFR 4.71a, General Rating Formula for the Spine

  • Up to 60°

    20%

    Can bend forward more than 30 but not more than 60 degrees (about to your thighs): 20%.

    Rule: 38 CFR 4.71a, General Rating Formula

  • Up to 30°

    40%

    Can bend forward only 30 degrees or less (a small bow): 40%. Also 40% if the whole low/mid back is fused in a good (favorable) position.

    Rule: 38 CFR 4.71a, General Rating Formula

Combined range of motion

  • Total of 235° or less

    10%

    All six back motions added together are more than 120 but not more than 235 degrees: 10%.

    Rule: 38 CFR 4.71a, General Rating Formula, Note (2)

  • Total of 120° or less

    20%

    All six motions added together are 120 degrees or less: 20%.

    Rule: 38 CFR 4.71a, General Rating Formula

Spasm or tenderness

  • 10%

    Muscle spasm, guarding, or tender spots that do NOT change how you walk or the shape of your spine; or a vertebra fracture that lost 50% or more of its height: 10%.

    Rule: 38 CFR 4.71a, General Rating Formula

Spasm that changes how you walk

  • 20%

    Muscle spasm or guarding bad enough to cause an abnormal walk or an abnormal spine shape (for example scoliosis, a flat low back, or a hunch): 20%.

    Rule: 38 CFR 4.71a, General Rating Formula

Ankylosis

  • 50%

    Whole thoracolumbar spine fused in a bad (unfavorable) position: 50%.

    Rule: 38 CFR 4.71a, General Rating Formula, Note (5)

  • 100%

    Entire spine (neck and back) fused in an unfavorable position: 100%.

    Rule: 38 CFR 4.71a, General Rating Formula

IVDS incapacitating episodes

  • 10%

    Disc problem (DC 5243) with doctor-prescribed bed rest AND doctor treatment totaling at least 1 week but less than 2 weeks in the past 12 months: 10%.

    Rule: 38 CFR 4.71a, IVDS Formula, Note (1)

  • 20%

    At least 2 but less than 4 weeks in 12 months: 20%.

    Rule: 38 CFR 4.71a, IVDS Formula

  • 40%

    At least 4 but less than 6 weeks in 12 months: 40%.

    Rule: 38 CFR 4.71a, IVDS Formula

  • 60%

    At least 6 weeks in 12 months: 60%.

    Rule: 38 CFR 4.71a, IVDS Formula

Measured at home? Check which level your number falls in.

Measure it at home

With a helper and a cheap tool. Your home numbers help you describe your bad days honestly at the exam.

The tool to get

  • Best: a clear plastic goniometer (say GO-nee-OM-eh-ter). It looks like a protractor with two long arms joined by a pin. A 12-inch, 360-degree one costs about $5 to $10 online or at a medical supply store. This is the same kind of tool most examiners use.

  • Free: a phone goniometer or inclinometer (angle-measuring) app. Many are free. Tape or hold the phone flat along the body part, set it to zero at the start, then move.

  • No money and no phone: print a paper protractor (half circle, 0 to 180 degrees) on stiff paper. Tape two straws or paper strips to the center with a brad so they swing. Lay it against the joint.

  • A pen and the log sheet below. A second person (spouse, adult child, friend) to hold the tool, because you cannot measure yourself well.

  • For the back, a phone inclinometer app works well. Home numbers are rough. Examiners round each motion to the nearest 5 degrees (Note 4).

No tool yet? Print our paper protractor below.

Step by step, with a helper

  1. 1. Forward flexion

    How to stand or lie
    Stand straight, feet hip-width, knees straight. Bend forward slowly as if to touch your toes.
    Where the tool goes
    Goniometer: pin at your side at belt level (about the top of the hip bone). Fixed arm points straight up and down (like a plumb line). Moving arm runs up your side toward your armpit. Phone: helper holds the phone flat against your upper back just below the neck, sets it to zero standing, and reads it when you say 'pain' and when you stop.
    Who holds what
    Helper watches that your knees stay straight and calls out the number at 'pain' and at stop. Stand close in case you lose balance.

  2. 2. Extension (lean back)

    How to stand or lie
    Stand straight. Put your hands on your low back. Lean back slowly.
    Where the tool goes
    Same goniometer placement as forward flexion, reading the other way.
    Who holds what
    Helper stands behind you for safety and reads the number.

  3. 3. Side bend (left and right)

    How to stand or lie
    Stand straight. Slide one hand down the side of your leg. Do not twist or lean forward.
    Where the tool goes
    Pin over the center of your low back at belt level. Fixed arm straight up and down. Moving arm points up your spine toward the bump at the base of your neck.
    Who holds what
    Helper stands behind you and reads each side.

  4. 4. Twist (left and right)

    How to stand or lie
    Sit on a hard chair so your hips cannot turn. Cross your arms over your chest. Turn your shoulders.
    Where the tool goes
    Helper stands above and behind you, looking down. Pin over the top of your head. Fixed arm lines up with the chair back (or across the hips). Moving arm lines up across your shoulders.
    Who holds what
    Helper reads each side. Do not let your hips turn.

  5. 5. Add it up

    How to stand or lie
    After all six motions, add them.
    Where the tool goes
    Example: forward 70 + back 20 + left bend 20 + right bend 20 + left twist 20 + right twist 20 = 170. 170 is more than 120 and not more than 235, and forward bend is more than 60, so this is about the 10% level. (Each motion counts only up to its normal number.)
    Who holds what
    Helper does the math on the log sheet.

Stop at the first real pain. Never force a joint to get a number. Stand close for balance during back and hip tests.

Check your number

1. Which motion did you measure?

Type the number where you had to stop.

degrees

Type your number above to see where it falls.

This is only to help you understand. The VA examiner measures and the VA decides.

The levels for forward flexion (bend forward):

  • 0° to 30°40%
  • 31° to 60°20%
  • 61° to 85°10%

If your number is close to the next level, VA may give the higher one (38 CFR 4.7).

Your log: what to write each time

  1. DateExample: 10/12
  2. TimeExample: 7 pm
  3. Good day or flare-up day?Example: Flare-up day
  4. Body part and side (R/L)Example: Low back
  5. MotionExample: Bend forward
  6. Degrees where pain STARTSExample: 40
  7. Degrees where you had to STOPExample: 55
  8. After 3 tries: degrees where you stopExample: 45
  9. Pain 0-10Example: 7
  10. Medicine taken today (what and when)Example: Ibuprofen 8 am
  11. Who measuredExample: Spouse
  12. Notes (clicking, giving way, swelling)Example: Hurt more after the 3rd try

Write it down (one line per try):

Measure on a normal day and again on a bad day. Do it 2 or 3 times over a few weeks. Bring the sheet to the exam.

For a disc problem, also keep: date bed rest started, date it ended, doctor who ordered it, and a copy of the note.

Tap Print this page to get a blank log sheet and your exam-day checklist on paper.

Printable paper protractor

01801516530150451356012075105909010575120601354515030165151800Center: push a brad through this dot
  • Print at 100% scale; check the 90° line with a square corner (like the corner of a sheet of paper).
  • Glue it to stiff paper or a cereal box. Push a brad through the center dot.
  • Tape two paper strips or straws to the brad so they swing. One stays on the body part that doesn't move. The other follows the moving part.
  • The top numbers count from the left. The small numbers count from the right. Use whichever side starts at 0.

This is only to help you understand. The VA examiner measures and the VA decides.

Exam-day checklist

Tick each one off. Nothing you tick is saved or sent anywhere.

Tell the examiner

Flare-ups

A flare-up is a time when your joint gets much worse for a while. The examiner must ask about your flare-ups and estimate, in degrees, how much motion you lose during them, even if your exam is on a good day (Sharp v. Shulkin, 2017). They can only skip this if they explain why after getting your information. Be ready to say: how often (for example, 2 times a week), how long each lasts (for example, 1 to 2 days), what triggers it, and exactly what you cannot do (for example, 'I can't lift my arm to comb my hair'). If you measured at home on a flare-up day, show that number.

Repeated use

The examiner will have you do each motion at least 3 times and then measure again. Tell them if pain, weakness, tiredness, or poor control gets worse with each try. The form also asks about repeated use over time, like at the end of a workday. Pain alone does not raise a rating; pain that actually limits how far, how strong, or how long you can move does (Mitchell v. Shinseki, 2011; DeLuca v. Brown, 1995; 38 CFR 4.40 and 4.45).

Honest exam rules

  • Move each joint until pain starts. Say 'pain starts here' out loud. Stop when pain or stiffness stops you. Do not push through sharp pain to look tough. Do not stop before pain or stiffness really stops you, either. The examiner writes down both points.
  • Give your real, full effort on strength tests. The goal is an exam that shows how you truly are.
  • Describe a typical day AND your worst days. Bad days count, but say they are bad days and how often they happen.
  • Take your medicine the way you normally do. Do not skip it, and do not take extra just for the exam. Tell the examiner what you took and when, and how you are when it wears off. (Court decisions Jones v. Shinseki (2012) and Ingram v. Collins (2025) say VA should not lower a joint rating because medicine helps, when the rating rules do not mention medicine. VA tried to change this by rule in February 2026 and took the change back on February 27, 2026.)
  • Wear or bring any brace, cane, crutches, or walker you normally use. Bring the prescription or a record showing a provider ordered it.
  • Bring a one-page list: your diagnoses, surgeries, treatments tried, medicines, how often you have flare-ups, your home measurement log, and what you can no longer do at work and at home.
  • If you do not know or do not remember, say so. Do not guess.
  • Fraud warning: knowingly giving VA false information is a federal crime (18 U.S.C. 1001) and can cost you all VA benefits (38 U.S.C. 6103). Honest, complete reporting is all you need.

Common mistakes

  • Pushing through pain so the examiner only writes down your end point. Painful motion is a key factor, and the exam should record where pain starts.

    Where this comes from: 38 CFR 4.59; Burton v. Shinseki, 25 Vet. App. 1 (2011); Mitchell v. Shinseki, 25 Vet. App. 32 (2011)

  • Saying 'I'm fine' or only describing a good day. Flare-ups that are not described cannot be estimated.

    Where this comes from: Sharp v. Shulkin, 29 Vet. App. 26 (2017); DBQ flare-up section

  • An exam that skipped passive motion, weight-bearing testing, or the opposite joint. That exam may be inadequate; you or your representative can point this out.

    Where this comes from: Correia v. McDonald, 28 Vet. App. 158 (2016)

  • Not asking for at least the minimum rating when the joint is actually painful, unstable, or out of line from an old injury.

    Where this comes from: 38 CFR 4.59; Petitti v. McDonald, 27 Vet. App. 415 (2015)

  • Not mentioning pain, numbness, or tingling that runs down a leg (or arm). Nerve problems from the spine are rated SEPARATELY from the back.

    Where this comes from: 38 CFR 4.71a General Rating Formula, Note (1); spine DBQ Section VIII (Radiculopathy)

  • Counting days you stayed in bed on your own. For the disc (IVDS) formula, only bed rest PRESCRIBED by a physician, with physician treatment, counts. Keep the doctor's note.

    Where this comes from: 38 CFR 4.71a, IVDS Formula Note (1)

  • Bending from the hips or knees to get lower. The examiner measures the spine. Stand straight, knees straight, and bend only as the back allows.

    Where this comes from: 38 CFR 4.71a, Plate V; spine DBQ

  • Not asking for the method that pays more. For a disc problem, VA must rate under BOTH the general spine formula and the bed-rest formula and use whichever is higher.

    Where this comes from: 38 CFR 4.71a, DC 5243

Questions to ask together

A spouse, grown child or friend can read these out loud. Talk about each one before the exam, so nothing gets left out.

  1. Can you put on your socks and shoes without help?
  2. Can you pick something up off the floor without bending your knees?
  3. How long can you sit in a car before you have to get out and stretch?
  4. Does pain or numbness go down either leg? How far down?
  5. In the last year, did a doctor tell you to stay in bed? For how many days total?

Sources

Checked against VA's rules on October 30, 2026.

Helping The Brave doesn't file or prepare claims. This guide is free education, not medical or legal advice. The VA examiner measures and VA decides your rating.