Veterans with back pain caused by their time in the service can face a lot of confusing forms as they apply for VA disability.
Researchers estimate that around 80% of the U.S. population will experience a back problem at least once in their lives.
Most of these conditions are linked to mechanical or non-organic issues, such as a fracture or inflammatory arthritis. Yet, for the more than 18 million veterans in the country, back pain often stems from their time in active duty.
If you’re suffering from a back or thoracolumbar spine condition that you believe to be service-connected, let’s see if you qualify for compensation from the U.S. Department of Veterans Affairs (VA). Part of the application process is completing the Disability Benefits Questionnaire.
Today, we’re explaining how to access and complete this questionnaire to ensure you don’t miss out on the benefits you deserve.
In this article about VA ratings for thoracolumbar spine injuries:
- How Does the VA Rate a Thoracolumbar Spine Condition?
- What is the VA Disability Benefits Questionnaire?
- Recent Changes to DBQ Public Accessibility
- Navigating the Different Versions of Form VBA-21-0960M-14
- December 2017 Version vs. Earlier Versions
- Medical Record Review Section
- Initial ROM Measurement
- Pain and Muscle Spasms
- Muscle Strength Testing
- Reflex and Sensory Exams
- Find Help With Your DBQ Today
How Does the VA Rate a Thoracolumbar Spine Condition?
Before we dive into how to find the forms you need, let’s briefly review the VA disability ratings you’ll need to understand.
Conditions of the back and spine can be difficult to rate, as a single injury to any muscle, tendon, joint, ligament or bone in this region can trigger complex health issues including nerve conditions. To simplify the rating system, the VA Schedule for Rating Disabilities (VASRD) follows a General Ratings Formula that applies to most physical conditions that are directly spine-related. This includes those that affect the cervical spine and the thoracolumbar spine.
Associated conditions rated separately from the General Ratings Formula include:
- Arthritis of the spine
- Musculoskeletal diseases
- Conditions affecting the coccyx bone
- Intervertebral disc syndrome
- Conditions affecting the sacroiliac and lumbosacral joints
Under the General Ratings Formula, the following conditions are coded and classified according to VA standards:
- Lumbosacral or cervical strain (5237): Can cause neck or back pain
- Spinal stenosis (5238): Can cause pressure on the spinal cord and surrounding nerves
- Spondylolisthesis or segmental instability (5239): Can cause back pain, numbness, and weakness in legs
- Ankylosing spondylitis (5240): Form of spinal arthritis that can cause severe, chronic pain
- Spinal fusion (5241): Type of spinal surgery that fuses vertebrae together
- Vertebral fracture or dislocation (5242): Caused when a vertebra is compressed or displaced
Understanding the General Rating Formula
Under the codes above, the VA will rate each spinal condition based primarily on one key factor: your Range of Motion (ROM) measurement.
The VA rates conditions affecting the cervical spine, or neck, separately from the way it rates those that affect the thoracolumbar spine or lower back. For all conditions, “flexion” refers to the spine’s ability to comfortably bend.
Cervical Spine Formulas
The VA rates cervical spine formulas by the following scale:
- 0% Rating: Flexion of at least 45 degrees or combined ROM of at least 340 degrees
- 10% Rating: Flexion of 30 to 45 degrees, or combined ROM of 175 to 340 degrees
- 20% Rating: Flexion of 15 to 35 degrees, or combined ROM of no more than 170 degrees
- 30% Rating: Flexion of no more than 15 degrees, or entire cervical spine frozen in a favorable position
- 40% Rating: Entire cervical spine frozen in an unfavorable position
- 50% Rating: Not applicable to cervical spine conditions
- 100% Rating: Entire spine frozen in an unfavorable position
Thoracolumbar Spine Formulas
The VA rates thoracolumbar spine formulas by the following scale:
- 0% Rating: Flexion of at least 90 degrees, or combined ROM of at least 240 degrees
- 10% Rating: Flexion of 60 to 90 degrees, or combined ROM of 125 to 240 degrees
- 20% Rating: Flexion of 30 to 65 degrees, or combined ROM of no more than 120 degrees
- 30% Rating: Not applicable to thoracolumbar spine conditions
- 40% Rating: Flexion of no more than 30 degrees, or entire thoracolumbar spine frozen in a favorable position
- 50% Rating: Entire thoracolumbar spine frozen in an unfavorable position
- 100% Rating: Entire spine frozen in an unfavorable position
Regardless of where your injury falls on these scales, you could qualify to receive disability compensation from the VA. This includes back-pay and a monthly tax free check for more than $3000 depending on your rating and household situation.
What is the VA Disability Benefits Questionnaire?
Due to the complexity of the above rating system, the VA has prepared a list of questions that can help the agency more accurately classify each veteran’s service-related condition to ensure they receive the benefits they’re due. This form’s official title is VBA-21-0960M-14.
This form is an example of a Disability Benefits Questionnaire (DBQ) issued by the VA. This is an important document that can help determine the outcome of your claim.
The VA issues DBQs for a range of conditions. For instance, you can find VA DBQ thyroid forms, as well as VA DBQ knee forms, and many others. Moving forward, it’s important to understand how a DBQ works, and how recent changes have affected it.
Recent Changes to DBQ Public Accessibility
In general, DBQs are designed to help the VA capture the appropriate medical information they need. These questionnaires were meant to model and follow the rating codes associated with each condition.
Beginning in 2010, these forms were publically accessible, available for download on the VA website.
When this was the case, a veteran could visit either his or her private physician (or a VA treating physician) and request that they complete the forms. This was advantageous, as it allowed veterans to choose their own providers. Often, this meant visiting a doctor who specialized in a specific field of medicine or was familiar with the veteran’s medical history.
Once the physician completed the form, the veteran could submit it as medical evidence when applying for disability benefits or issuing an appeal. This helped to greatly expedite the process by eliminating the need to wait for a VA-issued medical exam, a benefit that was especially helpful for veterans living overseas.
Recently, the VA significantly altered the way that DBQs look and operate. In turn, this affected the role that these forms play in future disability claims.
In the wake of VA medical clinic closures due to the COVID-19 pandemic, the VA has removed public access to DBQ forms, removing the page from its website. This change took place on April 2, 2020.
Navigating the Different Versions of Form VBA-21-0960M-14
As mentioned, veterans who wish to file a service-connected disability claim to receive medical benefits specifically for a spine-related condition will require access to Form VBA-21-0960M-14.
Although the most recent version of this form is no longer accessible via the VA DBQ forms download function, it is used by physicians around the globe. In fact, the VA explains that it discontinued public access because it is confident in its network of contracted doctors that fill out DBQ forms, a collection of physicians that spans more than 30 foreign countries.
December 2017 Version vs. Earlier Versions
The most recent version of Form VBA-21-0960M-14 is dated December 2017, with an expiration date (located in the top right corner) of December 31, 2020. Prior to the release of this version, the most recent iteration of Form VBA-21-0960M-14 was the May 2013 version, which expired on April 30, 2017. Before that, physicians used the December 2010 version.
While you might feel inclined to always work off the most recent version, keep in mind that many physicians still use the 2013 version. While most veterans will benefit from accessing the 2017 version, this isn’t always the case. The specific version you need will depend on your specific symptoms and your particular back conditions.
To help you understand which form to request, let’s take a look at a few of the major differences between the versions.
Medical Record Review Section
The December 2017 version of Form VBA-21-0960M-14 begins with a Medical Record Review, immediately following the patient’s identification information (name and Social Security Number).
In this space, physicians can ascertain whether the patient’s VA Claims File was reviewed. They can also check which specific records they reviewed, including, among others:
- Service treatment records
- Personnel records
- Your enlistment examination
- All military separation examinations
While the Medical Record Review is included in the May 2013 version of the form, it is not on earlier forms from 2010.
Diagnosis Section of the Form
In the most recent version, physicians are requested to list the claimed conditions that relate to the DBQ (Section 1A). Then, in Section 1B, they can check all of the conditions that the patient is actually diagnosed with, choosing from 13 different conditions, including an “Other” category.
If working from the 2010 version, physicians will note that this checklist is absent. In its place, there are fields to list three individual diagnoses, along with corresponding ICD codes and dates (Sections 1A and 1B).
Medical History is On All of the Forms
All forms have a Section II: Medical History. Yet, the level of detail required in the 2017 version and above is vastly more substantial than is available in earlier versions.
The 2010 version of Form VBA-21-0960M-14 only includes a narrative field for physicians to describe the patient’s medical history, along with the same type of field in Section III: Flare-Ups.
More recent versions of the form incorporate flare-ups into the patient’s medical history along with functional loss or functional impairment. Thus, Section II allows for a more detailed explanation of how long the patient has suffered from the back condition as well as how frequently they experience pain and any functional loss experienced.
Here are some tips on your C&P exam from one of our VA disability lawyers.
Initial ROM Measurement
All forms base repetitive use testing on three repetitions.
Yet, recent versions allow physicians to enter the specific ROM, with guidelines on normal endpoints for comparison (e.g. 90 degrees for forward flexion). In addition, this section (Section III in recent versions) also incorporates functional loss and additional limitations within Section III, both of which were formerly defined in a separate section (Section VI in outdated versions)
Conversely, outdated versions required physicians to select the ROM from a list of pre-defined checkboxes, ranging from 0 to “90 or greater” or “30 or greater”.
Pain and Muscle Spasms
Pain and Muscle Spasms are listed together as Section VII in outdated versions. In most recent DBQs, these have been broken into Section V (Pain) and Section VI (Muscle Spasms).
As expected, there is now room for physicians to go into greater detail while assessing these two categories. Formerly, physicians were only tasked with narratively describing the patient’s pain. Now, they have to identify specific ROM (Range of Motion) movements that cause pain, as well as differentiate between pain felt during weight-bearing versus non-weight-bearing exercises, as well as during palpitations.
The updated Guarding and Muscle Spasm section (Section VI in version 2017 and above) also clarifies any changes to the patient’s gait or spinal contour due to the condition.
Here one of our VA disability lawyers talks about one of the most important parts of a winning veteran’s disability claim: the nexus letter.
Muscle Strength Testing
The most recent Muscle Strength Testing section adds new categories, including knee flexion, foot abduction, and foot adduction. It also allows for custom rate strength entries and requires physicians to list the side and specific locations of all identified instances of muscle atrophy.
Ankylosis is a new section that was not included in a certain outdated version of this form. It is Section IX in the 2017 version. Here, physicians can indicate the severity of a patient’s ankylosis condition, classifying it as favorable or unfavorable and adding appropriate comments.
Reflex and Sensory Exams
All forms use the same rating scale for reflex exams, although recent versions allow doctors to enter specific numerical rates, rather than checkbox selections. Moreover, the outdated sensory exams only measured patients’ response to light touch, whereas newer versions incorporate additional sensory tests, including those that measure responses to:
- Position changes
In terms of radiculopathy, newer versions add a category for physicians to note the severity of the condition, as well as identify the presence of “dull pain”. These two sections were not included in previous versions.
New forms also allow patients to disclose their own objective findings due to radiculopathy if they did not feel that the exam adequately addressed them.
Here one of our VA compensation lawyers talks about the VA ratings for back pain and other back injuries.
Find Help With Your DBQ Today
If you suffer from a service-related form of back pain, you don’t have to endure the discomfort. You could qualify to receive VA benefits to help you find the relief you deserve.
As you’re completing the paperwork for your claim, a Disability Benefits Questionnaire (DBQ) can help. If you’re not sure how to navigate this next step, let us know. We’re well-versed in the VA claims process and can help set you on the right track. (And we have copies of all of these forms!)
Our team of lawyers will make sure you’re working with the correct forms and will help guide you, every step of the way. Contact us today to receive a free case evaluation and learn more about the services we provide.
Maybe, but it depends on your case and what you submitted originally. When you appeal, you have to have new evidence or show a way that the VA made a mistake. Typically, you are rated for the symptoms more than the diagnosis, so we’ll make sure we have the best case according to the condition you’re in, what you experienced in the service, and what the doctors connect together.
Yes, if he should have received VA disability when he was alive, you may be eligible for back pay. If he died from the disability that he got in the service, then you might be eligible for DIC payments also.