VA Disability Claim Guide: Musculoskeletal System (Back, Joints, Extremities)

A Special Report from American Heroes Medical Services

Overview: Musculoskeletal conditions (back pain, knee issues, arthritis, etc.) are some of the most common service-connected disabilities. Their ratings are complex, based almost entirely on the physical limitation of the affected joint, measured by Range of Motion (ROM).

VA ratings for joints (spine, shoulder, knee, ankle, etc.) are determined by objective measurement. Your rating depends on how far your joint can move, measured in degrees, before movement becomes painful or impossible.

• Spine / Back (Lumbar Spine)
  Rating criteria focus: Limited flexion (bending forward)
  Example rating:
  40% disability rating if forward flexion is limited to 30 degrees or less
• Knee / Elbow
  Rating criteria focus: Flexion (bending) and extension (straightening)
  Example rating:
  20% disability rating if flexion is limited between 10 degrees and 20 degrees
• Shoulder
  Rating criteria focus: Abduction (raising the arm out from the side)
  Example rating:
  20% disability rating if the arm can only be raised to 45 degrees

The Critical "Limitation" Factors:

A C&P examiner must consider four factors that justify a higher rating beyond the initial ROM measurement:

1. Painful Motion: If movement causes pain, the VA must grant the minimum compensable rating for that joint, even if the measured ROM is normal.
2. Decreased Strength: Loss of muscle strength.
3. Incoordination: Difficulty controlling the movement of the limb.
4. Guard/Spasm: Involuntary muscle guarding or spasm that prevents further movement.

Many spine and joint claims result in radiculopathy, which is nerve damage leading to pain, numbness, tingling, or weakness in the arms or legs.

• Separate Rating: Radiculopathy is rated separately from the underlying back/spine condition based on the severity of sensory and motor loss (e.g., slight numbness vs. complete paralysis).
• Documentation is Key: If you feel pain, numbness, or tingling traveling down your limbs, ensure your physician records it, as this can lead to a second, separate rating.

1. The "Greyhound Rule": At your C&P exam, demonstrate the ROM you experience on your worst days, not just your average or best day. Never push past the point of pain or limitation.
2. Detailed Pain Description: Document not just where the pain is, but when it occurs (on first movement, after 10 minutes, when lifting), and how it limits your daily activities (e.g., "I cannot bend over to tie my shoes," or "I can't lift my grandchild").
3. Chronic Treatment: Ensure your medical records show continuous treatment for the condition over time (physical therapy, chiropractic, injections, etc.) to prove it is chronic and persistent.

Ensure your C&P exam captures the full extent of your functional loss. Contact American Heroes Medical Services for assistance!