Musculoskeletal system
VA rating for lumbosacral or cervical strain, diagnostic code 5237
One diagnostic code covers both the low back and the neck. Code 5237 takes its criteria from the General Rating Formula for Diseases and Injuries of the Spine, which governs codes 5235 through 5243, measures forward bending in degrees, and sets a different threshold for each region.
Published 2026-08-21. Last updated 2026-08-24. Written and reviewed under Veteran Health Network's institutional review process.
What each level requires
lumbosacral or cervical strain is rated under diagnostic code 5237, at 38 CFR 4.71a.
The criteria below are not written for this condition on its own. They come from the General Rating Formula for Diseases and Injuries of the Spine, which governs every code in this group. The diagnosis decides which formula applies. The formula decides what each level requires.
100 percent requires
In plain English
The entire spine is fixed in an unfavorable position.
As written in 38 CFR 4.71a
Unfavorable ankylosis of the entire spine
50 percent requires
In plain English
The whole thoracolumbar spine, meaning the mid and lower back, is fixed in an unfavorable position.
As written in 38 CFR 4.71a
Unfavorable ankylosis of the entire thoracolumbar spine
40 percent requires
In plain English
Any one of three findings: the entire cervical spine fixed in an unfavorable position, forward bending of the mid and lower back limited to 30 degrees or less, or the entire thoracolumbar spine fixed in a favorable position.
As written in 38 CFR 4.71a
Unfavorable ankylosis of the entire cervical spine; or, forward flexion of the thoracolumbar spine 30 degrees or less; or, favorable ankylosis of the entire thoracolumbar spine
30 percent requires
In plain English
Forward bending of the neck limited to 15 degrees or less, or the entire cervical spine fixed in a favorable position. This level is available for the neck only.
As written in 38 CFR 4.71a
Forward flexion of the cervical spine 15 degrees or less; or, favorable ankylosis of the entire cervical spine
20 percent requires
In plain English
Any one of five findings: forward bending of the mid and lower back between 30 and 60 degrees, forward bending of the neck between 15 and 30 degrees, combined range of motion of the mid and lower back of 120 degrees or less, combined range of motion of the neck of 170 degrees or less, or muscle spasm or guarding severe enough to produce an abnormal gait or an abnormal spinal contour such as scoliosis.
As written in 38 CFR 4.71a
Forward flexion of the thoracolumbar spine greater than 30 degrees but not greater than 60 degrees; or, forward flexion of the cervical spine greater than 15 degrees but not greater than 30 degrees; or, the combined range of motion of the thoracolumbar spine not greater than 120 degrees; or, the combined range of motion of the cervical spine not greater than 170 degrees; or, muscle spasm or guarding severe enough to result in an abnormal gait or abnormal spinal contour such as scoliosis, reversed lordosis, or abnormal kyphosis
10 percent requires
In plain English
Any one of five findings: forward bending of the mid and lower back between 60 and 85 degrees, forward bending of the neck between 30 and 40 degrees, combined range of motion of the mid and lower back between 120 and 235 degrees, combined range of motion of the neck between 170 and 335 degrees, or muscle spasm, guarding or localized tenderness that does not produce an abnormal gait or contour, or a vertebral body fracture with loss of half its height or more.
As written in 38 CFR 4.71a
Forward flexion of the thoracolumbar spine greater than 60 degrees but not greater than 85 degrees; or, forward flexion of the cervical spine greater than 30 degrees but not greater than 40 degrees; or, combined range of motion of the thoracolumbar spine greater than 120 degrees but not greater than 235 degrees; or, combined range of motion of the cervical spine greater than 170 degrees but not greater than 335 degrees; or, muscle spasm, guarding, or localized tenderness not resulting in abnormal gait or abnormal spinal contour; or, vertebral body fracture with loss of 50 percent or more of the height
Notes the schedule attaches to this code
These are part of the regulation and they change how the criteria above are applied. They are reproduced word for word.
- Note (1): Evaluate any associated objective neurologic abnormalities, including, but not limited to, bowel or bladder impairment, separately, under an appropriate diagnostic code.
- Note (2): (See also Plate V.) For VA compensation purposes, normal forward flexion of the cervical spine is zero to 45 degrees, extension is zero to 45 degrees, left and right lateral flexion are zero to 45 degrees, and left and right lateral rotation are zero to 80 degrees. Normal forward flexion of the thoracolumbar spine is zero to 90 degrees, extension is zero to 30 degrees, left and right lateral flexion are zero to 30 degrees, and left and right lateral rotation are zero to 30 degrees. The combined range of motion refers to the sum of the range of forward flexion, extension, left and right lateral flexion, and left and right rotation. The normal combined range of motion of the cervical spine is 340 degrees and of the thoracolumbar spine is 240 degrees. The normal ranges of motion for each component of spinal motion provided in this note are the maximum that can be used for calculation of the combined range of motion.
- Note (3): In exceptional cases, an examiner may state that because of age, body habitus, neurologic disease, or other factors not the result of disease or injury of the spine, the range of motion of the spine in a particular individual should be considered normal for that individual, even though it does not conform to the normal range of motion stated in Note (2). Provided that the examiner supplies an explanation, the examiner's assessment that the range of motion is normal for that individual will be accepted.
- Note (4): Round each range of motion measurement to the nearest five degrees.
- Note (5): For VA compensation purposes, unfavorable ankylosis is a condition in which the entire cervical spine, the entire thoracolumbar spine, or the entire spine is fixed in flexion or extension, and the ankylosis results in one or more of the following: difficulty walking because of a limited line of vision; restricted opening of the mouth and chewing; breathing limited to diaphragmatic respiration; gastrointestinal symptoms due to pressure of the costal margin on the abdomen; dyspnea or dysphagia; atlantoaxial or cervical subluxation or dislocation; or neurologic symptoms due to nerve root stretching. Fixation of a spinal segment in neutral position (zero degrees) always represents favorable ankylosis.
- Note (6): Separately evaluate disability of the thoracolumbar and cervical spine segments, except when there is unfavorable ankylosis of both segments, which will be rated as a single disability.
Regulation text reproduced from 38 CFR 4.71a, read on 2026-08-21. Read the section at the eCFR. Part 4 is amended on a rolling schedule, so the date above is the date this text was checked and not the date it was written.
Two regions, one ladder, different numbers
Derived from the regulation
The formula rates the thoracolumbar spine, meaning the mid and lower back, and the cervical spine, meaning the neck, from the same six levels. At most levels it states a separate threshold for each region.
At 20 percent, for example, the criterion asks for forward flexion of the thoracolumbar spine greater than 30 but not greater than 60 degrees, or forward flexion of the cervical spine greater than 15 but not greater than 30 degrees. Two different numbers, one evaluation.
The 30 percent level is the exception in the other direction: it is available for the neck only. The 50 percent level is available for the mid and lower back only. A reader comparing their own region against the wrong row will read the wrong number.
The formula also opens with a clause that is easy to skip. Before any percentage appears it states that it applies "With or without symptoms such as pain (whether or not it radiates), stiffness, or aching in the area of the spine affected by residuals of injury or disease". Pain is neither required by the formula nor disqualifying under it. The measurement is what the levels ask for.
Two of the formula's own notes then set the measuring conventions. Note (4) directs that each range of motion measurement be rounded to the nearest five degrees. Note (6) directs that the thoracolumbar and cervical segments be evaluated separately, except where both are unfavorably ankylosed.
The 2003 renumbering, and what it replaced
Derived from the regulation
Diagnostic code 5237 is newer than most people expect, and the codes it replaced are still quoted in older material.
Appendix A to Part 4 records the amendment history for code 5237 in one line: "Replaces 5285-5295 September 26, 2003."
The Federal Register line for 4.71a is one of the longest in Part 4, and it belongs to the section rather than to code 5237: 29 FR 6718, May 22, 1964, as amended at 34 FR 5062, Mar. 11, 1969; 40 FR 42536, Sept. 15, 1975; 41 FR 11294, Mar. 18, 1976; 43 FR 45350, Oct. 2, 1978; 51 FR 6411, Feb. 24, 1986; 61 FR 20439, May 7, 1996; 67 FR 48785, July 26, 2002; 67 FR 54349, Aug. 22, 2002; 68 FR 51456, Aug. 27, 2003; 69 FR 32450, June 10, 2004; 80 FR 42041, July 16, 2015; 85 FR 76460, Nov. 30, 2020, 85 FR 85523, Dec. 29, 2020, 86 FR 8142, Feb. 4, 2021. Both records were read on 2026-08-21 against the edition current at 2026-08-01.
What gets rated separately from the spine
Derived from the regulation
Note (1) to the formula is the one with the widest effect. It directs that any associated objective neurologic abnormality, including but not limited to bowel or bladder impairment, be evaluated separately under an appropriate diagnostic code.
That is what allows a nerve rating to sit alongside a spine rating rather than being folded into it. The nerve codes are in a different section, 38 CFR 4.124a.
The limit on it is 38 CFR 4.14: the neurologic abnormality has to be a distinct impairment, not the same impairment counted a second time.
See every level beside the regulation it comes from
The rating threshold cheatsheet shows all of the levels for lumbosacral or cervical strain in one view, plain English on the left and the regulation itself on the right, in a layout built to print.
It is free and it never says which level anyone meets. It describes what each one requires and leaves the reading to the person whose record it is.
Sources
- 38 CFR 4.71a, Schedule of ratings, musculoskeletal system (Electronic Code of Federal Regulations)
- 38 CFR 4.14, Avoidance of pyramiding (Electronic Code of Federal Regulations)
- Appendix A to Part 4, Table of Amendments and Effective Dates Since 1946 (Electronic Code of Federal Regulations)
Accuracy owner Brayden Marley. Part 4 is amended on a rolling schedule, so the retrieval date above is what this page is accurate as of.