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Lumbar Strain (Low Back Pain)

Pain and limited motion in the lower back. The VA rates spine conditions based on how far you can bend and whether you have muscle spasm or abnormal posture, using the General Rating Formula for Diseases and Injuries of the Spine.

Code: 5237
Criteria: 38 CFR 4.71a, DC 5237 — General Rating Formula for Diseases and Injuries of the Spine
Exam length: ~30-45 minutes
Form: Spine DBQ (Thoracolumbar)

Rating steps

0%
10%
20%
40%
50%
100%

The percentages this diagnostic code can be rated at. Which one applies depends on the findings — no tool here can tell you in advance.

What happens at the appointment

The examiner will measure how far you can bend forward, backward, and side to side using a device called a goniometer.
You will be asked to bend and move your back in several directions. The examiner records exactly how many degrees you can move.
You will be asked to repeat the movements to check for pain, weakness, and fatigue on repeated use.
The examiner will test your reflexes, sensation, and strength in your legs to check for nerve involvement.
You will be asked about flare-ups — when your back gets significantly worse than its baseline.

What the examiner is actually filling in

01Forward flexion range of motion in degrees (this is the most important number for your rating).
02Combined range of motion (all six directions added together).
03Pain, weakness, fatigue, and incoordination on repeated use (DeLuca factors).
04Muscle spasm, guarding, and whether it causes abnormal gait or spinal contour.
05Neurological signs: reflexes, sensation, and strength in the lower extremities.
06Estimated additional range of motion loss during flare-ups.

Rated under 38 CFR 4.71a, DC 5237 — General Rating Formula for Diseases and Injuries of the Spine. The examiner records findings on the DBQ; a rating specialist makes the decision.

A complete answer sounds like

Stop bending when the pain starts, not when you absolutely cannot move any further. Pain onset is what matters.
Tell the examiner exactly where it hurts and what the pain feels like (sharp, burning, aching, shooting).
If you have a bad back day, that is actually a reasonable time to go to the exam — it shows your actual impairment.
Mention if repeated bending makes it worse. The examiner should test this, but remind them if they do not.
If you have pain or numbness going down your legs, make sure to say so — it affects your exam and may support a separate rating.

What costs veterans points

Taking extra pain medication before the exam, which masks your true range of motion.
Trying to push through pain during range of motion testing — stop when it hurts and say so.
Not telling the examiner about flare-ups and how much worse your range of motion gets during them.
Forgetting to mention radiating pain down your legs (radiculopathy) — this is a separate rating.
Not reporting the DeLuca factors: pain on motion, weakness, fatigue, and incoordination with repeated use.

The rating criteria, in plain language

Rating levels for Lumbar Strain (Low Back Pain) under 38 CFR 4.71a, DC 5237 — General Rating Formula for Diseases and Injuries of the Spine
Rating	Rating criteria	What that means for you
0%	§ 4.31 Zero percent evaluations. In every instance where the schedule does not provide a zero percent evaluation for a diagnostic code, a zero percent evaluation shall be assigned when the requirements for a compensable evaluation are not met.	The lumbar strain is diagnosed and service connected, but forward flexion and combined range of motion fall inside the normal ranges the General Rating Formula sets, and there is no muscle spasm, guarding, or localized tenderness. A zero percent rating pays nothing now, but it establishes service connection and fixes the effective date any later increase runs from.
0%	What supports this level Diagnosis of lumbar strain in the treatment record Forward flexion and combined range of motion measured and recorded, even when normal Examination finding no muscle spasm, guarding, or localized tenderness Range of motion re-measured during a flare-up, which is when it is most likely to be compensable
10%	Forward flexion of the thoracolumbar spine greater than 60 degrees but not greater than 85 degrees; or, combined range of motion of the thoracolumbar spine greater than 120 degrees but not greater than 235 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.	Your forward flexion is greater than 60 degrees but not greater than 85 degrees, or your combined range of motion is greater than 120 degrees but not greater than 235 degrees, or you have muscle spasm or guarding that does not result in abnormal gait or spinal contour.
10%	What supports this level Forward flexion 61-85 degrees Combined range of motion 121-235 degrees Muscle spasm or guarding without abnormal gait Localized tenderness on examination
20%	Forward flexion of the thoracolumbar spine greater than 30 degrees but not greater than 60 degrees; or, the combined range of motion of the thoracolumbar spine not greater than 120 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.	Your forward flexion is greater than 30 degrees but not greater than 60 degrees, or your combined range of motion is 120 degrees or less, or you have muscle spasm severe enough to cause abnormal gait or abnormal spinal contour.
20%	What supports this level Forward flexion 31-60 degrees Combined range of motion 120 degrees or less Muscle spasm causing abnormal gait or spinal contour Scoliosis, reversed lordosis, or abnormal kyphosis observed
40%	Forward flexion of the thoracolumbar spine 30 degrees or less; or, favorable ankylosis of the entire thoracolumbar spine.	Your forward flexion is 30 degrees or less, or you have favorable ankylosis (fused spine in a functional position) of your entire thoracolumbar spine.
40%	What supports this level Forward flexion 30 degrees or less Favorable ankylosis of entire thoracolumbar spine Significant functional limitation documented
50%	Unfavorable ankylosis of the entire thoracolumbar spine.	You have unfavorable ankylosis of your entire thoracolumbar spine (fused in a non-functional position).
50%	What supports this level Unfavorable ankylosis of entire thoracolumbar spine Spine fixed in flexion or extension Difficulty looking straight ahead or maintaining upright posture
100%	Unfavorable ankylosis of the entire spine.	You have unfavorable ankylosis of your entire spine (cervical and thoracolumbar).
100%	What supports this level Unfavorable ankylosis of the entire spine Complete fixation of both cervical and thoracolumbar segments

The middle column is our transcription of the criteria at 38 CFR 4.71a, DC 5237 — General Rating Formula for Diseases and Injuries of the Spine, condensed for reading. Read the section itself on eCFR before relying on the exact wording. The items under each level are the kinds of evidence that document it — not a VA checklist, and not a prediction of which level applies to you.

Mistakes we see most often

Not reporting pain and limitations on your worst days — the VA measures range of motion at the exam, but you should document flare-ups.

Forgetting to mention radiculopathy (shooting pain, numbness, or tingling down the legs) — this is rated separately under neurological codes.

Not filing for secondary conditions: hip problems, opposite knee issues from altered gait, bladder dysfunction.

Missing DeLuca factors: pain on motion, weakened movement, excess fatigability, and incoordination can support a higher rating even if range of motion numbers are borderline.

Before & after your exam

These apply to every C&P exam, whatever the condition.

Do not miss the appointment: Missing your C&P exam without a good reason can cost you. Under 38 CFR § 3.655, a missed exam can cause a claim for an increased rating or a reopened claim to be denied, and can cause an original claim to be decided on the evidence already in your file. If you cannot make it, call the VA or the exam company right away to reschedule — a documented good reason (illness, work conflict, no transportation, a family emergency) protects your claim.
Your examiner may be a contractor: Many C&P exams are performed by VA-contracted companies — QTC, Optum Serve (LHI), VES, or MSLA — not at a VA hospital. They will call, text, or mail you to schedule. Do not ignore an unknown number or letter while your claim is pending, and confirm the exam location and time before you go.
The examiner does not decide your claim: The examiner's job is to record findings on the Disability Benefits Questionnaire (DBQ). A rating specialist at the Regional Office makes the actual decision, using the exam together with your full record — service records, medical records, and lay statements. One appointment does not settle everything.
Get a copy of your exam report: After the exam you can request the report (often called the DBQ or C&P exam results) through VA.gov, the Blue Button tool, or your accredited representative. Reading it lets you catch errors while you still have time to respond.
If the exam was inadequate, you have options: If the examiner rushed you, evaluated the wrong condition, or the report is inaccurate, you can submit a statement and new evidence, and — after a decision — request a review (a Supplemental Claim or Higher-Level Review). A single bad exam is not the end of your claim.

View condition guide →View evidence checklist →

Folder readiness

Tick these off as you gather them. Nothing here is required — the exam happens either way — but each one is something the examiner cannot record if it is not in front of them.

Saved in this browser only.

Take it with you

Print the whole guide — what the examiner records, the folder list with your ticks, the criteria table and the mistakes to avoid — and bring it to the appointment.

Frequently paired

Documented secondary or co-occurring conditions. Each is examined separately and has its own guide.

Free tool · 282 guides · DBQ-aligned

C&P Exam Preparation Guides

The VA orders this exam to verify your diagnosis and measure how severe it is right now. It can shape your rating and your monthly compensation — but it does not decide your claim. A rating specialist weighs it against your full record, and if the exam does not reflect your condition, you can say so and ask the VA to correct it.

Source forms
Coverage

Lumbar Strain (Low Back Pain)

Rating steps

What happens at the appointment

What the examiner is actually filling in

A complete answer sounds like

What costs veterans points

The rating criteria, in plain language

What supports this level

What supports this level

What supports this level

What supports this level

What supports this level

What supports this level

Mistakes we see most often

Before & after your exam

Lumbar Strain (Low Back Pain)

Rating steps

What happens at the appointment

What the examiner is actually filling in

A complete answer sounds like

What costs veterans points

The rating criteria, in plain language

What supports this level

What supports this level

What supports this level

What supports this level

What supports this level

What supports this level

Mistakes we see most often

Before & after your exam