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Thoracic Spine Strain

Pain and limited motion in the middle and upper back caused by muscle strain or injury. The VA rates thoracic spine strain using the General Rating Formula for Diseases of the Spine, based on how much your forward bending and overall range of motion is limited.

Code: 5237
Criteria: 38 CFR 4.71a, DC 5237
Exam length: ~30 minutes
Form: Back (Thoracolumbar Spine) DBQ

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 your thoracolumbar spine range of motion in all planes: forward flexion (normal 90 degrees), extension (normal 30 degrees), left and right lateral flexion (normal 30 degrees each), and left and right rotation (normal 30 degrees each).
Repetitive use testing with at least three repetitions of forward bending will evaluate DeLuca factors — whether pain, weakness, fatigue, or incoordination causes additional functional loss.
The examiner will assess for muscle spasm, guarding, tenderness, and abnormal spinal contour in the thoracic region.
A neurological examination will test sensation and reflexes to rule out any radiculopathy or nerve involvement.
You will be asked about flare-ups, their triggers, frequency, and how much additional limitation of motion you experience during a flare compared to your baseline.

What the examiner is actually filling in

01Thoracolumbar range of motion in all planes measured in degrees — forward flexion is the primary determinant, with combined range of motion as the secondary measure.
02Whether muscle spasm or guarding is severe enough to result in abnormal gait or abnormal spinal contour (forward flexion of the thoracic spine, reversed lordosis, or abnormal kyphosis).
03Additional functional loss after repetitive use and during flare-ups, expressed in estimated degrees of lost range of motion per DeLuca criteria.
04Localized tenderness, muscle spasm, and whether guarding is present on one or both sides of the thoracic spine.
05Neurological findings including any intercostal neuralgia or thoracic radiculopathy causing pain along the rib cage distribution.

Rated under 38 CFR 4.71a, DC 5237. The examiner records findings on the DBQ; a rating specialist makes the decision.

A complete answer sounds like

During range of motion testing, focus on where the thoracic spine genuinely limits your motion — if forward flexion is painful at 60 degrees, stop there and tell the examiner.
If you have muscle spasms that you can feel knotting up in your mid-back, point to the exact location and describe how often they occur.
Describe how long you can sit before thoracic pain forces you to stand or change positions: "I have to get up every 20 minutes to stretch my mid-back" quantifies the impairment.
If thoracic strain causes headaches from muscle tension spreading up into the neck and base of the skull, report this secondary symptom.
Mention if the thoracic pain worsens with deep breathing, coughing, or sneezing — this is common with thoracic strain and adds to the functional limitation picture.

What costs veterans points

Not reporting thoracic pain because you think only lumbar conditions are significant — the thoracolumbar spine is rated as one unit and thoracic symptoms count.
Failing to mention that thoracic strain causes you to hunch forward or adopt a protective posture, which the examiner should observe and document.
Not describing how thoracic pain limits desk work, computer use, and sedentary occupations — many veterans assume back claims only matter for physical jobs.
Pushing through pain during forward flexion testing — stop at the point where pain genuinely limits further motion.
Forgetting to mention referred pain that wraps around the rib cage or into the chest wall, which is characteristic of thoracic spine problems.

The rating criteria, in plain language

Rating levels for Thoracic Spine Strain under 38 CFR 4.71a, DC 5237
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 thoracic spine 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. The lowest compensable rung on this ladder is 10 percent. 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 thoracic spine 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.	Your forward flexion of the thoracolumbar spine 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 not resulting in an abnormal gait.
10%	What supports this level Forward flexion of thoracolumbar spine 61-85 degrees Combined range of motion 121-235 degrees Muscle spasm or guarding documented Pain on motion of the thoracic spine
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 of the thoracolumbar spine is greater than 30 degrees but not greater than 60 degrees, or you have muscle spasm severe enough to cause an abnormal gait or abnormal spinal contour.
20%	What supports this level Forward flexion of thoracolumbar spine 31-60 degrees Combined range of motion 120 degrees or less Muscle spasm causing abnormal gait or spinal contour Imaging showing thoracic spine changes
40%	Forward flexion of the thoracolumbar spine 30 degrees or less; or, favorable ankylosis of the entire thoracolumbar spine.	Your forward flexion of the thoracolumbar spine is 30 degrees or less, or you have favorable ankylosis of the entire thoracolumbar spine.
40%	What supports this level Forward flexion of thoracolumbar spine 30 degrees or less Favorable ankylosis of entire thoracolumbar spine Severe limitation in all planes of motion Significant functional impairment
50%	Unfavorable ankylosis of the entire thoracolumbar spine.	You have unfavorable ankylosis of the entire thoracolumbar spine. Your thoracolumbar spine is fixed in an abnormal position.
50%	What supports this level Unfavorable ankylosis of entire thoracolumbar spine Spine fixed in abnormal position Total inability to bend the trunk Severe impact on daily activities
100%	Unfavorable ankylosis of the entire spine.	You have unfavorable ankylosis of the entire spine. Both your cervical and thoracolumbar spine are fixed in an abnormal position.
100%	What supports this level Unfavorable ankylosis of entire spine Entire spine fixed in abnormal position Total inability to move the spine Severe impact on all daily activities

The middle column is our transcription of the criteria at 38 CFR 4.71a, DC 5237, 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

The thoracic spine is rated together with the lumbar spine as "thoracolumbar" — you cannot receive separate ratings for thoracic and lumbar strain. However, if you also have cervical (neck) spine problems, that is rated separately.

Not reporting pain and limitations on your worst days — DeLuca factors (pain, weakness, fatigability, flare-ups) can support a higher rating even with borderline range of motion.

Not filing for radiculopathy separately — if thoracic nerve roots are compressed, causing pain that radiates around the trunk, this may warrant a separate neurological rating.

Not connecting thoracic spine problems to military activities — heavy lifting, rucking, parachute jumps, and vehicle vibration during service are common causes.

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.

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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.

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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

Thoracic Spine Strain

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

Thoracic Spine Strain

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