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5243
§ 4.71a Schedule of ratings—musculoskeletal system.

Intervertebral disc syndrome

A condition where a spinal disc bulges or ruptures, potentially compressing nearby nerves.

What the rating means

Intervertebral disc syndrome (diagnostic code 5243) applies only when there is disc herniation with compression or irritation of a nearby nerve root. VA rates this condition either under the General Rating Formula for Diseases and Injuries of the Spine or under the Formula for Rating Intervertebral Disc Syndrome Based on Incapacitating Episodes — whichever produces the higher combined rating under the rules for combining disabilities.

Under the General Rating Formula, ratings of 10%, 20%, 30%, 40%, 50%, or 100% are possible, based on how much forward flexion you have lost, whether your combined spinal range of motion is reduced, whether muscle spasm or guarding causes an abnormal gait or spinal contour, or whether the entire spine or a spinal segment is fused (ankylosis). Unfavorable ankylosis of the entire spine is rated 100%; unfavorable ankylosis of the entire thoracolumbar spine is 50%.

Under the Incapacitating Episodes Formula, ratings of 10%, 20%, 40%, or 60% depend on how many total weeks of incapacitating episodes — meaning acute flare-ups requiring physician-prescribed bed rest and physician treatment — occurred in the past 12 months. Any associated neurological problems, such as bowel or bladder impairment, are evaluated separately.

Evidence that helps

For the General Rating Formula, the most important records are spine examination findings that document how far you can bend forward and what your combined range of motion is. Range-of-motion measurements should be rounded to the nearest five degrees. Records showing muscle spasm, guarding, or an abnormal gait or spinal contour — such as scoliosis, reversed lordosis, or abnormal kyphosis — support higher ratings. Imaging and clinical notes confirming disc herniation with nerve root compression or irritation are needed to use this diagnostic code at all.

For the Incapacitating Episodes Formula, treatment records are central. You need documentation showing that a physician prescribed bed rest and provided treatment during each acute episode, along with the dates and duration of each episode so the total weeks within the past 12 months can be calculated. Physician notes, hospital or urgent-care records, and prescription records that establish both the bed-rest order and the treatment are the most direct evidence. Statements from you or people who live with you describing how episodes affect your ability to work or care for yourself can help fill in the picture, particularly when paired with those treatment records.

Secondary conditions

Conditions that are often caused or made worse by this one. If you have any of these, they may be claimable as secondary service connection.

  • All arm nerve groups paralysis
  • All nerve root inflammation (neuritis)
  • Ankle limited motion
  • GERD (acid reflux)
  • Knee instability or laxity
  • Lower arm nerve group paralysis
  • Lower nerve root inflammation (neuritis)
  • Lower spine nerve pain (neuralgia)
  • Major depressive disorder
  • Middle arm nerve group paralysis
  • Middle nerve root inflammation (neuritis)
  • Middle spine nerve pain (neuralgia)
  • Peptic ulcer disease
  • Peptic ulcer disease
  • Persistent depressive disorder (dysthymia)
  • Sciatic nerve pain (neuralgia)
  • Sciatic nerve paralysis
  • Thigh limited flexion
  • Upper arm nerve group paralysis
  • Upper nerve root inflammation (neuritis)
  • Upper spine nerve pain (neuralgia)
  • Widespread spine nerve pain (neuralgia)