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5238
§ 4.71a Schedule of ratings—musculoskeletal system.

Spinal stenosis (narrowed spinal canal)

Narrowing of the spinal canal that may compress nerves and cause pain or numbness.

What the rating means

Spinal stenosis (diagnostic code 5238) is rated under the General Rating Formula for Diseases and Injuries of the Spine, which covers diagnostic codes 5235 through 5243. Ratings apply with or without symptoms such as pain, stiffness, or aching in the affected area of the spine.

The possible ratings are 10%, 20%, 30%, 40%, 50%, and 100%, based on how much motion you have lost in your cervical (neck) or thoracolumbar (mid and lower back) spine, or on the presence of ankylosis, which means the spine is fixed in place. The cervical and thoracolumbar spine segments are generally evaluated separately, except when there is unfavorable ankylosis of both, which is then rated as a single disability.

Unfavorable ankylosis means the spine is fixed in a position that causes serious functional problems such as difficulty walking, difficulty breathing, or neurologic symptoms. Fixation in a neutral position is always considered favorable ankylosis. Any associated neurologic problems, such as bowel or bladder impairment, are evaluated separately under their own diagnostic codes.

Evidence that helps

Medical records showing measured range of motion are central to rating spinal stenosis. A VA or private examiner will measure forward flexion, extension, lateral flexion, and rotation of the cervical or thoracolumbar spine. Because ratings turn on specific degree thresholds, records that document exact measurements matter. Measurements should be rounded to the nearest five degrees.

Evidence of muscle spasm, guarding, or localized tenderness found on physical examination can support a 10% or 20% rating depending on whether those findings result in an abnormal gait or abnormal spinal contour such as scoliosis or abnormal kyphosis. Imaging or clinical findings that confirm a vertebral body fracture with loss of 50% or more of its height can also support a 10% rating.

For higher ratings, records documenting ankylosis, including clinical findings and imaging that show the spine is fixed in a particular position, are relevant. If unfavorable ankylosis is at issue, evidence describing its functional consequences, such as restricted jaw opening, limited breathing, gastrointestinal symptoms, or neurologic symptoms from nerve root stretching, directly addresses the regulatory criteria. Your own statements describing how your symptoms affect movement, walking, and daily activities can also help document the overall picture.

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
  • 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)
  • 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)