Do you have questions about lumbar injuries VA disability benefits? If you have a lower back (lumbar) injury, lumbar sprain (back sprain), or other types of back injury and back strain caused or aggravated by your military service, you may qualify for VA disability benefit payments.
Has the VA denied or underrated your VA disability claim for back injury? Do you want to get that denial overturned or increase your VA disability rating? This article discusses what you can expect in terms of back VA disability claims for lumbar injuries and ways to handle a VA disability rating dispute regarding your back-related disability.
The VA Disability Rating process
Veterans who have a current disabling condition that is service-connected can apply to receive monthly benefit payments through the VA disability process. These monthly benefits are intended to mitigate the financial impact those conditions have on veterans’ ability to work and support themselves and their families.
The process begins with filing an Application for Disability Compensation and Related Compensation Benefits (VA Form 21-526EZ). According to federal law, veterans cannot be charged for assistance in preparing this application, so you cannot hire a lawyer at this point (and beware of others who want to charge some type of consultation fee for this step of the process). What you can do for assistance in preparing your Application is get assistance from a local VSO (veteran service officer) trained and accredited by the VA to provide this assistance and do so free of charge to the veteran.
This first step of filing your Application establishes a starting point (“effective date”) for payment of benefits assuming your claim is granted.
This Application, along with your service and medical records and sometimes other supporting documentation, will be reviewed by a claim reviewer at the VA to decide whether (1) you have a current disabling condition; (2) if it was caused by, or made worse by, your military service; and, if so, (3) what the disability rating is (a number from 0% to 100%), and (4) what the effective date is (usually the date the claim was filed.)
Some claims are granted at this first level, and monthly payments commence soon after. Unfortunately, the VA often makes a mistake or underrates a veteran’s disability. If this happens to you, you still have options to get the decision changed. Many reasons VA disability claims are denied can be fixed or overcome on appeal (decision review) of that initial decision. In fact, per VA reporting, over 70% of appeals either result in an allowed claim or a remand (or another review).
If you disagree with the initial decision on your VA disability claim, you can appeal within one year of the decision letter. In VA claim appeals, you can ask for a Higher Level Review (same information reviewed by a more experienced examiner), a Supplemental Claim (allows you to add additional evidence to support your claim), or a Board Review (which will allow you a live hearing before a Veterans Law Judge, in person or via video conference).
The way to increase the VA disability rating is through appeal. Appeals can also challenge any other aspect of the VA’s decision, including denial of a claim or an underrating of the severity of the disability.
The VA disability appeal process can be complicated, and you may want to hire an experienced VA disability claim attorney to represent you in the process after an initial decision letter is received. Having worked on thousands of cases after their underlying education, a VA disability attorney has a much better understanding of how to argue the evidence in a way that makes it easy for the VA to agree with you.
Common lumbar injuries for veterans and how the VA rates them
Back injuries of all types are common with veterans, including lumbar strain (lower back pain), degenerative disc disease (DDD), and Intervertebral Disc Syndrome (IVDS). With back issues, a common secondary condition is radiculopathy (pinched nerves and sciatica pain).
All diseases and injuries of the spine, whether cervical (neck), thoracic (upper back), or lumbar (lower back), are all rated by the VA using the same scale from 10% to 100%, except for IVDS, which has its own separate formula.
For lumbar conditions other than IVDS, the rating formula is based primarily on range of motion (flexion) and, for the higher rating levels, ankylosis (immobility). Unfortunately, the language used by the VA is not easy to understand, making the assistance of a law firm invaluable to ensuring you are being rated at the highest permissible level. Importantly, if your IVDS is rated under Diagnostic Code 5243 rating criteria, you will not be able to be rated separately for radiculopathy, where if you are rated based on range of motion alone you can get them under separate evaluations.
The IVDS rating formula ranges from 10% – 60% and is based on the duration of incapacitating episodes within the past 12 months. For example, incapacitating episodes with a total duration of at least one week but less than two weeks in the past 12 months are rated at 10%, whereas incapacitating episodes of at least six weeks during the past 12 months would be rated at 60%.
As you might have guessed, medical professionals and the VA have different ways of looking at disabling conditions of the back, and there is overlap between these two ratings formula. Sometimes having an IME (independent medical exam) can add more clarity in diagnosis than a VA-requested C&P exam can.
What should you expect monetarily for lumber disabilities?
Whether your disability is some type of lumbar injury or PTSD, your monthly VA disability benefit payments will be based on your overall VA disability rating number, and, for ratings of 30% or higher, also factoring in your family status (whether you have a dependent spouse, children, or parents). An overall disability rating combines the ratings for each of your conditions (many veterans have multiple conditions as part of their disability claim) through a complicated formula for a final, single number. Click here for a ratings calculator for an idea.
Keep in mind, however, that every claim is unique and dependent on numerous variables, including specific diagnoses and parts of the body.
Can you receive TDIU for lumbar and neck disabilities?
To get a finding of Total Disability Individual Unemployability (TDIU), you must meet two conditions: (1) have at least one service-connected disability rated at 60% or two or more service-connected disabilities with at least one rated at 40% or more and a combined rating of 70% or more; and (2) evidence that you can’t hold down substantially gainful employment because of your service-connected disability. So, yes, you can receive TDIU if your lumbar condition meets the TDIU criteria.
Occasionally, TDIU can also be applied with a lower disability rating. Learn more about TDIU claims here.
Has your lumbar injury claim been denied or underrated by the VA? We may be able to help you. Veterans Law Group has helped thousands of veterans to get VA disability benefits; in fact, it’s all we do. Click here for a free evaluation of your case.
