Degenerative Disc Disease VA Rating and IVDS Criteria

Diagnostic Code 5242 vs. Diagnostic Code 5243: the nerve root rule

Effective February 7, 2021 (85 FR 76460), the VA revised 38 CFR 4.71a to establish a strict boundary between DC 5242 and DC 5243:

• Diagnostic Code 5242 — Degenerative arthritis, degenerative disc disease other than intervertebral disc syndrome (also, see either DC 5003 or 5010): Assigned for all disc diagnoses without nerve root compression or irritation—including disc space narrowing, desiccation, annular tears, non-compressive bulges, osteophytes, and spondylosis. When range of motion is non-compensable, painful motion under 38 CFR 4.59 or X-ray evidence of arthritis under DC 5003/5010 supports a 10% rating.
• Diagnostic Code 5243 — Intervertebral disc syndrome (IVDS): “Assign this diagnostic code only when there is disc herniation with compression and/or irritation of the adjacent nerve root; assign diagnostic code 5242 for all other disc diagnoses.”

Under the General Rating Formula, DC 5242 and DC 5243 yield identical percentages. Qualifying for DC 5243, however, allows evaluation under the Incapacitating Episodes Formula (up to 60%) and corroborates separate ratings for radiculopathy under 38 CFR 4.124a.

Complete VA rating tables for DDD and IVDS (38 CFR 4.71a)

Under Note (6) of the General Rating Formula in 38 CFR 4.71a, the VA rates the thoracolumbar spine (back, T1–L5) and cervical spine (neck, C1–C7) separately. See our back pain VA rating guide and neck VA rating guide.

Table 1: General Rating Formula for Diseases and Injuries of the Spine (DC 5235–5243)

Applies with or without symptoms such as pain (whether or not it radiates), stiffness, or aching in the area of the spine affected by residuals of injury or disease:

Table 2: Formula for Rating Intervertebral Disc Syndrome Based on Incapacitating Episodes (DC 5243)

Range of motion, spinal contour, and Notes (2) through (6)

Every criterion separated by “or” in the General Rating Formula independently qualifies for that rating tier:

• Normal spinal range of motion (Note 2 and Plate V): Starting from 0° neutral, an examiner uses a goniometer to measure six planes:
  • Thoracolumbar spine (240° normal combined ROM): Forward flexion 0–90°, extension 0–30°, left and right lateral flexion 0–30° each, and left and right lateral rotation 0–30° each.
  • Cervical spine (340° normal combined ROM): Forward flexion 0–45°, extension 0–45°, left and right lateral flexion 0–45° each, and left and right lateral rotation 0–80° each.
  • Normal values are the maximum counted for each component when summing combined motion.
• Individualized baseline exception (Note 3): In exceptional cases, an examiner may explain why reduced motion is normal for an individual due to age, body habitus, neurologic disease, or non-spinal factors.
• Five-degree rounding rule (Note 4): Each measurement is rounded to the nearest 5 degrees. Losing 5° in any plane reduces combined motion to 235° (thoracolumbar) or 335° (cervical), meeting the 10% threshold.
• Spasm, guarding, and abnormal contour: Localized tenderness, spasm, or guarding without abnormal gait or contour warrants 10%. Spasm or guarding severe enough to cause an abnormal gait or abnormal spinal contour (scoliosis, reversed lordosis, or abnormal kyphosis) warrants 20%.
• Favorable vs. unfavorable ankylosis (Note 5): Fixation of an entire segment at 0° neutral always represents favorable ankylosis (30% cervical, 40% thoracolumbar). Unfavorable ankylosis (40% cervical, 50% thoracolumbar, 100% entire spine) requires fixation in flexion or extension resulting in a limited line of vision when walking; restricted mouth opening/chewing; diaphragmatic respiration; gastrointestinal symptoms from costal margin pressure; dyspnea or dysphagia; atlantoaxial or cervical subluxation/dislocation; or neurologic symptoms from nerve root stretching. A partial fusion (DC 5241) is rated on residual motion loss.
• Separate evaluation of spinal segments (Note 6): Thoracolumbar and cervical segments are rated separately, unless both have unfavorable ankylosis (a single 100% disability).

How the IVDS incapacitating episodes formula works (DC 5243)

Two notes govern the incapacitating episodes formula under Diagnostic Code 5243 in 38 CFR 4.71a:

• Note (1) — Definition of an incapacitating episode: “For purposes of evaluations under diagnostic code 5243, an incapacitating episode is a period of acute signs and symptoms due to intervertebral disc syndrome that requires bed rest prescribed by a physician and treatment by a physician.” Both physician treatment and physician-prescribed bed rest are mandatory; self-directed rest does not count.
• Note (2) — Multiple spinal segments: “If intervertebral disc syndrome is present in more than one spinal segment, provided that the effects in each spinal segment are clearly distinct, evaluate each segment on the basis of incapacitating episodes or under the General Rating Formula for Diseases and Injuries of the Spine, whichever method results in a higher evaluation for that segment.”

Under DC 5243, the VA assigns whichever formula yields the higher evaluation when all disabilities are combined under 38 CFR 4.25—for example, a 20% back rating plus bilateral 20% sciatic ratings (50% combined) beats a 40% IVDS bed-rest rating.

Separate ratings for radiculopathy and neurological deficits (Note 1)

Under Note (1) to the General Rating Formula in 38 CFR 4.71a, the VA must “evaluate any associated objective neurologic abnormalities, including, but not limited to, bowel or bladder impairment, separately, under an appropriate diagnostic code.” Objective neurological signs—numbness, paresthesias, diminished reflexes, muscle weakness, or atrophy—are rated separately for each affected limb under 38 CFR 4.124a:

• Lumbar sciatic nerve radiculopathy (DC 8520 / 8620 / 8720): Rated per leg at 10% (mild), 20% (moderate), 40% (moderately severe), 60% (severe, with marked muscular atrophy), or 80% (complete).
• Lumbar femoral nerve radiculopathy (DC 8526 / 8626 / 8726): Rated per leg at 10% (mild), 20% (moderate), 30% (severe), or 40% (complete).
• Cervical radiculopathy (DC 8510–8513): Under DCs 8510–8512 and 38 CFR 4.69, rated per arm at 20% (mild), 40% major / 30% minor (moderate), 50% major / 40% minor (severe), or 70% major / 60% minor (complete).
• Bowel or bladder impairment: Neurogenic bladder (DC 7542) or bowel sphincter impairment (DC 7332) is rated separately.

See our radiculopathy VA rating guide for complete peripheral nerve criteria.

How the C&P exam and Spine DBQ measure DDD and IVDS

During a C&P exam, the clinician completes the Back (Thoracolumbar Spine) Conditions Disability Benefits Questionnaire (DBQ) or the Neck (Cervical Spine) Conditions Disability Benefits Questionnaire (DBQ), verified on VA.gov’s Public DBQ portal:

1. Diagnosis and medical history (Sections I–II): Records DC 5242 or DC 5243 diagnoses, onset and course, and flare-up descriptions.
2. Range of motion, repetitive use, and guarding (Section III): Measures active and passive motion in degrees across six planes, records where pain begins, tests three repetitions (38 CFR 4.40 and 38 CFR 4.45), estimates motion loss during flare-ups (DeLuca v. Brown), and records localized tenderness, muscle spasm or guarding, and abnormal gait or spinal contour. Under 38 CFR 4.59, painful motion warrants at least 10%; stop moving when pain starts.
3. Neurological, IVDS, and diagnostic imaging (Sections IV–XI and XV on Back DBQ; Sections IV–X and XIV on Neck DBQ): Tests muscle strength (0/5 to 5/5) and atrophy in Section IV, reflexes (0 to 4+) in Section V, sensory dermatomes in Section VI, straight-leg raising on the Back DBQ (Section VII), radiculopathy and ankylosis (Sections VIII–IX on Back DBQ; Sections VII–VIII on Neck DBQ), other neurologic abnormalities such as bowel or bladder impairment (Section X on Back DBQ; Section IX on Neck DBQ), IVDS incapacitating episodes requiring physician-prescribed bed rest over the past 12 months (Section XI on Back DBQ; Section X on Neck DBQ), and X-ray, CT, MRI, or EMG findings in the Diagnostic Testing section (Section XV on Back DBQ; Section XIV on Neck DBQ).

Service connection, secondary claims (38 CFR 3.310), and combined ratings

Direct service connection under 38 CFR 3.303 requires a current diagnosis of DDD or IVDS, in-service spinal injury or load stress, and a medical nexus. Under 38 CFR 3.310, conditions proximately caused or aggravated by service-connected DDD or IVDS may qualify for secondary service connection—including radiculopathy, compensatory neck or back disabilities, hip or knee strain from an altered gait, depressive or anxiety disorders under 38 CFR 4.130, and NSAID-induced GERD. Conversely, lumbar DDD may be claimed secondary to a service-connected lower-extremity injury that alters gait.

When combining ratings under 38 CFR 4.25, the VA applies a 10% bilateral factor under 38 CFR 4.26 when radiculopathy affects paired limbs. For example, 20% left and 20% right sciatic radiculopathy combine to 36%, plus a 3.6 bilateral factor (39.6%, rounded to 40%), which combines with a 40% thoracolumbar rating (64%) and a 20% cervical rating (71.2%) to round to 70% ($1,808.45 per month alone, effective 2025-12-01). Model your ratings with our VA combined rating calculator and VA back pay calculator.

Getting free, accredited help with your claim

Accredited Veterans Service Organizations (VSOs)—such as the DAV, VFW, and American Legion—provide representation free of charge, while VA-accredited claims agents and attorneys handle appeals. Never pay upfront fees or accept promises of guaranteed outcomes; verify accreditation in the VA Office of the General Counsel Accreditation Search.