Can I obtain VA disability benefits for back pain?

Yes, VA disability benefits for your back pain may be available.

You will need to prove that (a) you were in the military, (b) your back pain originated or was aggravated while you were on active duty, (c) you were continuously treated for your back pain since leaving the service (unless you are filing your disability claim within one year of leaving the service or your condition has been chronic), and (d) you are currently disabled by your back pain.

The degree of disability usually depends on how much your chronic pain interferes with your ability to function — that is, to walk, bend, stoop, twist, and lift.

Severity of back pain cannot be determined solely based on abnormalities seen on X-rays, computerized tomography (CT), or magnetic resource imaging (MRI) of the spine. Many people with significant degenerative abnormalities on X-ray have minimal or no symptoms, while some people with incapacitating back pain have minimal objective abnormalities.

The VA will consider your objective abnormalities, reported pain and symptoms, response to treatment, activities of daily living affected by pain, and comments about your credibility in the treating doctor’s records.

Degenerative disc disease
Herniated disc
Osteomyelitis
Osteoarthritis
Spinal stenosis
Spondylolisthesis
Trauma

Degenerative disc disease

Degenerative disc disease refers to dehydration and shrinkage of the intervertebral discs that cushion the vertebral bodies of the spine. Osteoarthritis of the spine is sometimes accompanied by degenerative disc disease and sometimes not.

Degenerative disc disease can be seen on X-rays, MRI, and CT scans of the spine.

Figure 1: Vertebral fusion using bone strips.

Surgical fusion of affected vertebral bodies is sometimes done in an attempt to stabilize the spine and reduce pain.

Fusions of the cervical spine are less limiting in regard to lifting and carrying, since they are not in the weight-bearing part of the spine. However, lifting heavy weights can put traction on the cervical spine through the back and neck muscles, resulting in symptoms. In other words, the lack of pain or other symptoms during resting physical examination does not imply the absence of limitation at heavier work-loads.

Some claimants who have had a fractured and unstable cervical spine may only be able to handle sedentary activities and work if there is risk of death or spinal cord injury from heavier work. Also, there may be a residual neurological deficit from spinal cord injury at the time of injury, in the case of the accident.

In other instances, a decompressive cervical laminectomy and fusion is necessary to relieve spinal stenosis pressure on the cervical spinal cord. These cases are likely to require more limitation than those with a simple, uncomplicated cervical fusion. If the claimant has had pain lifting during his or her activities of daily living or attempt to return to a prior job, it is important that this information be documented in his or her disability file. Furthermore, cervical fusions can make it impossible for a person to perform overhead work, which can be a critical limitation in some cases.

Herniated disc

A herniated disc is the protrusion of the hard, cartilaginous center or nucleus of an intervertebral disc through the outer fibrous tissue.

A small herniation can produce acute symptoms that improve with time. Injection of corticosteroid drugs in the area of the herniation help relieve inflammation and pain.

A large herniation can press on a spinal nerve root and need to have part of the herniation removed. The problem with surgery around spinal nerve roots is that manipulation of tissues often leads to scarring that then again pressures the nerve root. This is particularly likely when an individual has had multiple back surgeries. Many claimants who complain of chronic back pain and have a history of back surgery near nerve roots have scarring that can be identified on CT or MRI scans.

Figure 2: An intervertebral disk with lateral herniation.

Figure 3: MRI view of herniated discs.

Osteomyelitis

Osteomyelitis most often occurs as a result of trauma producing open wounds that allows the entry of bacteria into the body, as a result of surgical procedures, or as a result of bacteria circulating in the bloodstream—a condition known as bacteremia. Osteomyelitis of joints can affect their function by means of bone destruction and joint deformity.

In weight-bearing bones, fractures through the area of infection can occur during the stage of acute infection, or later due to brittle bone. The orthopedic surgical management of osteomyelitis can be complex. Surgery may be needed to remove infected bone.
With modern antibiotics, acute osteomyelitis can be treated more effectively, so that chronic osteomyelitis is not as common as it was in the past. When chronic osteomyelitis does occur, it can present a difficult problem because the chronically infected bone may die and that restricts delivery of antibiotics through the bloodstream. Also, secondary infection may occur in tissues near the bone that involves different organisms than those that infect the bone itself.

An area of infected bone is called a sequestrum. In the treatment of chronic osteomyelitis, surgery to remove the sequestrum (sequestrectomy and curettage) along with infected soft tissues near the infection is a common requirement. Infected soft tissue removal may require reconstruction of soft tissues, such as muscle and skin grafts. The hole in the bone left by removal of the sequestrum may be packed with antibiotic beads. Antibiotic bead implantation may be temporary (10 days) to permanent, depending on the judgment of the surgeon. Whatever surgical antibiotic treatment is given, the patient will require prolonged systemic antibiotic therapy lasting well through surgical recovery in order to prevent recurrent infection.

Infected bone fractures can be particularly difficult to heal. Such a situation might arise from an open wound and fractures occurring from trauma.

Osteoarthritis

Osteoarthritis of the spine can take several forms. In ankylosis, parts of the spine are abnormally fused together as a result of bony overgrowth. For example, bony spurs can fuse vertebral bodies together.

Some of the peripheral nerves can become encroached by osteoarthritis and required surgical decompression.

Arthritis affecting facet joints can become painful and limit the motion of the spine.

Figure 4: Spinal cord and nerve roots.

Figure 5: Normal spinal canal with facet joints.

Spinal stenosis

Spinal stenosis is a narrowing of the space inside the bony spine which sometimes results in pressure on the spinal cord and peripheral nerve roots. Spinal stenosis can be worsened by bulging or herniated discs and by spondylolisthesis.

Spinal stenosis is one of many possible causes of damage to the spinal cord (myelopathy). Myelopathy may be irreversible. Surgical decompression of the spinal cord may be necessary for severe cases, but even after surgery symptoms may not improve.

A person with lumbar stenosis may have no symptoms during a physical examination, but may have severe symptoms with exertion.

Pain, weakness, numbness or other symptoms related to spinal stenosis usually appear gradually over a period of months or years. Symptoms are rapidly worsened by walking, lifting, jarring, carrying or other activities that strain the spinal structures. Sensory abnormalities, such as numbness, will occur before the onset of weakness. Symptoms are lessened or relieved by bending forward (including crouching) or lying.

Spinal stenosis can be seen on imaging studies such as myelography, CT, and MRI scans. But myelography and CT scans can miss some types of stenosis.

The important evaluation questions are:

• How much weight can you lift and carry, both frequently and occasionally, without symptoms?
• How long can you walk or stand?

It is difficult to assess how far a person can walk or how much a person can lift just by looking at imaging studies showing the anatomical severity of spinal stenosis. Greater weight should be given to alleged symptoms and limitations in activities of daily living than trying to guess degree of restriction from imaging results. The only exceptions might be in highly atypical cases where, for example, a claimant with extremely mild spinal stenosis—perhaps borderline abnormal—alleges marked limitations.

Figure 6: Spinal stenosis with a narrowing of the spinal canal.

Figure 7: Spinal stenosis caused by a herniated disk and osteoarthritis.

Spondylolisthesis

Spondylolisthesis is a slippage of vertebral bodies out of their normal position, usually a forward slippage of the 5th lumbar vertebra over the 1st sacral vertebra (LF-S1). Most spondylolisthesis is seen in the lumbar spine. This disorder can be seen on plain X-rays … particularly on X-rays taken in the standing position rather than in the lying position.

Most individuals with spondylolisthesis lead active lives with little adjustment. However, adding other spinal disorders like osteoarthritis or bulging discs can cause limitations.

Trauma

Fractures of the bony spine most commonly occur with vehicle accidents. There may be associated spinal cord injury. Traumatically-fractured vertebrae are treated with a combination of surgical fusion and sometimes metal rods.

Figure 8: Vertebral fusion involving placement of a bone graft into a hollowed out disc space.