General Rating Formula for Diseases and Injuries of the Spine

(For diagnostic codes 5235 to 5243 unless 5243 is evaluated under the Formula for Rating Intervertebral Disc Syndrome Based on Incapacitating Episodes):

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

Description Percentage

Unfavorable ankylosis of the entire spine

100
Description Percentage

Unfavorable ankylosis of the entire thoracolumbar spine

50
Description Percentage

Unfavorable ankylosis of the entire cervical spine; or, forward flexion of the thoracolumbar spine 30 degrees or less; or, favorable ankylosis of the entire thoracolumbar spine

40
Description Percentage

Forward flexion of the cervical spine 15 degrees or less; or, favorable ankylosis of the entire cervical spine

30
Description Percentage

Forward flexion of the thoracolumbar spine greater than 30 degrees but not greater than 60 degrees; or, forward flexion of the cervical spine greater than 15 degrees but not greater than 30 degrees; or, the combined range of motion of the thoracolumbar spine not greater than 120 degrees; or, the  combined range of motion of the cervical spine not greater than 170 degrees; or, muscle spasm or guarding severe enough to result in an abnormal gait  or abnormal spinal contour such as scoliosis, reversed lordosis, or abnormal kyphosis

20
Description Percentage

Forward flexion of the thoracolumbar spine greater than 60 degrees but not greater than 85 degrees; or, forward flexion of the cervical spine greater than 30 degrees but not greater than 40 degrees; or, combined range of motion of the thoracolumbar spine greater than 120 degrees but not greater than 235 degrees; or, combined range of motion of the cervical spine greater than 170 degrees but not greater than 335 degrees; or, muscle spasm, guarding, or localized tenderness not resulting in abnormal gait or abnormal spinal contour; or, vertebral body fracture with loss of 50 percent or more of the height

10
Vertebral Fracture Dislocation

Vertebral compression fractures (VCFs) happen when the hard square or vertebral body in the spine breakdowns, which can prompt extreme torment, deformation and deficiency of stature. These fractures all the more generally happen in the thoracic spine (the center bit of the spine), particularly in the lower part.

Causes

In individuals with serious osteoporosis (frail, fragile bones), a VCF might be brought about by straightforward day by day exercises, for example, venturing out of the shower, sniffling powerfully or lifting a light item. In individuals with moderate osteoporosis, it for the most part takes expanded power or injury, for example, tumbling down or endeavoring to lift a substantial item to cause a VCF. Albeit undeniably more normal in ladies, VCFs are likewise a significant wellbeing worry for more seasoned men.

Individuals who have had one osteoporotic VCF are at multiple times the danger of supporting a second VCF. Incidentally, a VCF can be available with either minor symptoms or no symptoms, yet the danger actually exists for extra VCFs to happen.

Individuals with sound spines most usually endure a VCF through serious injury, for example, a fender bender, sports injury or a hard fall.

Metastatic tumors ought to be considered as the reason in patients more youthful than 55 with no set of experiences of injury or just negligible injury. The bones of the spine are a typical spot for some sorts of malignant growths to spread. The disease may cause obliteration of a piece of the vertebra, debilitating the bone until its breakdowns.

Symptoms

The principle clinical symptoms of VCFs may incorporate any of the accompanying, alone or in blend:

  • Abrupt beginning of back torment
  • An expansion of torment force while standing or strolling
  • A decline in torment force while lying on the back
  • Restricted spinal versatility
  • Possible stature misfortune
  • Possible distortion and handicap

Description Percentage

With incapacitating episodes having a total duration of at least 6 weeks during the past 12 months

60
Description Percentage

With incapacitating episodes having a total duration of at least 4 weeks but less than 6 weeks during the past 12 months

40
Description Percentage

With incapacitating episodes having a total duration of at least 2 weeks but less than  4 weeks during the past 12 months

20
Description Percentage

With incapacitating episodes having a total duration of at least one week but less than 2 weeks during the past 12 months

10

Formula for Rating Intervertebral Disc Syndrome Based on Incapacitating Episodes

Sacroiliac Injury And Weakness

Sacroiliitis is an aggravation of either of your sacroiliac joints — arranged where your lower spine and pelvis associate. Sacroiliitis can cause torment in your bum or lower back and can reach out down one or the two legs. Drawn out standing or step climbing can deteriorate the torment.

Sacroiliitis can be hard to analyze, on the grounds that it very well may be confused with different reasons for low back torment. It's been connected to a gathering of sicknesses that cause inflammatory arthritis of the spine. Treatment may include active recuperation and prescriptions.

Symptoms

The torment related with sacroiliitis most generally happens in the rear end and lower back. It can likewise influence the legs, crotch and even the feet. Sacroiliitis torment can be disturbed by:

  • Delayed standing
  • Bearing more weight on one leg than the other
  • Step climbing
  • Running
  • Taking huge steps

Causes

Reasons for sacroiliac joint brokenness include:

  • Traumatic injury

 An unexpected effect, for example, an engine vehicle mishap or a fall, can harm your sacroiliac joints.

  • Arthritis

 Mileage arthritis (osteoarthritis) can happen in sacroiliac joints, as can ankylosing spondylitis — a sort of inflammatory arthritis that influences the spine.

  • Pregnancy

 The sacroiliac joints should extricate and stretch to oblige labor. The additional weight and modified walk during pregnancy can cause extra weight on these joints and can prompt strange wear.

  • Contamination

 In uncommon cases, the sacroiliac joint can get contaminated.

Confusions

Likewise, with different conditions that cause chronic torment, sacroiliitis can bring about misery and insomnia.

Treatment

Your primary care physician or actual specialist can assist you with learning scope of-movement and extending activities to keep up joint adaptability, and reinforcing activities to make your muscles steadier.

Careful Techniques

On the off chance that different techniques haven't mitigated your torment, you specialist may recommend:

  • Joint infusions
  • Radiofrequency denervation
  • Electrical incitement
  • Joint combination

Description Percentage

With incapacitating episodes having a total duration of at least 6 weeks during the past 12 months

60
Description Percentage

With incapacitating episodes having a total duration of at least 4 weeks but less than 6 weeks during the past 12 months

40
Description Percentage

With incapacitating episodes having a total duration of at least 2 weeks but less than  4 weeks during the past 12 months

20
Description Percentage

With incapacitating episodes having a total duration of at least one week but less than 2 weeks during the past 12 months

10

Formula for Rating Intervertebral Disc Syndrome Based on Incapacitating Episodes

Lumbosacral Or Cervical Strain

There are 7 bones (vertebrae) in the neck that are important for the spine. These are known as the cervical spine. Cervical strain is a clinical term for neck torment. The neck has a few layers of muscles. These are associated with ligaments to the cervical spine and different bones. Neck torment is frequently the consequence of injury to these muscles and ligaments.

Reasons For Cervical Strain

Various sorts of weight on the neck can harm muscles and ligaments (delicate tissues) and cause cervical strain. Cervical tissues can be harmed by:

  • The neck being constrained past its ordinary scope of movement, for example, in an auto crash or sports injury
  • Steady, low-level pressure, for example, from helpless stance or an ineffectively set-up workspace

Symptoms Of Cervical Strain

These may include:

  • Neck agony or firmness
  • Agony in the shoulders or upper back
  • Muscle fits
  • Cerebral pain, frequently beginning at the base of the neck
  • Peevishness, inconvenience concentrating, or restlessness
  • Deadness in the arm or hand
  • Shivering or shortcoming in the arm
  • Treatment for cervical strain

More broad neck strains include more irritation, which prompts seriously growing, torment, and a more drawn out recuperation period. The strained muscle's solidarity while the injury is healing generally relies upon the number of muscle filaments were torn.

Treatment

This issue regularly improves all alone. Medicines expect to lessen torment and aggravation and increment the scope of movement of the neck. Potential medicines include:

  • Over-the-counter or professionally prescribed medication. These assistances diminish torment and aggravation.
  • Muscle relaxant can assist with muscle fits.
  • Extending activities to diminish neck solidness.
  • Back rub to diminish neck firmness.
  • Cold or warmth pack. This assistance diminish agony and expanding

Description Percentage

With incapacitating episodes having a total duration of at least 6 weeks during the past 12 months

60
Description Percentage

With incapacitating episodes having a total duration of at least 4 weeks but less than 6 weeks during the past 12 months

40
Description Percentage

With incapacitating episodes having a total duration of at least 2 weeks but less than  4 weeks during the past 12 months

20
Description Percentage

With incapacitating episodes having a total duration of at least one week but less than 2 weeks during the past 12 months

10

Formula for Rating Intervertebral Disc Syndrome Based on Incapacitating Episodes

Spinal Stenosis

Spinal stenosis is a narrowing of the spaces inside your spine, which can squeeze the nerves that movement through the spine. Spinal stenosis happens regularly in the lower back and the neck. A few people with spinal stenosis might not have symptoms. Symptoms can deteriorate after some time.

Spinal stenosis is most regularly brought about by mileage changes in the spine identified with osteoarthritis. In extreme instances of spinal stenosis, specialists may prescribe a medical procedure to make extra space for the spinal rope or nerves.

Sorts Of Spinal Stenosis

The sorts of spinal stenosis are characterized by where on the spine the condition happens. It's conceivable to have more than one sort. The two fundamental kinds of spinal stenosis are:

  • Cervical stenosis.

 The spine is narrowed from you neck in this condition.

  • Lumbar stenosis.

 In this condition, the narrowing happens in the piece of the spine in your lower back. It's the most widely recognized type of spinal stenosis.

Symptoms

Numerous individuals have proof of spinal stenosis on an MRI or CT filter however might not have symptoms. At the point when they do happen, they regularly begin slowly and deteriorate once again time. Symptoms differ contingent upon the area of the stenosis and which nerves are influenced.

In The Neck (Cervical Spine)

  • Deadness or shivering in a hand, arm, foot or leg
  • Shortcoming in a hand, arm, foot or leg
  • Issues with strolling and equilibrium
  • Neck torment
  • In extreme cases, gut or bladder brokenness (urinary desperation and incontinence)

In The Lower Back (Lumbar Spine)

  • Deadness or shivering in a foot or leg
  • Shortcoming in a foot or leg
  • Agony or squeezing in one or the two legs when you represent significant stretches of time or when you walk, which typically facilitates when you twist advance or sit
  • Back agony

Description Percentage

With incapacitating episodes having a total duration of at least 6 weeks during the past 12 months

60
Description Percentage

With incapacitating episodes having a total duration of at least 4 weeks but less than 6 weeks during the past 12 months

40
Description Percentage

With incapacitating episodes having a total duration of at least 2 weeks but less than  4 weeks during the past 12 months

20
Description Percentage

With incapacitating episodes having a total duration of at least one week but less than 2 weeks during the past 12 months

10
Description Percentage

With incapacitating episodes having a total duration of at least 6 weeks during the past 12 months

60
Description Percentage

With incapacitating episodes having a total duration of at least 4 weeks but less than 6 weeks during the past 12 months

40
Description Percentage

With incapacitating episodes having a total duration of at least 2 weeks but less than  4 weeks during the past 12 months

20
Description Percentage

With incapacitating episodes having a total duration of at least one week but less than 2 weeks during the past 12 months

10


Formula for Rating Intervertebral Disc Syndrome Based on Incapacitating Episodes

Spondylolisthesis Or Segmental Instability

Spondylolisthesis is a spinal condition that influences the lower vertebrae (spinal bones). This illness makes one of the lower vertebrae slip forward onto the bone straightforwardly underneath it. It's an agonizing condition however treatable much of the time. Both restorative and careful techniques might be utilized. Legitimate exercise procedures can assist you with dodging this condition.

Signs And Symptoms Of Spondylolisthesis

The manifestations of spondylolisthesis change. Individuals with gentle cases might not have any indications. Nonetheless, those with extreme cases might be not able to perform day by day exercises. Probably the most well-known side effects are:

  • steady lower back torment
  • firmness in your back and legs
  • lower back delicacy
  • thigh torment
  • tight hamstring and butt cheek muscles

Reasons For Spondylolisthesis

Reasons for spondylolisthesis change dependent on age, heredity, and way of life. Youngsters may experience the ill effects of this condition as the aftereffect of a birth deformity or injury. Nonetheless, individuals of any age are helpless if the condition runs in the family. Quick development during puberty may likewise be a contributing variable.

Playing sports may likewise make your strain overstretch and set weight on your lower back. The accompanying games are particularly liable to cause this condition:

  • football
  • vaulting
  • Olympic style events
  • weightlifting

Spondylolysis is regularly an antecedent to spondylolisthesis. Spondylolysis happens when there is a break in a vertebra, yet it hasn't yet fallen onto a lower bone in your spine. Nonsurgical medicines can help ease torment and urge the unresolved issue once again into the right spot. It's imperative to keep away from physical games during the healing interaction.

Treatment

Regular nonsurgical treatment techniques include:

  • wearing a back brace
  • doing non-intrusive treatment works out
  • assuming control over-the-counter or solution anti-inflammatory medications, (for example, ibuprofen) to diminish torment
  • utilizing epidural steroid infusions

Description Percentage

With incapacitating episodes having a total duration of at least 6 weeks during the past 12 months

60
Description Percentage

With incapacitating episodes having a total duration of at least 4 weeks but less than 6 weeks during the past 12 months

40
Description Percentage

With incapacitating episodes having a total duration of at least 2 weeks but less than  4 weeks during the past 12 months

20
Description Percentage

With incapacitating episodes having a total duration of at least one week but less than 2 weeks during the past 12 months

10

Formula for Rating Intervertebral Disc Syndrome Based on Incapacitating Episodes

Ankylosing Spondylitis

Ankylosing spondylitis (AS) is an uncommon kind of arthritis that causes pain and solidness in your spine. This long lasting condition, for the most part begins in your lower back. It can spread up to your neck or harm joints in different pieces of your body.

"Ankylosis" signifies melded bones or other hard tissue. "Spondylitis" signifies aggravation in your spinal bones, or vertebrae. Serious cases can leave your spine slouched. There's no remedy for AS. Yet, prescription and exercise can ease pain and help keep your back solid.

Ankylosing Spondylitis Symptoms

AS frequently begins in your sacroiliac joints, where your spine associates with your pelvis. It can influence where your ligaments and tendons connect to bones. It can even reason your vertebrae to combine.

You May Have Pain Or Solidness In Your:

  • Lower back
  • Rump
  • Shoulders
  • Hands
  • Rib confine
  • Hips
  • Thighs
  • Feet
  • Heels

You May Take Note:

  • Pain that is more terrible in the first part of the day or subsequent to sitting for quite a while
  • An inflexible spine that bends forward
  • Sleepiness
  • Growing in your joints
  • Inconvenience taking full breaths

Manifestations can contrast from individual to individual. Your condition likewise may change snappier or slower than somebody else's.

Ankylosing Spondylitis Complications

AS can cause pain and irritation all through your body, remembering for your:

Spine

 In uncommon cases, your vertebrae may get feeble, making them bound to crack or break. Harmed vertebrae can press on or bother a gathering of nerves in the lower part of your spinal cord called the cauda equina. You may experience difficulty controlling your guts or bladder, sexual issues, or a deficiency of reflexes.

Eyes

 About 40% of individuals with AS have an eye issue called uveitis. It's a sort of eye irritation that is painful and can obscure your vision and make you delicate to brilliant light. On the off chance that you have uveitis, your PCP may check for AS regardless of whether you don't have some other manifestations.

Heart Valve

 Seldom, AS can amplify your aorta, the biggest course in your body. This can change the state of your aortic valve, permitting blood to spill once again into your heart. Your heart will not siphon too, which can leave you drained and winded.

Description Percentage

With incapacitating episodes having a total duration of at least 6 weeks during the past 12 months

60
Description Percentage

With incapacitating episodes having a total duration of at least 4 weeks but less than 6 weeks during the past 12 months

40
Description Percentage

With incapacitating episodes having a total duration of at least 2 weeks but less than  4 weeks during the past 12 months

20
Description Percentage

With incapacitating episodes having a total duration of at least one week but less than 2 weeks during the past 12 months

10

Spinal Fusion

Spinal fusion is surgery to forever interface at least two vertebrae in your spine, wiping out movement between them.

Spinal fusion includes methods intended to impersonate the typical mending interaction of broken bones. During spinal fusion, your surgeon places bone or a bonelike material inside the space between two spinal vertebrae. Metal plates, screws and poles might be utilized to hold the vertebrae together, so they can mend into one strong unit.

Why Is Spinal Fusion Done?

Spinal fusion forever interfaces at least two vertebrae in your spine to improve strength, right a distortion or lessen pain. Your PCP may prescribe spinal fusion to treat:

  • Distortions of the spine

 Spinal fusion can help right spinal disfigurements, for example, a sideways bend of the spine (scoliosis).

  • Spinal shortcoming or flimsiness

 Your spine may get flimsy if there's unusual or extreme movement between two vertebrae. This is a typical symptom of serious arthritis in the spine. Spinal fusion can be utilized to reestablish spinal soundness in such cases.

  • Herniated plate

 Spinal fusion might be utilized to settle the spine after expulsion of a harmed (herniated) circle.

Dangerous Factors

Spinal fusion is by and large a protected method. However, similarly as with any surgery, spinal fusion conveys the likely danger of confusions.

Potential intricacies include:

  • Contamination
  • Helpless injury mending
  • Dying
  • Blood clumps
  • Injury to veins or nerves in and around the spine
  • Pain at the site from which the bone unite is taken

What Happens During Spinal Fusion?

Surgeons perform spinal fusion while you're under broad sedation so you're oblivious during the technique. Surgeons have built up an assortment of strategies for performing spinal fusion surgery. The procedure your surgeon utilizes relies upon the area of the vertebrae to be melded, the purpose behind the spinal fusion, and in certain examples, your overall wellbeing and body shape.

Description Percentage

With incapacitating episodes having a total duration of at least 6 weeks during the past 12 months

60
Description Percentage

With incapacitating episodes having a total duration of at least 4 weeks but less than 6 weeks during the past 12 months

40
Description Percentage

With incapacitating episodes having a total duration of at least 2 weeks but less than  4 weeks during the past 12 months

20
Description Percentage

With incapacitating episodes having a total duration of at least one week but less than 2 weeks during the past 12 months

10


Formula for Rating Intervertebral Disc Syndrome Based on Incapacitating Episodes

Degenerative Arthritis Of The Spine

Osteoarthritis (OA) is a degenerative joint infection influencing millions of individuals. This infection is brought about by the decay of ligament. This is the smooth, flexible tissue that secures joints and gives the grease important to ordinary joint capacity.

Osteoarthritis can influence various joints in the body, for example, those in the:

  • hands
  • knees
  • hips
  • spine

OA of the spine explicitly influences the feature joints, the ligament between the bones that make up the spine, and the tendons in the spine.

As you age, the ligament covering the feature joints can gradually erode. Your invertebral plates are made basically of water. These circles can dry out as you become more established. This can make the circles in your spine tight and put expanded focus on feature joints.

What Are The Manifestations Of OA Of The Spine?

OA of the spine causes different manifestations. The most widely recognized is back pain. Pain frequently begins in the lower back. In the beginning phases of the illness, you may just have pain in the mornings because of long periods of inertia. Since this is a reformist illness, side effects regularly deteriorate over the long run. Different manifestations of osteoarthritis of the spine include:

  • joint delicacy
  • joint solidness
  • restricted scope of movement
  • shortcoming or deadness in the legs or arms, shivering in the legs

Back pain brought about by OA of the spine is frequently more awful when sitting upstanding or standing. It normally improves when resting. A few people who have osteoarthritis of the spine don't have any manifestations.

What Causes OA Of The Spine?

OA is brought about by sluggish weakening of ligament around joints in the lower back. The specific reason for this disintegration is obscure, however a few people have a higher danger for the infection. This incorporates people who have encountered a spine injury.

Encountering a physical issue at a more youthful age can make your ligament separate a lot quicker. Corpulence can likewise assume a part in OA of the spine since additional body weight places included pressure the joints in your spine. Other danger factors include:

  • propelling age
  • being a female
  • family background of osteoarthritis
  • working in an occupation including redundant pressure
  • flawed joints or ligament upon entering the world

Description Percentage

With incapacitating episodes having a total duration of at least 6 weeks during the past 12 months

60
Description Percentage

With incapacitating episodes having a total duration of at least 4 weeks but less than 6 weeks during the past 12 months

40
Description Percentage

With incapacitating episodes having a total duration of at least 2 weeks but less than  4 weeks during the past 12 months

20
Description Percentage

With incapacitating episodes having a total duration of at least one week but less than 2 weeks during the past 12 months

10

Intervertebral Disc Syndrome

 

Intervertebral Disk Syndrome (IVDS) is a back condition where an intervertebral circle or plate pieces are uprooted at any level of the spine: lumbar, cervical, or thoracic. IVDS can cause ongoing agony in the back, typically aggravated by delayed sitting or twisting. IVDS can likewise cause nerve torment in the legs and arms, contingent upon where the dislodged circle is situated in the spine. One regular kind of nerve torment that it can cause is sciatica which is torment along the sciatic nerve. Every now and again, the individuals who experience the ill effects of this disease have restricted scope of motion, and some can encounter inconvenience controlling their bladder or guts, and additionally experience erectile disorders.

Symptoms

  • Sharp (instead of dull) torment.
  • Commonly, reciprocal agony situated at the back belt line.
  • Alluded torment instead of radicular.
  • Typically went before by different scenes of less extreme low back agony.
  • Confined to the lower back and gluteal territory.
  • Agony with flexion, revolution, or delayed sitting or standing.

What Causes It?

It is recommended that intervertebral disk degeneration ought to be characterized as a deviant, cell-interceded reaction to reformist underlying disappointment. Basic causes incorporate hereditary legacy, age, insufficient metabolite transport, and stacking history, all of which can debilitate circles so much that underlying disappointment happens during the exercises of everyday living.

Treatment

Treatment for intervertebral disc disease include:

  • Agony prescription.
  • Chiropractic control
  • Epidural infusions.
  • TENS units.
  • These gadgets convey mellow electrical incitement that supersedes the agonizing signs shipped off the lower back.
  • For intense back torment, ultrasound might be utilized to warm the territory, which thus brings blood stream and mending supplements to the region.
  • Back rub.
  • Restorative low back rub is thought to give low back help with discomfort by improving blood stream, decreasing muscle firmness, expanding scope of motion, and bringing endorphin step up in the body
  • Stopping smoking.
  • Weight reduction.
  • Getting in shape can diminish low back torment in overweight individuals by reducing the measure of weight on the low back's muscles and tendons.

Evaluate intervertebral disc syndrome (preoperatively or postoperatively) 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 method results in the higher evaluation when all disabilities are combined under §4.25.

Formula for Rating Intervertebral Disc Syndrome Based on Incapacitating Episodes

Description Percentage

With incapacitating episodes having a total duration of at least 6 weeks during the past 12 months

60
Description Percentage

With incapacitating episodes having a total duration of at least 4 weeks but less than 6 weeks during the past 12 months

40
Description Percentage

With incapacitating episodes having a total duration of at least 2 weeks but less than  4 weeks during the past 12 months

20
Description Percentage

With incapacitating episodes having a total duration of at least one week but less than 2 weeks during the past 12 months

10

Note (1): Evaluate any associated objective neurologic abnormalities, including, but not limited to, bowel or bladder impairment, separately, under an appropriate diagnostic code.

 

Note (2): (See also Plate V.) For VA compensation purposes, normal forward flexion of the cervical spine is zero to 45 degrees, extension is zero to 45 degrees, left and right lateral flexion are zero to 45 degrees, and left and right lateral rotation are zero to 80 degrees. Normal forward flexion of the thoracolumbar spine is zero to 90 degrees, extension is zero to 30 degrees, left and right lateral flexion are zero to 30 degrees, and left and right lateral rotation are zero to 30 degrees. The combined range of motion refers to the sum of the range of forward flexion, extension, left and right lateral flexion, and left and right rotation. The normal combined range of motion of the cervical spine is 340 degrees and of the thoracolumbar spine is 240 degrees. The normal ranges of motion for each component of spinal motion provided in this note are the maximum that can be used for calculation of the combined range of motion.

 

Note (3): In exceptional cases, an examiner may state that because of age, body habitus, neurologic disease, or other factors not the result of disease or injury of the spine, the range of motion of the spine in a particular individual should be considered normal for that individual, even though it does not conform to the normal range of motion stated in Note (2). Provided that the examiner supplies an explanation, the examiner’s assessment that the range of motion is normal for that individual will be accepted.

 

Note (4): Round each range of motion measurement to the nearest five degrees.

 

Note (5): For VA compensation purposes, unfavorable ankylosis is a condition in which the entire cervical spine, the entire thoracolumbar spine, or the entire spine is fixed in flexion or extension, and the ankylosis results in one or more of the following: difficulty walking because of a limited line of vision; restricted opening of the mouth and chewing; breathing limited to diaphragmatic respiration; gastrointestinal symptoms due to pressure of the costal margin on the abdomen; dyspnea or dysphagia; atlantoaxial or cervical subluxation or dislocation; or neurologic symptoms due to nerve root stretching. Fixation of a spinal segment in neutral position (zero degrees) always represents favorable ankylosis.

 

Note (6): Separately evaluate disability of the thoracolumbar and cervical spine segments, except when there is unfavorable ankylosis of both segments, which will be rated as a single disability.

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