What Is the VA Rating for Thoracic Spine Pain? Mid Back Diagnostic Codes, ROM Criteria, and the Information Gap Most Veterans Never Overcome

If you have thoracic spine pain — the mid back region between your shoulder blades — and you are trying to figure out how the VA rates it, you have probably already noticed something frustrating: almost nothing exists online about thoracic spine VA ratings specifically.

That is not an accident. It is a structural problem baked into the VA rating system itself, and it directly disadvantages veterans with thoracic conditions.

Here is the core issue: the VA groups the thoracic spine (T1-T12) and the lumbar spine (L1-L5) into a single "thoracolumbar" segment for rating purposes under 38 CFR 4.71a. There is no diagnostic code that says "thoracic strain." There is no ROM chart specific to the thoracic spine. And because thoracic conditions represent only 10-20% of all back pain cases, the advocacy material, the case law, and the C&P exam guidance all default to lumbar.

That means if you do not understand how the system actually works, your thoracic spine claim is likely to be under-rated.

In this guide, I am going to break down the exact rating criteria, explain the diagnostic code ambiguity that trips up veterans and raters alike, show you how the painful motion floor applies to thoracic conditions, and give you the C&P exam strategy that accounts for the unique anatomy of the mid back.

The Thoracolumbar Rating Framework: Where Thoracic Spine Fits

The VA overhauled its spine rating system in September 2003 through a Federal Register update that consolidated dozens of separate diagnostic codes into two rating pathways: the General Rating Formula for Diseases and Injuries of the Spine and the Formula for Rating Intervertebral Disc Syndrome Based on Incapacitating Episodes.

Under this system, the spine is divided into two segments for rating purposes:

• Cervical spine (C1-C7) — rated separately with its own ROM criteria
• Thoracolumbar spine (T1-L5) — thoracic and lumbar rated together as a single unit

This grouping is important. It means your thoracic spine condition and any lumbar spine condition you may also have are combined into one rating. You do not get separate ratings for thoracic and lumbar. The VA evaluates the entire thoracolumbar segment and assigns a single percentage.

ROM Rating Criteria for Thoracic Spine Conditions

The General Rating Formula for the thoracolumbar spine uses forward flexion range of motion as the primary measurement. Normal thoracolumbar forward flexion is 90 degrees. Normal combined range of motion is 240 degrees (flexion + extension + bilateral lateral flexion + bilateral rotation).

Here are the exact rating thresholds:

Diagnostic Code Selection: The Thoracic Ambiguity Problem

This is where things get confusing for veterans and raters alike.

The VA's diagnostic codes for the spine under 38 CFR 4.71a include:

• DC 5235 — Vertebral fracture or dislocation
• DC 5236 — Sacroiliac injury and weakness
• DC 5237 — Lumbosacral or cervical strain
• DC 5238 — Spinal stenosis
• DC 5239 — Spondylolisthesis or segmental instability
• DC 5240 — Ankylosing spondylitis
• DC 5241 — Spinal fusion
• DC 5242 — Degenerative arthritis of the spine
• DC 5243 — Intervertebral disc syndrome (IVDS)

Notice what is missing: there is no code that says "thoracic strain" or "thoracic spine condition." The closest match for a thoracic strain-type condition is DC 5237, which the VA labels as "Lumbosacral or Cervical Strain" — neither of which is anatomically thoracic.

In practice, the VA typically codes thoracic spine conditions under:

• DC 5237 — if the diagnosis is strain or sprain involving the thoracolumbar segment
• DC 5242 — if there is documented degenerative arthritis (spondylosis) of the thoracic spine
• DC 5243 — if there is thoracic intervertebral disc syndrome

The Painful Motion Floor (38 CFR 4.59 and Saunders v. Wilkie)

This section is critically important for thoracic spine claimants, and here is why: many veterans with thoracic conditions have pain throughout their range of motion but still measure within "normal" ROM limits because the lumbar spine compensates for thoracic stiffness.

38 CFR 4.59 states that joints that are painful on motion are entitled to at least the minimum compensable evaluation for that joint. For the thoracolumbar spine, the minimum compensable evaluation is 10%.

The Federal Circuit confirmed this in Saunders v. Wilkie (2018), holding that pain itself — even without structural joint abnormality — can constitute a functional impairment warranting disability compensation. The court established that pain causing functional loss is entitled to a minimum compensable rating regardless of the measured ROM.

What this means for thoracic spine claimants:

• If you have documented painful motion in the thoracic spine, you are entitled to at least a 10% rating even if your overall thoracolumbar flexion measures above 85 degrees
• If you have X-ray evidence of arthritis in the thoracic spine (T-spine spondylosis, degenerative disc disease), the 10% floor is essentially guaranteed under 38 CFR 4.59
• The examiner must document where pain begins during ROM testing — not just the end-point ROM measurement

DeLuca Factors and Functional Loss in the Thoracic Spine

The DeLuca/Mitchell/Sharp case law trilogy is especially important for thoracic spine claims because functional loss is often the primary basis for a higher rating.

DeLuca v. Brown (1995)

Requires the VA to assess functional loss beyond static ROM measurements. For thoracic spine conditions, this means evaluating pain on motion, weakness, fatigue, incoordination, and ROM reduction during repetitive use and flare-ups.

Mitchell v. Shinseki (2011)

Clarified that pain causing actual functional loss must be rated equivalent to structural limitation. If your thoracic pain makes you function as though your flexion is limited to 50 degrees even though the goniometer reads 70 degrees, the functional limitation controls.

Sharp v. Shulkin (2017)

Requires C&P examiners to provide specific flare-up ROM estimates in degrees rather than claiming it would be "speculative." If the examiner declines to estimate flare-up ROM, the examination is inadequate and you can request a new one.

IVDS and Thoracic Disc Disease

If you have been diagnosed with thoracic intervertebral disc syndrome (herniated disc, bulging disc, or degenerative disc disease at T1-T12), you may qualify for rating under DC 5243 using the Incapacitating Episodes formula.

An "incapacitating episode" is defined as a period of acute signs and symptoms requiring bed rest prescribed by a physician and treatment by a physician. Self-imposed bed rest does not count.

Thoracic Radiculopathy: Rare but Ratable

Thoracic radiculopathy — nerve root compression causing pain, numbness, or weakness radiating from the mid back — is far less common than cervical or lumbar radiculopathy. But when it exists and is documented, it is separately ratable.

Thoracic radiculopathy is rated under the peripheral nerve codes:

• DC 8510-8519 — Upper and middle thoracic nerve roots (intercostal nerves)
• Symptoms typically present as band-like pain wrapping around the ribcage, chest wall pain, or abdominal wall weakness
• Mild incomplete paralysis: 10%
• Moderate incomplete paralysis: 20%
• Severe incomplete paralysis: 40% (major extremity) or 30% (minor)

Secondary Conditions Linked to Thoracic Spine

Thoracic spine conditions can serve as the primary condition for several secondary service-connection claims:

• Thoracic radiculopathy / intercostal neuralgia — nerve compression from disc disease or spinal stenosis at the thoracic level
• Lumbar spine condition — altered biomechanics from thoracic dysfunction can accelerate lumbar degeneration (and vice versa); however, both are rated as a single thoracolumbar condition
• Cervical spine condition — compensatory postural changes from thoracic kyphosis can cause or aggravate cervical strain (this one is separately rated)
• Depression and anxiety — chronic pain secondary conditions rated under DC 9434/9413
• Sleep disturbance — mid back pain interfering with sleep, documented in medical records
• GERD — certain thoracic conditions and medications (NSAIDs) can contribute to gastrointestinal issues
• Respiratory limitation — severe thoracic kyphosis or scoliosis can restrict lung expansion (rated under respiratory codes)

C&P Exam Strategy for Thoracic Spine Claims

The C&P exam for a thoracic spine condition uses the same thoracolumbar ROM testing protocol as lumbar claims. But there are several thoracic-specific considerations you need to prepare for.

Before the Exam

• Gather imaging — X-rays or MRI of the thoracic spine showing any structural changes (spondylosis, disc disease, kyphosis, scoliosis). Imaging evidence strengthens the 38 CFR 4.59 painful motion argument.
• Document pain onset during ROM — Note at what degree of forward flexion, extension, and rotation your thoracic pain begins. This is separate from where motion physically stops.
• Track flare-ups — Keep a 90-day log of pain severity, duration, and how flare-ups limit function (cannot sit at desk, cannot drive, cannot carry objects). Sharp v. Shulkin requires examiners to estimate flare-up ROM.
• List medications — NSAIDs, muscle relaxants, and any prescription medications for thoracic pain support the chronicity of the condition.

During the Exam

• Specify thoracic location — Tell the examiner your primary pain is in the thoracic spine (mid back, between shoulder blades). Do not just say "back pain."
• Report onset of pain, not just end of motion — If pain begins at 60 degrees of forward flexion even though you can push to 80 degrees, say so. The examiner should record where painful motion begins.
• Request repetitive-use testing — The examiner should test ROM after three repetitions and document any additional functional loss. This is required under DeLuca.
• Describe worst-day function — When asked about flare-ups, describe what you cannot do during a bad episode. "I cannot turn my torso to check blind spots while driving" or "I cannot sit upright for more than 30 minutes" are functional descriptions the rater can use.
• Mention any radiating symptoms — If you have pain wrapping around your ribs, numbness in your trunk, or chest wall pain, report it. The examiner may not specifically ask about thoracic radiculopathy.

The Information Desert: Why Thoracic Claims Are Chronically Under-Rated

If this guide feels like it fills a gap you have been searching for, that is because it does.

Based on our review of VA rating practices and available advocacy resources, thoracic spine conditions exist in a genuine information desert. Here is why:

1. Low claim frequency — Thoracic conditions represent 10-20% of back pain cases, so fewer veterans file thoracic-specific claims
2. Less advocacy material — Because fewer veterans search for thoracic information, fewer organizations create content about it
3. Less regulatory clarification — With fewer thoracic claims and appeals, there is less case law interpreting how thoracic conditions should be rated
4. Less examiner experience — C&P examiners see thoracic-specific claims infrequently, which means less familiarity with thoracic-specific functional limitations
5. Anatomical masking — The lumbar spine compensates for thoracic limitation, making ROM measurements appear more normal than the veteran's actual functional capacity

This creates a self-reinforcing cycle: low frequency leads to less information, which leads to worse claims, which leads to lower ratings, which leads to fewer appeals, which leads to even less case law.

Frequently Asked Questions