What does the examiner check at a Low Back Pain C&P exam?

Forward flexion of the thoracolumbar spine in degrees (normal is 0–90°) — the primary rating driver The full list is on this page.

What should I bring to a Low Back Pain C&P exam?

A short written summary of your worst days: what happens, how often, how long it lasts. A symptom log or calendar if you keep one — dates beat memory. Names and doses of medications, and whether they actually help.

Low Back Pain: C&P Exam Prep

The C&P (Compensation & Pension) exam is where a low back pain claim is usually won or lost. Here is exactly what the examiner measures, and how to describe your condition accurately and completely so the rating reflects your real life.

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Sources: 38 CFR Part 4 (rating schedule), VA DBQ 21-0960M-14

Describe your worst day and how often it happens — not your average day

C&P exams are snapshots. If you happen to feel okay that day and describe an okay day, that is what gets rated. The law (Sharp v. Shulkin) requires the examiner to account for your flare-ups and worst days, but only if you describe them. Give concrete frequency and duration: "three or four days a week I cannot…", "twice a month it lays me out for two days", not "sometimes it is bad."

The honest line: Report the full, honest picture — the bad days you tend to downplay included. Never invent or exaggerate symptoms. Overstating is both wrong and easy for an examiner to catch, and it can sink an otherwise valid claim.

What the examiner will assess

Taken from the Back (Thoracolumbar Spine) Conditions DBQ (21-0960M-14) — these are the rating drivers.

1Forward flexion of the thoracolumbar spine in degrees (normal is 0–90°) — the primary rating driver
2Combined range of motion of the thoracolumbar spine (normal combined is 240°)
3Objective painful motion and the degree at which pain begins
4Additional loss after three repetitions and during flare-ups (DeLuca / Correia)
5Muscle spasm/guarding severe enough to cause abnormal gait or spinal contour; ankylosis if present
6Incapacitating episodes requiring physician-prescribed bed rest (IVDS formula)
7Associated radiculopathy or bowel/bladder impairment (rated separately)

How the rating tiers work

The examiner's findings map onto these tiers under 38 CFR 4.71a, General Rating Formula for Diseases and Injuries of the Spine (DC 5237/5242). Radiculopathy and other neurologic abnormalities are rated separately under 4.124a.. Know which describes your real function so you can report the details that matter.

10%Forward flexion of the thoracolumbar spine greater than 60 degrees but not greater than 85 degrees; or combined range of motion of the thoracolumbar spine greater than 120 but not greater than 235 degrees; or muscle spasm, guarding, or localized tenderness not resulting in abnormal gait or abnormal spinal contour; or a vertebral body fracture with loss of 50 percent or more of the height.

20%Forward flexion of the thoracolumbar spine greater than 30 degrees but not greater than 60 degrees; or the combined range of motion of the thoracolumbar spine not greater than 120 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.

40%Forward flexion of the thoracolumbar spine 30 degrees or less; or favorable ankylosis of the entire thoracolumbar spine.

50%Unfavorable ankylosis of the entire thoracolumbar spine.

100%Unfavorable ankylosis of the entire spine.

Symptoms to describe (if you have them)

• Chronic lower back pain
• Pain radiating to legs (sciatica)
• Difficulty standing long periods
• Pain with bending/lifting/twisting
• Morning stiffness
• Muscle spasms
• Reduced range of motion
• Pain interferes with sleep
• Numbness/tingling in legs

Functional limits that raise a rating

• Sitting for extended periods
• Standing for long periods
• Lifting or carrying heavy objects
• Bending or stooping
• Walking long distances
• Sleeping comfortably
• Performing physically demanding work

Which exam you might get

In-person exam

A clinician examines you at a VA facility or a contractor (LHI, QTC, VES, MSLA). Bring your notes; you can hand them over.

Telehealth / video

Same questions over video. Have your notes on paper, not the same screen, and a quiet, private space.

Records-only (ACE)

No appointment — the examiner reviews your file. Everything rests on what is already documented, so your statements and medical records must carry the full picture.

Mention connected (secondary) conditions

Low Back Pain commonly leads to these. If you have any, raise them — they can each be rated on their own, and examiners will not connect the dots for you.

Radiculopathy Depression Hip Pain Erectile Dysfunction Knee Pain Plantar Fasciitis Bladder Dysfunction

What to bring

✓ A short written summary of your worst days: what happens, how often, how long it lasts.
✓ A symptom log or calendar if you keep one — dates beat memory.
✓ Names and doses of medications, and whether they actually help.
✓ Any private treatment records the VA may not have.
✓ A buddy statement or family note describing what they witness, if you have one.
✓ Your list of secondary conditions you believe are connected (see below).

Terms the examiner uses, in plain English

Prostrating: So severe you have to stop what you are doing and lie down (used for migraines).

Ankylosis: A joint frozen or fused so it cannot move at all — very different from "stiff" or "limited."

Occupational and social impairment: How much the condition hurts your ability to work AND to keep up relationships — the driver for mental-health ratings.

Flare-up: A period when the condition gets temporarily worse. Frequency and duration matter as much as severity.

Functional loss: What you cannot do because of the condition — lift, walk, focus, sleep, be around people.

Range of motion (ROM): How far a joint moves, measured in degrees. Report where PAIN begins, not just where motion stops.

Painful motion: Motion that hurts counts toward a rating even if the joint still moves — say exactly where the pain starts.

Deficiencies in most areas: A higher mental-health tier: the condition damages work, school, family, mood, and judgment across the board.

Before and after the exam

Low Back Pain rating & evidence

The full 38 CFR breakdown and the peer-reviewed studies behind the claim.

Build the claim & statement

Chart your claim and draft your personal statement first.

Educational content, not professional advice

This article is published by Military Transition Toolkit for educational and planning purposes. It is not legal, medical, or financial advice. VA rating criteria, benefits, and regulations change — verify anything benefits-affecting against VA.gov, 38 CFR Part 4, or a VA-accredited representative (VSO, agent, or attorney) before filing.

MTT is a veteran-owned planning tool and is not affiliated with or endorsed by the Department of Veterans Affairs, the Department of Defense, or any military branch.

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