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Back pain is the most common cause of chronic pain among adults. Nearly a quarter of adults will have episodes of back pain at some point. Many times, back pain becomes an ongoing part of their lives. For veterans, back pain is a leading cause of disability.
Back issues can begin with a traumatic injury or may creep up over time. Some veterans leave service knowing their injuries will result in long-term back pain. Others develop back problems years after experiencing ongoing spinal stress during military service.
If back pain prevents veterans from working, they may be eligible for VA disability benefits. But some veterans don’t realize that chronic back problems can lead to additional disabilities in the future. In this case, veterans can also apply for secondary disability benefits.
The secondary disability claims process is similar to filing an original disability claim, but instead of proving that military service caused a disability, the veteran must show that the original disability led to the secondary disability.
Original Disability Claims
The VA considers the first disability claim a veteran files as the starting point for all future disability ratings. The original claim is the most straightforward determination of disability. Veterans must demonstrate a connection between military service and their current state of health.
For example, a veteran might have sustained a significant knee injury during active duty. The veteran no longer has full use of the knee, limiting their ability to work or conduct typical daily life activities. The VA would rate that as a disability caused by military service.
A pre-existing condition aggravated by military service is also considered a disability by the VA. For example, a veteran might have had a knee injury from playing sports in high school. The injury healed enough that it did not disqualify the veteran from service. However, military service might have caused the knee to degenerate from wear and tear, leading to joint damage similar to that of a veteran who sustained the original injury during service.
If the veteran can prove that service-related activities aggravated the old injury, the VA will assign an original disability rating to the injury.
Secondary Disability Claims
The VA also recognizes that disabilities can have a domino effect. One chronic health condition can lead to additional conditions that increase a veteran’s state of disability. When this happens, a veteran might need greater levels of assistance from the VA.
Filing for an additional disability caused by the first disability is known as making a secondary claim. For example, a veteran with a disability due to a knee injury may develop arthritis over time. Perhaps the veteran changed how they walk to compensate for pain and weakness in the injured knee. This altered way of walking eventually caused a problem in the veteran’s low back.
If the veteran can demonstrate that the original disability caused lower back problems, the VA might award secondary benefits due to disability from the knee arthritis.
Veterans can file a secondary claim whenever an additional disability appears. There isn’t a time limit on secondary claims. In addition, veterans can file secondary claims for each additional disability caused by the original disability.
For example, the veteran with a knee injury can file a secondary claim for arthritis of the hip and later file another secondary claim for arthritis of the ankle or low back. In fact, it is common for altered gait due to pain in the feet, ankles, or knees to eventually alter the body mechanics of the spine, resulting in low back problems.
We have also seen many cases where a disability to one knee causes the veteran to favor the good knee, placing abnormal stress on the good knee. Over time, the veteran will also develop a problem in the good knee.
It’s important to note that a secondary claim must be for a new disability caused by a prior disability. A worsening of the original disabling condition is not a secondary claim. In that event, the veteran should apply for an increased rating claim related to the original disability.
Back Pain in Veterans
It’s not unusual for veterans to have back pain after active duty. Military service often requires service members to carry and lift heavy loads, jump, run, and pivot during training and combat. Those activities cause stress on the spine and lead to back pain that can get worse over time.
Back pain can be debilitating. Veterans with chronic back pain may not be able to work. In addition, they may not be able to move without pain, which reduces their activity levels. The combination of pain and a sedentary lifestyle can put veterans at risk for secondary conditions.
The VA is notorious for denying back conditions. In our extensive experience, most back disability claims have similar deficiencies that make them easy prey for a VA denial.
Why does VA deny so many back disability claims? The presentation is very similar in most cases that the VA denies. An initial injury may be noted in the service treatment records with no further follow-up. Moreover, the discharge exam is usually negative. Finally, many years go by without any medical treatment for the back problem. When the veteran finally goes to the doctor, decades have passed since service, and the VA attributes the problem to something that transpired as a civilian.
The reality is that the initial injury, even though the acute pain may subside soon afterward, sets in motion a slow degenerative process that takes years to get to the point where it causes debilitating pain. This explains the hiatus of many years without symptoms or treatment.
Alternatively, a veteran may have symptoms at discharge from the service but does not want to say anything for fear of getting held over. Then, he may find himself needing to work to support a family, so he deals with the pain without saying anything until many years go by and the pain becomes too severe to ignore anymore.
Secondary Conditions Related to Back Pain
Obesity
Limited movement is a risk factor for weight gain. Veterans who lose mobility due to back pain may not be able to exercise or engage in an active lifestyle. They may gain weight as a result.
The VA has not historically considered obesity as a disability. It was considered an “intermediate step.” But in 2021, the Federal Circuit weighed in on this topic, paving the way in the case of Larson v. McDonough for service connection for obesity. This means that if the original disability led to obesity and produced a disability as defined by VA, it could be service-connected.
Naturally, the “intermediate step” approach could also be used, which involves obesity leading to additional disabilities. Showing a record of weight gain following the original disability claim may help demonstrate a link to obesity-related health conditions.
Diabetes
Veterans who experience weight gain due to disability can develop type 2 diabetes. This metabolic condition affects how the body regulates the amount of sugar in the bloodstream. People with diabetes can live full lives if properly controlled, but the condition requires life-long management.
Most people with diabetes need to alter their diet and lifestyle significantly. They will need to test their blood sugar multiple times each day. Some people need insulin therapy, which may require daily injections. Insulin can also be administered with a surgically attached insulin pump.
The VA recognizes diabetes as a disability. Benefits vary based on the severity of the condition.
Cardiovascular Disease
Another complication of physical disabilities and low activity levels is heart disease. Issues like weight gain and limited movement can put veterans at risk for cardiovascular conditions, including heart failure, high blood pressure, and coronary artery disease. All of these are considered disabilities, and the VA rates them according to severity based on tests performed by doctors.
If a disability leads to a heart attack, also called a myocardial infarction, the veteran is entitled to 100% disability for three months. After that, future disability benefits are based on the general heart disease rating scale.
Other heart conditions such as heart rhythm disorders, peripheral artery blockages, or varicose veins may qualify for secondary disability claims. The VA rating scales for those conditions vary based on severity.
Heart disease is life-threatening without proper treatment. Veterans with heart conditions may need medication and lifestyle changes to manage the condition. In some cases, heart disease progresses and requires surgery.
Arthritis
Persistent back pain can alter how a veteran walks, runs, lifts, or sits. This can result in unusual wear on other joints, such as the knees or hips. Excessive wear on joints can damage the cartilage that protects the bones from rubbing directly against each other. The loss of cartilage is known as arthritis. It can cause significant pain. Arthritis may further limit a veteran’s mobility.
Historically, the VA combined several factors when rating arthritis as a disability. The baseline diagnosis of arthritis of two or more joints entitles veterans to a 10% disability rating. If the arthritis is periodically debilitating, the rating rises to 20%. The diagnosis must be confirmed by X-ray. Note that there are changes in the works for rating certain orthopedic disabilities. So, stay tuned for further updates on the VA rating code.
In addition to determining the presence of arthritis, the VA may award additional benefits based on how significantly arthritis affects the joint in question. Doctors will perform tests to determine whether the joint’s range of motion is limited and to what degree. The greater the effect, the higher the disability rating for the affected joint. Veterans can be entitled to as much as 80% disability for a range of motion limits caused by arthritis.
Arthritis is a chronic condition that cannot be reversed. Veterans with arthritis may need medication or physical therapy to manage pain and stiffness. If joint health continues to deteriorate, veterans may require surgery to replace the joint. Some veterans need mobility aids such as canes, walkers, or wheelchairs.
Mental Health Effects
Chronic pain and loss of mobility or independence can have a significant adverse effect on mental health. Veterans are at risk for depression, anxiety, insomnia, and other mental health conditions. The risk increases if they are disabled and/or struggling with chronic pain.
If a mental health condition interferes with work and other activities, the VA may award disability benefits. All mental health conditions are rated according to their effect on a veteran’s ability to participate in typical activities.
Treatment for mental health conditions can include medication and counseling. If symptoms of depression worsen or the veteran shows signs of self-harm, they may need to be admitted for in-patient treatment.
Sleep Apnea
Another potential side effect of disability-related weight gain is sleep apnea. This condition causes pauses in breathing during sleep. The pauses may last for several seconds or longer. The person then resumes breathing, often with a choking or snorting noise. They may wake up when this happens. Sleep apnea is often accompanied by persistent snoring.
The condition disturbs sleep repeatedly through the night. People who experience sleep apnea report feeling tired and may have trouble with concentration and energy during the day due to sleep deprivation.
The VA rates sleep apnea based on what kind of treatment veterans need to manage the symptoms and whether they feel tired more often than not.
Treatment for sleep apnea may involve custom mouth-guards to wear at night or a CPAP machine to provide constant oxygen. But VA is proposing wide-ranging changes to how it rates sleep apnea.
Neurological Problems, Including Bladder or Bowel Problems
In some cases, lower back pain involves damage to nerves in the spinal column. These damages can affect the peripheral nerves, causing radiating pain and numbness into the lower extremities. If a traumatic injury caused the pain, there might be residual damage from that incident.
In other cases, back pain causes physical changes to the spine, affecting the nerves. For example, inflammation or injury to the discs between vertebrae may cause pressure on nerves. The vertebrae themselves may then shift and pinch or push on nerves.
When back issues affect the nerves near the base of the spine, veterans might experience bladder or bowel function loss. Symptoms might include fecal and urinary incontinence, overactive bladder, or constipation.
Bladder dysfunction is considered a disability, according to the VA. Claims for bowel dysfunction may be more complicated. The VA doesn’t specifically address bowel disorders due to nerve damage, though they recognize conditions like irritable colon syndrome or loss of rectal control. Veterans should work with their doctors to characterize their bowel conditions most accurately.
Applying for Secondary Benefits from the VA
Veterans who have developed secondary disabilities related to back pain may be eligible for additional benefits. To qualify for secondary VA disability benefits, veterans must establish a link between their original disability and current health conditions. To demonstrate that connection, a veteran must provide medical evidence of a current disability. Veterans will need to show that the condition impacts their well-being and ability to work.
In addition, veterans need to show records of their diagnosis and treatment of their secondary disability. Veterans will need copies of medical records detailing symptoms, treatment, and results. Any test results or medical imaging records will be important, as well.