What Veterans Need to Know About Neck Range of Motion

Neck range of motion (ROM) entails how flexible your neck is in each of the directions it was designed made to move in.1 This is relevant to disabled veterans who are seeking a VA disability compensation rating for a neck disability. The VA largely bases the ratings for a neck disability on impairments in neck range of motion.

Range of motion essentially means the maximum amount of movement available at a joint. When movement is compromised at the cervical spine, decreased neck ROM occurs.1

The neck is often referred to as the Cervical portion of the spine or the Cervical Spine and would go from C1-C7. C1 and C2 would be referred to as the Atlas and Axis, respectively.1

What Is Normal Neck ROM?

The cervical spine’s range of motion is approximately 80° to 90° of flexion (the joint angle decreases), 70° of extension (the joint angle increases), 20° to 45° of lateral flexion (bend the neck to the side), and up to 90° of rotation to both sides.1

What Causes Limited Neck ROM?

Limited neck ROM can occur as a result of a number of reasons, such as soft tissue injuries of the neck, wear and tear on the neck’s cervical vertebrate creating disc degeneration, or damage to the spinal joints or discs themselves. While these are underlying causes of limited neck ROM, they may make it challenging for you to move your neck.2

Other reasons you may experience limited neck ROM are:2

• A mechanical issue within the neck joint
• Swelling of tissue around the joint
• Pain in the joint or radiating into your head or down to your arms and your fingers
• Stiffness and difficulty moving your neck through its full ROM

How Is Neck ROM Assessed?

Your physician can assess neck ROM through a visual examination and through the utilization of tools such as a:2

• Goniometer
• Inclinometer
• Cervical range of motion (CROM instrument)
• Compass

In a visual examination, your doctor would queue you to move your neck into flexion, extension, and lateral flexion. For example, for forward flexion, you would be asked to touch your chin to your neck.2 These factors are important to keep in mind whenever you have to undergo a VA C&P exam to assess the level of impairment in neck range of motion.

Depending on your condition, you may also be queued to assess for functional movement capabilities of your neck such as making neck circles.2

Why Is Having a Healthy Neck ROM Important?

Without full neck ROM, difficulties can arise in neighboring anatomical structures of your body. For example, if you are experiencing pain in your neck, it can potentially create headaches and/or photophobia (light sensitivity).1,2

Depending on the reasons you are experiencing limited neck ROM, you may also feel numbness and tingling in your arm(s), hand(s), and finger(s). As a result, you may have limitations such as difficulty lifting objects or raising your arms overhead. 1,2 While this is not always the case, it might happen, so it is important to seek medical assessment and treatment if you are experiencing limited neck ROM.

VA Rating for Neck ROM

The VA uses the General Rating Formula for Diseases and Injuries of the Spine under 38 CFR § 4.71a to evaluate the majority of neck pain conditions. This rating formula is based mainly on range of motion measurements according to the following criteria:3

• 10% Disability: Forward flexion of your thoracolumbar spine between 60° and 85°; or that of the cervical spine between 30° and 40°; or the combined ROM of the thoracolumbar spine between 120° and 235°; or the combined ROM of the cervical spine between 170° and 335°; or guarding, muscle spasm, or localized tenderness that do not affect gait or the contour of the spine.
• 20% Disability: Forward flexion of your thoracolumbar spine between 30° and 60°; or the forward flexion of the cervical spine between 15° and 30°; or the combined ROM of the thoracolumbar spine less than or equal to 120°; or the combined ROM of the cervical spine less than or equal to 170°; or muscle spasm or guarding serious enough to warrant an abnormal spinal contour or gait.
• 30% Disability: Forward flexion of the cervical spine less than or equal to 15°; or favorable ankylosis of the whole cervical spine.
• 40% Disability: Unfavorable ankylosis of the whole cervical spine; or forward flexion of the thoracolumbar spine less than or equal to 30°; or favorable ankylosis of the whole thoracolumbar spine.
• 50% Disability: Unfavorable ankylosis of the whole thoracolumbar spine.
• 100% Disability: Unfavorable ankylosis of the complete spine.

As you can see, the percentage awarded for your condition increases when you are more immobile, your range of motion decreases, or your natural stance locks at an unnatural angle.

If you are a veteran who believes your limited Neck ROM could be eligible to receive VA benefits, contact a veteran’s benefits attorney. You will first have to establish service connection. Once service connection is established, then the VA raters will determine the proper rating using the VA’s General Rating Formula for Diseases and Injuries of the Spine.

Practical Tips

When undergoing a VA exam for any neck or back injury, keep in mind that VA’s examiners are often testing to determine if you are exaggerating your symptoms. There are several orthopedic tests that, if positive, tell the doctor that you may be exaggerating your symptoms. In medical circles, the exaggeration of symptoms is called malingering. It is crucial to shoot straight with the VA examiners and not try to exaggerate. Being labeled a malingerer is the kiss of death for any claimant in a disability case.

To determine malingering, doctors use what is called the Waddell’s signs. These signs are as follows:

A common method of testing for exaggeration of faking is the use of Waddell’s signs.

These signs may include:

1. Tenderness over a wide area. This is considered a positive Waddell’s sign if you claim tenderness over a wide area.
2. Compression on the top of the head. If you claim that pressure on the top of the head causes low back pain, then this may be a positive Waddell’s sign.
3. Overreaction. – If you overreact with theatrical demonstrations of excruciating pain, this will be considered a positive sign of malingering. So, don’t exaggerate your pain responses.
4. Arm drop test. This is a test to ascertain false paresis (due to neurological involvement in most cases). This test is conducted by the examiner holding the alleged arm/hand above the patient’s face and then dropping it. The idea is that if the neurological impairment is genuine, the hand would hit the face. But, if the arm/hand does not hit the patient’s face, then this could indicate malingering.

Rather than try to outsmart a VA C&P examiner, be honest about your impairment. Don’t take pain medication on the day of the exam, and tell the examiner what it is like on a really bad day. Make sure the examiner tests you after multiple repetitions of movement and after the body part has been sufficiently fatigued.

If you have been denied an increased rating for a service-connected neck problem, and you are not working, it is especially important that you reach out to a qualified veterans benefits attorney.

If you have questions or need help with an appeal, please contact us at 888.878.9350 or info@eglawoffice.com.

References:

1. Swartz E.E., Floyd R.T., Cendoma M. (2005). Cervical Spine Functional Anatomy and the Biomechanics of Injury due to Compressive Loading. Journal of Athletic Training. 40(3),155-61.
2. Sukari A.A.A., Singh S., Bohari M.H., Idris Z, Ghani A.R.I, Abdullah J.M. (2021). Examining the Range of Motion of the Cervical Spine: Utilizing Different Bedside Instruments. Malays Journal of Medical Science. 28(2),100-105.
3. National Archives Federal Register: The Daily Journal of the United States Government. (2003, August 27). Schedule for Rating Disabilities; The Spine, A Ruling by The Veterans Affairs Department.