Back or Neck Strain Secondary to Ankle Limitation Claim Guide
Back or Neck Strain (VA diagnostic code 5237) is sometimes claimed as secondary to service-connected Ankle Limitation (code 5271) under 38 CFR 3.310. We analyzed published Board of Veterans' Appeals decisions on that pairing; here is what they show. It is an encyclopedic reference, not a forecast.
The Numbers, from 1.9M Appeals
We analyzed the Board's published decisions and found back or neck strain (DC 5237) claimed as secondary to ankle limitation (DC 5271) is a real, mid-sized claim pool that loses more often than it wins once it reaches a merits decision.
How those 969 issues came out
Start with the essentials
- 01Service Connection
The ways a secondary connection can be established for this pairing.
- 02Diagnosis and Evidence
Common symptoms and the evidence cited in published Board appeals.
- 03Your History
What you experienced, what others observed, and what treatment changed.
Understand the claim
ICD-10 Diagnosis Codes for Back or Neck Strain
The ICD-10 diagnosis codes most commonly used for DC 5237, Back or Neck Strain (the kind on your medical records, decision letter, or C&P exam report). VA rates the disability and its residuals, not the diagnosis itself, so coding can vary.
What a secondary claim on this pairing needs
Under 38 CFR 3.310 a secondary claim turns on three elements:
- A current diagnosis: a medical diagnosis of back or neck strain (the secondary).
- A service-connected primary: Ankle Limitation, already service-connected (the primary). A 0% primary still counts.
- A medical nexus: a medical opinion linking the back or neck strain to the ankle limitation, showing the primary caused or aggravated it.
See the Secondary Claim guide for the caused-versus-aggravated split, and the Nexus Letter guide for what makes the medical opinion strong.
Why back or neck strain is claimed secondary to ankle limitation
Whether that medical link exists in any one case is a medical question decided on that case's own evidence (the nexus).
Pairing research and evidence
Symptoms Recorded in Granted Back and neck (spine) Decisions
We analyzed 19,539 granted Board decisions involving back and neck (spine) for symptoms named in sentences about the condition (rating-criteria recitations excluded). Descriptive of the published record, what the Board wrote down, not a checklist of what to report.
Bar length shows decisions. Percentages remain context.
Detected by phrase-reading the decision text with condition-specific vocabularies. Source: Board of Veterans' Appeals decisions, RateMyVSO analysis.
Caused By vs Aggravated By: What the Board Found
The outcome split above counts whole issues. This section goes one layer deeper. Under 38 CFR § 3.310 a secondary claim can be won two ways: the ankle limitation caused the back or neck strain (§ 3.310(a)), or it aggravated an existing back or neck strain (§ 3.310(b)). Every grant rests on one or the other, so the numbers below divide up the granted claims only.
Direct causation is the route that carries most grants here: 85% of them found the ankle limitation caused the back or neck strain, the rest found aggravation. A practical consequence for the nexus opinion: it should address both routes, because a medical opinion that only argues causation leaves the aggravation theory, a separate legal basis, on the table. See the caused-vs-aggravated guide for how the two theories differ.
On the other side: in 94 denied claims the Board looked at this pairing and found no link, meaning it decided the ankle limitation neither caused nor worsened the back or neck strain. That is a separate group from the grants above, counted here so the picture is not one-sided.
We analyzed published Board decisions on this pairing to build this split. The grant split covers granted claims only; denied, remanded, and dismissed claims are not in it. Descriptive of the published record, not a prediction.
What VA Looks For: Tests, Records, and Diagnostic Codes
We analyzed published Board decisions on these claims and ranked the records that appeared most often:
- A medical nexus opinion: the one record VA weighs most on a secondary claim, a doctor's statement linking your back or neck strain to your service-connected ankle limitation and naming the mechanism.
- In-service back or neck injury documented
- Range of motion measured in degrees
- Flare-ups and additional functional loss addressed
- Radiculopathy or EMG/nerve-conduction findings
- MRI or imaging of the spine
- Physician-prescribed bed rest
The diagnostic code involved: DC 5237 (Back or Neck Strain). The rating levels for this code are in the rating section below.
Records ranked by how often published Board decisions cited them. The exam that captures most of this is covered in the C&P Exam section below. Source: Board of Veterans' Appeals decisions, RateMyVSO analysis.
The Evidence That Wins Back or Neck Strain Secondary Claims
What veterans who win this pairing actually put in the file, and why each piece moves the claim.
- A current back diagnosis: A VA or private exam naming the condition, such as lumbosacral strain. In one grant, an earlier VA diagnosis counted even though a later VA exam found none.
- A service-connected ankle: The ankle must be service connected first. In two grants, the Board granted the ankle and then the back in the same decision.
- A nexus opinion that explains how: A doctor's opinion that the ankle changed your gait and that this strained your back, with reasons drawn from your records.
- An opinion on aggravation: A statement on whether the ankle made the back worse. One grant came on aggravation, and a VA opinion that skipped it was set aside.
- Medical literature: Opinions that cited studies on gait and the lumbar spine, and applied them to the veteran, were given weight.
- Your own description of your gait: Statements or testimony about limping, favoring the ankle and back pain. These were part of two grants.
- Treatment records with a steady timeline: Notes from treating doctors that link back pain to the ankle, and that record a consistent start date. One denial turned on start dates that did not match.
Evidence Cited in Published Back and neck (spine) Decisions
We analyzed 305,501 published Board decisions involving back and neck (spine) for condition-specific evidence, counting only case-specific mentions (boilerplate recitations excluded). "Favorable" is the share of decisions citing that evidence where every issue was granted or the outcome was mixed; the baseline across all these decisions is 43.4%, combining every diagnostic code below. Evidence appearing in a decision does not mean it decided the case. Descriptive of the published record, not a prediction.
Bar length shows decisions citing the evidence.
By diagnostic code
These codes are grouped together above. They do not perform the same, so find your own code here rather than reading the combined figure. A code retired in the schedule rewrites appears without a link, because its decisions were judged under criteria that no longer apply.
Bar length shows published decisions reviewed.
Detected by phrase-reading the decision text with condition-specific vocabularies. Source: Board of Veterans' Appeals decisions, RateMyVSO analysis.
Board Grants on This Pairing, Dissected
These five Board decisions from 2026 granted a back condition as secondary to a service-connected ankle. In every one, a medical opinion or treatment note tied a change in how the veteran walked to the back. In two of them, the Board granted the ankle itself first, in the same decision. The back diagnoses differ: three were lumbosacral strain, and two were disc, stenosis or facet conditions. Published Board decisions are not binding precedent. Each one decides only that veteran's appeal.
A treating doctor's gait opinion balanced two negative VA exams Citation A26064247 (July 13, 2026), Evidence Submission docket
The record: A December 2024 VA exam diagnosed lumbosacral strain. A December 2025 VA examiner found no back diagnosis. Both VA opinions were negative. The 2024 opinion said orthopedic literature shows no clear link between an injury to one joint and another, unless there is paralysis or a leg length difference over 5 cm with an obvious Trendelenburg gait. The 2025 opinion said arthritis in one joint does not cause arthritis in another, and found no aggravation. Dr. K.R., who had treated the veteran's right ankle since 2021, wrote in August 2025 that the ankle caused an altered (Trendelenburg) gait, that the ankle pain and limp put extra stress on the body, and that the back was as likely as not aggravated by the ankle. He said poor posture and balance from ankle instability cause lumbar spine problems, and he cited medical literature.
Why it won: The Board relied on the 2024 VA diagnosis to find a current back disability. It then weighed the VA opinions against Dr. K.R.'s and found the evidence in approximate balance on aggravation. It resolved reasonable doubt for the veteran under 38 CFR 3.310. The Board granted a cervical spine condition on the same reasoning.
A new gait opinion reopened a claim the Board denied in 2020 Citation A26035523 (April 16, 2026), Hearing docket
The record: The Board had denied the back and the ankle in November 2020. The back diagnoses included herniated lumbar disc, spinal stenosis, IVDS, degenerative disc disease and radiculopathy. A July 2020 VA examiner said degenerative disc disease is caused by aging and normal wear and tear, "not by an ankle" disability. Older private evidence was already in the file: a 2015 DBQ from Dr. P.N. said the veteran wore an ankle support daily, which caused aberrant weight bearing, and a 2015 letter from Dr. J.W.B. and Dr. L.W. said the ankle had chronically affected his gait and posture. The veteran testified that falls caused by his ankle hurt his back. New May 2025 private opinions said the ankle was injured in service, and that the low back disorder was at least as likely as not secondary to the ankle because of a chronic abnormal gait. The examiner cited medical literature on how an abnormal gait strains the lumbar spine over time.
Why it won: The new May 2025 opinions were new and relevant evidence, so the Board decided the claim again. It found them significantly probative because they applied medical principles to this veteran's facts. The evidence was in relative equipoise, so the benefit of the doubt applied. The Board granted the ankle on a direct basis and the back as secondary to it.
A VA opinion that skipped aggravation was set aside Citation A26030701 (April 3, 2026), Direct Review docket
The record: February 2025 VA exams diagnosed lumbosacral strain, bilateral sciatica and bilateral leg radiculopathy. A March 2025 VA opinion said there was no direct injury relating the right ankle to the back strain, and that back strain is common, with factors such as obesity, age, outside work and a sedentary lifestyle. A January 2025 private examiner (no credentials stated in the decision) noted that the back problem began after the ankle disability and the gait changes. She concluded that the ankle more likely than not caused an antalgic (pain-avoiding) gait that changed how he walked and led to biomechanical changes in the lumbar spine. She based this on her training, clinical experience and medical literature.
Why it won: The VA opinions did not address whether the ankle aggravated the back. Citing El-Amin v. Shinseki, the Board found them inadequate and did not consider them further. The evidence was in relative equipoise, and the benefit of the doubt applied. Radiculopathy in both legs was granted as secondary to the back.
Hearing testimony and one treatment note were enough Citation A26030326 (April 2, 2026), Hearing docket
The record: VA had already found a lumbosacral strain diagnosis. The veteran was service connected for a right ankle osteochondral defect and peroneal tendonitis. There was no positive VA opinion. At his hearing, he testified that the ankle changes his gait, that he overcompensates with his back to relieve the pain, and that the back pain is constant. Within the time allowed after the hearing, he sent in an April 2020 private treatment record. The physician wrote that his back pain was likely secondary to the change in gait from a significant ankle injury.
Why it won: The Board read the testimony and the treatment record together, in the light most favorable to the veteran. It found the conditions interconnected and resolved the conflicting evidence in his favor under the benefit of the doubt.
The ankle was granted first, then the back followed Citation A26039296 (April 28, 2026), Hearing docket
The record: The back diagnoses were lumbar facet arthropathy, spinal stenosis and bilateral lumbar radiculopathy. There was no VA exam for the back. The veteran testified that his back hurts because of the way he walks on his right ankle. In the same decision, the Board granted the right ankle after finding the VA ankle exam inadequate. Private records received in June 2025 showed his physician found the ankle so severe it would need surgery. The physician wrote that this was "likely affecting [the Veteran's] gait and therefore affecting his lower back."
Why it won: The Board found the private opinion adequate and gave it significant weight, because it gave reasons based on an accurate view of the record and the medical literature. Applying the "but-for" standard from Spicer v. McDonough, the Board found that the evidence persuasively showed the ankle caused the low back disability.
Why VA Denies, and How the Board Answered
The rationales below are the ones VA examiners actually used against this pairing in the published record, each paired with the Board's response.
- Read the left column first: if a VA opinion in your file uses one of these arguments, that is the reasoning your own evidence has to meet.
- The right column is the counter: it shows how the Board actually answered that argument, with the decision cited.
- A rationale appearing here is not a verdict: the same argument won some cases and lost others, on different records.
| VA examiner's rationale | How the Board answered it |
|---|---|
| Orthopedic literature shows no clear link from one injured joint to another, unless there is paralysis or a leg length difference over 5 cm with an obvious Trendelenburg gait. | In one case, the Board weighed this against a treating doctor's literature-backed gait opinion, found the evidence balanced and granted (A26064247). In another, it adopted the rationale because VA notes from 2007 and 2008 showed a steady gait and the private opinions rested on a history it found not credible (23044869). |
| No direct injury links the ankle to the back strain. Back strain is common, and obesity, age, work and a sedentary lifestyle are factors. | Inadequate. The opinion never addressed whether the ankle aggravated the back, so the Board set it aside and granted on the private opinion (A26030701). |
| Degenerative disc disease is caused by aging and normal wear and tear, not by an ankle disability. | Outweighed. New private opinions that applied medical literature to the veteran's chronic abnormal gait put the evidence in relative equipoise, and the claim was granted (A26035523). |
| Watching the veteran stand and walk without his cane showed no changes from favoring his painful ankles. Degenerative disc disease is common with aging. | Accepted. The examiner never used the word aggravation, but the Board found that ruling out any gait change also ruled out aggravation. The veteran's own belief was not competent evidence of a link (23067456). |
| Mild spine arthritis on a 2013 x-ray was consistent with the veteran's age. He did not walk with a grossly abnormal gait, and his ankle was not weak. A follow-up opinion found no imaging or treatment showing aggravation. | Accepted. No medical opinion in the file supported a link, and the veteran was not competent to give one himself (23065484). |
| A VA orthopedic surgeon found no causal relationship between the low back and the ankle, and no sign of sciatic nerve compression. | The Board gave the orthopedic surgeon more weight than the veteran's chiropractor, whose statements tied the back to an abnormal gait (9803379). |
If granted: rating and daily function
If Granted: How Back or Neck Strain Is Rated
The VA assigns one of these percentages based on what your medical record documents. Plain-language summary of the rating criteria at 38 CFR; the controlling text is the regulation itself.
| Rating | What the record has to show for DC 5237, Back or Neck Strain |
|---|---|
| 100% | Your entire spine has fused together in a bad position that severely limits your ability to move your back and neck (unfavorable ankylosis means the bones have grown together abnormally). This complete fusion makes it extremely difficult or impossible to bend, twist, or turn your spine in any direction, significantly impacting your daily activities and quality of life. |
| 50% | Your entire middle and lower back spine has fused together in a way that severely limits your movement and function. Unfavorable ankylosis means the vertebrae (spine bones) have grown together abnormally, creating a rigid, inflexible spine that significantly restricts your ability to bend, twist, or move your back normally. |
| 40% | You qualify for this rating if your entire neck is fused or locked in place in a bad position (unfavorable ankylosis), or if you can only bend forward 30 degrees or less in your mid to lower back, or if your entire mid to lower back is fused in a good functional position (favorable ankylosis). Ankylosis means your spine joints have become stiff and immobile, either naturally from your condition or surgically fused together. |
| 30% | You qualify for this rating if your neck can only bend forward 15 degrees or less (normal is 45 degrees), or if your entire neck spine has fused together in a good position (favorable ankylosis means the bones have grown together but in a way that doesn't cause major problems). This represents severe limitation in neck movement that significantly restricts your ability to look down or bend your head forward. |
| 20% | You qualify for this rating if your back or neck injury limits how far you can bend forward - either bending your back forward between 30-60 degrees or bending your neck forward between 15-30 degrees. You also qualify if your overall spine movement is significantly restricted (back movements totaling 120 degrees or less, neck movements totaling 170 degrees or less), or if you have severe muscle spasms that cause you to walk abnormally or develop visible spine curvature like a hunched back, loss of natural back curve, or sideways spine curvature. |
| 10% | You qualify for this rating with any one of these: forward bending of the lower (thoracolumbar) spine of more than 60 but not more than 85 degrees; forward bending of the neck of more than 30 but not more than 40 degrees; combined range of motion of the lower spine of more than 120 but not more than 235 degrees, or of the neck of more than 170 but not more than 335 degrees; muscle spasm, guarding or localized tenderness that does not change your gait or the spine's curves; or a vertebral body fracture with loss of 50 percent or more of its height. The combined range adds the six measured movements together (38 CFR 4.71a, Plate V). |
Do's and Don'ts
Every item below comes from a pattern in the decisions on this pairing, not from general claim advice.
- Get a medical opinion that explains how your ankle changed the way you walk and how that strained your back. Each grant rested on that explanation.
- Ask the doctor to address aggravation (the ankle making the back worse), not just cause. One grant came on aggravation alone, and one VA opinion was set aside because it skipped aggravation.
- Ask the doctor to cite medical literature and apply it to your facts. The Board gave weight to opinions that did this.
- Describe your limp or altered gait yourself, in statements or at a hearing. Testimony about favoring the ankle was part of two grants.
- Send in treatment records within your docket's evidence window. In one grant, a treatment note sent in after the hearing was the only medical opinion in favor.
- Don't rely on your own belief that the ankle caused the back. Two denials said the veteran was not competent to give that medical opinion.
- Don't file with no medical opinion at all. One 1996 claim failed because no doctor linked the ankle to the back.
- Don't give different doctors different start dates for your back pain. In one denial, the Board found the veteran not credible for this reason.
- Don't ignore other possible causes in your records, like heavy work, falls, age or weight. VA examiners pointed to them, and the Board accepted them in denials.
- Don't rely on an opinion built only on your own account. The Board gave little weight to private opinions that reviewed only civilian records and the veteran's history.
Prepare and take the next step
Prepare: your own working pages
Optional. These are your own notes, in your own words. They are not a VA form, they are not sent to the VA, and nothing here is a medical finding or a prediction about your claim.
Three reminders while you prepare
- Keep the two conditions separate
Record the history, diagnosis, symptoms, and treatment for Ankle Limitation and Back or Neck Strain separately before describing the possible relationship. Go to this part
- Ask about causing and worsening separately
A clinician may need to address whether Ankle Limitation caused Back or Neck Strain, whether it worsened it, and what other explanations the record shows. Go to this part
- Build the timeline from records you have
Mark missing or unverified records honestly. Research from published Board decisions describes the record reviewed; it does not predict an individual claim. Go to this part
Sign in or create an account to save your answers and come back to them later. You can fill these in and print them without an account.
Two-condition timeline
Back or Neck Strain: symptoms and daily function
Provider questions about the relationship
Records and unanswered questions
Decision-letter reading sheet
Quick Checklist Before You File
- Service connection already in place for Ankle Limitation, and a current medical diagnosis of back or neck strain.
- Diagnostic testing, imaging, or clinical records documenting the back or neck strain, whatever your provider used to diagnose and track it.
- A nexus opinion, whenever possible from a doctor familiar with back or neck strain, stating it is at least as likely as not caused or aggravated by the ankle limitation, and naming the mechanism rather than just the conclusion.
- Lay statements: spouse, family, friends, or battle buddies describing what they've witnessed or noticed.
- Your STRs and any VA opinions already in the file on either condition. If a VA opinion already went against you, your submitted opinion or statement should address its specific reasoning.
For the mechanics of filing itself, see the Standard Claim Guide and the Fully Developed Claim Guide.
The Claims Process, Step by Step
A secondary claim moves through the same pipeline as any other. Understanding who does what helps you know who to contact and what to expect.
- You file the claim, naming Ankle Limitation as the service-connected primary and back or neck strain as secondary. Directly with VA, through VA.gov, or with an accredited representative's help.
- VA assigns a Veteran Service Representative (VSR) to develop the claim: gather your service treatment records, VA and private medical records, and order a C&P exam if needed.
- The C&P exam is conducted, usually with the examiner asked to address the specific secondary theory (causation and aggravation both).
- The file goes to a Rating Veteran Service Representative (RVSR), the "rater," who weighs the medical evidence and decides service connection and, if granted, the rating percentage.
- VA issues the decision letter stating the outcome and the reasoning.
- If denied or under-rated, you choose an appeal lane, Supplemental Claim, Higher-Level Review, or a Board appeal, covered below.
Who's who: VSO vs. VSR vs. Rater vs. C&P Examiner
Your VSO
An accredited representative, agent, or attorney. Not a VA employee. Helps prepare and file, and can represent you on appeal. Has no authority to decide your claim.
VSR
VA staff who develops the claim: gathers records and schedules the exam. Does not decide the rating.
Rater (RVSR)
VA staff who reviews the complete file and makes the actual decision on service connection and percentage.
C&P Examiner
Conducts the exam and, where asked, gives a nexus opinion. Does not decide the claim, but the opinion's reasoning and legal framing carry real weight.
For the full walkthrough, see Inside Your Claim and Claim Stages.
DBQs and Your C&P Exam
A Disability Benefits Questionnaire (DBQ) is the standardized form the examiner completes for your condition. See the DBQ Guide for how these forms work and whether a private DBQ from your own doctor can be submitted instead of relying solely on a VA exam. For what to expect and how to prepare, see the C&P Exam Prep Guide, and be specific about how your back or neck strain symptoms relate to your ankle limitation timeline, treatment, and any aggravation, that is the detail a nexus opinion relies on.
Reading Your Decision Letter, and What to Do If Denied
Your decision letter has a narrative "reasons and bases" section and a codesheet with the rating and effective date. See the Reading Your Decision Letter Guide or use the Letter Interpreter tool to decode your own letter. If denied, you have three main lanes:
- Supplemental Claim: refile with new and relevant evidence, such as a nexus opinion that addresses the mechanism and the specific VA rationale you're rebutting. See Supplemental Claim Guide.
- Higher-Level Review (HLR): a senior reviewer looks at the same evidence again, useful if the denial rested on a legal error. See HLR Guide.
- Board Appeal: your case goes to a Veterans Law Judge, with a direct review, evidence, or hearing docket. See Board Appeal Guide.
Not sure which lane fits? See the Appeals decision guide for a side-by-side comparison.
After You Win: Maintaining Your Rating
Keep documentation of ongoing treatment, follow-up evaluations, and any updated diagnostic testing for your back or neck strain on file, this protects you if VA schedules a future reexamination. See Protect Your Rating for when a rating becomes protected and Future Reexaminations for what triggers one. If your back or neck strain worsens, see the Rating Increase Guide.
References and related resources
Frequently Asked Questions
Does Ankle Limitation have to be highly rated to support a back or neck strain secondary claim?
No. 38 CFR 3.310 looks at whether the service-connected Ankle Limitation caused or aggravated the back or neck strain, not at how severe the Ankle Limitation rating is. Even a 0% service-connected primary can anchor a secondary claim.
What do the percentages on this page mean?
They are the historical outcomes of 969 published Board decisions on this exact pairing: 14% granted, 24% denied, 61% remanded. They describe decided appeals already on record. They do not predict what would happen in any individual case.
RateMyVSO. Educational resource. Not affiliated with the U.S. Department of Veterans Affairs. Not legal advice. All RateMyVSO tools are free. Find a VSO representative for personalized guidance.