On this page
- Ankylosing spondylitis VA rating criteria (DC 5240 and DC 5002)
- Active disease or stiff spine: which rating VA uses
- Fusion: favorable and unfavorable ankylosis
- Painful motion and flare-ups
- How much VA pays for ankylosing spondylitis
- How to prove ankylosing spondylitis is service connected
- The C&P exam and the back, neck and arthritis DBQs
- Why VA denies ankylosing spondylitis claims
- Questions veterans ask about ankylosing spondylitis
- What is the VA rating for ankylosing spondylitis?
- What is the highest VA rating for ankylosing spondylitis?
- Can I be rated under DC 5002 and the spine formula at the same time?
- Is a fused spine favorable or unfavorable ankylosis?
- Can uveitis be secondary to ankylosing spondylitis?
- Can ankylosing spondylitis diagnosed after service be connected to service?
- Sources
Ankylosing spondylitis has its own diagnostic code, DC 5240, but no percentages of its own. The code sits in the list of spine conditions that all rate on one shared table, the General Rating Formula for Diseases and Injuries of the Spine. A second code, DC 5002, rates spondyloarthropathies as an active disease, by flares and by how much the disease wears down your health. VA cannot pay both, so a key question in an ankylosing spondylitis claim is which path gives you more.
This page covers both rating paths word for word, how VA decides whether a fused spine is favorable or unfavorable ankylosis, how to show service connection, and the conditions veterans claim secondary to ankylosing spondylitis. Other spine conditions rated on the same formula have their own pages: back, cervical spine and thoracic spine. The Board section further down shows how ankylosing spondylitis appeals have ended.
Ankylosing spondylitis VA rating criteria (DC 5240 and DC 5002)
The spine formula (DC 5240)
38 CFR § 4.71a rates DC 5240 under the General Rating Formula for Diseases and Injuries of the Spine, which applies "with or without symptoms such as pain (whether or not it radiates), stiffness, or aching in the area of the spine affected by residuals of injury or disease." Here is the formula in full (eCFR current through October 5, 2026):
| Rating | General Rating Formula for Diseases and Injuries of the Spine |
|---|---|
| 100% | "Unfavorable ankylosis of the entire spine" |
| 50% | "Unfavorable ankylosis of the entire thoracolumbar spine" |
| 40% | "Unfavorable ankylosis of the entire cervical spine; or, forward flexion of the thoracolumbar spine 30 degrees or less; or, favorable ankylosis of the entire thoracolumbar spine" |
| 30% | "Forward flexion of the cervical spine 15 degrees or less; or, favorable ankylosis of the entire cervical spine" |
| 20% | "Forward flexion of the thoracolumbar spine greater than 30 degrees but not greater than 60 degrees; or, forward flexion of the cervical spine greater than 15 degrees but not greater than 30 degrees; or, the combined range of motion of the thoracolumbar spine not greater than 120 degrees; or, the combined range of motion of the cervical spine not greater than 170 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" |
| 10% | "Forward flexion of the thoracolumbar spine greater than 60 degrees but not greater than 85 degrees; or, forward flexion of the cervical spine greater than 30 degrees but not greater than 40 degrees; or, combined range of motion of the thoracolumbar spine greater than 120 degrees but not greater than 235 degrees; or, combined range of motion of the cervical spine greater than 170 degrees but not greater than 335 degrees; or, muscle spasm, guarding, or localized tenderness not resulting in abnormal gait or abnormal spinal contour; or, vertebral body fracture with loss of 50 percent or more of the height" |
Three of the notes that follow the formula matter most for ankylosing spondylitis:
- Note (1): "Evaluate any associated objective neurologic abnormalities, including, but not limited to, bowel or bladder impairment, separately, under an appropriate diagnostic code."
- Note (2) sets normal motion. "The normal combined range of motion of the cervical spine is 340 degrees and of the thoracolumbar spine is 240 degrees."
- Note (6): "Separately evaluate disability of the thoracolumbar and cervical spine segments, except when there is unfavorable ankylosis of both segments, which will be rated as a single disability."
The thoracolumbar spine is the mid and lower back together. The neck (cervical spine) gets its own rating from the same table.
The active process code (DC 5002)
DC 5002 is titled "Multi-joint arthritis (except post-traumatic and gout), 2 or more joints, as an active process." It rates at four levels:
| Rating | DC 5002, multi-joint arthritis as an active process |
|---|---|
| 100% | "With constitutional manifestations associated with active joint involvement, totally incapacitating" |
| 60% | "Less than criteria for 100% but with weight loss and anemia productive of severe impairment of health or severely incapacitating exacerbations occurring 4 or more times a year or a lesser number over prolonged periods" |
| 40% | "Symptom combinations productive of definite impairment of health objectively supported by examination findings or incapacitating exacerbations occurring 3 or more times a year" |
| 20% | "One or two exacerbations a year in a well-established diagnosis" |
Three notes follow the table:
- Note (1): "Examples of conditions rated using this diagnostic code include, but are not limited to, rheumatoid arthritis, psoriatic arthritis, and spondyloarthropathies."
- Note (2): "For chronic residuals, rate under diagnostic code 5003."
- Note (3): "The ratings for the active process will not be combined with the residual ratings for limitation of motion, ankylosis, or diagnostic code 5003. Instead, assign the higher evaluation."
NIAMS identifies ankylosing spondylitis as a type of arthritis affecting the spine. Ask the rheumatologist to document whether the active disease meets the multi-joint requirements of DC 5002, whose note includes spondyloarthropathies. The diagnosis alone does not establish every requirement of the active-process code. Rheumatoid arthritis and psoriatic arthritis rate under DC 5002 too and have their own pages.
Active disease or stiff spine: which rating VA uses
Note (3) to DC 5002 forces a choice. VA rates either the active disease under DC 5002 or the damage it has left behind, meaning lost motion and fusion of the spine under DC 5240 and lost motion of any other joint under that joint's code. It cannot give you both.
When VA adopted this note in the musculoskeletal update that took effect February 7, 2021, it explained in the Federal Register that the note "requires claims processors to assign the evaluation more advantageous to the claimant: An evaluation for active disease process OR an evaluation for the residual effects of the disease (including combined and/or bilateral factors, where applicable)." In plain terms, VA adds up your residual ratings first, using the combined ratings table, and compares that total to the DC 5002 rating.
The two paths reward different pictures of the disease, as the DC 5002 and spine formula tables show:
- Frequent flares favor DC 5002. Four or more severely incapacitating flares a year, or weight loss and anemia that severely impair your health, meet the 60 percent level even if your spine still moves fairly well.
- A stiff or fused spine favors the residual path. Favorable ankylosis of the whole thoracolumbar spine rates 40 percent and of the whole cervical spine 30 percent. Those two combine to 60 percent before any hip, shoulder or nerve rating is added.
If your rating decision used only one path, ask why the other was not compared. 38 CFR § 4.7 adds that when a picture falls between two levels, VA assigns the higher one if the disability "more nearly approximates the criteria required for that rating."
Fusion: favorable and unfavorable ankylosis
Ankylosis means a segment of the spine is fixed and no longer moves. Whether it is favorable or unfavorable decides several rows of the formula. Note (5) to the spine formula defines it:
Note (5): For VA compensation purposes, unfavorable ankylosis is a condition in which the entire cervical spine, the entire thoracolumbar spine, or the entire spine is fixed in flexion or extension, and the ankylosis results in one or more of the following: difficulty walking because of a limited line of vision; restricted opening of the mouth and chewing; breathing limited to diaphragmatic respiration; gastrointestinal symptoms due to pressure of the costal margin on the abdomen; dyspnea or dysphagia; atlantoaxial or cervical subluxation or dislocation; or neurologic symptoms due to nerve root stretching. Fixation of a spinal segment in neutral position (zero degrees) always represents favorable ankylosis.
So a spine fused straight, in neutral position, is favorable ankylosis: 40 percent for the thoracolumbar spine and 30 percent for the neck. A spine fused bent forward or back is unfavorable only if it also causes one of the listed problems, such as trouble walking because you cannot look ahead, trouble opening your mouth to chew, breathing only with the diaphragm, or trouble swallowing. Unfavorable ankylosis rates 50 percent for the whole thoracolumbar spine, 40 percent for the whole neck, and 100 percent for the entire spine.
The quoted ankylosis rows refer to the entire spinal segment. An imaging report mentioning partial fusion does not by itself answer those criteria. The examination should also describe motion, pain, repeated use and loss of function during flares.
Painful motion and flare-ups
The spine formula applies with or without pain, but pain still shapes the measurements. 38 CFR § 4.40 says "a part which becomes painful on use must be regarded as seriously disabled," and § 4.45 lists "pain on movement, swelling, deformity or atrophy of disuse" among the factors to weigh. 38 CFR § 4.59 adds that the schedule intends "to recognize actually painful, unstable, or malaligned joints, due to healed injury, as entitled to at least the minimum compensable rating for the joint."
Flares matter twice in this condition: they set the DC 5002 level, and they change how far your spine moves. In Sharp v. Shulkin, 29 Vet. App. 26 (2017), the Court held that an examiner has to ask about flare-ups and estimate the functional loss during them from all the evidence, including your own account, or explain why that cannot be done. If the disease reaches your hips or shoulders, Correia v. McDonald, 28 Vet. App. 158 (2016), requires those joint exams to test active and passive motion, weight-bearing and non-weight-bearing, and the opposite joint when possible. See the hip page for the hip codes.
How much VA pays for ankylosing spondylitis
At VA's rates effective December 1, 2025, a veteran alone receives $180.42 a month at 10 percent, $356.66 at 20 percent, $552.47 at 30 percent, $795.84 at 40 percent, $1,132.90 at 50 percent, $1,435.02 at 60 percent and $3,938.58 at 100 percent.
On the residual path, the neck and the rest of the spine are rated separately and then combined. A 40 percent thoracolumbar rating and a 30 percent cervical rating combine to 58 under 38 CFR § 4.25, which VA rounds to 60 percent. Nerve ratings under Note (1) and ratings for other joints combine on top of that. The combined rating calculator does the math. If service-connected conditions prevent substantially gainful employment, you may qualify for TDIU, which pays at the 100 percent rate.
How to prove ankylosing spondylitis is service connected
Ankylosing spondylitis that began in service
A direct claim needs a current diagnosis, symptoms or a diagnosis in service, and a medical opinion linking the two. Back pain and stiffness in service may have been charted as a strain. Those notes still matter: an opinion that reads them as early inflammatory disease, in light of your later diagnosis, is the link the claim needs.
Ankylosing spondylitis is diagnosed in service members of both sexes. In a study of 728,556 U.S. Army personnel from 2014 to 2017, all screened under a clinical guideline for chronic back pain, ankylosing spondylitis was diagnosed at similar rates in men and women, and rates rose with age (Nelson and colleagues, 2023). The authors noted that earlier studies finding far more men than women may have identified patients later in the disease. A study of 657,417 active-duty soldiers over the same years found that a new diagnosis of ankylosing spondylitis raised the risk of discharge from service about 2.5 times for men and 2.1 times for women, the highest of the conditions studied along with diabetes, though many soldiers with the diagnosis stayed in (Nelson and colleagues, 2022). If you were diagnosed in service or separated through a medical board, the board and profile records are strong evidence. If you were not, the buddy letter tool helps people who saw you struggle with stiffness or pain describe it.
When VA calls it genetic
An examiner may say ankylosing spondylitis is genetic, for example because a blood test found the HLA-B27 gene, and stop there. That is not the end of the claim. VA's General Counsel held in VAOPGCPREC 82-90 that service connection "may be granted for diseases (but not defects) of congenital, developmental or familial origin" when the evidence shows they were incurred or aggravated in service. Under 38 CFR § 3.304(b), you are also presumed to have been sound when you entered service, except for conditions noted on the entrance exam.
Document the actual onset
Do not assume that a diagnosis after discharge rules out a direct claim. Section 3.303(d) permits service connection for a disease diagnosed after discharge when the evidence establishes that it was incurred in service. Gather the early treatment records and ask the clinician to explain what they show about onset.
Conditions secondary to ankylosing spondylitis
Under 38 CFR § 3.310, a condition caused or aggravated by a service-connected condition is service connected too. The opinion should cover aggravation as well as cause: the condition is aggravated by the veteran's service-connected ankylosing spondylitis, meaning it would be less severe but for the ankylosing spondylitis. When aggravation is at issue, an opinion addressing only cause can be inadequate under El-Amin v. Shinseki, 26 Vet. App. 136 (2013).
Eye inflammation is one documented association. A review of 156 studies found uveitis in about one in four people with ankylosing spondylitis (pooled prevalence 25.8 percent), and prevalence increased with disease duration in the analysis. Estimates varied substantially between studies. The same review found psoriasis in 9.3 percent and inflammatory bowel disease in 6.8 percent (Stolwijk and colleagues, 2015). DC 6000 uses the eye formula, based on visual impairment or incapacitating episodes, whichever gives the higher evaluation. The formula defines an incapacitating episode as an eye condition severe enough to require a clinic visit specifically for treatment. Its treatment-visit path ranges from 10 percent for one or two visits to 60 percent for seven or more in the past year; a routine visit does not automatically satisfy that definition. See vision loss, psoriasis, Crohn's disease and ulcerative colitis.
Nerve problems in the legs are rated separately under Note (1) to the spine formula; see radiculopathy. Any secondary condition still needs evidence of its relationship to the service-connected disease. The research does not establish that link in every individual case.
The C&P exam and the back, neck and arthritis DBQs
VA examines ankylosing spondylitis with the Back DBQ for the thoracolumbar spine, the Neck DBQ for the cervical spine and the Arthritis DBQ for the active disease and other joints. Before the exam:
- Keep a flare log. Write down each flare, how long it lasted, whether you missed work or stayed in bed, and any steroid course or urgent visit. DC 5002 counts incapacitating flares per year.
- Make sure both segments are measured. The neck and the thoracolumbar spine are rated separately, so each needs its own range of motion and flare-up estimate.
- Ask about ankylosis directly. The report should say whether any segment is fused, whether the whole segment is fixed, and whether it causes any of the Note (5) problems.
- List everything else. Other painful joints, eye flares, leg numbness or weakness, and bowel or bladder problems each need their own findings.
- Bring your treatment history. Rheumatology notes, imaging and prescribed medicines help document an active process.
Before the exam, Raven Scan can help you review your uploaded medical records as you prepare for the exam.
Why VA denies ankylosing spondylitis claims
The Board section below shows the available ankylosing spondylitis appeal results. The small sample does not support publishing detailed denial or remand breakdowns. The evidence issues below follow from the rating and service-connection rules described above.
An inadequate exam. An exam needs enough information to address the applicable rating criteria. Exams that skip flare-ups, measure only one spine segment, or never address DC 5002 leave the rater without what both rating paths need.
Missing records. Missing records can leave the onset and severity unclear. Rheumatology records, imaging, service treatment records and medical board files all bear on when the disease started and how active it is. Tell VA where each set of records is.
No link to service. When the diagnosis came years after service, VA may find nothing tying it to service. A favorable opinion has to read your in-service back complaints, profiles and sick call notes in light of the later diagnosis.
The genetic argument. An opinion that rests only on HLA-B27 or family history does not answer whether the disease began or worsened in service. VAOPGCPREC 82-90 is the source to cite.
Only one rating path considered. A decision that rates the spine without comparing DC 5002, or rates DC 5002 without adding up the residuals, has not done what Note (3) requires.
Questions veterans ask about ankylosing spondylitis
What is the VA rating for ankylosing spondylitis?
Ankylosing spondylitis rates under DC 5240 on the spine formula, 10 to 100 percent across the formula, with 100 percent reserved for unfavorable ankylosis of the entire spine, or under DC 5002 as an active disease at 20, 40, 60 or 100 percent. VA assigns whichever path gives the higher rating, counting the combined value of the residual ratings.
What is the highest VA rating for ankylosing spondylitis?
100 percent, either for unfavorable ankylosis of the entire spine under the spine formula or for active disease that is totally incapacitating under DC 5002. TDIU can also pay at the 100 percent rate when the condition keeps you from working.
Can I be rated under DC 5002 and the spine formula at the same time?
No. Note (3) to DC 5002 bars combining the active process rating with ratings for limited motion or ankylosis. VA must compare the two and assign the higher one.
Is a fused spine favorable or unfavorable ankylosis?
A spine fused in neutral position is always favorable ankylosis. It is unfavorable only when the entire segment is fixed in flexion or extension and causes one of the problems in Note (5), such as difficulty walking because of a limited line of vision.
Can uveitis be secondary to ankylosing spondylitis?
Yes. Under 38 CFR § 3.310, uveitis caused or aggravated by service-connected ankylosing spondylitis is service connected, and a review of 156 studies found uveitis in about one in four people with the disease. Its evaluation uses visual impairment or qualifying incapacitating episodes under the eye formula, whichever is higher.
Can ankylosing spondylitis diagnosed after service be connected to service?
Yes, when the evidence establishes that it was incurred in service under § 3.303(d). A clinician should address the early symptoms, treatment and later diagnosis. The date of the diagnosis alone does not decide that question.
Sources
- 38 CFR § 4.71a, DC 5240, the General Rating Formula for Diseases and Injuries of the Spine, and DC 5002 (opens in a new tab), eCFR current through October 5, 2026
- VA final rule, Schedule for Rating Disabilities: Musculoskeletal System and Muscle Injuries, 85 FR 76453 (opens in a new tab), November 30, 2020, effective February 7, 2021
- 38 CFR § 4.40 and § 4.45, functional loss and the joints (opens in a new tab)
- 38 CFR § 4.59, painful motion (opens in a new tab)
- 38 CFR § 4.7, higher of two evaluations (opens in a new tab)
- 38 CFR § 4.25, combined ratings table (opens in a new tab)
- 38 CFR § 4.79, DC 6000 and the General Rating Formula for Diseases of the Eye (opens in a new tab)
- 38 CFR § 3.304, presumption of soundness (opens in a new tab)
- 38 CFR § 3.310, secondary service connection (opens in a new tab)
- VA General Counsel Precedent Opinion 82-90, congenital and familial conditions (opens in a new tab)
- Sharp v. Shulkin, 29 Vet. App. 26 (2017); Correia v. McDonald, 28 Vet. App. 158 (2016); El-Amin v. Shinseki, 26 Vet. App. 136 (2013)
- Nelson DA, Kaplan RM, Kurina LM, Weisman MH. Incidence of ankylosing spondylitis among male and female United States Army personnel. Arthritis Care Res (Hoboken). 2023;75(2):332-339. doi:10.1002/acr.24774 (opens in a new tab)
- Nelson DA, Kaplan RM, Weisman MH, Kurina LM. Service discharges among US Army personnel with selected musculoskeletal and skin conditions: a retrospective cohort study. BMJ Open. 2022;12(10):e063371. doi:10.1136/bmjopen-2022-063371 (opens in a new tab)
- Stolwijk C, van Tubergen A, Castillo-Ortiz JD, Boonen A. Prevalence of extra-articular manifestations in patients with ankylosing spondylitis: a systematic review and meta-analysis. Ann Rheum Dis. 2015;74(1):65-73. doi:10.1136/annrheumdis-2013-203582 (opens in a new tab)
- VA disability compensation rates (opens in a new tab), effective December 1, 2025
- Back DBQ guide, Neck DBQ guide, Arthritis DBQ guide
- NIAMS, ankylosing spondylitis overview (opens in a new tab)
- El-Amin, court opinion (opens in a new tab)
- Sharp, court opinion (opens in a new tab)
- Correia, court opinion (opens in a new tab)
- 38 CFR § 3.303, service connection (opens in a new tab)
- 38 CFR § 4.16, unemployability (opens in a new tab)