Documents the Veteran's thoracolumbar spine conditions, including range of motion, radiculopathy and incapacitating episodes so VA can decide service connection and assign a disability rating.
- Completed by
- Veteran's treating or examining health care provider (MD, DO, NP, PA or other licensed clinician)
- Issued by
- U.S. Department of Veterans Affairs, Veterans Benefits Administration
- Format
- Fillable PDF
- Language
- English