Diagnostic Code 8021 · 38 CFR §4.124a
DC 8021 covers malignant (cancerous) tumors of the spinal cord — primary spinal cord cancers like ependymoma, astrocytoma, and glioblastoma when they arise in the cord rather than the brain, as well as metastatic tumors that have spread to the cord from other primary sites. The clinical course typically involves progressive neurological deficits below the level of the tumor — weakness, sensory loss, bowel and bladder dysfunction — and the diagnosis is usually established by MRI followed by biopsy or surgical resection. Treatment combines neurosurgical resection (when feasible), radiation therapy, and chemotherapy. For veterans, the relevant service-connection pathways include direct nexus to in-service exposures (toxic exposures recognized under the PACT Act and other presumptive frameworks for cancers), prior radiation exposure during service, and traumatic spinal cord injury as a possible risk factor for certain tumor types. The VA rates malignant spinal cord tumors at 100% during active disease and for six months after the cessation of active treatment, after which the rating shifts to whatever residuals remain.
| Rating | Criteria |
|---|---|
| 30% | Post-treatment with no active disease, but with residual neurological deficits at the 30% level — mild sensory loss, mild weakness, or mild functional limitation in the body areas innervated below the tumor level. |
| 60% | Post-treatment residuals at the 60% level — moderate weakness or sensory loss with measurable functional limitation, bowel or bladder dysfunction, ataxia, or other significant neurological residuals. |
| 100% | Active malignant neoplasm of the spinal cord, OR active treatment (surgery, chemotherapy, radiation, immunotherapy). The 100% rating continues for six months after cessation of active treatment. After that, residuals are evaluated and the rating shifts to whatever rating those residuals support under the appropriate code. Severe post-treatment residuals — complete paralysis below the tumor level, total functional loss, requirement for aid and attendance — keep the rating at 100% under the appropriate code, and Special Monthly Compensation applies based on the specific functional losses. |
MRI of the spinal cord showing the tumor is foundational. Pathology reports from biopsy or surgical resection confirm the malignant diagnosis, the tumor type, and the grade. Treatment records — operative notes, radiation oncology summaries, chemotherapy regimens, immunotherapy administration — establish the active treatment timeline that drives the 100% rating period. Serial post-treatment imaging documents any recurrence or progression. Neurological examination documents the functional residuals after treatment. Service records establishing exposure history (Agent Orange, burn pits, radiation, contaminated water) support the nexus when an environmental cause is the basis for service connection.
Yes — the six-month continuation of the 100% rating after cessation of active treatment is part of DC 8021 as written. Active treatment means surgery, chemotherapy, radiation, immunotherapy, or other antineoplastic therapy. The rating remains at 100% for six months after the last such treatment ends, after which a mandatory re-evaluation is performed and the rating shifts to whatever the residuals support. Surveillance imaging without active treatment does not extend the 100% period.
Some spinal cord tumors fall within the PACT Act presumptive framework for veterans exposed to burn pits or other airborne hazards, depending on the tumor type. Radiogenic cancers in veterans with documented ionizing radiation exposure during service are evaluated under the radiation-exposed veteran framework. Agent Orange presumptives cover certain other cancers but not all spinal cord tumor types. The specific presumptive pathway depends on the pathology diagnosis and the exposure history; a representative or VSO can match the diagnosis to the applicable framework.
Recurrence resets the 100% rating during the new active treatment period and for six months after that treatment ends. Each treatment cycle qualifies for its own 100% window. The post-treatment residuals from each cycle are evaluated independently, and the rating reflects whichever residuals are dominant at the time of the most recent evaluation.