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🦴 MusculoskeletalSpine / PelvisDC 5236

Sacroiliitis / Sacroiliac Joint Pain

Inflammation of one or both sacroiliac joints (where the sacrum meets the iliac bones of the pelvis), causing pain in the lower back, buttock, and sometimes radiating into the thigh. Common in veterans from heavy rucking, marching, jump landings, and prolonged load-bearing that strains the sacropelvic junction. Rated under DC 5236 (sacral spine) or by analogy to the nearest musculoskeletal condition. Often misattributed to lumbar spine pain.

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VA Rating Tiers

40%
severe
20%
moderate
10%
mild
0%
Meets minimum criteria

Rating Notes

  • ›40%: Severe sacroiliac dysfunction — near-complete ankylosis or significant ROM limitation with chronic incapacitating pain. DC 5236.
  • ›20%: Moderate sacroiliac dysfunction — limited lumbosacral motion with recurring episodes. DC 5236.
  • ›10%: Mild sacroiliac dysfunction — pain on prolonged activity with some functional limitation. DC 5236.
  • ›0%: Below rating threshold — service connected but non-compensable.
  • ›Rated under DC 5236 (sacral spine) or by analogy to the nearest spinal condition.
  • ›VA rates based on lumbar/sacral range of motion — forward flexion measurement is key.
  • ›A confirmed SI joint injection providing significant relief is strong evidence of the SI joint as pain source.
  • ›Often coexists with lumbar strain (DC 5237) — both can be rated if genuinely separate conditions.
  • ›Parachute jump history or vehicle rollover records are particularly strong service nexus evidence.

Eligibility Basics

✅
Current symptoms
✅
In-service event
✅
Diagnosis or lay evidence
  • •Sacroiliitis is rated under DC 5236 (sacral spine) or by analogy to the nearest spinal condition.
  • •Rating is based on limitation of lumbar and sacral motion — the VA will measure range of motion at the C&P exam.
  • •Common service causes: parachute landings, heavy rucking, prolonged marching, and vehicle rollover.
  • •MRI of the sacroiliac joints is the most sensitive imaging for sacroiliitis — X-ray may miss early changes.
  • •Sacroiliac joint injections (diagnostic and therapeutic) document the SI joint as the pain source.
  • •Often confused with lumbar spine pain — key distinction is pain at the dimples of Venus (posterior iliac spine) and the FABER/FADIR tests.

Evidence to Gather

Service Records

  • •records of lower back or pelvic pain during service
  • •records of parachute landing, fall, or direct sacral trauma during service
  • •records of heavy rucking or marching causing lower back/pelvic pain
  • •sick call or treatment records noting SI joint or sacral pain
  • •separation physical noting lower back or pelvic condition

Medical Evidence

  • •physician or orthopedic evaluation documenting sacroiliitis or SI joint dysfunction
  • •MRI of the sacroiliac joints (bone marrow edema, erosion, sclerosis)
  • •X-ray of the pelvis or SI joints (bony changes in chronic cases)
  • •CT of the SI joints (structural changes, erosion)
  • •records of SI joint injection (diagnostic or therapeutic)
  • •physical therapy records for SI joint rehabilitation

Lay Evidence (Buddy Statements)

  • •statement describing the parachute landings, rucking, or vehicle trauma that caused pelvic pain
  • •statement describing where the pain is — above the buttock at the dimple of Venus, not the low lumbar
  • •buddy statement noting observed back/hip pain or altered gait during service

Diagnostic Tests

  • •FABER test (Flexion, ABduction, External Rotation — hip and SI stress; positive = SI joint pain reproduction)
  • •FADIR test (Flexion, ADduction, Internal Rotation — differentiates hip from SI)
  • •Gaenslen's test (bridges one hip into extension while the other flexes — stresses SI joint)
  • •Distraction and compression tests of the pelvis (direct SI joint stress tests)
  • •MRI of the sacroiliac joints (most sensitive for early sacroiliitis)
  • •X-ray of the pelvis (sclerosis, fusion in advanced cases)
  • •Diagnostic SI joint injection under fluoroscopy (pain relief confirms SI joint as source)

C&P Exam Preparation

Exam type: Musculoskeletal / Spine — Sacroiliitis

Be ready to describe

  • •exactly where the pain is — at the dimple of Venus area above the buttock, not the center of the low back
  • •the in-service events that caused the SI joint pain (jumps, vehicle impacts, rucking)
  • •what movements reproduce the pain — sitting too long, getting up from a chair, uneven terrain
  • •whether you have had an SI joint injection and whether it helped
  • •how morning stiffness and positional changes affect your pain

Prep notes

  • •The pain you describe must be clearly localized to the SI joint area — point to the dimples in your lower back.
  • •Describe the specific in-service events: jump tower landings, Humvee rollover, ruck mileage.
  • •Tell the examiner about what makes it worse — sitting too long, getting up, one-legged activities.
  • •Bring MRI results and any injection records.
  • •If you also have a low back (lumbar) claim, tell the examiner — they are separate conditions.
  • •Note any morning stiffness, which supports an inflammatory component.

Quick Facts

Diagnostic Code
DC 5236
Category
Musculoskeletal
Subcategory
Spine / Pelvis
Typical Claim Type
direct
Rating Range
0% – 40%

Also Known As

sacroiliitissacroiliac joint painSI joint painSI joint dysfunctionsacroiliac dysfunctionSI joint inflammationsacroiliac painlow back SI painpelvic pain from backsacral paintailbone adjacent painlower lumbar pelvic painSI joint syndromeposterior pelvic pain

Related Conditions

Secondary to

lower back pain
📋

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