Injury occurs when there is trauma or damage to some part of the body. In this case, the spinal cord is affected. Manifestations of the injury depend on what area of the spinal cord is involved.

Injuries to the spinal cord may result from whiplash and other traumatic events, e.g., gunshot wounds, motor vehicle accidents, or falls causing fracture or dislocation or both resulting in compression or deformity of the cord leading to paresthesia or paralysis. Injury to levels C-4 to C-5 (cervical) or above cause loss of respiratory muscle function. In addition, injury below the C-4 level can cause swelling and bleeding, affecting the phrenic nerve's function, ultimately causing respiratory insufficiency.

Patients with spinal cord injuries present with different symptoms depending on the location and severity of the injury. Patients who sustain injuries that affect respiratory function (C-4 to C-5 or above) most often manifest signs of respiratory insufficiency, e.g., cyanosis, diminished breath sounds, apnea, weak cough, diaphragmatic breathing, decreased respiratory reserve, respiratory paralysis, and often death.

Spinal cord injury is usually diagnosed by appearance of clinical signs and symptoms, magnetic resonance imaging (MRI) or computed tomography (CT) scan of the spine. Respiratory status can most often be evaluated by observation of the clinical signs and symptoms. However, diaphragmatic weakness is most often determined by the measurement of pressures present across the diaphragm.

Patients with cervical cord injuries that could bring on respiratory involvement should initially be placed in supine position. In addition, maintenance of a patent airway and avoiding constriction around the chest is necessary. Corticosteroids given within 8 hours of injury are noted to be effective. Furthermore, once the spine is stabilized, injuries are treated with rest, analgesics, and muscle-relaxing drugs. The treatment most often used for respiratory insufficiency, depending on the degree, is ventilation (mechanical inhalation) assistance, all, or part of the day. Finally, emotional care of patients with spinal cord injury is essential due to the inevitable depression that can occur following the loss of control of one's body.

Once a patient is stabilized, extensive rehabilitation is indicated. Patients with spinal cord injury, with less than desirable outcomes, are subject to dealing with many lifestyle changes that may affect the rest of their lives socially, financially, physically and emotionally.

• May be entitled to special monthly compensation where the Veteran has a single service-connected disability rated as 100% with additional service-connected disability or disabilities independently ratable at 60% or more, which are separate and distinct from the 100% service-connected disability and involves different anatomical segments or bodily systems. See  38 CFR 3.350(i)(1) – Special Monthly Compensation (SMC).

• A 100% rating shall be assigned for pleurisy with empyema, with or without pleurocutaneous fistula, until resolved.

• Following episodes of total spontaneous pneumothorax, a rating of 100% shall be assigned as of the date of hospital admission and shall continue for three months from the first day of the month after hospital discharge.

• Gunshot wounds of the pleural cavity with bullet or missile retained in lung, pain or discomfort on exertion, or with scattered rales or some limitation of excursion of diaphragm or of lower chest expansion shall be rated at least 20% disabling. Disabling injuries of shoulder girdle muscles (Groups I to IV) shall be separately rated and combined with ratings for respiratory involvement. Involvement of Muscle Group XXI (Diagnostic Code 5321), however, will not be separately rated.  

• Review special provisions regarding the evaluation of specific respiratory conditions under 38 CFR 4.96(a)- Rating co-existing respiratory conditions and 38 CFR 4.96(d) - Special provisions for the application of evaluation criteria for diagnostic codes 6600, 6603, 6604, 6825–6833, and 6840–6845.