VA Disability Rating for Shoulder and Arm Conditions: The Definitive Guide

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VA ratings for shoulder and arm conditions range from 10% to 50%, with breaks at 20%, 30%, and 40%.

The lowest VA rating for shoulder and arm pain is 10%, while the highest rating is 40% if you have limited range of motion in your dominant arm at 25 degrees from the side.

The highest scheduler VA rating for the shoulder and arm is 90% for disarticulation (amputation at the shoulder joint) of the major arm.

The rating factors include the severity of the limitation of range of motion, measured by degrees with a goniometer, and whether it affects your major (dominant) or minor (non-dominant) arm.

Your final VA rating for the shoulder and arm depends on the frequency (how often), severity (how bad), and duration (how long) of symptoms and how those symptoms negatively impact your work, life, and social functioning.

Summary of Main Points

• Range of Ratings: VA ratings for shoulder and arm conditions generally range from 10% to 50%, based on the severity of symptoms, limitation of range of motion, and whether it affects the major (dominant) or minor (non-dominant) arm.

• Common Conditions: Conditions include rotator cuff tears, shoulder impingement syndrome, bursitis, tendonitis, dislocations, fractures, frozen shoulder, arthritis, nerve injuries, and muscle strains and sprains.

• Risk Factors: Common risk factors for veterans include repetitive movements, heavy lifting, trauma, poor ergonomics, prolonged use of handheld equipment, pre-existing conditions, and improper training techniques.

• Multiple Diagnostic Codes (DCs): In general, ratings for the shoulder and arm are assigned using DC 5200 for ankylosis, DC 5201 for limitation of motion, and DC 5202 for humerus impairment, evaluating specific impairments and their impact on functionality. The 5300 series is used for muscle injuries. A host of other DCs are used for conditions such as shoulder and arm arthritis, bursitis, tendonities, nerve injuries, and shoulder amputations, among others.

• Key Considerations: Factors like the painful motion principle, dominant vs. non-dominant arm, functional loss, and comprehensive medical documentation play crucial roles in determining VA ratings for shoulder and arm conditions.

What are Shoulder and Arm Conditions in Veterans?

Shoulder and arm conditions are common among veterans due to the physical demands of military service.

These conditions can result from repetitive use, trauma, or injury sustained during training, combat, or other military activities.

Here are some of the most frequently encountered shoulder and arm conditions in veterans:

Rotator Cuff Tears

Rotator cuff tears involve damage to the group of muscles and tendons that stabilize the shoulder joint. These tears can cause pain, weakness, and limited range of motion, making it difficult to lift or rotate the arm.

Shoulder Impingement Syndrome

Shoulder impingement syndrome occurs when the tendons or bursa in the shoulder are compressed during arm movements. This can lead to pain and reduced mobility, especially when lifting the arm overhead.

Bursitis

Bursitis is the inflammation of the bursa, the small fluid-filled sacs that cushion the bones, tendons, and muscles near the joints. In the shoulder, this condition can cause pain, swelling, and restricted movement.

Tendonitis

Tendonitis is the inflammation or irritation of a tendon, typically caused by repetitive use or minor impact on the affected area. In the shoulder and arm, tendonitis can lead to pain, tenderness, and difficulty moving the joint.

Dislocations and Fractures

Dislocations and fractures of the shoulder and arm are often the result of trauma or injury. These conditions can cause severe pain, instability, and long-term functional impairment if not properly treated.

Frozen Shoulder (Adhesive Capsulitis)

Frozen shoulder is characterized by stiffness and pain in the shoulder joint, leading to a significant reduction in the range of motion. This condition can develop gradually and is often associated with a prolonged period of immobility.

Arthritis

Arthritis in the shoulder and arm can result from wear and tear (osteoarthritis) or autoimmune conditions (rheumatoid arthritis). Symptoms include pain, swelling, stiffness, and decreased range of motion.

Nerve Injuries

Nerve injuries in the shoulder and arm, such as brachial plexus injuries, can cause pain, numbness, and weakness. These injuries are often related to trauma or overuse during military service.

Muscle Strains and Sprains

Muscle strains and sprains are common due to the heavy lifting and physical exertion required in military duties. These conditions can cause pain, swelling, and difficulty moving the affected limb.

What are the Risk Factors for Military Veterans?

Military service often involves rigorous physical activities that can increase the risk of developing shoulder and arm conditions.

Here are some common risk factors for military veterans:

Repetitive Hand and Arm Movements

Military duties often require repetitive motions, such as lifting, pushing, pulling, and carrying heavy loads. Repeated use of the shoulder and arm muscles and tendons can lead to overuse injuries, such as tendonitis and bursitis.

Heavy Lifting

Military personnel frequently engage in tasks that involve lifting and carrying heavy equipment, which can strain the shoulder and arm muscles and joints, leading to conditions like rotator cuff tears and muscle strains.

Trauma and Injuries

Combat situations, training exercises, and physical activities can expose service members to traumatic injuries, such as fractures, dislocations, and nerve damage. These injuries can have long-term effects on the shoulder and arm.

Poor Ergonomic Practices

Inadequate ergonomic conditions, such as poorly designed workstations or equipment, can contribute to musculoskeletal disorders. Improper lifting techniques and prolonged awkward postures can exacerbate shoulder and arm conditions.

Prolonged Use of Handheld Equipment

Extended use of handheld tools, weapons, and communication devices can place repetitive strain on the shoulder and arm, increasing the risk of conditions like tendonitis and impingement syndrome.

Pre-Existing Conditions

Veterans with pre-existing health issues, such as arthritis, diabetes, or obesity, may be more susceptible to developing shoulder and arm conditions due to compromised joint health and increased inflammation.

Age and Gender

Certain shoulder and arm conditions, such as rotator cuff tears and frozen shoulder, are more common in older adults. Additionally, some conditions may be more prevalent in one gender due to differences in anatomy and physical demands during service.

Improper Training Techniques

Inadequate training or improper techniques during physical exercises can lead to injuries. Ensuring proper training and form can help reduce the risk of shoulder and arm injuries.

Occupational Hazards

Exposure to environmental hazards or traumatic events during military service can lead to injuries or conditions that predispose veterans to musculoskeletal disorders.

Previous Injuries

Veterans with a history of shoulder or arm injuries, such as fractures, sprains, or dislocations, may have altered biomechanics or weakened structures, making them more prone to further injuries or chronic conditions.

Physical Exertion During Deployments

Combat deployments and field training exercises often involve intense physical exertion under challenging conditions. The physical demands of these activities can lead to acute and chronic shoulder and arm conditions.

What are the VA Ratings for Shoulder and Arm Conditions?

The VA uses a series of Diagnostic Codes (DCs) in the 5200 and 5300 series of 38 CFR § 4.71a, Schedule of Ratings, the Musculoskeletal System to evaluate and rate shoulder and arm conditions based on the severity of the disability and its impact on a veteran’s ability to perform daily activities.

Here’s a look at how the VA generally rates musculoskeletal and muscle injuries of the shoulder and arm:

DC 5200: Ankylosis of Scapulohumeral Articulation (Shoulder Joint)

Ankylosis refers to the abnormal stiffening and immobility of a joint due to fusion of the bones.

• Unfavorable, abduction limited to 25 degrees from the side:
  • Major Arm: 50%
  • Minor Arm: 40%
• Intermediate between favorable and unfavorable:
  • Major Arm: 40%
  • Minor Arm: 30%
• Favorable, abduction to 60 degrees, can reach mouth and head:
  • Major Arm: 30%
  • Minor Arm: 20%

DC 5201: Limitation of Motion of the Arm

This code evaluates the limitation of motion of the shoulder joint.

• At shoulder level:
  • Major Arm: 20%
  • Minor Arm: 20%
• Midway between side and shoulder level:
  • Major Arm: 30%
  • Minor Arm: 20%
• To 25 degrees from the side:
  • Major Arm: 40%
  • Minor Arm: 30%

DC 5202: Other Impairment of the Humerus

This code covers conditions such as malunion, recurrent dislocation, fibrous union, nonunion (false flail joint), and loss of head of the humerus (flail shoulder).

• Malunion of humerus with moderate deformity:
  • Major Arm: 20%
  • Minor Arm: 20%
• Malunion of humerus with marked deformity:
  • Major Arm: 30%
  • Minor Arm: 20%
• Recurrent dislocation of scapulohumeral joint with frequent episodes and guarding of all arm movements:
  • Major Arm: 30%
  • Minor Arm: 20%
• Recurrent dislocation of scapulohumeral joint with infrequent episodes and guarding of movement only at shoulder level:
  • Major Arm: 20%
  • Minor Arm: 20%
• Fibrous union of the humerus:
  • Major Arm: 50%
  • Minor Arm: 40%
• Nonunion of the humerus (false flail joint):
  • Major Arm: 60%
  • Minor Arm: 50%
• Loss of head of the humerus (flail shoulder):
  • Major Arm: 80%
  • Minor Arm: 70%

DC 5203: Impairment of Clavicle or Scapula

This code is used for rating impairments such as malunion, nonunion, or dislocation of the clavicle or scapula.

• Dislocation of the clavicle or scapula:
  • Major Arm: 20%
  • Minor Arm: 20%
• Nonunion of the clavicle or scapula with loose movement:
  • Major Arm: 20%
  • Minor Arm: 20%
• Nonunion of the clavicle or scapula without loose movement:
  • Major Arm: 10%
  • Minor Arm: 10%
• Malunion of the clavicle or scapula:
  • Major Arm: 10%
  • Minor Arm: 10%

DC 5301: Muscle Injuries – Group I

This code covers injuries to Muscle Group I, which involves the shoulder girdle and arm muscles responsible for upward rotation of the scapula and elevation of the arm.

• Slight:
  • Major Arm: 0%
  • Minor Arm: 0%
• Moderate:
  • Major Arm: 10%
  • Minor Arm: 10%
• Moderately Severe:
  • Major Arm: 30%
  • Minor Arm: 20%
• Severe:
  • Major Arm: 40%
  • Minor Arm: 30%

DC 5302: Muscle Injuries – Group II

This code involves Muscle Group II, responsible for the depression of the arm from the vertical overhead to the hanging at the side position.

• Slight:
  • Major Arm: 0%
  • Minor Arm: 0%
• Moderate:
  • Major Arm: 20%
  • Minor Arm: 20%
• Moderately Severe:
  • Major Arm: 30%
  • Minor Arm: 20%
• Severe:
  • Major Arm: 40%
  • Minor Arm: 30%

DC 5303: Muscle Injuries – Group III

This code pertains to injuries to Muscle Group III, which includes the deltoid muscles that control the elevation and abduction of the arm.

• Slight:
  • Major Arm: 0%
  • Minor Arm: 0%
• Moderate:
  • Major Arm: 20%
  • Minor Arm: 20%
• Moderately Severe:
  • Major Arm: 30%
  • Minor Arm: 20%
• Severe:
  • Major Arm: 40%
  • Minor Arm: 30%

DC 5304: Muscle Injuries – Group IV

This code covers injuries to Muscle Group IV, involving the intrinsic muscles of shoulder girdle that control the stabilization of the shoulder.

• Slight:
  • Major Arm: 0%
  • Minor Arm: 0%
• Moderate:
  • Major Arm: 10%
  • Minor Arm: 10%
• Moderately Severe:
  • Major Arm: 20%
  • Minor Arm: 20%
• Severe:
  • Major Arm: 30%
  • Minor Arm: 30%

How Does the VA Rate the Most Common Shoulder and Arm Conditions?

The VA assigns disability ratings for shoulder and arm conditions based on the severity of the impairment and its impact on the veteran’s ability to perform daily activities.

Here is a detailed explanation of how the VA rates each of these common conditions in veterans:

Rotator Cuff Tears

Rotator cuff tears involve damage to the muscles and tendons that stabilize the shoulder joint, leading to pain, weakness, and limited range of motion.

• Mild (Minor Arm): Typically rated at 10% if there is occasional pain with limited motion.
• Moderate (Minor Arm): Usually rated at 20% if there is frequent pain that limits motion significantly.
• Severe (Minor Arm): Could be rated at 30% if there is constant pain with a significant loss of motion and function.
• Mild (Major Arm): Typically rated at 20%.
• Moderate (Major Arm): Usually rated at 30%.
• Severe (Major Arm): Could be rated at 40%.

Shoulder Impingement Syndrome

Shoulder impingement syndrome occurs when tendons or bursa in the shoulder are compressed during arm movements, leading to pain and reduced mobility.

• Mild: Generally rated at 10% for occasional pain and minimal functional loss.
• Moderate to Severe: Can range from 20% to 30%, depending on the extent of functional limitations.

Bursitis

Bursitis is the inflammation of the bursa, small fluid-filled sacs that cushion the bones, tendons, and muscles near the joints.

• Diagnostic Code 5019:
  • Mild: Rated at 10% for mild inflammation with slight pain and minimal impact on motion.
  • Moderate: Rated at 20% for moderate inflammation causing pain and noticeable limitation of motion.
  • Severe: Rated at 30% for severe inflammation resulting in significant pain and marked restriction in motion.

Tendonitis

Tendonitis is the inflammation or irritation of a tendon, typically caused by repetitive use.

• Diagnostic Code 5024:
  • Mild: Rated at 10% for mild pain and slight functional loss.
  • Moderate: Rated at 20% for moderate pain with significant impact on motion and daily activities.
  • Severe: Rated at 30% for severe pain causing substantial functional impairment and restricted range of motion.

Dislocations and Fractures

Dislocations and fractures of the shoulder and arm result from trauma or injury, leading to severe pain, instability, and long-term functional impairment.

• Recurrent Dislocations:
  • Occasional dislocations with mild instability: Typically rated at 20%.
  • Frequent dislocations with marked instability: Could be rated as high as 30%.
• Fractures:
  • Healed with limited motion: Ratings can range from 10% to 20%.
  • Severe residuals such as ongoing pain or significant deformity: Ratings might be higher, up to 30% or more.

Frozen Shoulder (Adhesive Capsulitis)

Frozen shoulder is characterized by stiffness and pain in the shoulder joint, leading to a significant reduction in the range of motion.

• Diagnostic Code 5200:
  • Mild: Rated at 20% for mild stiffness and pain with some limitation of motion.
  • Moderate: Rated at 30% for moderate stiffness and pain causing significant functional loss.
  • Severe: Rated at 40% to 50% for severe stiffness and pain resulting in substantial limitation of motion.

Arthritis

Arthritis in the shoulder and arm can result from wear and tear (osteoarthritis) or autoimmune conditions (rheumatoid arthritis).

• Diagnostic Code 5003:
  • Mild: Rated at 10% for occasional symptoms and slight functional loss.
  • Moderate: Rated at 20% for moderate symptoms causing noticeable restriction in motion.
  • Severe: Rated at 30% or higher for severe symptoms with substantial limitation of motion and functional impairment.

Nerve Injuries

Nerve injuries in the shoulder and arm, such as brachial plexus injuries, can cause pain, numbness, and weakness.

• Diagnostic Codes 8510-8519:
  • Mild incomplete paralysis: Rated at 20%.
  • Moderate incomplete paralysis: Rated at 40%.
  • Severe incomplete paralysis or complete paralysis: Rated at 70% or more, depending on the severity of the nerve damage.

Muscle Strains and Sprains

Muscle strains and sprains are common due to heavy lifting and physical exertion required in military duties.

• Diagnostic Codes 5301-5304:
  • Slight: Rated at 0%.
  • Moderate: Rated at 10-20%, depending on the severity and functional impact.
  • Moderately Severe: Rated at 20-30%.
  • Severe: Rated at 30-40%.

Shoulder Pain

Shoulder pain itself is typically rated based on the limitation of motion and other specific conditions as follows:

Diagnostic Codes 5201, 5019, 5024:

• At shoulder level: Rated at 20% for both major and minor arms.
• Midway between side and shoulder level: Rated at 30% for the major arm, 20% for the minor arm.
• To 25 degrees from the side: Rated at 40% for the major arm, 30% for the minor arm.
• Mild cases of bursitis or tendonitis (causing pain with minimal functional loss): Rated at 10%.
• Painful Motion Principle (38 CFR § 4.59): Any shoulder condition causing pain during motion is considered at least 10% disabling.

Shoulder Separations

Shoulder separations involve the disruption of the acromioclavicular (AC) joint, where the collarbone meets the highest point of the shoulder blade.

• Mild Separations (Non-Displaced)
  • Diagnostic Code 5203: Rated under “impairment of the clavicle or scapula”.
    • Nonunion without loose movement: 10%
    • Nonunion with loose movement: 20%
    • Dislocation: 20%
• Severe Separations (Displaced)
  • Ratings depend on the functional impairment and the degree of joint instability.
  • If there is significant limitation of motion or deformity, ratings can be higher based on the impact on the shoulder’s function.

Shoulder Dislocations

Shoulder dislocations involve the upper arm bone popping out of the shoulder socket, often leading to joint instability and repeated dislocations.

• Recurrent Dislocations
  • Diagnostic Code 5202: Rated under “other impairment of the humerus”.
    • Frequent episodes and guarding of all arm movements:
      • Major Arm: 30%
      • Minor Arm: 20%
    • Infrequent episodes and guarding of movement only at shoulder level:
      • Major Arm: 20%
      • Minor Arm: 20%

Shoulder Surgery

Shoulder surgery ratings depend on the type of surgery and the residual effects post-surgery.

• Post-Surgery Recovery Period
  • Temporary 100% rating during convalescence under Diagnostic Code 5051.
  • The period of convalescence can last from 1 to 3 months and may be extended based on the surgery’s complexity and recovery progress.
• Residual Effects Post-Surgery
  • Rated based on limitation of motion, pain, and functional impairment.
  • Diagnostic Code 5201: Limitation of motion of the arm.
    • At shoulder level:
      • Major Arm: 20%
      • Minor Arm: 20%
    • Midway between side and shoulder level:
      • Major Arm: 30%
      • Minor Arm: 20%
    • To 25 degrees from the side:
      • Major Arm: 40%
      • Minor Arm: 30%

Shoulder Amputations

Shoulder amputations are rare but are rated based on the level of amputation and its impact on the veteran’s functionality.

• Diagnostic Code 5120-5125: Ratings depend on the exact site of the amputation.
  • Disarticulation (Amputation at the Shoulder Joint)
    • Diagnostic Code 5121:
      • Major Arm: 90%
      • Minor Arm: 80%
  • Amputation Above the Deltoid Insertion
    • Diagnostic Code 5122:
      • Major Arm: 80%
      • Minor Arm: 70%
  • Amputation Below the Deltoid Insertion
    • Diagnostic Code 5123:
      • Major Arm: 70%
      • Minor Arm: 60%
• Loss of Use of the Arm:
  • If the remaining arm function is negligible, it may be rated as equivalent to amputation under Diagnostic Code 5125:
    • Major Arm: 70%
    • Minor Arm: 60%

VA Ratings for the Shoulder and Arm: Key Considerations

• Painful Motion Principle: Under 38 CFR § 4.59, any painful motion with joint or periarticular pathology is considered productive of disability. This means that even if the range of motion is not severely limited, the presence of pain during movement can justify a minimum compensable rating.

• Dominant vs. Non-Dominant Arm: The VA assigns higher ratings for conditions affecting the dominant (major) arm compared to the non-dominant (minor) arm, reflecting the greater impact on daily activities and occupational duties.

• Functional Loss: The VA evaluates functional loss due to pain, weakness, excess fatigability, incoordination, or other factors. This includes assessing the veteran’s ability to perform normal working movements of the body with normal excursion, strength, speed, coordination, and endurance.

• Documentation and Medical Evidence: Comprehensive medical evidence, including detailed medical records, physician statements, and results from VA examinations, is crucial for accurately documenting the severity of the condition and supporting the disability claim.

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