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Injuries to the shoulder and arm commonly occur while performing both combat and non-combat duties during service. However, establishing service connection for shoulder and arm conditions can be difficult. Veterans must (1) have a current, diagnosed shoulder or arm condition; (2) have experienced an event, injury, or illness during service; and (3) provide a medical nexus linking their shoulder or arm condition to their in-service event. Once service connection is granted, VA will assign a disability rating based on the severity of the veteran’s condition.

Common Shoulder and Arm Conditions Among Veterans

Many activities in service, such as lifting heavy objects, transporting heavy supplies, or forms of physical training, can often cause shoulder and arm injuries. Injuries in combat, such as a blow from an accident, a forceful impact, or a fall, could also result in shoulder or arm injury. Below are some common examples of shoulder and arm conditions:

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Shoulder Dislocation – A dislocated shoulder occurs when the upper arm bone pops out of the socket in the shoulder blade. It can cause swelling, bruising, pain, or the inability to move the shoulder or arm. The shoulder may appear visibly dislocated as well.

Shoulder Separation – A shoulder can become separated when the ligaments that attach the collarbone, or clavicle, to the shoulder become stretched or torn. In some cases, a separated shoulder requires surgery to repair. Symptoms include pain, weakness, bruising, swelling, and limited movement.

Rotator Cuff Tear – The rotator cuff is the collection of muscles and tendons surrounding the shoulder joint. The rotator cuff is responsible for keeping the head of the upper arm bone in the shoulder socket. Usually, a single injury can cause a rotator cuff tear and extensive tears may not be repairable. With a rotator cuff injury, symptoms may include weakness, pain, and trouble moving the arm or lifting things.

Shoulder Tendonitis – Shoulder tendonitis occurs when the rotator cuff and the biceps tendon become inflamed. The inflammation can be mild to severe. Symptoms include pain and limited mobility.

Shoulder Bursitis – Like shoulder tendonitis, shoulder bursitis is caused by inflammation. The subacromial bursa lies between the rotator cuff and shoulder blade and protects the tendons in this area. When the bursa becomes inflamed, it can cause pain and stiffness in the shoulder.

Shoulder Replacement – A shoulder may need to be replaced to reduce pain and increase mobility, strength, and function. Typically, a shoulder may need to be replaced as the result of severe arthritis or a serious shoulder fracture. During replacement surgery, parts of the shoulder joint are replaced with artificial implants.

Shoulder Amputation—As the result of injury, the arm or shoulder may need to be amputated. The VA has specific rating codes if a shoulder or arm need to be amputated.

How VA Rates Shoulder and Arm Conditions

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Generally speaking, VA rates shoulder and arm conditions under both 38 CFR § 4.71a – Schedule of Ratings – Musculoskeletal System and § 4.73, Schedule of Ratings – Muscle Injuries. The following Diagnostic Codes are included under the former and evaluated based on the range of motion of a major/minor joint group:

Diagnostic Code 5200 – Scapulohumeral articulation, ankylosis (abnormal stiffening and immobility) of:

50% (major)/40% (minor) – unfavorable, abduction limited to 25 degrees from side
40/30% – intermediate between favorable and unfavorable
30/20% – favorable, abduction to 60 degrees, can reach mouth and head

Diagnostic Code 5201 – Arm, limitation of motion of:

40/30% – to 25 degrees from side
30/20% – midway between side and shoulder level
20/20% – at shoulder level

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Diagnostic Code 5202 – Humerus, other impairment of:

80/70% – loss of head of (flail shoulder)
60/50% – nonunion of (false flail joint)
50/40% – fibrous union of
Recurrent dislocation of scapulohumeral joint
- 30/20% – with frequent episodes of guarding of all arm movements
- 20/20% – with infrequent episodes, and guarding of movement only at shoulder level
Malunion of
- 30/20% – marked deformity
- 20/20% – moderate deformity

Diagnostic Code 5203 – Clavicle or scapula, impairment of:

20/20% – dislocation of
Nonunion of
- 20/20% – with loose movement
- 10/10% – without loose movement
10/10% – malunion of

The Diagnostic Codes under 38 CFR § 4.73 for shoulder and arm conditions are split into six groups based on the limitation of motion of the different affected muscles. All of the criteria include severe, moderately severe, moderate, or slight and corresponds to a disability rating ranging from 0 to 40 percent. The disability rating assigned also depends on whether the veteran’s dominant (higher evaluation) versus nondominant (lower evaluation) arm is affected.

Compensation and Pension Exams (C&P) for Shoulder and Arm Conditions

VA may request a Compensation and Pension (C&P) exam to examine the veteran’s shoulder or arm condition. In the exam, either a VA physician or VA contracted physician will generally ask questions about the shoulder or arm condition and the veteran’s time in service. The examiner may also perform a physical exam on the veteran.

Often shoulder and arm conditions are rated based on range of motion. To obtain an official measurement of range of motion, the examiner will typically use a tool called a goniometer.

After the exam, the examiner will use the findings to issue an opinion, which will either be favorable or unfavorable. A favorable opinion will endorse the view that the shoulder or arm condition was caused by service. An unfavorable opinion will not.

Vetera