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VA Disability Ratings for Shoulder and Arm Conditions

August 6, 2019
va disability ratings for shoulder and arm conditions amputation surgery

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.

How VA Rates Shoulder and Arm Conditions

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

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.

Amputations Resulting from Shoulder and Arm Conditions

If a veteran’s shoulder or arm condition results in an amputation, then it will be rated differently.  Specifically, if the entire arm is amputated from the shoulder joint down, it is rated 90 percent regardless of whether it is the dominant or nondominant arm (Diagnostic Code 5120).  If the arm is amputated below the shoulder but above the point where the deltoid attaches to it, then it is rated 90 percent for the dominant arm, and 80 percent for the non-dominant arm (Diagnostic Code 5121).  Finally, if the amputation is below the deltoid but above the elbow, it is rated 80 percent for the dominant arm and 70 percent for the nondominant arm (Diagnostic Code 5122).

VA Ratings for Shoulder Replacements

Shoulder replacements are evaluated under Diagnostic Code 5051.  If the entire shoulder joint has been replaced by a prosthetic device, the condition is rated at 100 percent for the first year after the surgery.  After the one-year period, the condition is then given a permanent rating.  Specifically, if there is weakness and severe pain with motion, then it is rated 60 percent for the dominant arm and 50 percent for the nondominant arm.  If there are occasional periods of weakness, pain, or limited motion, then the condition should be rated analogously either under Diagnostic Code 5002 (i.e. rheumatoid arthritis) or 5203 (i.e. impairment of the clavicle or scapula), whichever most closely describes the condition’s symptoms.  The final diagnostic code for this rating will either look like 5051-5002 or 5051-5203, where the first four-digit code defines the condition as a shoulder replacement, and the second code tells how the condition is rated.  Importantly, the minimum rating for any total shoulder replacement is 30 percent for the dominant arm and 20 percent for the nondominant arm.

VA Disability Compensation for Shoulder Surgery

Veterans who undergo shoulder surgery may be eligible for a temporary total rating based on convalescence.  Specifically, veterans will be assigned a 100 percent rating until intensive treatment is over.  Once it ends, then the 100 percent rating will continue for a period of 3 months (unless otherwise specified).

Separate Ratings vs. Pyramiding

Separate ratings occur when there is another distinct manifestation of a disability that is not currently rated.  For example, a veteran can be entitled to multiple disability ratings for a knee condition if they experience instability in addition to limitation of motion.  In contrast, pyramiding is a practice prohibited by VA, and refers to when a veteran has two disability ratings for a single manifestation of their disability.  Veterans can only be compensated once for each manifestation of a disability.  For example, a veteran cannot receive two disability ratings to compensate them for their back pain caused by a single condition.

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