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Shoulder & Arm Conditions

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Emma Peterson: Good afternoon and welcome to another edition of CCK live. We are going to be talking about shoulder and arm conditions today and VA ratings for them. I am joined today by Kaitlyn Degnan and Alec Saxe both of whom are attorneys at the firm. Why do not we just dive right into it. As always, if you have questions or comments, please feel free to leave them and we will get back to you as soon as we can. We also have a number of blog posts on our website at cck-law.com that go more into depth about the things we are going to be talking about today. Please be sure to check those out too. Kaitlyn, what types of shoulder and arm conditions are common among veterans?

Kaitlyn Degnan: Shoulder and arm conditions commonly occur while veterans are performing both combat and non-combat duties during service. Injuries can occur when a veteran is doing typical activities such as physical training, transporting supplies, or lifting heavy objects on a regular basis. Alternatively, a tear might occur from a globe, an accident, a forceful impact, that kind of thing. These injuries can often include impairment of limitation of motion, a shoulder dislocation, a shoulder separation, a rotator cuff tear, a shoulder replacement, and an amputation for various parts of the arms.

Emma: That sounds pretty common among all groups of veterans. Let us say we have a veteran that has one of these conditions, Alec, how are these shoulder and arm conditions going to be rated?

Alec Saxe: Once VA grants service connection, the veteran will be assigned a rating based on the severity of their disability. The VA rates shoulder and arm conditions under two general rating criteria. 38 CFR 4.71 which is the schedule of ratings for the musculoskeletal system. Then 4.73 which is the rating schedule for muscle injuries. Emma and Kaitlyn will get a little more into this but in my practice, typically once a shoulder condition is service-connected, it is rated under the diagnostic criteria that determine the severity of the condition based on the outwards range of motion of the shoulder from your side. So, from the side to a 90-degree angle or shoulder level typically. That is the musculoskeletal. Then the muscle injuries, which Kaitlyn will talk about are based more on these criteria: severe, moderately severe, moderate, or slight categories.

Emma: That is right. Diving into the first thing Alec mentioned there, the range of motion. Under 38 CFR 4.71a, if anyone wants to take a look, there is a variety of ratings for the musculoskeletal system. Most of the time it is going to be based on your range of motion. An examiner or your doctor is going to look at how your shoulder is moving when you move your arm. Often times they will have you try to move your arm out to the side and out in front of you and see how far you get before you feel pain. They will also look at whether that arm is the dominant arm. Are you left-handed right-handed or is it the minor arm? You get a different rating based on which arm it is. The higher rating will be assigned for a dominant arm because you are going to be using that more. If you want to look into this further, we are going to put a link in the comments with all the codes and ratings listed out. Just know that oftentimes it is being rated on range of motion. Another way VA might rate your shoulder based on the musculoskeletal system diagnostic criteria is if whether you have ankylosis, a fusion of the joint. That is going to warrant a much higher rating. Other ratings that can be assigned, diagnostic code 5200 to 5203 can also include if you have frequent dislocation of the shoulder. I know people obviously are probably pretty familiar with shoulder dislocations. They can pop in and out and lead to a whole host of other disabilities. Arthritis down the line, ligament injuries, please be sure to take a look at that link in our comments if you want to dive further into it. Just know that it is really based on how far can you go before you feel pain. Kaitlyn, Alec mentioned that it also could be based on a muscle injury. Why do not you tell us a little bit about that?

Kaitlyn: Muscle injuries are rated under 38 CFR 4.73. Muscle injuries for the shoulder and arm conditions are split into six groups based on the limitation of the different affected muscles. As Alec mentioned earlier, these muscle injuries are rated based on the level of impairment that they resolved[?] in. Whether they are slight, moderate, moderately severe, or severe and that corresponds to a disability rating ranging from 0 to 40 percent. Just like a musculoskeletal disability, the rating assigned does depend on which extremity is disabled. So, a veteran’s dominant extremity is going to be rated at a higher evaluation than a non-dominant extremity because, as Emma mentioned, you are going to use your dominant extremity a little bit more than you would be using your non-dominant extremity.

Emma: Alec, let us say, worst-case scenario here, a veteran unfortunately has to have their arm amputated or anywhere up the arm, how is VA going to rate that disability?

Alec: They rate it differently. These cases are rated under diagnostic codes 5120 to 5122. Currently, VA rates amputations between 70 and a hundred percent. Pretty high ratings obviously. Depending on the proximity to the shoulder. Where the amputation is to the shoulder and again, based on whether it is the dominant or non-dominant arm. Where the computation is done closer to the elbow specifically below the insertion of the deltoid, those are on the lower range but still pretty a high rating. A 70 or 80% based on whether it is the non-dominant or dominant arm. Then when the shoulder is affected in the amputation, specifically above the insertion of the deltoid, it is a higher rating. Again, it will range based on whether it is the dominant or non-dominant arm. We just also want to note that as of January 17th of next year, the diagnostic code will change and will go up to 100% for amputees with more than shoulder joint and arm removed. You can click the link in our comments for a full list of our amputation ratings.

Emma: Another common procedure that can happen are shoulder replacements. Those are going to be rated under diagnostic code 5051. Again, it really is based on how much of your shoulder is being replaced. Is it the entire joint or is it something less than that? If your entire shoulder joint has been replaced by a prosthetic device, it is going to be rated at a hundred percent for the first year after surgery and then VA will send you for another examination to determine the severity of your disability post replacement. If there is weakness and severe pain with motion, it is going to rated at 60% for the dominant arm or 50% for the non-dominant arm. Some correlation to knee replacements there. Then, if you have occasional periods of weakness or pain or limitation of motion, they are going to rate you under that limitation of motion diagnostic codes we talked about in the beginning of the discussion. 5,002 for arthritis or 5203 for limitation of the impairment of the clavicle or scapula. The minimum rating you should know if you have one of these happening or you have had a shoulder replacement, the minimum rating you will get is 30% for the dominant arm and 20% for the non-dominant arm. Hopefully the surgery goes well and it fixes your problems and you no longer have pain and weakness. That is definitely the goal. But you still end up with either are 30 or 20% rating. Kaitlyn, what if I need to get a shoulder surgery, are there things I should be on the lookout for?

Kaitlyn: Yes. You do not need to have a shoulder replacement surgery in order to get a temporary total rating for your shoulder. If you undergo any kind of shoulder surgery that is service-connected, you might be eligible for a temporary table rating based on convalescence. In that situation, you would be assigned a 100% rating until intensive treatment is over. Once that treatment has ended, the 100% rating would continue for a period of three months, unless otherwise specified, then your disability would be rated on the residual symptoms. If there is a residual limitation of motion, your residual rating would be based on the limitation of motion.

Emma: Certainly, if you have one of these surgeries scheduled, be sure to reach out to your VSO, your accredited rep, an attorney or agent that you work with, whoever used to help you with VA claims to make sure you get the paperwork together and get this filed right away so that you can get that hundred percent rating however long you are entitled to it. Now is probably the time to do it. I know a lot of surgeries have been postponed due to the pandemic. Certainly, while you have the time, get everything together and reach out to your rep so that you can be sure to get this benefit that you deserve. Alec, are there any other benefits that veterans might qualify for impairment to the shoulder or arm?

Alec: We can talk about the bilateral factor. When we talk about the bilateral factor, what we mean is that if you have two service-connected disabilities with one on each side of the body, your rating may increase due to the bilateral factor. You do not need to have the same injury on each side in order to qualify but your conditions must affect either both upper extremities or both lower extremities. Not one of each. The example would be a service-connected right shoulder at 20% disabling and the service-connected left elbow maybe at 10%. That could combine to equal, using the VA map, 28 percent. But we recommend you use our VA disability calculator to factor your combined rating. You will see what we mean and you will see that there is the option to click left or right upper or lower extremity. When you do that, it should factor in this bilateral factor which can result in a higher rating. As always and finally, we like to remind veterans and their family members out there watching that you may be eligible for TDIU or total disability a hundred percent rating based on individual unemployability. If you are unable to maintain substantial gainful employment due to the severity or impact of your shoulder or arm injury, I encourage you to look into that. Visit our website and view our other videos. We have many of them with information about TIU or individual unemployability.

Emma: With that, we are pretty much covered. I think a good basic discussion of the shoulder and arm impairment. Kaitlyn, do you have any closing thoughts or suggestions for veterans out there watching?

Kaitlyn: As with trying to obtain any rating with any VA disability, one of the most important things that you can do is attend your C&P exam and accurately describe your symptoms to the examiner. Your ultimate rating is going to be decided based on how much that disability impairs you. If you are not giving that information to the C&P examiner, if you are not otherwise providing that information to VA, they are not going to be able to rate you based on that impairment. It is so important to give an accurate description of what your disability looks like in pursuing your claim.

Emma: I completely echo what you say, Kaitlyn. I think one of the ways in which veterans, unfortunately, get underrated for their shoulder and arm conditions, you are in that awkward rating. Moving your arm this way and this way and maybe that is not particularly natural to you. So, the best is you can describe how your shoulder and arm impact you in everyday activities. Can you pick up a gallon of milk? Can you carry groceries? Can you pick up your grandchildren or your children? Just try to describe it in everyday activities as best as you can. That will certainly help VA get a better picture of how your shoulder and arm impacts you. Alec, any closing thoughts or suggestions for veterans out there?

Alec: Those are both good points. I can just piggyback off that. Again, it is not just the statements that you would make to your CV examiners but really any documented treatment that is in the record is relevant. Any time you are seeing your treating providers at the VA, just be sure to give a full history about the functional impact of the shoulder injury and even the extent at which you are limited in that range of motion because that is what these criteria are mechanically based on the end of the day. That is helpful to give a picture of the disability and relevant evidence that VA has to consider in reading it.

Emma: We have posted a number of links in our comments for more in-depth information from our blog. Please be sure to check those out. You can also follow us on social media to stay up-to-date on various veterans topics. With that, I will sign off here with Kaitlyn Degnan and Alec Saxe. Emma Peterson and thank you so much for joining us.