The Shoulder and Upper Arm

Topics:

Loss of Use/Amputation of the Shoulder
Shoulder Replacement
Shoulder and Arm Limitation of Motion
Shoulder Dislocation
The Humerus Bone
The Clavicle and Scapula Bones
Other Shoulder and Upper Arm Conditions
DBQ for Shoulder and Upper Arm Conditions
Principles that Apply

Reminder: The VA will give a Military Disability Rating for each service-connected condition a service member has, but the DoD will only rate service-connected conditions that make a service member Unfit for Duty.

 


Loss of Use/Amputation of the Shoulder

The shoulder has two areas of movement. The shoulder joint moves the arm, and the scapula in the upper back moves the shoulder.

. amputation of the shoulder and upper arm

Code 5200: If the shoulder joint is frozen in place and cannot move at all, then it is rated depending on where it is frozen. (Note that the scapula could still move the shoulder even if the shoulder joint is frozen.) If the shoulder joint is frozen so that the arm cannot extend out to the side more than 25°, then it is rated 50% for the dominant arm and 40% for the non-dominant arm. If the arm can extend more than 25° but less than 60°, then it is rated 40% for the dominant arm and 30% for the non-dominant arm. If the arm can move to 60° or more and reach the head and mouth, then the dominant arm is rated 30% and the non-dominant rated 20%.

.loss of use of the shoulder and upper arm

amputation of the shoulder and upper arm

Code 5120: If the entire arm is amputated from the shoulder joint down, it is rated 90% for either arm.

Code 5121: If it is amputated below the shoulder but above the point where the deltoid attaches to the arm, then it is rated 90% for the dominant arm, and 80% for the non-dominant arm.

Code 5122: An amputation below the deltoid but above the elbow is rated 80% for the dominant arm and 70% for the non-dominant arm.

Your condition may also qualify for additional compensation by the VA. Please see the Special Monthly Compensation page for more information.

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Shoulder Replacement

Code 5051: If the entire shoulder joint has been replaced by a prosthetic device, the condition is rated 100% for the first year after the surgery. (This period is mainly for the VA, but the DoD will also use it if the veteran is placed on TDRL before being permanently separated). After the 1-year period, the condition is given a permanent rating. If there is weakness and severe pain with motion, then it is rated 60% for the dominant arm and 50% for the non-dominant arm.

If there are occasional periods of weakness, pain or limited motion, then the condition should be rated analogously (see the Analogous and Equivalent Codes page) either under code 5002, rheumatoid arthritis, or 5203, impairment of the clavicle or scapula, whichever most closely describes the condition’s symptoms. The final code for these analogous ratings look like this: 5051-5002. The first four-digit code defines the condition as a shoulder replacement, and the second code tells how the condition is rated.

The minimum rating for any total shoulder replacement is 30% for the dominant arm and 20% for the non-dominant arm.

Note: This code is only for total shoulder replacements. Partial replacements are rated on any symptoms that they cause, like limited motion.

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Shoulder and Arm Limitation of Motion

Code 5201: If the arm cannot be raised to the side more than 25°, it is rated 40% for the dominant arm and 30% for the non-dominant arm. If it cannot be raised more than 45° from the side, it is rated 30% for the dominant arm and 20% for the non-dominant arm. If the arm can be raised to shoulder level (90°), then it is rated 20% for either arm.

limited motion of the shoulder and upper arm

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Shoulder Dislocation

the bones of the shoulder and upper arm

Code 5202: If the humerus bone of the shoulder frequently dislocates, causing you to guard the arm and all of its movements, it is rated 30% for the dominant arm and 20% for the non-dominant arm. If it dislocates, but only occasionally, and movements of the arm are only guarded when the arm is raised to shoulder level, then it is rated 20% for either arm.

Code 5203: If the clavicle is dislocated from the scapula (“AC separation”), it is rated 20% for either arm.

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The Humerus Bone

Code 5202: Any problems with the humerus or humeral neck bones are under this code. If the humeral head is lost, causing flail shoulder, then it is rated 80% for the dominant arm and 70% for the non-dominant arm.

the bones of the shoulder and upper armIf the humeral neck bone is broken and does not heal back together, then the condition is rated 60% for the dominant arm and 50% for the non-dominant arm.

A fibrous union of a joint is one where the bones do not properly connect. The joint is held together by tissues instead of the bones. A fibrous union of the shoulder joint is rated 50% for the dominant arm and 40% for the non-dominant arm.

If the humerus or humeral neck bones are broken and heal, but not correctly, and thus cause a severe visual (you can see it just by looking at the arm) deformity, it is rated 30% for the dominant arm and 20% for the non-dominant arm. If there is a visual deformity, but it is not severe, then it is rated 20% for either arm.

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The Clavicle and Scapula Bones

Code 5203: If either the clavicle or scapula bones are broken and do not heal back together, it is rated 20% for either arm if there is loose or uncontrolled movement or 10% for either arm if there is not any loose movement. If they are broken and heal, but not correctly, then it is rated 10% for either arm.

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Other Shoulder and Upper Arm Conditions

Diseases that affect the shoulder and arm can be found on the Diseases of the Musculoskeletal System page and cancer in the shoulder and arm can be found on the Cancer and Tumors of the Musculoskeletal System page. All other shoulder and upper arm injuries or conditions will either be rated analogously (see the Analogous and Equivalent Codes page) with the above ratings or on the condition itself. The bottom line rule is to rate any condition under the code that BEST describes it, even if it is not exact. So, if you have tenosynovitis that affects the shoulder, it is rated under code 5024 for tenosynovitis. If the condition does not have an underlying disease to rate it under, then rate it on the condition above that best describes its symptoms.

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DBQ for Shoulder and Upper Arm Conditions

Here is the Disability Benefits Questionnaire (DBQ) used for conditions of the shoulder and upper arm: Shoulder and Upper Arm DBQ.

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Principles that Apply

amputation of the shoulder and upper arm

The Amputation Rule: Dominant arm: Any ratings for the shoulder and arm cannot be combined to be more than 90% for the entire arm including the shoulder joint, 80% for below the deltoid, and 70% below the pronator teres (see The Wrist and The Elbow and Forearm pages). Non-dominant arm: Any ratings for the shoulder and arm cannot be combined to be more than 90% for the entire arm including the shoulder joint, 80% for just below the shoulder, 70% for below the deltoid, and 60% below the pronator teres.

Painful Motion: If pain is present with motion, then the minimum rating must be given.

Special Monthly Compensation: If your condition makes it impossible to grasp things with your fingers or hold things in your hand, you may qualify for the VA’s Special Monthly Compensation. You may also qualify if your arm has been amputated.

The Joints: When rating arthritis, the shoulder is considered a major joint.

Pyramiding: A single condition can only be rated once! However, if a nerve condition exists that is additional to the shoulder or arm condition (not simply caused by it), then it can also be rated.

Probative Value: If two exams record the condition differently, the exam with the most thorough data and performed by the most qualified person in that specialty will be the exam the rating is based on.

A Tie Goes to the Veteran: If there are two equally strong exams with conflicting information, or if the condition can be equally rated under two different codes, then the one that gives the highest rating will be assigned. Every conflict should be resolved in favor of the higher rating.

Accurate Measurements: It is essential that the necessary information to rate your condition is recorded by the physician in your exam. All ranges of motion should be measured with a goniometer. With the information on this page, you should know what needs to be measured and recorded. Make sure this happens correctly to ensure that you receive a proper rating.

Hospital or Convalescent Ratings: Some conditions require periods of hospitalization or constant medical care (at-home nurse, etc.). Any condition that requires this is rated 100% during this intensive treatment. Once it ends, then the 100% rating will continue for a certain period. This period is 3 months unless another length (6 months, 1 year, etc.) is directly specified in the condition ratings. Some patients may need more time to recover than others, so the physician or Rating Authorities can lengthen this time period if they see fit.

Please see the Musculoskeletal Principles and the VASRD Principles pages for further guidance.

For muscle conditions, see The Shoulder and Upper Arm Muscles page.

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