Shoulder pain and limited range of motion are some common issues in veterans. It can develop while the service member is in the service or after their discharge. The inability to move the shoulder as necessary interferes with daily activities considerably, like doing chores, driving, or carrying objects.
You are entitled to VA compensations if you have service-connected shoulder conditions, such as limited range of motion. VA will rate your disability based on the specific movement range you can make. So, you may need to prepare for a thorough C&P exam.
Let’s get you through the intricacies of the shoulder’s limited Range of Motion (ROM) to help you get the VA compensation.
Anatomy of the Shoulder
To understand how VA rates vary depending on the ROM of the shoulder, you need to learn the different parts of your shoulder first. It will also help you understand your medical report and let you answer your questionnaire in detail.
Your shoulder has two joints: the acromioclavicular joint and the glenohumeral joint.
- Acromioclavicular Joint: The joint between the clavicle (collar bone) and the scapula (shoulder blade.
- Glenohumeral Joint (Ball-and-Socket Joint): The connection between the ball of the humerus (upper arm bone) and the glenoid joint socket.
Four tendons make up the connection between the joint of the humerus and the scapula- supraspinatus, infraspinatus, teres minor, and subscapularis. Together, they make the rotator cuff. Other names you may need to know are-
- Tendon: A tendon links muscles to the bones. They are fibrous tissues that can shrink or stretch as necessary during motion.
- Ligament: Aside from tendons, there are also fibrous tissues in the shoulder that make bone-to-bone joints. They are ligaments. For example, the coracoclavicular ligament, consisting of the trapezoid and conoid ligaments, links the coracoid process of the scapula to the clavicle.
- Labrum: It is another tissue that keeps the shoulder joints in line, preventing them from dislocation or becoming unstable.
- Shoulder Muscle: The muscles in the bones keep the bones firmly in their place against each other.
- Joint Capsule (Articular Capsule): These capsules are fibrous structures containing fluids. They keep a shield around the joint with the fibrocartilage tissue, keeping them lubricated. Thus, the parts can move without damage or friction between each other.
Causes of a Limited ROM of the Shoulder
Any of the following factors can be the reason behind the limitation of the motion range of your shoulder-
- Shoulder Bursitis: A condition when the articular capsules of the shoulder inflame.
- Shoulder Tendonitis: A condition when the rotator cuff or biceps inflame. It can cause limitation to movement and pain.
- Shoulder Dislocation: A dislocated shoulder means the humerus (upper arm bone) dislocation from the socket of the glenohumeral joint. A patient may require treatment that can help relocate it. This condition may result in the following symptoms-
- Pain
- Bruising
- Swelling of the part
- The chance of the region to dislocate again in the future is also there.
- Tearing of the Shoulder Cuff: Remember the four tendons we mentioned above? If they receive any damage, they may tear. While it is primarily reparable, a severe injury may not be so. The following symptoms come with a shoulder cuff tear-
- Pain
- Limited range of motion
- Weakness of the arm and shoulder
- Separation of Soulder: Shoulder separation is when the coracoclavicular ligament that links the collar bone to the shoulder blade tears or stretches. It is a serious condition requiring surgery to repair. The patient can experience the following-
- Pain
- Swelling
- Bruising
- Limited motion of the shoulder
- Weakness
- Shoulder Replacement: If a person receives serious damage to the shoulder, sometimes, they can be irreparable without replacing a part. In that case, they are replaced by artificial parts through surgery. Since it may not function as your original piece, it may cause the following-
- Limited range of movement
- Weakening of the shoulder and arm
- Frozen Shoulder: A condition where the shoulder joints get stiff, making any movement painful and limiting the motion.
Different Types of Range of Motion for the Shoulder
Your shoulder joints will allow you to move your arm in any direction without causing any pain under normal circumstances. Note that all arm movements cause some shoulder motion, too. Anyway, the VA gives specific names to each of these motions. When rating a veteran’s condition, they check the range of these movements and factor them in.
So, knowing them may help you in the process. The motions are as follows-
- Extension: Extending both arms backward with an angle of 45-60°. The palms will be facing towards the front of the body.
- Abduction: Extending both arms sideward with an angle of around 150°. The palms will be facing downward (towards the floor).
- Forward Flexion: Extending both arms frontward with an angle of around 180°. The hands should be as high as possible to the front of the body.
- Cross-body Adduction: Crossing any arm over the trunk towards the opposite shoulder with an ideal angle of 30-50°. The arm must be extended across the body as much as possible, as if reaching for something towards the opposite shoulder.
- Internal Rotation: While both arms are extended sidewards, flex both elbows at around 45° angle. Now, reach the lower arms at the waist level across the front side of the body with an ideal 70-90° angle.
- External Rotation: Like internal rotation, but the elbows will bend upwards at 90° between the upper and lower arms. Next, rotate your lower arm away from your body at an ideal angle of around 90°.
The movement and positions may be slightly confusing to you from reading. You can research for pics or videos to have a detailed understanding.
Service Connecting Your Shoulder Condition
If you want to establish a service connection for your shoulder disability, including ROM or pain, the following documents will be necessary-
- Medical diagnosis of the shoulder condition. It should explain the ROM limitation and symptoms in detail.
- Any MRI or X-ray report.
- Any other such treatment record and lab results.
- Military treatment report.
- Military personnel record.
- A nexus letter from a doctor explaining the connection between your condition and any event during your service. You may need to provide the physician with details about your military reports and any treatment reports during your service.
If your shoulder condition is secondary to other conditions, such as surgery for another service-connected disability, you may get VA disability compensation for both.
How VA Rates Limited ROM of Shoulder?
VA rates limited ROM of the shoulder under 38 CFR 4.71 and 38 CFR 4.73. The former is for the musculoskeletal system, and the latter is for any damage to the muscle. But you may get only one rating if you have conditions at both.
Whether the condition is on the side of your dominant or non-dominant side will affect your rating, too. For example, if you are right-handed, your right hand is your dominant hand. So, if your right shoulder has limited ROM, you will get a higher rating than your left shoulder.
Since we are talking about limited ranges of motion, the musculoskeletal rating will describe the conditions best. So, without further ado, let’s jump to the rating table below-
| Condition | Diagnostic Code | Severity and ROM | VA Rating for the Dominant Side | VA Rating for the Non-Dominant Side |
|---|---|---|---|---|
| Shoulder Replacement | 5051 | For one year after surgery | 100% | 100% |
| 5051,5200,5203 | One year after the surgery, with serious painful movement, weakness, and other symptoms | 60% | 50% | |
| 5051 | One year after the surgery but without many severe symptoms (minimum rating) | 30% | 20% | |
| Shoulder Immobility, Stiffness, and Scapulohumeral articulation | 5200 | Abduction motion is limited to 25° from the side; Unfavorable | 50% | 40% |
| Abduction is possible from 26° to 50° from the side; Between favorable and unfavorable | 40% | 30% | ||
| Abduction is possible till 60% from the side (possible to reach the head and mouth); Favorable | 30% | 20% | ||
| Limited Motion of Arm and Shoulder | 5201 | Abduction and/or flexion is limited to 25° from the side | 40% | 30% |
| Abduction and/or flexion is limited to 45° (between shoulder level and side) | 30% | 20% | ||
| Abduction and/or flexion is limited to 90° (at shoulder level) | 20% | 20% | ||
| Impairment of the Humerus Bone | 5202 | Flail Shoulder: Loss of the head of humerus, loss of joint function and shoulder stability | 80% | 70% |
| False Flail Joint: Nonunion of the humerus | 60% | 50% | ||
| Fribous Union: Fracture site while having some mobility | 50% | 40% | ||
| Dislocation of Shoulder with frequent episodes and guarding all arm movements | 30% | 20% | ||
| Dislocation of Shoulder with infrequent episodes and guarding of arm movements at shoulder level, where the abduction and flexion are at 90°. | 20% | 20% | ||
| Malunion of humerus bone with marked deformity | 30% | 20% | ||
| Maleunion of humerus bone with moderate deformity | 20% | 20% | ||
| Impairment of Clavice or Scapula | 5203 | Dislocation | 20% | 20% |
| Nonunion with loose movements | 20% | 20% | ||
| Nonunion without loose movements | 10% | 10% | ||
| Malunion | 10% | 10% |
Other shoulder condition ratings are based on their severity. These conditions are limitations to specific arm and shoulder movements. They are-
- Raising arms forward (5301)
- Lowering arms (5302)
- Raising arms to the side (5303)
- Shoulder rotation (5304)
- Shoulder movement and using biceps for elbows (5305)
- Shoulder movement and using triceps for elbows (5306)
The ratings for all these movement limitations are as follows-
| Severity | VA Rating for the Dominant Arm | VA Rating for the Non-Dominant Arm |
|---|---|---|
| Severe | 40% | 30% |
| Moderately Severe | 30% | 20% |
| Moderate | 10% | 10% |
| Slight | 0% | 0% |
If you have arthritis in your shoulder (not necessarily a limitation to ROM), you can get a 10% or 20% rating from it with X-ray evidence. You will get a higher rating if there are incapacitating exacerbations often.
Final Note
If you have a service-connected limitation of the range of motion of your shoulder, you need to file a claim for VA disability compensation as soon as possible. Of course, you must gather the necessary evidence and submit it alongside. Since the rating criteria for these conditions are like a maze, an eligibility review from the VA Disability Coach can help you find the correct path.
Make sure to answer openly during your Compensation & Pension (C&P) exam for your shoulder condition. Tell the examiner right when you are feeling pain when doing any movement according to their instruction. Also, explain how your state hinders you from doing certain activities during the exam.