How VA rates shoulder condition
DC 5201 addresses limitation of arm flexion and/or abduction. The dominant (major) and non-dominant (minor) arm have different percentages at the 45-degree and 25-degree limits, but both are 20% at shoulder level. Other shoulder findings use other criteria.
Reference shoulder motion: forward flexion 0-180 degrees, abduction 0-180 degrees, and internal/external rotation 0-90 degrees. Rotation is not mapped to a percentage in this illustration.
Rating criteria from the tool data
| Rating | What VA looks for |
|---|---|
| 20% (major) / 20% (minor) | Arm limited to shoulder level (90° — can raise arm to horizontal but no higher) |
| 30% (major) / 20% (minor) | Arm limited to midway between side and shoulder level (45°) |
| 40% (major) / 30% (minor) | Arm limited to 25° from side |
DBQ and symptom topics to review
Review these topics against your own records. Describe function accurately, without exaggerating or minimizing symptoms.
- Which arm is dominant, and which shoulder is affected.
- Flexion and abduction endpoints in degrees, measured by the examiner.
- Pain, weakness, fatigue, incoordination, and whether they produce functional loss.
- Any additional loss after repetition, with repeated use over time, or during flare-ups.
- Dislocation, instability, or a fixed joint (ankylosis), which need their own clinical findings and rating criteria.
What may happen in the exam room
- Measurement of arm flexion, abduction, and internal/external rotation.
- Assessment of active and passive motion, repetitive use, and functional limitations when testing is medically appropriate.
- Clinical shoulder tests, such as empty-can, Hawkins-Kennedy, or apprehension testing, where appropriate. The examiner interprets the findings; a single response is not a diagnosis.
- Identification of the dominant arm and discussion of symptoms during flare-ups.
Measurements and findings to understand
- DC 5201 lists 20%/20% major/minor at 90 degrees, 30%/20% at 45 degrees, and 40%/30% at 25 degrees.
- Pain onset and the measured endpoint are not interchangeable. Documented functional loss needs clinical assessment.
- DC 5202 addresses certain humerus findings. Its percentages are not automatically added to a motion rating for the same manifestations.
Questions the examiner may cover
- Which arm is dominant?
- What activities are limited, and how do symptoms affect reaching, dressing, lifting, or sleep?
- How often do flare-ups occur, how long do they last, and what changes during them?
- What happens after repeated use over time?
- Have dislocations occurred, and what treatment or testing is documented?
Functional-impact language to think through
Use plain, truthful wording that matches your records and daily limitations. These are topics to consider, not exam scripts.
- Describe tasks you cannot complete, need help with, or must modify.
- Explain the frequency and duration of flare-ups and changes after repeated activity.
- Mention sleep disruption, treatment, and documented instability when relevant.
- Do not assign yourself a diagnosis, angle, or percentage based on this illustration.
Preparation notes
- Identify your dominant arm and explain your actual daily limitations.
- Follow the examiner's directions and report pain or difficulty accurately. Do not force motion to match a diagram.
- Bring relevant treatment records and describe flare-ups and repeated-use effects.
- Do not change prescribed medication without guidance from your clinician.
DeLuca and flare-up notes
DeLuca factors especially important — overhead reaching, carrying objects, sleeping position affected.
How secondary service connection works
A secondary condition is not automatic. The evidence must connect a current diagnosed disability to an already service-connected condition or its medically indicated treatment.
- Basic evidence: a current diagnosis, an already service-connected primary condition, and competent evidence linking the two.
- Two theories: the primary condition or its treatment caused the new disability under 38 CFR § 3.310(a), or aggravated a pre-existing non-service-connected disability under § 3.310(b). An opinion should address both when the record raises both; causation alone may be inadequate (El-Amin).
- Treatment pathway: service-connected condition → medically indicated medication or surgery → documented adverse effect → current diagnosis. Pharmacy records, start and stop dates, and a treating clinician’s reasoning matter; medication use alone does not establish the connection.
- Weight as an intermediate step: obesity or weight gain can be part of the causal chain under VAOPGCPREC 1-2017, but obesity itself is not a disability for a VA rating.
- Standard of proof: VA applies the “at least as likely as not” standard and reasonable-doubt rule under 38 CFR § 3.102. This guide identifies evidence questions; it does not tell you what to file.
- Avoid pyramiding: 38 CFR § 4.14 prohibits rating the same manifestation twice. Mental-health diagnoses generally use one § 4.130 evaluation for the same occupational and social impairment, and insomnia may be a symptom rather than a separate disability.
- Presumptives are different: qualifying service may make chronic rhinitis, chronic sinusitis, hypertension associated with herbicide exposure, or type 2 diabetes presumptive. OSA is not a PACT Act presumptive. Check current eligibility before seeking nexus evidence for a condition the law may already presume.
- DBQ is not a nexus: a DBQ documents diagnosis and severity; it does not necessarily establish service connection. A VA-accredited VSO can help with filing strategy at no charge.
Other medically indicated treatments for a service-connected condition may support a secondary theory when a clinician documents the adverse effect in this veteran.
Sources: 38 CFR § 3.310 · 38 CFR § 4.14 · VA-accredited representatives
Possible secondary conditions to discuss with a qualified reviewer
These are educational issue-spotting notes, not medical nexus opinions. VA decides service connection.
Review with documented guarding or altered mechanics and medical support.
Review with documented compensatory use and medical support.
Overuse is not presumed; longitudinal records and clinician reasoning are needed.
Review only if diagnosed and medically connected.
Document interrupted sleep as functional impact; it is not a separate disability by default.