Inside the exam room
1. You will be asked which shoulder hurts and which hand you use most. Explain trouble reaching, dressing, lifting, or carrying. Mention surgery or dislocations.
2. You will be asked to raise your arm forward, out to the side, and rotate it. Tell the examiner when pain starts and where movement stops. They may also move your arm when safe.
3. You may be asked to repeat the movements at least three times, if safe. Explain what changes after repeated use or on worse days, how often that happens, and how long it lasts.
The examiner measures joint movement with a goniometer (angle-measuring tool).
How VA rates shoulder condition
Tell the examiner which arm is affected and which arm you use most. Compare how high that arm can rise with the rows below. The arm you use most is called dominant in DC 5201. Do not add the forward-raise and side-raise percentages. Other shoulder problems use other rules. Source: 38 CFR 4.71a (2025 edition) .
VA’s guide shows a full arm raise forward (flexion) or out to the side (abduction) from 0 degrees at the side to 180 degrees overhead; shoulder level is 90 degrees.
What each rating percentage means
Match the whole description with your exam and records. A single symptom or illustration does not decide your rating.
| Rating | What the rule requires |
|---|---|
| 20% / 20% | Dominant / non-dominant arm: raising the arm forward (flexion) or raising the arm out to the side (abduction) limited to shoulder level, 90 degrees (DC 5201). |
| 30% / 20% | Dominant / non-dominant arm: raising the arm forward (flexion) or raising the arm out to the side (abduction) limited to 45 degrees. |
| 40% / 30% | Dominant / non-dominant arm: raising the arm forward (flexion) or raising the arm out to the side (abduction) limited to 25 degrees from the side. |
Check these details in your records
The examiner uses a condition form called a Disability Benefits Questionnaire (DBQ). Compare these items with your own records and explain what actually happens in daily life.
- A clinician's records show raising the arm forward (flexion) or raising the arm out to the side (abduction) limited to shoulder level (90 degrees), either arm20%
- A clinician's records show dominant-raising the arm forward (flexion) or raising the arm out to the side (abduction) limited to midway (45 degrees)30%
- A clinician's records show non-dominant-raising the arm forward (flexion) or raising the arm out to the side (abduction) limited to midway (45 degrees)20%
- A clinician's records show dominant-raising the arm forward (flexion) or raising the arm out to the side (abduction) limited to 25 degrees from the side40%
- A clinician's records show non-dominant-raising the arm forward (flexion) or raising the arm out to the side (abduction) limited to 25 degrees from the side30%
What may happen in the exam room
- The examiner may ask you to move the joint, then move it for you. They may check it with and without weight on it when safe. Follow their directions and tell them when something hurts.
- The examiner checks strength, pain, and what changes after doing the movement several times. One result alone does not decide the diagnosis.
What the measurements tell you
- The examiner records raising the arm forward, raising it sideways, and turning it. Tell them which arm is affected and which one you use most.
- Explain where pain begins, where movement stops, and what changes after repeating an activity or during worse periods.
Questions the examiner may cover
- How do symptoms affect overhead reach, dressing, lifting, or carrying?
- Which arm is affected, which is dominant, and what changes during a flare-up?
Questions to expect
How high can you raise this arm, and which hand do you normally use?
Explain: Identify the side, handedness, pain onset and the point movement stops. Explain reaching a shelf, washing your hair or dressing, including changes during flares.
Rating connection: DC 5201 compares the measured limit with 90, 45 and 25 degrees. The 45- and 25-degree rows differ for the dominant and other arm.
Does the shoulder dislocate, or is it fixed in place?
Explain: Report actual dislocations, surgery and any clinician-recorded fixation. Distinguish avoiding painful motion from a joint that cannot move.
Rating connection: Dislocation, bone injury and ankylosis have different codes from limited arm raising. Forward and side raising are not two separate DC 5201 ratings.
Your answer outline
My [side] shoulder is affected, and I am [right/left]-handed. [Specific task] causes [what happens]. I can still [task or amount], but I [adjustment]. After doing it several times or on a worse day, [change and duration].
Mark approximate dates and counts as estimates.
My notes: ________________________
Service connection records
1. How is this connected to your service?
For a direct claim, identify your current disability, what happened in service, and evidence linking them. Being on active duty or orders alone does not prove that link.
- Write the 5 Ws and how: who was there; what happened; when; where; why you were there; how the problem began. Add duty status, treatment, witnesses, and records. Mark uncertain dates as estimates.
- Guard or Reserve: find your orders, dates, duty type, and any line-of-duty records. Active duty, training, and drills have different rules.
- Secondary condition: it may start after service. Identify the service-connected condition and evidence that it caused or worsened this problem. A medical opinion may help explain the link.
- Started before service? Record what changed during service. Presumptive condition? Check the required diagnosis and service history; qualifying claims do not require separate proof of a link.
- Already service connected and seeking an increase? Focus on what has worsened and the records showing it.
If you do not know the cause, say so. Do not guess a medical connection.
Explain what changes in daily life
Describe both what you can do and what becomes difficult. Include how often it happens and how long it lasts.
- Use your own examples of affected tasks. Do not choose a dominant-arm example for a non-dominant arm or add raising the arm forward (flexion) and raising the arm out to the side (abduction) percentages.
Common mistakes to avoid
- Describe a usual day and a worse day, including how often symptoms get worse and how long that lasts. Do not make your symptoms sound better or worse than they are.
- Keep taking medicines as prescribed unless your health care provider tells you otherwise. If a movement hurts or feels unsafe, tell the examiner and follow their directions.
Records to get ready before the exam
- Your treatment records, movement measurements already recorded by a health care provider, and medicine list.
- Notes about daily tasks, what changes after repeating them, and worse periods. Send personal records through VA’s official channels.
Preparation notes
- Use the picture to understand the measurement. At the exam, follow the examiner’s directions and do not force unsafe movement.
- Explain where pain starts, where movement stops, and what changes after repeated activity or during worse periods.
- VA reviews your whole record, including whether the condition is linked to service. The highest box you check here does not decide your rating.
Pain, repeated use, and worse periods
Tell the examiner where pain begins and how far you can move. Those may be different points. Pain alone does not set a percentage. Explain what becomes harder after repeating an activity or during worse periods (flare-ups). The examiner uses your records and description to estimate those changes, and explains if there is not enough information to do so.
Could one health problem have caused another?
A condition VA has already linked to your service may cause another health problem or make it worse. VA calls this secondary service connection. Having both conditions does not prove the link. Your records need to show a current diagnosis and explain how the first condition or its treatment affected the second.
- Start with your records. Find the current diagnosis, the condition VA already linked to service, and evidence from someone qualified to explain the connection.
- Ask about cause and worsening. Did the first condition or its treatment cause the new disability, or make an existing disability worse? These are different questions. The rules call them causation under 38 CFR § 3.310(a) and aggravation under § 3.310(b). If both are raised by your records, the medical opinion should address both; answering only the cause question may not be enough (El-Amin).
- If treatment may be involved, collect the dates. List the medicine or surgery prescribed for the condition VA linked to service, the side effect, and the new diagnosis. Bring pharmacy records and dates when treatment started or stopped. A provider must explain the connection in your case; taking a medicine alone does not prove it.
- If weight gain may be involved, ask how it fits. Weight gain or obesity can be a step between the first condition and another diagnosed disability under VAOPGCPREC 1-2017. Obesity itself does not receive a VA disability rating.
- You do not need absolute certainty. VA uses the “at least as likely as not” standard and the reasonable-doubt rule under 38 CFR § 3.102. Ask a VA-accredited representative how the evidence applies to your claim.
- The same symptom cannot be counted twice. This is the rule against pyramiding in 38 CFR § 4.14. Mental-health diagnoses generally share one § 4.130 rating when they affect the same work and social abilities. Trouble sleeping may be a symptom rather than a separate disability.
- Check whether VA already assumes a link to service. Some conditions qualify based on where or when you served. These are called presumptive conditions. Examples can include chronic rhinitis, chronic sinusitis, hypertension after qualifying herbicide exposure, and type 2 diabetes. Sleep apnea (OSA) is not a PACT Act presumptive. Check eligibility before seeking a medical opinion about the link.
- An exam form and a medical opinion do different jobs. A Disability Benefits Questionnaire (DBQ) records the diagnosis and how severe it is. It may not explain why it is linked to service, often called a nexus. A VA-accredited veterans service organization (VSO) can help you file at no charge.
If another prescribed treatment may have caused a problem, ask your health care provider to record what happened and explain the connection in your case.
Sources: 38 CFR § 3.310 · 38 CFR § 4.14 · VA-accredited representatives
Other health problems to ask about
Use these notes to ask your provider about problems you already have. Your records must explain the connection. VA decides whether the condition is linked to service.
Bring records showing how you hold or move your body differently to protect a painful area. Ask your provider whether that caused this problem or made it worse.
Bring records showing whether you rely more on this part of your arm. A provider must explain any connection to the other condition.
Using the other shoulder more does not prove it caused a problem. Bring records over time and ask your provider to explain the connection.
Ask about this only if it is diagnosed and a provider can explain the connection.
Describe how pain interrupts your sleep. Trouble sleeping is not automatically a separate disability.
Choose the related health problems you want to discuss. Your preparation packet will include the notes you select and the full condition guides available for them.