Impairment of the Clavicle or Scapula
Your clavicle or scapula rating turns on one question: did the bone heal properly, or is there still loose movement, nonunion, or dislocation? The schedule pays 10% for malunion or stable nonunion, 20% for nonunion with loose movement or dislocation — or you can be rated on impairment of function of the shoulder joint itself, whichever pays more.
Impairment of the clavicle or scapula — Diagnostic Code 5203 — is the rating code for clavicle fractures, AC joint separations, scapular fractures, and sternoclavicular dislocations. These are among the most common upper-extremity injuries in military service: a fall onto an outstretched hand, a direct blow to the shoulder, or a blast concussion can snap the collarbone or separate the joint. The rating schedule under 38 CFR §4.71a is unusually simple — just two tiers plus an alternative — but it contains a hidden advantage most veterans and even many examiners overlook: the code says you can rate the clavicle or scapula impairment on the basis of impairment of function of the contiguous joint (the shoulder), whichever method produces the higher rating. That means a veteran with a malunion clavicle fracture who can only raise the arm to 80° because of the deformity is not capped at 10% under DC 5203 — the veteran can instead be rated under DC 5201 at 20% for limitation of motion at shoulder level.
The Diagnostic Codes
Conditions Rated In Shoulder Conditions
These are the codes the VA will actually stamp on a decision in this group. The code you are granted under decides which formula is used — and that decides your percentage. Clavicle / Scapula is highlighted below.
DC 5201
Limitation of Motion of the Arm
Your shoulder rating turns on one measurement: how far you can raise the arm. The examiner uses a goniometer to check whether you reach shoulder level, midway, or only 25 degrees from the side — and the dominant arm pays more at every level.
Read the full page
DC 5202
Other Impairment of the Humerus
Your shoulder instability rating turns on two things: how often the shoulder dislocates, and how much you guard the arm to keep it from happening again. The schedule separates infrequent episodes with guarding only at shoulder level from frequent episodes with guarding of all arm movements — and the gap between those two findings is a full rating tier.
Read the full page
DC 5203
Impairment of the Clavicle or Scapula
Your clavicle or scapula rating turns on one question: did the bone heal properly, or is there still loose movement, nonunion, or dislocation? The schedule pays 10% for malunion or stable nonunion, 20% for nonunion with loose movement or dislocation — or you can be rated on impairment of function of the shoulder joint itself, whichever pays more.
You are reading this page
Before Anything Gets Rated
What The VA Is Actually Looking For — And What Service Connection Really Means
Before the VA ever opens the rating schedule, it asks one question: is this disability the government’s responsibility? That is what “service connection” means. It is not a diagnosis, it is not sympathy, and it is not a reward for having served. It is a legal finding that a current, diagnosed disability is linked to something that happened to you in uniform. Percentages come later. If service connection is not established, there is nothing to rate and the claim is denied — no matter how bad the clavicle / scapula is.
The three elements the VA must find. All three. Every time.
These come out of Caluza v. Brown and Shedden v. Principi, and they are the checklist a rating officer works through on your file. Miss one and the claim fails on that element alone.
A current, diagnosed disability
A doctor has to have written a diagnosis in a medical record — clavicle / scapula. Symptoms by themselves are not a disability the VA can rate. Saunders v. Wilkie held that pain causing functional impairment can be a disability, but you still need a clinician to document it as diagnosed and impairing. The diagnosis must exist now, during the claim period — not only years ago.
An in-service event, injury, illness or aggravation
Something in service had to have happened — an injury, an exposure, a documented sick call, or steady wear over a career. It does not have to be one dramatic moment and it does not have to be spelled out in your service treatment records: buddy statements, unit records, performance evaluations and your own competent lay testimony can establish it.
A medical nexus linking the two
A qualified medical opinion that says the current diagnosis is at least as likely as not related to the in-service event. That phrase matters: at least as likely as not means 50 percent or better. Under 38 C.F.R. §3.102, when the evidence is evenly balanced, the benefit of the doubt goes to you and the claim must be granted.
The five ways service connection is established
Most veterans only know the first one. The other routes are lower-effort paths to the same grant — and the secondary route is the one most often left on the table.
Direct — 38 C.F.R. §3.303(a)
The injury or disease began in service and never went away. The classic route: three elements, one nexus opinion.
Chronicity and continuity — §3.303(b)
A chronic condition shown in service, plus continuity of the same symptoms from separation to now, can establish the link without a formal nexus opinion. Your own testimony about symptoms you can observe is competent evidence.
Presumptive — §3.307 and §3.309
Certain chronic diseases are presumed service connected if they manifest to a compensable degree within a set window after separation. You do not have to prove causation at all.
Secondary — §3.310(a) and (b)
A disability proximately due to, or aggravated by, an already service-connected condition is itself service connected. This is how the downstream conditions clavicle / scapula sets off get on the rating sheet.
Aggravation of a pre-service condition — §3.306
If you entered service with a condition and service made it permanently worse, the increase is compensable. The VA must rebut the presumption of soundness by clear and unmistakable evidence — a bar it frequently fails to meet.
VA medical care — 38 U.S.C. §1151
An additional disability caused by VA treatment, surgery, or a failure to diagnose is compensated as if it were service connected.
The bottom line — there is no way around this
No diagnosis, no rating. It has to be chronic. It has to cause impairment.
Without a diagnosis, the VA will not rate your claim.
The rating schedule is a list of diagnosed conditions and the codes attached to them. If no clinician has put a name on your condition in a medical record, there is no code to assign. Symptoms reported to a claims examiner are not a diagnosis. Get in front of a doctor and get it written down.
The condition must be chronic.
Chronic means persistent and ongoing — not something that resolved decades ago. The VA compensates a disability you carry today, which is why a documented, continuing treatment history matters more than the single worst day you ever had.
It must cause actual impairment.
Under 38 C.F.R. §4.1 and §4.10, VA compensation exists to pay for reduction in earning capacity. A diagnosis that costs you nothing gets a zero percent rating. The function you have lost is what converts a diagnosis into a percentage.
What this means for you before you file: get the diagnosis in writing, get the treatment history documented so the chronicity is undeniable, and describe the impairment in functional terms — what you can no longer do, and what it costs you at work and at home. Everything on the rest of this page is built on top of those three things.
The Percentages
Rating Schedule — Impairment of the Clavicle or Scapula, Diagnostic Code 5203
Reproduced verbatim from 38 CFR §4.71a, Diagnostic Code 5203. Unlike most shoulder codes, this code does not distinguish between the major (dominant) and minor (non-dominant) arm. However, the alternative pathway — rating on impairment of function of the contiguous joint — may use a code that does distinguish (such as DC 5201), in which case the major/minor distinction applies.
20%
Nonunion with loose movement; or dislocation of the clavicle or scapula — 20% on either side.
10%
Malunion of the clavicle or scapula; or nonunion without loose movement — 10% on either side.
—
Or rate on impairment of function of the contiguous joint (the shoulder), whichever is more favorable to the veteran.
Service Connection
Advice from the Advocate
The advocate's notes on causation — Clavicle / Scapula
The separate arguments that decide this code: where the VA will attack, the regulation that answers it, and the evidence that closes the gap.
1Direct service connection — §3.303(a)
A current diagnosis of clavicle malunion, nonunion, or AC joint separation linked to a documented in-service injury. If your service treatment records show the fracture, the X-ray, or the profile, that is the anchor. The nexus opinion ties the current deformity to the original injury.
2Continuity of symptomatology — §3.303(b)
If the malunion or nonunion was not formally diagnosed during service, 38 CFR §3.303(b) bridges the gap with continuity — the visible bump that never went away, the persistent pain, and the crepitus that started at the time of the in-service injury and has been continuous since.
3Presumptive connection for arthritis — §3.307/§3.309
Degenerative arthritis at the AC joint or sternoclavicular joint shown to a compensable degree within one year of discharge is presumptively service-connected. A post-service X-ray showing joint-space narrowing or osteophytes at the fracture site within that window removes the need for a separate nexus.
4Secondary to another service-connected condition — §3.310(a)
A clavicle or scapula condition can be secondarily service-connected when it results from a fall caused by a service-connected knee, ankle, or balance disorder. If the veteran fell because of a lower-extremity disability and fractured the clavicle on impact, §3.310(a) connects the fracture to the service-connected cause of the fall.
5Downstream secondary conditions — §3.310(a)
Once the clavicle or scapula impairment is service-connected, the conditions it causes become claimable: limitation of shoulder motion (DC 5201) from the deformity restricting the arc, thoracic outlet syndrome from clavicle malunion compressing the neurovascular bundle, and depression or anxiety from chronic pain and lost function.
Exposure & Aggravation
How Clavicle / Scapula Happens In Service — And How It Gets Worse
How veterans pick this up in uniform — Clavicle / Scapula
Clavicle / Scapula rarely announces itself with one dramatic moment. It is built by what service asked of your body over months and years — and once it is service-connected, it is compensated for how it keeps getting worse, not for how it started. Below is how veterans pick this up in uniform, and who is most prone to it.
- Falls onto an outstretched hand during training, obstacle courses, or field operations
- Direct blows to the shoulder from combat, vehicle accidents, or parachute landing falls
- Blast-wave concussive forces that slam the torso and clavicle against body armor
- Motorcycle and vehicle accidents during duty or deployment
- Contact sports injuries during unit PT, combatives, or intramural athletics
- Heavy rucksack straps compressing and fracturing the clavicle over long marches
- Falls from height — rappelling, fast-rope, ladder, or shipboard operations
- Crush injuries from heavy equipment, hatches, or vehicle maintenance accidents
Who is most prone to it
Infantry and airborne soldiers who carry heavy rucks and absorb repeated falls; motorcycle riders; military police and combatives instructors with high shoulder-impact exposure; paratroopers and special operations personnel; anyone who sustained a clavicle fracture or AC joint separation during training or deployment.
The Symptoms
What Clavicle / Scapula Actually Feels Like
- A visible bump, deformity, or prominence at the fracture site or AC joint
- Pain and tenderness directly over the clavicle or scapula, worsened by pressure or shoulder movement
- Grinding or crepitus felt under the skin at the fracture or nonunion site
- Pain when bearing weight through the arm — pushing up from a chair, doing a push-up, or leaning on the hand
- Difficulty carrying a bag, backpack, or sling across the affected shoulder
- Pain radiating from the clavicle into the neck, shoulder, and upper arm
- Weakness in the shoulder and arm on the affected side
- Inability to sleep on the affected side due to direct pressure on the deformity
How this one is rated
Clavicle and scapula impairment is rated under 38 CFR §4.71a, Diagnostic Code 5203 on a two-tier ladder: 10% for malunion of the clavicle or scapula, or nonunion without loose movement; 20% for nonunion with loose movement, or dislocation of the clavicle or scapula. Alternatively, the code permits rating on impairment of function of the contiguous joint — the shoulder — under DC 5200, 5201, or 5202, whichever is more favorable. Unlike most shoulder codes, DC 5203 does not distinguish between the major and minor arm.
What you are measured against
The examiner palpates the clavicle and scapula for malunion deformity, crepitus, and loose movement at the fracture site or AC joint. X-rays confirm whether the bone has healed (malunion), failed to heal (nonunion), or the joint has separated (dislocation). The examiner also measures shoulder range of motion, because the alternative rating pathway requires documenting the functional impairment of the shoulder joint itself.
Each One On Its Own Page
Secondary Conditions — Aggravated or Caused by a Current Service-Connected Condition
Under 38 CFR §3.310(a), a disability that is proximately due to a service-connected condition is service-connected in its own right — and under §3.310(b), so is any additional disability caused when a service-connected condition aggravates a problem you already had. Each condition below is a separate evaluation with its own diagnostic code and its own percentage. They do not fold into the clavicle / scapula rating — they stack on top of it. A veteran who claims only the primary condition leaves these ratings on the table.
Pressure on the shoulder eliminates activities
The deformity at the clavicle makes any direct pressure unbearable — seatbelts, bag straps, backpacks, body armor, and even lying on that side at night. This eliminates entire categories of activity and is a functional impairment that goes beyond the bone itself. If you switched to a crossbody bag, drive with the seatbelt held away, or cannot sleep on that side, those are daily-life consequences the examiner must hear.
Trade and manual work capacity destroyed
Many trades require overhead reach, heavy carrying, and pushing — all of which load the clavicle. A veteran who cannot swing a hammer, carry materials, or push a wheelbarrow because the collarbone shifts or aches under load has suffered a concrete occupational loss. Document the specific work tasks you can no longer do and bring an employer or vocational letter if available.
Persistent icing and pain management
If you are still icing the clavicle or shoulder area regularly, that is evidence of ongoing active pathology, not a healed injury. Chronic inflammation at a malunion or nonunion site means the bone is not functioning properly, and the need for regular pain management supports a finding that the condition is not stable and may warrant a higher rating or the alternative pathway.
Accredited Claims Agent #45147
Ready To Get This Rated Correctly?
Contingency fee — zero upfront, paid only from back pay when you win. If your rating does not increase, you owe nothing.
Shoulder Conditions, In Detail
Shoulder Conditions — Service Connection In Depth
Here is each claimable condition in this group on its own terms — what it is, what service did to it, and what the VA requires before it will connect it.
Limitation of Motion of the Arm
Limitation of motion of the arm — Diagnostic Code 5201 — is the workhorse rating for most shoulder disabilities, including rotator cuff tears and repairs, impingement syndrome, tendinitis, bursitis, and adhesive capsulitis (frozen shoulder). The schedule under 38 CFR §4.71a divides the arc into three tiers: motion limited to shoulder level (90°), motion limited to midway between the side and shoulder (roughly 45°), and motion limited to 25° from the side. Before the first measurement is taken, 38 CFR §4.69 requires the examiner to record whether the affected shoulder is your dominant (major) or non-dominant (minor) arm, because every tier above the floor pays a higher percentage for the major extremity. Claims fail not because the pain is not real, but because the examiner measures one good try instead of documenting the arc after repetitive use, during a flare, and with painful motion under §4.40 and §4.45 factored in.
Read the full Shoulder ROM / Rotator Cuff pageOther Impairment of the Humerus
Other impairment of the humerus — Diagnostic Code 5202 — is the rating code for recurrent shoulder dislocation, subluxation, malunion, fibrous union, nonunion, and loss of the humeral head (flail shoulder). This code captures the instability that lingers long after the first traumatic dislocation, the shoulder that pops out during sleep, reaching behind, or any unguarded movement. The rating schedule under 38 CFR §4.71a grades the severity on a ladder from 20% for infrequent episodes with guarding only at shoulder level, up to 70%/80% for a flail shoulder. As with all upper-extremity codes, 38 CFR §4.69 requires the examiner to record handedness — the major (dominant) arm pays more at every level above the floor. Claims fail not because the instability is not real, but because the veteran describes the problem as "my shoulder pops out sometimes" instead of documenting the frequency of episodes, the guarding pattern, and the functional devastation that chronic instability inflicts on work and daily life.
Read the full Shoulder Instability / Dislocation pageImpairment of the Clavicle or Scapula
Impairment of the clavicle or scapula — Diagnostic Code 5203 — is the rating code for clavicle fractures, AC joint separations, scapular fractures, and sternoclavicular dislocations. These are among the most common upper-extremity injuries in military service: a fall onto an outstretched hand, a direct blow to the shoulder, or a blast concussion can snap the collarbone or separate the joint. The rating schedule under 38 CFR §4.71a is unusually simple — just two tiers plus an alternative — but it contains a hidden advantage most veterans and even many examiners overlook: the code says you can rate the clavicle or scapula impairment on the basis of impairment of function of the contiguous joint (the shoulder), whichever method produces the higher rating. That means a veteran with a malunion clavicle fracture who can only raise the arm to 80° because of the deformity is not capped at 10% under DC 5203 — the veteran can instead be rated under DC 5201 at 20% for limitation of motion at shoulder level.
You are reading this page now
The C&P Exam
What To Expect At The Clavicle / Scapula Exam
This is the encounter your rating is built on. The examiner has a checklist and a limited window — what follows is exactly what happens in that room, so none of it surprises you.
Clinical Section — What To Expect at the Exam
What to Expect at Your Clavicle/Scapula C&P Examination
Diagnostic Code 5203 — this exam measures bone healing and joint function
A clavicle or scapula C&P exam is one of the most straightforward shoulder exams — but it carries a hidden tactical opportunity that most veterans and even many examiners miss. The code itself (DC 5203) only goes to 20%, but it contains language allowing you to be rated instead on **impairment of function of the contiguous joint** — the shoulder — under DC 5201 or 5202, whichever is higher. That means the examiner must measure both the bone healing (malunion, nonunion, dislocation) and the shoulder range of motion, strength, and stability. If the clavicle deformity limits your arm elevation to below shoulder level, you are entitled to a 20% or higher rating under DC 5201 instead of the 10% that DC 5203 would give for malunion alone.
Condition
Clavicle / Scapula — DC 5203
Governing questionnaire
VA Form 21-0960M-12, Shoulder and Arm Conditions DBQ
Click the form number to open the official questionnaire on VA.gov.
01In The Room
What happens during the exam
The tests and maneuvers for this condition
- Palpation of the entire clavicle from sternum to AC joint for deformity, tenderness, and crepitus
- Stress testing of the fracture site for loose movement (nonunion assessment)
- Cross-body adduction test — arm brought across the chest to stress the AC joint
- AC joint compression test — direct downward pressure on the distal clavicle
- Scapular assistance test — clinician stabilizes scapula while patient raises arm to assess scapular contribution
- Shoulder range of motion with goniometer (for alternative rating pathway under DC 5201)
- X-ray of the clavicle and shoulder to document malunion angle, nonunion gap, or AC separation
- Comparison with the uninjured side for symmetry and deformity assessment
What gets measured, and to what number
Bone healing status
Whether the fracture healed with malunion (healed in a bad position), nonunion (failed to heal), or the joint dislocated (AC joint separation, sternoclavicular dislocation).
Loose movement at the fracture site
Whether the nonunion site moves when stressed — this is the difference between 10% (stable nonunion) and 20% (loose nonunion). The examiner palpates and applies gentle stress.
Shoulder range of motion
Flexion, abduction, and rotation of the shoulder — required for the alternative rating pathway under DC 5201. If the clavicle deformity restricts the arc, the ROM measurement drives the rating.
AC joint stability
Whether the acromioclavicular joint is stable, partially separated (Grade I-II), or fully separated (Grade III+) with visible step-off deformity.
Imaging findings
X-ray showing the malunion angle, the nonunion gap, or the AC joint separation grade. Imaging confirms what palpation suggests.
02Orientation
What to expect during this exam
What makes this exam different from every other C&P exam
1The alternative rating pathway is your greatest advantage
DC 5203 explicitly states: "Or rate on impairment of function of the contiguous joint." This means if your clavicle fracture limits shoulder motion below 90°, you skip the 10% malunion rate and go straight to DC 5201 at 20% or higher. Make sure the examiner measures your shoulder ROM in addition to examining the bone.
2Palpable deformity and crepitus are objective findings
A bump you can see and feel at the fracture site, or a grinding sensation when you move the shoulder, is objective evidence of malunion or nonunion that cannot be disputed. Point it out to the examiner if they do not palpate it themselves.
3No major/minor distinction under this code
Unlike DC 5201 and 5202, Diagnostic Code 5203 pays the same percentage whether the injury is on your dominant or non-dominant side. However, if you are rated under the alternative pathway (DC 5201), the major/minor distinction re-applies — and could pay more for the dominant arm.
See it before you sit in the room
03Preparation
Know your symptoms and secondary factors
What the report must actually say about clavicle / scapula — dc 5203
- "You can feel the bump where it healed wrong" — point out the visible deformity.
- "It grinds when I move my shoulder" — crepitus is objective evidence of malunion or nonunion.
- "I cannot raise my arm above my shoulder" — trigger the alternative rating pathway under DC 5201.
- "A bag strap across that shoulder is unbearable" — document the pressure sensitivity.
- "I cannot push myself up from a chair" — weight-bearing through the arm is a functional test.
- "The pain goes from my collarbone into my neck" — radiating pain supports secondary claims.
Pain level, frequency, lost work and functional loss — how to say them
Point out the visible deformity
A palpable bump, step-off, or prominence at the fracture site or AC joint is objective evidence of malunion or dislocation that the examiner must document. It proves the bone did not heal properly and the impairment is structural, not just subjective pain.
If the bump is visible through a shirt, or if it catches on a seatbelt or bag strap, describe that. Show the examiner both sides for comparison.
"You can see the bump right here where the bone healed crooked. It catches on my seatbelt and any strap across my shoulder causes sharp pain."
Describe the pressure sensitivity
Pressure directly over the clavicle — from a seatbelt, a bag strap, body armor, or even lying on that side — causes pain that limits daily activities. This is functional impairment that the examiner must document, and it connects the structural deformity to real-world limitations.
If you cannot carry a messenger bag, wear a backpack, or buckle a child into a car seat, say so.
"I cannot carry a bag across that shoulder. Even a seatbelt pressing on the bump makes me wince. I have to hold the belt away from my chest the whole drive."
Admit to the grinding and crepitus
Grinding, clicking, or crepitus at the fracture site or AC joint is an objective clinical finding that proves ongoing pathology. It indicates the bone surfaces are irregular, there may be loose fragments, or the joint is not tracking properly. Tell the examiner about every sound and sensation.
If you can reproduce the grinding by moving your shoulder in a specific way, demonstrate it during the exam.
"I can feel it grinding when I roll my shoulder. It crunches and catches, and it has done that ever since the fracture."
Explain the weight-bearing limitation
The clavicle transmits force from the arm to the trunk. When it is structurally compromised, pushing through the arm — push-ups, pushing up from a chair, leaning on the hand — sends pain through the fracture site. This weight-bearing limitation is functional impairment that the schedule must capture.
Describe specific tasks: pushing a shopping cart, getting off the floor, doing any exercise that loads the arm.
"I cannot push myself up from a chair with that arm. Push-ups are impossible. Even leaning on my hand to get up from the floor sends a jolt of pain through the collarbone."
Secondary conditions to raise in the same appointment
Pressure on the shoulder eliminates activities
The deformity at the clavicle makes any direct pressure unbearable — seatbelts, bag straps, backpacks, body armor, and even lying on that side at night. This eliminates entire categories of activity and is a functional impairment that goes beyond the bone itself. If you switched to a crossbody bag, drive with the seatbelt held away, or cannot sleep on that side, those are daily-life consequences the examiner must hear.
Trade and manual work capacity destroyed
Many trades require overhead reach, heavy carrying, and pushing — all of which load the clavicle. A veteran who cannot swing a hammer, carry materials, or push a wheelbarrow because the collarbone shifts or aches under load has suffered a concrete occupational loss. Document the specific work tasks you can no longer do and bring an employer or vocational letter if available.
Persistent icing and pain management
If you are still icing the clavicle or shoulder area regularly, that is evidence of ongoing active pathology, not a healed injury. Chronic inflammation at a malunion or nonunion site means the bone is not functioning properly, and the need for regular pain management supports a finding that the condition is not stable and may warrant a higher rating or the alternative pathway.
How to prepare for this specific exam
- Bring your original X-ray or imaging reports showing the fracture and its current healing status.
- If you have a visible bump or deformity, point it out at the start of the exam — make the examiner palpate it.
- Track how the collarbone affects your daily activities for a month before the exam — reaching, carrying, sleeping.
- Bring a lay statement from your spouse describing the deformity, the pain, and the tasks you can no longer do.
- Know that DC 5203 allows rating on shoulder joint function instead — push for ROM testing if your motion is limited.
- Do not take pain medication before the exam — show the unmedicated level of pain and limitation.
04The Protocol
What procedures are required during the exam
These are not courtesies. Each comes out of the regulation or out of binding case law. Take this list in with you and tick them off as they happen.
01Clavicle and scapula palpation
38 C.F.R. §4.71a, Diagnostic Code 5203
The examiner runs their fingers along the entire length of the clavicle — from the sternoclavicular joint to the AC joint — feeling for bumps, step-offs, tenderness, and crepitus. The scapula is palpated along its borders and spine. Any deformity, malunion prominence, or abnormal movement is documented and compared to the uninjured side.
Palpation is the primary clinical test for DC 5203. It identifies malunion (healed in a bad position), nonunion (failed healing with possible loose movement), and dislocation (joint separation with a palpable step-off). The physical finding drives the code selection.
02Scapular assistance and dyskinesis testing
38 C.F.R. §4.71a
The scapular assistance test evaluates whether the scapula is contributing properly to shoulder movement. The clinician stabilizes the scapula with one hand while the veteran raises the arm, then releases. If the arm rises higher or with less pain when the scapula is manually stabilized, it proves the scapula is not functioning correctly — supporting a rating on impairment of the contiguous joint.
Scapular dyskinesis — abnormal scapular movement — is a direct consequence of clavicle malunion or scapular fracture. It degrades shoulder function beyond what the bone deformity alone would suggest and strengthens the case for the alternative rating pathway.
03AC joint and cross-body testing
38 C.F.R. §4.71a
The cross-body adduction test stresses the AC joint by bringing the arm across the chest. Pain at the AC joint is a positive finding that indicates separation, arthritis, or instability at the joint where the clavicle meets the acromion. The examiner also applies direct downward compression to the distal clavicle to assess AC joint integrity.
AC joint pathology is a common consequence of clavicle fractures and direct shoulder impacts. A positive cross-body test with a palpable step-off at the AC joint supports either the 20% dislocation rating under DC 5203 or a separate limitation of motion rating under DC 5201.
04Imaging review — X-ray of the clavicle and shoulder
38 C.F.R. §4.71a
X-rays confirm the clinical findings: the malunion angle (how far the bone healed out of alignment), the nonunion gap (whether healing failed), the AC joint separation grade (the distance between the distal clavicle and the acromion), and any secondary arthritis at the fracture or joint surfaces. Comparison views of the uninjured side quantify the deformity objectively.
Imaging is the objective confirmation of what the examiner feels on palpation. A visible malunion on X-ray with a measured angulation makes the diagnosis undeniable and anchors the rating at 10% minimum — or higher if the deformity restricts shoulder function.
05Functional and occupational impact assessment
38 C.F.R. §§4.10, 4.40, 4.45
The examiner documents how the clavicle or scapula impairment affects the veteran's work and daily life — carrying, lifting, overhead reach, sleeping, driving, and any trade or occupation that requires loading the arm. This assessment feeds directly into the alternative rating pathway and any TDIU consideration.
The alternative pathway in DC 5203 rates on "impairment of function of the contiguous joint." That functional impairment must be documented, and the occupational impact is where the real-world consequences of the bone deformity are captured — turning a 10% malunion into a 20% or higher shoulder rating.
05The Standard
What makes an exam adequate
Read your exam report against these. An exam that fails the standard is legally inadequate, and an inadequate exam is something you challenge rather than accept.
The range of motion has to be MEASURED, not estimated
38 CFR §4.46 states that the use of a goniometer in the measurement of limitation of motion is indispensable in examinations conducted within the Department of Veterans Affairs. An examiner who eyeballs your bend and writes a number has not complied with the regulation. This is the most common defect in a spine exam and it is the easiest one to spot from the chair.
Joints must be tested in every required condition
Under Correia v. McDonald, a joint examination for pain must, wherever possible, record active motion, passive motion, motion in weight-bearing and motion in non-weight-bearing — and where relevant, the range of the opposite undamaged joint. An exam that records one set of numbers and stops is incomplete on its face, and that incompleteness is grounds to challenge it.
Flare-ups have to be addressed, not dodged
Under Sharp v. Shulkin, when a veteran describes flare-ups, the examiner is obligated to estimate the additional loss of motion during a flare based on all the available evidence — including your own account of it. "I cannot opine without resorting to mere speculation" is not automatically acceptable; the examiner has to have actually sought the information first and explained why an estimate is impossible.
Repetitive use and functional loss must be factored in
Sections 4.40 and 4.45, and the DeLuca line of cases, require that pain, weakness, fatigability, incoordination and lack of endurance after repeated use be considered — and expressed in additional degrees of lost motion where that is feasible. Your rating is supposed to reflect what you can do on the fifth repetition and on a bad day, not just the first careful bend of the morning.
Neurological findings must be separately documented
Note (1) to the General Rating Formula requires that any associated objective neurologic abnormality be evaluated separately under an appropriate diagnostic code. If your leg symptoms were mentioned in the narrative but never tested and never assigned, the exam did not do what the schedule requires of it.
The examiner must review the record when the question requires it
Where a medical opinion on cause, aggravation or a secondary relationship was requested, the examiner is expected to review the relevant evidence and give a reasoned explanation. A bare conclusion — "less likely than not related to service" with no reasoning attached — carries little weight, and an opinion with no rationale is challengeable.
The examiner has to be qualified for the body system
The VA may use its own clinicians or a contract vendor. Either way, the examiner is expected to have the competence to evaluate the system being examined. If a spinal exam with a neurological component was performed by someone who never tested a reflex, that is a problem worth raising.
The exam has to be CURRENT
A rating is supposed to reflect your condition now. An exam performed before a documented worsening, or years before the decision, may not support the current evaluation — and you can request a new one on that basis.
06Afterward
What happens after your exam is complete
The examiner writes the report and submits it, it is reviewed for completeness, and only then does the claim move toward a rating decision. Here is what actually controls the clock.
The examiner writes and submits the report
Days 1–5 after the exam
The examiner compiles the history, the physical findings, the measurements and any testing into the questionnaire, adds any requested medical opinion, and submits it. Contract vendors typically have a turnaround requirement measured in days, not weeks.
Nothing about your claim moves while this is happening, and nothing you do speeds it up. What matters is that the report is written from notes taken in the room — which is exactly why what you said, and how the examiner recorded it, is already locked in by the time you get to your car. Request your copy now rather than later.
Quality review — and the request for clarification
Days 3–30
The report is reviewed for completeness. If it is internally inconsistent, missing a required field or missing the opinion the VA asked for, it goes back for correction or a second opinion. This is the single most common cause of a claim appearing to stall after the exam.
Understand what a finished exam actually means: it means the appointment happened, not that your claim is ready for a decision. If the reviewer finds a blank range-of-motion field, an opinion that does not answer the question that was asked, or findings that contradict each other, the file goes back out for more information. That is a normal quality control step, not a rejection of your claim, and it is not a sign that you did something wrong — but it does add weeks, and it is the reason so much of what you read online sounds like the system is broken.
Your status tracker moves backward — and it is usually not bad news
Any time after the exam
The online tracker shows eight steps. Veterans watch it reach step 7 or 8, then find it back at step 3 or 4 a week later. That regression almost always means one thing: the file went back for additional information, most often a returned or clarified exam.
This is the number one thing veterans panic about, and it is misread constantly. The tracker is not a countdown — it is a location marker. When the VA decides it needs one more piece of evidence, a corrected exam, a clarifying medical opinion or an outstanding record, the claim is routed back to the evidence gathering step and the bar redraws itself where the file physically is. It does not mean a denial. It does not mean your case was thrown out or restarted. It does not erase anything already in the file, and it does not change your effective date. What it does mean is that something in the record was not good enough to decide on yet — which is worth knowing, because if the weak link is the exam, this is the window where a corrective statement or a private opinion from your own doctor does the most good.
Evidence gathering closes
Varies
Before anyone rates your claim, the file has to be built. This is the stretch where the Regional Office pulls together everything the decision will rest on: your service treatment records, your VA medical records, any federal records, the C&P exam report, and any private records it has requested on your behalf. The claim sits here until the VA is satisfied the record is complete enough to decide — which is exactly why a status tracker can appear to stall or slide backward at this step. You are not powerless while it sits here. Anything you put into the file yourself lands the day you send it, and every relevant record you add now is one less thing the rater can later say was missing.
A VA request to a private provider is a letter that may or may not be answered, and the VA will wait on it for weeks before moving on — sometimes without ever getting a response. A record you walk in yourself, or upload through your claim, is in the file the day you send it. So do not sit and wait to be asked. If you know a treatment record, an imaging report, a surgical note or a buddy statement exists and it matters, send it now, with a VA Form 21-4138 statement that explains in plain words what the document is and what it shows. This is also the window where a corrective statement or a private medical opinion from your own doctor does the most good — before the rater has locked in a decision, not after. Once the evidence gathering step closes, the file goes to a rating specialist, and your chance to shape the record cheaply and quickly closes with it.
Rating decision and promulgation
Typically several weeks after the last piece of evidence lands
This is the stage where your evidence finally becomes a number. A rating specialist — not the examiner, and not a doctor — takes everything in the file and applies the rating schedule to it: the exam findings, your range-of-motion measurements, your lay statements, your private records and any medical opinions. They assign a diagnostic code to each condition, pull a percentage from the schedule, set your effective date, and either grant, deny or defer each issue. The decision is then reviewed and authorized — promulgation is simply the VA’s word for making it official — and the decision letter and code sheet are generated and mailed. Where an award is made, payment follows the effective date rules, and back pay is calculated to that date.
Read the code sheet, not just the percentage. It names the diagnostic code used, the exact measurements relied on and the effective date assigned — and that is where most mistakes live. This is a human being reading a file under a production quota, and the two things that go wrong most often are a rater using the pre-repetition range-of-motion numbers instead of the worst-case figures §4.59 and §4.40 require, and a claimed condition being decided on a thin record or quietly left out. Check whether painful motion was accounted for, whether your radiculopathy was rated separately under Note (1) or folded into the spine rating, and whether every condition you claimed was actually addressed. A decision you do not read is a decision you cannot challenge — and the deadline to challenge it starts the day the letter is dated, not the day you understand it.
C&P examination is the decision letter
The day it lands in your mailbox
The envelope holds two different documents: the narrative decision letter, and the code sheet. Together they are the single most important piece of paper in your claim, because every deadline, every appeal option and every dollar of back pay is set by what is printed on them — not by what you were told at the exam.
Most veterans read one thing on that letter: the percentage. Then they either celebrate it or get angry at it, and file it in a drawer. That is the mistake. The percentage is the conclusion; the reasons section is the reasoning, and the reasoning is what you attack. It tells you which diagnostic code the rater used, which range-of-motion figures they relied on and which they ignored, whether painful motion under §4.59 was accounted for, whether your neurological findings were rated separately under Note (1) or folded into the spine rating, which conditions were decided, which were deferred, and which were never addressed at all. It also assigns your effective date, which controls back pay. A rating that looks low is very often not a disagreement about how bad your neck is — it is a rater who used the pre-repetition numbers, or missed the radiculopathy, or rated one side and not both. You cannot see any of that from the percentage. Do not go by the percentage alone, and do not decode it by yourself if you are not sure what you are looking at — have someone who reads these for a living read it with you before the clock runs out. You have one year from the date on that letter to file a Higher-Level Review (VA Form 20-0996), a Supplemental Claim (VA Form 20-0995) or a Board appeal, and the deadline runs from the date printed on the letter, not the date you opened it. Bring it to this office and we will go through it line by line, at no cost, and tell you plainly whether it is right.
What normal looks like: 30 to 60 days for a simple claim, longer for a complex one
After your exam you should expect some kind of notification from the VA — a decision, a request for more information, or a notice that another exam has been scheduled. For a straightforward, single-issue claim that often lands within 30 to 60 days. But 30 to 60 days is a rough guide, not a rule, and it is not a ceiling. A claim with several conditions, a toxic-exposure or presumptive question, a returned exam, or missing records routinely takes 90 days or more, and that alone does not mean anything is wrong — the more moving parts your case has, the longer the VA takes to work it. Inside the window that is normal for a case like yours, silence is expected and there is nothing to fix, and a tracker that jumps backward is normal too.
What matters is not a fixed number of days — it is whether the claim is still moving and whether you can get a straight answer about where it is. Once you are well past what is normal for a case like yours and the VA either goes silent or cannot tell you what the claim is waiting on, stop waiting. That is usually where the real trouble hides — an exam that came back twice, a records request that was never answered, a claimed condition that got dropped, or a file sitting in the wrong queue. Call the VA at 800-827-1000, ask specifically what the claim is waiting on and who it is assigned to, and write down the answer. If you cannot get a straight answer, or the answer tells you the exam is the problem, that is the moment to bring it to this office rather than sitting on it for another three months. Problems raised early get fixed inside the claim. Problems discovered in a denial letter get fixed on appeal, and that costs you a year.
Other things that control the clock
Six things decide how long you wait, and none of them are visible from the tracker alone.
The average is a moving number
Check it at the source, not second-hand
The VA publishes an average days-to-complete figure for disability claims that moves month to month; check the current number on the VA’s own claim status page rather than relying on any second-hand figure. In practice, most veterans see a decision somewhere between roughly three and eight months from the date the claim was filed, with the exam usually falling in the middle of that window.
The exam is not the last step
Three stages still sit in front of you
The exam is not the last step. The clock does not start at the exam and it does not stop there either — the claim still has to clear evidence gathering, the rating decision and authorization.
A returned exam is the invisible delay
The reason a tracker slides backward
A returned or clarified exam is the most common invisible delay, and it is why a tracker can slide backward. Expect some contact from the VA within 30 to 60 days of the exam. Past 60 days with nothing at all, call and ask specifically what the claim is waiting on.
30 to 60 days is a guide, not a deadline
A complex case can take 90 days or more
Thirty to sixty days is a rough average for a simple, single-issue claim — not a hard rule and not a ceiling. A claim with several conditions, a presumptive or toxic-exposure question, a returned exam, or missing records can easily take 90 days or more, and that alone does not mean anything is wrong. Watch whether the claim is still moving, not the calendar. Only when it stalls well past what is normal for a case like yours, and no one can tell you what it is waiting on, should you stop waiting — call 800-827-1000 and ask what the claim is waiting on and who it is assigned to.
Watch your status yourself — in one of three places
Weekly, not daily
Check your own status in one of three places: your VA.gov claim status page, the VA Health and Benefits mobile app, or by calling 800-827-1000. Check it weekly, not daily. And understand exactly what a status check can tell you: if a decision is posted in your account, it is live; if it is not posted, it is not ready. That is the whole rule. This is not something your representative or your attorney can speed up — we see the same thing you see, at the same time, and calling us to ask does not move it. Calling the VA to ask for an update does not move it either. Watch it yourself, weekly, and the moment a decision posts, bring it to us.
Your decision letter arrives — read it, then start the appeal clock
What to do the day it lands in your mailbox
The decision letter is the finish line of the claim and the starting line of the appeal — and the moment it arrives, a one-year clock starts running. Read it the same day. Find the combined rating, the percentage assigned to each condition, and the effective date, because the effective date controls how far back your back pay reaches. Then request a copy of your C&P exam report so you can see whether the rater used your real range-of-motion numbers or ignored the radiculopathy. If any part of the decision is wrong — a low rating, a denied condition, or a bad effective date — you have three appeal lanes, and you must choose one within one year of the date printed on the letter: a **Higher-Level Review (VA Form 20-0996)**, where a senior reviewer re-decides on the same evidence; a **Supplemental Claim (VA Form 20-0995)**, when you have new and relevant evidence such as a private DBQ or your own range-of-motion exam; or a **Board Appeal (VA Form 10182)** to a Veterans Law Judge. Miss that one-year deadline and the decision becomes final. You can still file again later, but you lose the original effective date — and that lost time is lost back pay you never get back. Bring the letter to this office before the year runs out and we will read it with you, line by line, at no cost.
07Remedy
How to report a bad exam
Where this exam goes wrong
The most common trap is being rated at 10% for malunion when your shoulder motion is actually limited below 90°. The examiner notes the malunion, assigns 10% under DC 5203, and never measures your range of motion. You walk out with 10% when you were entitled to 20% or more under DC 5201. Insist on a full shoulder ROM evaluation — the code explicitly allows rating on the contiguous joint.
Write it down the moment you get to your car
Date, start time, end time, the examiner’s name and credentials, the vendor, every test that was performed, and every test that was not. A contemporaneous note written the same day is evidence. A memory reconstructed four months later is not.
Get the exam report and the questionnaire
Request a copy through VA.gov, through a written request to the Regional Office, or by calling 800-827-1000. You cannot challenge what you have not read. Compare it line by line against what actually happened in the room.
Name the defect specifically, with the citation
Never write "the exam was unfair." Write "no goniometer was used, contrary to 38 CFR §4.46" or "flare-ups were reported and not addressed, contrary to Sharp v. Shulkin" or "repetitive use testing was not performed, contrary to 38 CFR §4.40 and DeLuca." A specific, citable defect is what forces action.
Submit a statement asking for a new examination
VA Form 21-4138, Statement in Support of Claim, filed through VA.gov or mailed to the Evidence Intake Center. State the defect, cite the authority, and request a new or supplemental examination. Do this BEFORE the decision if the claim is still open — it is far easier than undoing a decision afterward.
Report examiner conduct separately
If the problem is behavior rather than methodology — you were rushed out, dismissed, never touched, or treated with hostility — file a complaint with the VA facility’s Patient Advocate, or with the vendor directly for a contract exam, and copy the Regional Office. Conduct complaints and adequacy challenges are two different tracks and you can run both.
If a decision has already issued, pick the right lane
A Higher-Level Review (VA Form 20-0996) argues the VA erred on the evidence it had — the right vehicle when the exam was inadequate on its face. A Supplemental Claim (VA Form 20-0995) is the vehicle when you are adding new and relevant evidence, such as your own private range-of-motion examination or a completed DBQ from your treating provider.
Put your own measurements on the table
A private examination with full goniometric measurements, or a DBQ completed by your own provider, creates a conflict in the evidence that the VA has to resolve — and under 38 CFR §3.102 reasonable doubt is resolved in your favor.
End of clinical section
Clavicle / Scapula — DC 5203
See It Before You Sit In The Room
Shoulder VA Disability Claims — How VA Rates Shoulder Conditions
Combat Craig
How to Win Your Shoulder VA Claim
Hill & Ponton
The Questions Veterans Actually Ask
Clavicle / Scapula Claims — Frequently Asked Questions
Straight answers to the questions that decide clavicle / scapula claims — the ratings, the separate evaluations, and the exam mistakes that cost veterans money.
Clavicle / Scapula is evaluated under DC 5203. The scale runs across 3 rating levels, and the highest is 20%, which the VA assigns for: nonunion with loose movement; or dislocation of the clavicle or scapula — 20% on either side. Where your evaluation actually lands depends on how your exam and records document those criteria — not on how bad the condition feels on an average day.
Every condition in Shoulder Conditions
Three Ways to Put an Accredited Agent on Your Case
No fee unless you win. An accredited agent #45147 personally reviews every request — we respond within 48 hours.
Book a Free Consultation
Pick a time to talk through your VA claim with our team — no pressure, no obligation.
Hire Us · File VA Form 21-22a
Appoint us as your accredited representative and get registered as a client so we can act on your behalf.
Call an Accredited Agent
Speak to a real person on our team right now.
702-992-4883