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.
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.
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. Shoulder Instability / Dislocation 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.
You are reading this 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.
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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 shoulder instability / dislocation 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 — shoulder instability / dislocation. 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 shoulder instability / dislocation 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 — Other Impairment of the Humerus, Diagnostic Code 5202
Reproduced verbatim from 38 CFR §4.71a, Diagnostic Code 5202. The VA assigns the evaluation that most closely approximates the veteran's level of impairment. Handedness (major vs. minor arm) determines the percentage at every level above the 20% floor.
70% (major) / 80% (minor)
Loss of the head of the humerus (flail shoulder) — 70% minor, 80% major.
50% (major) / 60% (minor)
Nonunion of the humerus (false flail joint) — 50% minor, 60% major.
40% (major) / 50% (minor)
Fibrous union of the humerus — 40% minor, 50% major.
20% / 30%
Malunion with marked deformity; or recurrent dislocation at the scapulohumeral joint with frequent episodes and guarding of all arm movements — 20% minor, 30% major.
20%
Malunion with moderate deformity; or recurrent dislocation at the scapulohumeral joint with infrequent episodes and guarding of movement only at shoulder level — 20% on either side.
Service Connection
Advice from the Advocate
The advocate's notes on causation — Shoulder Instability / Dislocation
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 recurrent shoulder dislocation or instability linked to a documented in-service traumatic event — a fall, a dislocation on the obstacle course, or a combatives injury. If your service treatment records show the initial dislocation, a profile, or a field reduction, that is the anchor.
2Continuity of symptomatology — §3.303(b)
If the formal instability diagnosis came after separation, 38 CFR §3.303(b) lets you bridge the gap with continuity. Lay statements describing the shoulder popping out repeatedly since service, emergency room visits for reductions, and the progressive inability to trust the arm all establish the unbroken chain from the in-service event to the current condition.
3Presumptive connection for arthritis — §3.307/§3.309
Chronic shoulder instability often leads to secondary arthritis from repeated dislocations wearing down the joint surfaces. If arthritis appears within one year of discharge, it is presumptively service-connected.
4Secondary to another service-connected condition — §3.310(a)
Shoulder instability can develop secondary to a service-connected condition that alters biomechanics — a contralateral upper-extremity injury, a cervical spine condition, or a TBI that impairs proprioception and coordination, making falls and dislocations more likely.
5Downstream secondary conditions — §3.310(a)
Once instability is service-connected, the conditions it causes become claimable: limitation of arm motion (DC 5201) from chronic guarding, depression and anxiety from the constant dread of the next dislocation and the occupational destruction it causes, and cervical strain from compensatory posturing.
Exposure & Aggravation
How Shoulder Instability / Dislocation Happens In Service — And How It Gets Worse
How veterans pick this up in uniform — Shoulder Instability / Dislocation
Shoulder Instability / Dislocation 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.
- Traumatic shoulder dislocation during combatives, hand-to-hand training, or contact sports
- Falls from height — rappelling, fast-rope, parachute landing, or vehicle rollover
- Shoulder forced out during heavy lifting, equipment handling, or crew-served weapon operation
- Blast-wave or concussive forces that slam the torso and upper extremities
- Repetitive overhead stress that weakens the labrum and capsule — throwing, PT, and operational duties
- Wrestling or restraint encounters that wrench the arm beyond its stable range
- Dislocations during training exercises that were "reduced" in the field and never properly imaged
- Progressive instability from an initial in-service dislocation that was never surgically repaired
Who is most prone to it
Infantry, airborne, and special operations soldiers with high fall and impact exposure; combatives instructors and military police; service members who sustained an initial traumatic dislocation during training or deployment and continued to serve without surgical repair; and anyone with a history of labral tear or Bankart lesion from military service.
The Symptoms
What Shoulder Instability / Dislocation Actually Feels Like
- Shoulder that dislocates or subluxes during overhead reaching, throwing, or unguarded movement
- The sensation of the shoulder "slipping" or "shifting" out of the joint and snapping back
- Apprehension and dread before any arm movement that could trigger a dislocation
- Guarding the arm against the body to prevent the shoulder from going out
- Night dislocations — waking in pain with the shoulder out of place after rolling in sleep
- Visible deformity or a hollow at the shoulder during a dislocation event
- Inability to trust the arm for carrying, lifting, or any weight-bearing task
- Progressive looseness — each dislocation makes the next one easier to trigger
How this one is rated
Shoulder instability is rated under 38 CFR §4.71a, Diagnostic Code 5202, on a ladder that escalates from malunion and recurrent dislocation through fibrous union, nonunion, and loss of the humeral head. For recurrent dislocation, the schedule draws a bright line: infrequent episodes with guarding only at shoulder level is the floor (20%), while frequent episodes with guarding of all arm movements jumps to 20%/30% (minor/major). Fibrous union, nonunion, and flail shoulder carry progressively higher ratings up to 70%/80%. The major/minor distinction under §4.69 applies at every level above the 20% floor.
What you are measured against
The examiner documents the history of dislocation episodes — how many, how often, what triggers them — and performs provocative tests to quantify the instability. The apprehension test, relocation test, anterior and posterior drawer, and sulcus sign all measure the degree of laxity and the veteran's involuntary guarding response. Imaging (MRI for labral tears, X-ray for bony Bankart or Hill-Sachs lesions) corroborates the structural damage.
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 shoulder instability / dislocation rating — they stack on top of it. A veteran who claims only the primary condition leaves these ratings on the table.
Chronic guarding destroys function
The constant guarding that instability forces on a veteran is itself a disabling condition. Keeping the arm pinned against the body to prevent dislocation means you cannot reach, carry, lift, or work overhead. This functional loss supports a separate limitation of motion claim under DC 5201 in addition to the instability rating — the two codes rate different impairments and can be combined.
Occupational capacity eliminated
Recurrent shoulder instability eliminates entire categories of work — anything involving lifting, carrying, overhead reach, or physical labor. A veteran who cannot stock a shelf, swing a hammer, or carry equipment has suffered a concrete occupational loss. Document the jobs you have lost or cannot apply for, and bring a vocational expert letter if available.
Progressive structural deterioration
Each dislocation stretches the capsule and erodes the bone surfaces — the Bankart lesion deepens, the Hill-Sachs defect enlarges, and the shoulder becomes easier to dislocate with less force. This progressive deterioration means the condition is getting worse, not stable, and it supports a future claim for increase or for the higher tiers of DC 5202 (fibrous union, nonunion, or flail shoulder) if the damage advances.
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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.
You are reading this page now
Impairment 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.
Read the full Clavicle / Scapula pageThe C&P Exam
What To Expect At The Shoulder Instability / Dislocation 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 Shoulder Instability C&P Examination
Diagnostic Code 5202 — this exam measures dislocation frequency and guarding pattern
A shoulder instability C&P exam is about two things: **how often the shoulder dislocates** and **how much you guard the arm to stop it from happening.** The schedule draws a hard line between infrequent episodes with guarding only at shoulder level (20%) and frequent episodes with guarding of all arm movements (20%/30%). The examiner will perform provocative tests designed to reproduce the instability — the apprehension test, the relocation test, the drawer, and the sulcus sign — and your involuntary reaction to those tests is some of the most powerful evidence in the exam. Do not mask your fear. If you flinch, tense up, or refuse to let the examiner move your arm into the position that causes a dislocation, that is apprehension, and it must be documented.
Condition
Shoulder Instability / Dislocation — DC 5202
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
- Apprehension test — arm abducted to 90° and externally rotated; positive if the veteran resists or shows fear
- Relocation test — posterior pressure applied to the humeral head in the apprehension position; positive if the fear resolves
- Anterior drawer test — humeral head translated forward with the scapula stabilized; graded on degree of translation
- Posterior drawer test — humeral head translated posteriorly; assessed for multidirectional instability
- Sulcus sign — downward traction on the arm; positive if a visible gap appears at the acromion
- Load and shift test — humeral head loaded into the glenoid and then shifted anteriorly and posteriorly
- Review of dislocation history — number of episodes, triggers, method of reduction, emergency room visits
- Shoulder imaging review — MRI for labral pathology, X-ray for bony defects
What gets measured, and to what number
Dislocation frequency
How often the shoulder fully dislocates or subluxes — weekly, monthly, or less. The examiner needs a number, not a vague "sometimes." Track episodes on a calendar before the exam.
Guarding pattern
Whether you guard the arm only at shoulder level (avoiding overhead reach) or guard all arm movements (keeping the arm pinned against the body to prevent any movement that might trigger a dislocation).
Provocative test results
The apprehension test, relocation test, anterior/posterior drawer, and sulcus sign — each graded positive or negative, with the degree of laxity documented.
Imaging findings
MRI showing a Bankart lesion, Hill-Sachs defect, or capsular laxity; X-ray showing bony Bankart fragment or glenohumeral arthritis from repeated dislocations.
Surgical history
Whether the veteran has had a Bankart repair, Latarjet procedure, or other stabilization surgery, and whether the instability has recurred after surgery.
02Orientation
What to expect during this exam
What makes this exam different from every other C&P exam
1Frequency and guarding are the two variables that set the rating
The schedule uses two criteria together: episode frequency (infrequent vs. frequent) and guarding pattern (at shoulder level vs. all movements). Both must be assessed. If you guard all arm movements but the examiner only documents "infrequent episodes," you are capped at 20%. Push for accurate documentation of both.
2The apprehension test is your strongest piece of evidence
When the examiner places your arm in the abducted, externally rotated position and you involuntarily tense up, flinch, or refuse to let them continue — that is a positive apprehension test, and it is objective proof of instability. Do not try to be tough. Let the examiner see the fear.
3Night dislocations are high-severity evidence
If your shoulder dislocates while you sleep, that means the instability is so severe that no voluntary guarding can prevent it. Night dislocations prove the shoulder is structurally incompetent — the labrum and capsule are too damaged to hold the joint in place even at rest. Document every night episode.
See it before you sit in the room
03Preparation
Know your symptoms and secondary factors
What the report must actually say about shoulder instability / dislocation — dc 5202
- "My shoulder dislocates [X] times per month" — give the examiner a specific frequency.
- "I guard my arm against my body all day" — describe the guarding pattern, not just the pain.
- "It went out in my sleep last week" — night dislocations are high-severity evidence.
- "I am afraid to raise my arm" — apprehension is a clinical finding, not weakness.
- "I cannot throw, reach behind, or carry anything in that arm" — document the functional loss.
- "Each dislocation is easier to trigger than the last" — progressive instability proves structural failure.
Pain level, frequency, lost work and functional loss — how to say them
Describe the dislocation events
Dislocation frequency is one of the two variables that set your rating. The examiner needs concrete episodes, not abstract descriptions. Describe the most recent dislocations — what you were doing, how the shoulder came out, how it was put back, and how long you were incapacitated afterward.
If it happens reaching for a seatbelt, rolling in sleep, or throwing a ball to your kid, say exactly that. Everyday triggers prove the severity.
"My shoulder dislocated twice last month. Once I was reaching behind me in the car and it popped out. The other time it went out in my sleep and I woke up screaming."
Admit to the night dislocations
Night dislocations are among the strongest evidence of severe instability because they happen without any voluntary movement. The shoulder is so structurally compromised that the simple act of rolling in sleep is enough to displace the humeral head. This proves the joint cannot be protected by guarding alone.
Describe waking up in pain with the arm in an abnormal position, having to reduce it yourself or go to the ER at 2 AM.
"I wake up with my shoulder out of place at least once a month. My wife has to help me push it back in. I cannot sleep on that side anymore."
Explain the reaching and daily-task triggers
If routine daily activities — reaching for a seatbelt, putting on a coat, reaching behind to tuck in a shirt — trigger subluxation or the fear of it, that proves the instability has invaded every part of your life. These are not athletic injuries; they are functional failures that the examiner must document.
Name the specific tasks you avoid or do differently because of the instability.
"I cannot reach across my body to grab the seatbelt. I have to use my other hand. Even reaching behind to tuck in my shirt makes it feel like it is about to go out."
Describe the constant apprehension and guarding
Guarding pattern is the second variable that sets your rating. If you guard only at shoulder level, you are at 20%. If you guard all arm movements — keeping the arm pinned against your body, refusing to reach, flinching when someone bumps you — you cross into the 20%/30% tier. Describe the mental burden of living in fear of the next dislocation.
Explain that you keep your arm tucked in, that you flinch when someone touches your shoulder, and that you avoid any arm movement that feels risky.
"I keep my arm against my body all day. I flinch if someone bumps my shoulder. I will not raise it above my waist unless I absolutely have to because I know it could go out."
Secondary conditions to raise in the same appointment
Chronic guarding destroys function
The constant guarding that instability forces on a veteran is itself a disabling condition. Keeping the arm pinned against the body to prevent dislocation means you cannot reach, carry, lift, or work overhead. This functional loss supports a separate limitation of motion claim under DC 5201 in addition to the instability rating — the two codes rate different impairments and can be combined.
Occupational capacity eliminated
Recurrent shoulder instability eliminates entire categories of work — anything involving lifting, carrying, overhead reach, or physical labor. A veteran who cannot stock a shelf, swing a hammer, or carry equipment has suffered a concrete occupational loss. Document the jobs you have lost or cannot apply for, and bring a vocational expert letter if available.
Progressive structural deterioration
Each dislocation stretches the capsule and erodes the bone surfaces — the Bankart lesion deepens, the Hill-Sachs defect enlarges, and the shoulder becomes easier to dislocate with less force. This progressive deterioration means the condition is getting worse, not stable, and it supports a future claim for increase or for the higher tiers of DC 5202 (fibrous union, nonunion, or flail shoulder) if the damage advances.
How to prepare for this specific exam
- Track every dislocation and subluxation episode on a calendar for at least two months before the exam — date, trigger, how it was reduced.
- Bring emergency room records from any dislocation reductions.
- Bring your MRI report showing the Bankart lesion, Hill-Sachs defect, or capsular damage.
- Write down every activity you avoid because of the instability — throwing, reaching, carrying, sleeping on that side.
- Bring a lay statement from your spouse describing the night dislocations, the guarding, and the activities you can no longer do.
- If you had surgical repair and it failed, bring the operative report and the evidence that instability recurred.
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.
01Apprehension and relocation testing
38 C.F.R. §4.71a, Diagnostic Code 5202
The apprehension test is the cornerstone of a shoulder instability exam. The examiner places the arm in 90° of abduction and maximal external rotation — the position that most closely replicates a dislocation — and watches for the veteran's involuntary response. If the veteran tenses up, resists, or shows visible fear, the test is positive. The relocation test follows: the examiner applies posterior pressure to the humeral head in the same position, and relief of the apprehension confirms anterior instability.
A positive apprehension test is objective, reproducible evidence of instability that cannot be faked. It is the single strongest clinical finding in the exam.
02Sulcus sign and multidirectional laxity
38 C.F.R. §4.71a
The sulcus sign test measures inferior laxity: the examiner pulls the arm downward and measures the gap that opens between the acromion and the humeral head. A sulcus greater than 2 cm is significant. If the shoulder is lax in multiple directions — anterior, posterior, and inferior — the examiner documents multidirectional instability (MDI), which is typically more disabling than unidirectional instability.
Multidirectional instability means no position is safe — the shoulder can dislocate anteriorly, posteriorly, or inferiorly — and that degree of structural failure supports the higher "frequent episodes, guarding all movements" tier.
03Relocation test and load-and-shift
38 C.F.R. §4.71a
After the apprehension test, the relocation test confirms that posterior pressure on the humeral head relieves the fear and pain. The load-and-shift test loads the humeral head into the glenoid and then translates it anteriorly and posteriorly, graded on how far the head slides: Grade 1 (translation to the glenoid rim), Grade 2 (over the rim with spontaneous reduction), or Grade 3 (locked dislocation). Higher grades correlate with more severe structural damage.
Graded translation quantifies the instability. A Grade 2 or 3 load-and-shift, combined with a positive apprehension test, makes the case for frequent episodes and guarding of all arm movements.
04Shoulder imaging — MRI and X-ray review
38 C.F.R. §4.71a
The examiner reviews imaging to identify the structural damage that causes the instability: a Bankart lesion (torn anterior-inferior labrum), a Hill-Sachs defect (compression fracture of the posterior humeral head from repeated dislocations), capsular laxity, or bony Bankart fragments. X-rays may show glenohumeral arthritis from chronic instability. Each structural finding corroborates the clinical tests and strengthens the frequency and guarding assessment.
Imaging is objective proof that the shoulder is structurally compromised. A veteran with a Bankart lesion on MRI and a positive apprehension test has two independent lines of evidence pointing to the same conclusion.
05Functional and occupational impact assessment
38 C.F.R. §§4.10, 4.40
The examiner documents how the instability affects work and daily life: jobs lost because of the inability to lift or reach, sports and hobbies abandoned, daily tasks that require assistance, and the psychological toll of living in constant fear of the next dislocation. This assessment feeds directly into the rating decision and strengthens any TDIU consideration.
Instability is not just a mechanical problem — it destroys confidence, eliminates occupational capacity, and creates a secondary psychological burden. The functional assessment is where all of those consequences are captured.
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 minimizing the frequency. Veterans say "it happens sometimes" or "a few times a year." The schedule draws a line between infrequent and frequent. If your shoulder subluxes weekly and you call it "sometimes," you are handing the examiner the word that caps you at 20%. Count the episodes and report the real number.
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
Shoulder Instability / Dislocation — DC 5202
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
Shoulder Instability / Dislocation Claims — Frequently Asked Questions
Straight answers to the questions that decide shoulder instability / dislocation claims — the ratings, the separate evaluations, and the exam mistakes that cost veterans money.
Shoulder Instability / Dislocation is evaluated under DC 5202. The scale runs across 5 rating levels, and the highest is 70% (major) / 80% (minor), which the VA assigns for: loss of the head of the humerus (flail shoulder) — 70% minor, 80% major. 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.
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