The Department of Veterans Affairs sees many VA disability claims for orthopedic impairments like severe shoulder issues, back problems, legs, arms, feet, etc. Some veterans may not be aware that VA disability ratings can be assigned for shoulder-specific impairments and painful motion like rotator cuff tears, bursitis, and more. In this specific post we’ll cover the Rotator Cuff and we will also discuss bursitis briefly as it can lead to rotator cuff injuries.
Shoulder Rotator cuff repair refers to the surgery to correct a rotator cuff tear in the shoulder. The rotator cuff is the group of muscles and tendons that make it possible for the arm and shoulder to move. When these muscles are overused or subjected to undue force, the tendons may tear from the stress. Rotator cuff tears can severely limit a person’s range of motion, which may qualify them for disability benefits based on their inability to work. Before we get to a full-blown tear, let’s talk about why it’s so frequent among veterans.
What Causes Bursitis of the Shoulder in Veterans?
Bursitis is defined as inflammation and swelling of a fluid-filled sac called the bursae; typically this leads to thickening and pain in the area. The most common cause of bursitis is injury or repetitive use. Two things that veterans know are a given in active duty military life. Bursitis could also be related to other disabling conditions like Diabetes, tendonitis, gout, or arthritis. If you are feeling shoulder pain from your time in service and you are not receiving VA disability compensation, you may want to file a veterans claim.
Common Symptoms of Rotator Cuff Tears
- Recurring pain when using your shoulder (e.g., lifting, pushing, etc.)
- Painful motion
- Inability to sleep or use the shoulder for weight-bearing
- Cracking sounds when lifting your arm
- Restricted range of motion
- Weak muscle strength or incoordination
A rotator cuff tear caused by a shoulder injury will generally result in acute pain directly after it occurs. Rotator cuff tears that stem from overuse may be less obvious to the veteran though. This is why workers’ compensation claims may be filed even though the surgery was actually a result of a problem that one experienced in the service. It’s also important to remember that certain arm conditions, shoulder bursitis, frozen shoulder syndrome,rheumatoid arthritis, and or nerves may result in similar symptoms to a tear.
Rotator cuff repair generally includes shoulder surgery followed by physical therapy. During surgery, the doctor might make a large incision into one of the major tendons of the cuff, such as the supraspinatus or labrum, or they might make smaller incisions for an arthroscopy procedure. The surgeon might also perform a debridement where they remove damaged tissue from the shoulder. The doctor may then reattach the tendons and a physical therapist will work with the veteran to further strengthen the rotator cuff tendons.
Service Connection for Shoulder Disability Repair
Rotator cuff tears and shoulder bursitis fall under the category of arm and shoulder muscles. The VA does allow veterans to file for shoulder pain if it was caused by their time in the service. This is a relatively common condition that can be caused by the tasks required of military members, including physical training, transporting supplies, or lifting heavy objects on a regular basis. Some vets don’t realize how their bodies may experience some form of atrophy through active duty due to unknown injuries or dislocations. Sometimes, rotator cuff tears might have been caused by a blow, such as a fellow service member running into the shoulder.
If you believe that your torn rotator cuff occurred in the military, you’ll need to gather the following documents to present to your local VA Regional Office (RO):
- A diagnosis from your treating physician for a torn rotator cuff.
- A statement from your treating physician that states that the tear was caused by your time in the service (known as a medical nexus).
- A full description of the events that led up to the shoulder pain and limitation of motion.
The RO is looking for specificity in all documents. The description of the events must be verifiable and they present a clear narrative of what happened. VA officials will attempt to corroborate as many details as possible before determining the next steps.
It may surprise you to learn that rotator cuff tears do not need to have occurred during an active shift. For instance, if you were lifting weights during your free time while on base and you tore your rotator cuff, this would still count as a service-connected disability.
Secondary Service Connection for Rotator Cuff Repair
You can file for a rotator cuff injury as a secondary service connection if it was caused by a primary service connection. For example, if you sustained a blow to the shoulder joint in the military that weakened the infraspinatus. It may take some time for you to experience severe pain from an obvious tear, but it would still be a direct result of the original injury.
If you choose to file for the pain in your upper extremity, you will need your medical records (including a recent diagnosis), a description of how the primary disability caused the secondary disability, and a statement from your doctor that confirms the connection. Again, whether you’re connecting the tear to a clavicle or an elbow injury, it’s important to be as detailed as possible.
Compensation & Pension (C&P) Exams for Rotator Cuff Repair
To file for disability, you’ll need to submit your documentation to the RO where it will be reviewed. The likeliest response from VA will be to schedule a Compensation & Pension (C&P) exam eventually for service-connected VA compensation. During this procedure, a VA doctor will examine your injuries. They will not treat your upper arm or prescribe pain killers, but they may take X-rays to determine if the cuff tear was partial-thickness or full-thickness, a malunion, etc. They’ll do a physical examination and ask questions about how the tear affects your ability to work. They may inquire into the details of your arthroscopic surgery and the pain levels that you’ve experienced since.
If the doctor does not agree with you or you feel that the rating is too low, you do have the right to appeal. Per the Appeals Modernization Act (AMA), you have several options to fight the decision:
- You can request another review at the RO
- You can submit new evidence, such as new documentation of thickness tears
- You can request for a higher authority to look at the case.
VA Disability Ratings for Shoulder Rotator Cuff Repair
The VA will rate rotator cuff surgery based on the severity of the pain and the thickness rotator cuff tears, often around 10 – 20%. In some cases though, such as the case of a right shoulder impingement syndrome, it may rate higher. Under more severe circumstances, such as shoulder replacement, the individual may also be granted a higher rating (at least until they recover from surgery).
The VA may use several ratings schedules in combination when rating rotator cuff injuries. The first is 38 CFR § 4.71a (Schedule of Ratings – Musculoskeletal System). The percent ratings that relate to rotator cuff injuries look as follows:
38 CFR § 4.71a – Diagnostic Code 5200 – Scapulohumeral articulation, ankylosis of:
- Unfavorable, abduction limited to 25° from side:
- 50% (major)
- 40% (minor)
- Intermediate between favorable and unfavorable:
- 40% (major)
- 30% (minor)
- Favorable, abduction to 60°, can reach mouth and head:
- 30% (major)
- 20% (minor)
38 CFR § 4.71a – Diagnostic Code 5201 – Arm, limitation of motion of:
- Flexion and/or abduction limited to 25° from side:
- 40% (major)
- 30% (minor)
- Midway between side and shoulder level (flexion and/or abduction limited to 45°)
- 30% (major)
- 20% (minor)
- At shoulder level (flexion and/or abduction limited to 90°)
- 20% (major and minor)
The VA may also use 38 CFR § 4.73 (Schedule of Ratings – Muscle Injuries) when rating rotator cuff injuries. This diagnostic code breaks down the way that the shoulder and arm move. The code also takes into account whether the dominant or non-dominant side is affected.
For example, diagnostic code 5301 measures the upward rotation of the scapula, elevation of the arm above shoulder level, and the extrinsic muscles of the shoulder girdle. These ratings include:
- 40% (dominant)
- 30% (non-dominant)
- Moderately Severe:
- 30% (dominant)
- 20% (non-dominant)
- 10% (dominant & non-dominant)
- 0% (dominant & non-dominant)
The most important factors of a veterans disability and getting an increased rating will be how the shoulder pain developed, what kind of treatment you needed, and how the initial pain and recovery impacted your ability to earn an income. The right law firm can help you present these facts to the VA so you may receive your rightful VA disability benefits.
TDIU for Rotator Cuff Repair
Total Disability based on Individual Unemployability (TDIU) is the VA designation for a veteran who is unable to work due to the level of disability. In order to qualify, the person will need a rating of 100%. This may be achieved by having one serious condition that is rated at least 60% or more, though will more likely be the result of having several conditions related to the service.
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Rotator cuff surgery is rated based on the severity of the pain and the thickness of the rotator cuff tear. Most often, VA rates this condition as 10 or 20 percent disabling. If shoulder replacement surgery takes place, a higher rating may be warranted.What is the VA rating for right shoulder bursitis? ›
Bursitis of the Shoulder VA Ratings
Non-dominant shoulder bursitis with the same limitation would warrant a rating of 30%. Veterans unable to lift their dominant arm midway between their side and shoulder are entitled a 30% disability rating, and a 20% rating if their non-dominant arm is affected.
The specific diagnostic code for bursitis of the shoulder is 5201. The rating breakdown is as follows: 40% Disability rating: Veterans who cannot lift their dominant arm more than 25 degrees. 30% Disability rating: Veterans who cannot lift their non-dominant arm more than 25 degrees.What is the VA disability rating for shoulder surgery? ›
If you need to have your shoulder replaced, you will likely receive 100% disability for one year after your surgery. After you've healed, the VA will give you a permanent disability rating based on your level of function. This rating could be 30% - 60%.Can you get disability after rotator cuff surgery? ›
Some people may be able to qualify for disability benefits after a serious rotator cuff tear, but the specifics depend on each person's medical records. In order to receive Social Security Disability, the applicant's disability must be expected to persist for at least 12 months.Can you get disability for shoulder bursitis? ›
Many bursitis cases are evaluated as “Major Joint Dysfunction.” If your bursitis symptoms have caused chronic pain or immobility of a major joint, you may be eligible for disability benefits under “Major Joint Dysfunction.”How bad is shoulder bursitis? ›
It is rarely painful and usually not reddened. However, this type of bursal swelling can get warm and painful without being infected. In infected bursitis patients usually experience excessive warmth at the site of the inflamed bursa. They often complain of a great deal of tenderness, pain, and fever.What is the most common shoulder bursitis? ›
Bursitis of the shoulder (impingement syndrome) occurs when there is swelling and redness between the top of the arm bone and the tip of the shoulder. The most common causes of bursitis are injury or overuse. Infection may also cause it. To relieve bursitis of the shoulder, avoid doing the things that cause pain.How long is recovery for bursitis in shoulder? ›
Recovery Time for Shoulder Bursitis
There is no definitive recovery time but it typically ranges from 4 weeks to 6 months. When the bursitis is the result of a physical injury, the recovery is simpler and can be treated within a few days to weeks.
The VA rates shoulder conditions based on how they affect the use of shoulders and arms. They use the rules of the VASRD to determine that rating. Veterans may be eligible to receive as much as 50% disability compensation.
Rotator cuff surgery is rated based on the severity of the pain and the thickness of the rotator cuff tear. Most often, VA rates this condition as 10 or 20 percent disabling.Does VA reduce rating after surgery? ›
Recovery time from either a surgery or the immobilization of a joint by a cast without surgery requires a temporary 100% disability rating for a service-connected disability. The temporary 100% rating may continue for 1 to 3 months—depending on your unique case.Can the VA reduce disability rating after surgery? ›
Once a treatment is performed, the condition no longer exists. The veteran is allowed a 3 to 12 month recuperative rating after surgery...that rating is always 100%. That is a temporary assignment. It follows that the condition is "cured" so he can't be rated for that any longer.What is the prognosis for rotator cuff repairs? ›
This is because there is intrinsic weakness in the rotator cuff and with heavy activity there is always a risk of re-rupture. The success rate of the surgery is in the vicinity of 90%. The success rate and return of function is very dependent on the size of the tear, the bigger the tear the worse the result.What percentage of shoulder injury is VA disability? ›
Importantly, the minimum rating for any total shoulder replacement is 30 percent for the dominant arm and 20 percent for the non-dominant arm.What is the recovery period for rotator cuff repair? ›
It takes the repaired rotator cuff tendons about six weeks to heal initially to the bone, three months to form a relatively strong attachment to the bone, and about six to nine months before the tendon is completely healed to the bone.What is the exam for shoulder bursitis? ›
Bursitis is typically identified by localized pain and/or swelling, tenderness, and pain with motion of the tissues in the affected area. X-ray testing can sometimes detect calcifications in the bursa when bursitis has been chronic or recurrent. MRI scanning (magnetic resonance imaging) can also define bursitis.Is shoulder bursitis a form of arthritis? ›
Is it Arthritis or Bursitis? In the most general sense, arthritis is a long-lasting condition that affects bones and cartilage while bursitis is a transient condition that affects bursae, tendons, ligaments, and muscles.Is bursitis a rotator cuff injury? ›
Rotator cuff tendinitis is also called impingement, bursitis or biceps tendinitis. These are all different names for the same problem. They mean that there is pain and swelling of the cuff tendons and the surrounding bursa.What are 3 symptoms of bursitis? ›
- Shoulder. Pain when raising arms above head. Discomfort worsens at night. ...
- Elbow. Increased pain if the elbow is bent. Infection is common in this bursa.
- Hip. Pain while walking. Tenderness in groin area. ...
- Knee. Swelling on the front of the kneecap. Pain when knee is bent.
You may experience a dull ache, sharp pain or mild tenderness. Other signs of shoulder bursitis include: Shoulder stiffness or a feeling of swelling. Painful range of motion.Does shoulder bursitis show up on xray? ›
X-ray images can't positively establish the diagnosis of bursitis, but they can help to exclude other causes of your discomfort. Ultrasound or MRI might be used if your bursitis can't easily be diagnosed by a physical exam alone.Can shoulder bursitis affect the neck? ›
Can Shoulder Bursitis Cause Neck Pain? If you are experiencing shoulder pain that won't seem to go away or worsens, it is possible that the pain can radiate to the neck. Neck pain isn't a direct symptom of shoulder bursitis; however, it may be present in addition to shoulder pain.What are the four 4 common types of bursitis? ›
Common types of bursitis include prepatellar, olecranon, trochanteric, and retrocalcaneal. Most patients respond to nonsurgical management, including ice, activity modification, and nonsteroidal anti-inflammatory drugs.Why won't my shoulder bursitis go away? ›
Shoulder bursitis may take longer to heal if other shoulder problems are present, including tendinitis or bone problems. Bursitis can be chronic when it is caused by medical conditions, particularly rheumatoid arthritis.Can you get bursitis after rotator cuff surgery? ›
In one study of 14 asymptomatic patients with rotator cuff repair and a mean follow-up period of 40 months (range, 24–49 months), the prevalence of bursitis-like abnormalities was 100%.What are the stages of bursitis in the shoulder? ›
Bursitis can subdivide into three phases: acute, chronic and recurrent.What is the VA over 55 rule? ›
Once you turn 55, you are typically "protected" and will no longer have to attend an exam to prove that your condition has not changed unless there is reason to suspect fraud. This is sometimes called the 55-year rule.What is the average VA disability rating for joint pain? ›
Degenerative arthritis, caused by overuse of the joints or an injury, is the most common form of arthritis in veterans and is rated under Diagnostic Code 5003. Veterans receive either a 10% or 20% rating depending on the severity of their symptoms and the number of joints affected.How much is a rotator cuff surgery worth? ›
The most severe shoulder injuries may have a typical settlement payout in the range of $150,0000 to $300,000 or more.
However, it is important to realize that it may not make your shoulder feel 100% normal again. Research studies have shown that one year after surgery patients will have shoulder function which is about 80% of normal (see the attached graph from a publication in JBJS).Is your shoulder 100 after rotator cuff surgery? ›
Lack of improvement: Arthroscopic rotator cuff surgery has a high success rate, but it is not 100 percent. Lack of improvement is not a true complication, but the result can be disappointing for patients. It is possible patients will find they do not regain full motion, strength and function in the shoulder.Is 70% PTSD a permanent VA disability? ›
The veteran's total disability due to PTSD is permanent with no likelihood of improvement. The 100 percent rating for PTSD is total, permanent, and static in nature.At what age does VA disability become permanent? ›
There is no set age of when your VA disability becomes permanent. The VA rater will determine “permanence” of a VA disability if it is reasonably certain, based upon medical evidence, that the level of impairment will continue for the rest of your life. Translation: Whether you're 35 or 75 years old it does not matter.What is the 8 year rule for VA disability? ›
The 8-year provision actually goes both ways. The veteran needs to have been totally disabled for at least 8 years before death and then the benefit will be granted to surviving spouses for the same 8 years.How to go from 70 to 100 VA disability? ›
- Method 1: Appeal the Decision or File a New Claim. The most straightforward approach is to appeal VA's decision on the original claim. ...
- Method 2: Prove Individual Unemployability (TDIU) ...
- Method 3: File for a Secondary Service Connection. ...
- Assistance with Your Claims and Appeals.
No, VA disability does not stop at age 65; nor does it stop at age 67. VA disability benefits are for the life of the disabled veteran! And in some instances, the veteran's VA benefits can pass to the surviving spouse. At age 65, a disabled veteran may also become eligible for VA pension benefits.How to go from 60 to 100 VA disability rating? ›
- Filing an appeal within VA's deadlines.
- Filing a new claim for an increased rating.
- Filing for TDIU, or total disability based on individual unemployability.
- Filing for secondary service connection.
You can get a 20%, 30%, 40%, or 50% rating for a torn rotator cuff. The VA might also use diagnostic code 5304 to assign the rating if the injury affects the shoulder muscles. The ratings are 0%, 10%, 20%, and 30% depending on severity and whether the injury is to your dominant or non-dominant arm.Is a torn rotator cuff a permanent disability? ›
Can a Rotator Cuff Injury Lead to Permanent Disability? In some cases, yes. Severe rotator cuff injuries involve a significant or complete tear in one or more structures in the rotator cuff. A severe rotator cuff tear can lead to a permanent loss in a person's range of motion.
Rotator cuff tears do not heal on their own without surgery, but many patients can improve functionally and decrease pain with nonsurgical treatment by strengthening their shoulder muscles.Who gets 100 percent VA disability? ›
The highest percentage that can be given for service-connected compensation purposes is a 100 percent VA disability rating, or total disability rating. This rating is only available to veterans with extremely debilitating service-connected ailments that make them unable to work and mostly unable to care for themselves.What will VA disability pay be in 2023? ›
Effective December 1st, 2023, the monthly veterans disability payment amounts for veterans with no dependents are as follows: $165.92 per month for 10% disability. $327.99 per month for 20% disability. $508.05 per month for 30% disability.What is VA C&P exam for shoulders? ›
Understanding the C&P Exam for Shoulder Injuries
This exam determines if the veteran's disability is service-connected and the severity of the condition. Musculoskeletal injuries, such as those to the shoulder and arm, are examples of disabilities that a veteran may have suffered during military service.
A rotator cuff surgery is a major surgical intervention in the shoulder, and the reason that there is pain after surgery is the amount of normal surgical trauma. Cutting, drilling, cauterizing, and suturing tissues create pain and inflammation.When is pain the worst after rotator cuff surgery? ›
Introduction: Pain can be severe during the first days after arthroscopic surgery, and acute pain is an important outcome in clinical trials of surgical technique or anaesthetic strategy.Is it painful after rotator cuff surgery? ›
Most people who have rotator cuff surgery can expect to feel some level of pain for at least six months after their procedure.What is the average VA rating for shoulder pain? ›
VA Disability Ratings for Shoulder Rotator Cuff Repair
The VA will rate rotator cuff surgery based on the severity of the pain and the thickness rotator cuff tears, often around 10 – 20%. In some cases though, such as the case of a right shoulder impingement syndrome, it may rate higher.
The minimum permanent rating for a shoulder replacement is 30 percent for a dominant arm and 20 percent for a non-dominant arm, but you could get a rating as high as 50 or 60 percent, depending on your condition.What shoulder problems qualify for disability? ›
Many shoulder pain sufferers qualify for Social Security disability because they have a “major dysfunction of a joint.” In order to qualify pursuant to this Blue Book listing, a claimant must show that he has one of the following conditions: Partial shoulder dislocation. Partial or full fusing of the shoulder joints.
Veterans receive either a 10% or 20% rating depending on the severity of their symptoms and the number of joints affected. A 20% rating requires that two or more major joints or two or more groups of minor joints have occasional incapacitating episodes.Can you get disability for chronic shoulder pain? ›
Many workers who suffer from shoulder problems are eligible for SSD benefits. For the Social Security Administration (SSA) to consider a shoulder issue a disability, sufferers must show that their condition is severe enough to prevent them from working full-time for at least twelve months.What triggers bursitis in shoulder? ›
The most common causes of bursitis are injury or overuse. Infection may also cause it. Bursitis is also associated with other problems. These include arthritis, gout, tendonitis, diabetes, and thyroid disease.Is shoulder bursitis permanent? ›
Shoulder bursitis is by no means a permanent injury and it is quite possible to recover from it.