VA Disability Rating for Shoulder Ankylosis
Diagnostic Code 5200 · 38 CFR §4.71a
What Is It?
Ankylosis of the shoulder means the shoulder joint itself is frozen or fused, so the shoulder blade and upper arm move as one piece. This can result from severe arthritis, surgical fusion, trauma, or prolonged immobilization. The position in which the shoulder is frozen determines the rating level. In the schedule's words, favorable ankylosis is abduction to 60 degrees, where you can reach your mouth and head. Unfavorable ankylosis is abduction limited to 25 degrees from the side. Intermediate ankylosis is between favorable and unfavorable. Veterans may develop shoulder ankylosis from combat injuries, severe fractures, failed surgeries, or progressive arthritis. 38 CFR 4.71a notes that under this code the scapula and humerus move as one piece. Unfavorable ankylosis is 50 percent in the major arm and 40 in the minor arm; intermediate ankylosis is 40 and 30; favorable ankylosis is 30 and 20.
Rating Criteria
| Rating | Criteria |
|---|---|
| 50% | Unfavorable ankylosis, abduction limited to 25 degrees from the side — major (dominant) arm. |
| 40% | Unfavorable ankylosis, abduction limited to 25 degrees from the side — minor (non-dominant) arm. Also: ankylosis intermediate between favorable and unfavorable — major (dominant) arm. |
| 30% | Ankylosis intermediate between favorable and unfavorable — minor (non-dominant) arm. Also: favorable ankylosis, abduction to 60 degrees, can reach mouth and head — major (dominant) arm. |
| 20% | Favorable ankylosis, abduction to 60 degrees, can reach mouth and head — minor (non-dominant) arm. |
Evidence Needed
- Imaging of the shoulder showing fusion or ankylosis of the joint
- An examination stating that the shoulder joint is ankylosed, and recording the position it is fixed in, including how far the arm can be abducted
- Documentation of the position in which the shoulder is fixed
- Medical records connecting the ankylosis to service
- Records showing which shoulder is on the dominant side
C&P Exam Tips
- Ask the examiner to state whether the shoulder joint is ankylosed or only limited in motion
- Make sure the examiner documents the position of ankylosis as favorable, intermediate, or unfavorable
- Demonstrate what you can and cannot reach with the frozen shoulder
- Confirm which arm is your dominant arm
- Describe how the frozen shoulder affects dressing, hygiene, and work tasks
How to File
File under DC 5200 for shoulder ankylosis. The rating depends on two factors: whether the shoulder is your dominant or non-dominant side, and the position of ankylosis. Include imaging and an examination that states the shoulder joint is ankylosed. Make sure the position of ankylosis, including how far the arm can be abducted, is clearly documented.
Common Mistakes
- Not having the specific position of ankylosis documented.
- Confusing severe limitation of motion, rated under DC 5201, with ankylosis, rated under DC 5200.
- Not specifying dominant versus non-dominant shoulder.
- Not filing for secondary conditions caused by compensating with the other arm.
Frequently Asked Questions
What is the difference between ankylosis and severe limitation of motion?
DC 5200 rates ankylosis of the scapulohumeral articulation, the shoulder joint fixed in place, and the schedule notes that under this code the scapula and humerus move as one piece. Its levels are set by the position the joint is fixed in: favorable, intermediate, or unfavorable. A shoulder that still moves but is limited is rated under DC 5201, limitation of motion of the arm, whose levels are set by how far flexion and/or abduction is limited: to 25 degrees from the side, midway between side and shoulder level, or at shoulder level. Because the two codes use different criteria and percentages, the examination report should say whether the joint is ankylosed or limited in motion, and describe the position or the measured motion.
What does favorable versus unfavorable ankylosis mean?
Favorable ankylosis is the schedule's term for a shoulder fixed with abduction to 60 degrees, where you can reach your mouth and head. Unfavorable ankylosis is abduction limited to 25 degrees from the side. Anything between the two is intermediate. Unfavorable is rated highest: 50 percent in the major arm and 40 in the minor arm, against 30 and 20 for favorable.
Do muscle injuries around a frozen shoulder change the rating?
They can. Under 38 CFR 4.55(c), no rating is assigned for muscle groups that act on an ankylosed joint, with exceptions. For the shoulder, 4.55(c)(2) provides that if muscle groups I and II are severely disabled, the evaluation under DC 5200 is elevated to the level for unfavorable ankylosis, if not already assigned, but the muscle groups themselves are not rated.