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.
Symptoms of a rotator cuff tear include:
- Recurring pain when using your shoulder (e.g., lifting, pushing, etc.)
- Inability to sleep or put pressure on the one side
- Cracking sounds when lifting your arm
- Restricted range of motion
- Weak muscle strength
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 frozen shoulder syndrome, rheumatoid arthritis, and pinched 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 Rotator Cuff Repair
Rotator cuff tears 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. Or the tear 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 most common response will be to schedule a Compensation & Pension (C&P) exam. 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 request a second opinion:
- 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.
If you ask to have your claim reviewed again, it’s likely that your paperwork will be given to a specialist with more experience in your surgical repair. This means they may have a better understanding of common subacromial or subscapularis injuries.
How does the VA Rate 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:
- Severe:
- 40% (dominant)
- 30% (non-dominant)
- Moderately Severe:
- 30% (dominant)
- 20% (non-dominant)
- Moderate:
- 10% (dominant & non-dominant)
- Slight
- 0% (dominant & non-dominant)
The most important parts of the 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 they have a better idea of how everything links together.
TDIU for Rotator Cuff Repair
Total Disability based on Individual Unemployability (TDIU) is the VA designation for someone who is unable to work due to their disability. In order to qualify, the person will need a rating of 100. This may be achieved by having one serious condition, though will more likely be the result of having several conditions related to the service. The right legal advice plus the development of an attorney-client relationship can make a world of difference to your rating. Call today for a free consultation to discuss your disability and options.
