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Nexus Letters for Shoulder Pain
Licensed Physician, MD | Patriot Path Medical Team
Specializing in VA musculoskeletal evaluations and independent medical opinions • Last updated: June 2026
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Shoulders wear out from overhead work, heavy lifting, and carrying gear. Rotator cuff tears and dislocations are common in service, and so are claims that get denied because the injury was never well documented.
A nexus letter can fix that. Our physicians connect your shoulder condition to your service, or to another condition that changed how you use the arm, in the language the VA expects. One flat fee of $1,500, and the first consultation is free.
How VA Rates the Shoulder (DC 5201)
VA rates most shoulder claims under 38 C.F.R. § 4.71a, DC 5201, by how far you can raise your arm. The numbers below are for your dominant arm, the one you write with. A normal arm raises to about 180 degrees, straight overhead.
| Rating | What it generally takes | Monthly pay (approx) |
|---|---|---|
| 20% | Arm raises only to about shoulder level (about 90 degrees, straight out to the side).Most Common | ~$357/mo |
| 30% | Arm raises only about halfway to shoulder level (about 45 degrees). | ~$552/mo |
| 40% | Arm raises only about 25 degrees from your side. | ~$796/mo |
| 50% and up | Shoulder fused in a bad position (ankylosis, DC 5200), or severe damage to the upper arm bone (humerus, DC 5202). | ~$1,133/mo+ |
These percentages are for your dominant arm. The non-dominant arm (the one you do not write with) is rated a little lower at the top levels. For example, raising the arm only 25 degrees from the side is 40% for the dominant arm and 30% for the non-dominant arm. A fused shoulder or major bone damage is rated higher, under DC 5200 and DC 5202. A shoulder that keeps dislocating is rated under DC 5202.
Pay figures are approximate 2026 rates (effective December 1, 2025) for a single veteran with no dependents. Check VA.gov for current amounts.
Estimate your likely shoulder rating
This estimates your likely shoulder rating from how high you can raise your arm. A doctor measures this at an exam, so treat it as a rough guide, not a rating. Outcomes shown are for the dominant arm.
Making a VA Disability Claim for Shoulder Conditions
When you file a VA disability claim for your shoulder, three things need to line up:
A current diagnosis
A diagnosed shoulder condition, usually backed by an exam and imaging such as an X-ray or MRI.
A service connection
Either a shoulder injury or overuse in service, or a link to another service-connected condition that changed how you use the arm.
A medical nexus
A qualified opinion that the shoulder condition is 'at least as likely as not' connected to your service.
The nexus is where most shoulder claims fall apart, especially when a dislocation popped back in and never made it into your records. A nexus letter supplies it: a written medical opinion tying your shoulder to your service. The 'at least as likely as not' standard (a 50% or better chance) comes from the benefit-of-the-doubt rule in 38 U.S.C. § 5107(b), carried out in 38 C.F.R. § 3.102.
How to Connect Your Shoulder to Service
There are a few ways to tie a shoulder condition to your service. A clear in-service injury helps, but the secondary path matters too.
Direct connection
A shoulder injury or repeated strain happened in service.
- A specific injury. A dislocation, a rotator cuff tear, a fall, or a heavy lift gone wrong.
- Wear and tear. Years of overhead work, heavy packs, and lifting. A sick-call visit in your records helps a lot.
Secondary connection
Another service-connected condition changed how you use the shoulder (38 C.F.R. § 3.310).
- From the neck. Nerve problems from a service-connected neck can weaken the shoulder and change how you use it.
- Overcompensation. Favoring a service-connected arm or hand loads the other shoulder harder.
Aggravation
You had shoulder problems before service, and service made them permanently worse.
- Worsened by service. Symptoms got worse during active duty, beyond normal aging.
Secondary Conditions
Shoulder problems rarely stay in the shoulder. These links can add to your combined rating, so they are worth documenting.
A shoulder condition may be secondary to
- Neck conditions. Nerve problems from the neck can weaken the shoulder and change how you use it.
- The other arm or hand. Favoring a service-connected arm overloads the other shoulder.
- Posture from carrying gear. Years of heavy packs and overhead work wear the shoulder down.
Conditions that may be secondary to a shoulder
- The neck or upper back. Guarding a hurt shoulder changes posture and strains the neck and upper back.
- The other shoulder or arm. Favoring one shoulder overloads the other over time.
- Depression or anxiety. Chronic pain and lost use wear on mood and can be claimed as secondary.
What to Gather - Evidence Checklist
Gather these before you file or ask for a letter. Tick each off as you go.
Frequently Asked Questions
How does the VA rate the shoulder?
Mainly by how far you can raise your arm, under 38 C.F.R. 4.71a, DC 5201. A fused shoulder or severe bone damage is rated higher under DC 5200 and DC 5202. A shoulder that keeps dislocating is rated under DC 5202.
Does it matter which arm?
Yes. The arm you write with, your dominant arm, can be rated higher than the other arm at the higher levels. For example, raising the arm only 25 degrees from the side is 40% for the dominant arm and 30% for the non-dominant arm.
My shoulder keeps dislocating. How is that rated?
Recurrent dislocation is rated under DC 5202, based on how often it happens and how much it guards your arm movement. Get each dislocation documented when you can.
Does shoulder pain alone get a rating?
Yes. Under 38 C.F.R. 4.59, painful motion earns at least the minimum rating, usually 10%, even if your motion looks near-normal. The VA should also account for weakness, fatigue, and flare-ups.
What does it cost, and how do we start?
Patriot Path charges $1,500 flat for a nexus letter, and the first consultation is free. Book a consultation and a clinician will tell you straight whether a letter can help.
Years of overhead work add up. Let your records show it.
Let our physicians prepare a shoulder nexus letter that meets the VA's evidence standards and supports the benefits you earned.
Sources & Regulatory References
- VA disability compensation (VA.gov) https://www.va.gov/disability/
- 38 CFR 4.71a, Schedule of ratings, musculoskeletal system, including the shoulder codes (eCFR) https://www.ecfr.gov/current/title-38/section-4.71a
- 38 CFR 4.40, Functional loss (eCFR) https://www.ecfr.gov/current/title-38/section-4.40
- 38 CFR 4.45, The joints (eCFR) https://www.ecfr.gov/current/title-38/section-4.45
- 38 CFR 4.59, Painful motion (eCFR) https://www.ecfr.gov/current/title-38/section-4.59
- 38 CFR 3.303, Principles relating to service connection (eCFR) https://www.ecfr.gov/current/title-38/section-3.303
- 38 CFR 3.310, Secondary service connection (eCFR) https://www.ecfr.gov/current/title-38/section-3.310
- 38 U.S.C. 5107, Benefit of the doubt (Cornell LII) https://www.law.cornell.edu/uscode/text/38/5107