ARM LIMITATION OF MOTION

Summary

The veteran, who served in the Navy from July 1989 to July 2009, honorably discharged, appealed the denial of an increased disability rating for his right shoulder, specifically seeking a rating in excess of 40 percent, including extraschedular consideration. The claim covered two periods: August 1, 2009, to March 2, 2021, and after March 2, 2021. The case has a lengthy history of remands and appeals, with the Board and the Court of Appeals for Veterans Claims (CAVC) vacating previous decisions due to inadequate VA examinations. The veteran underwent multiple surgeries and treatments for right shoulder conditions including labral tears, impingement, arthritis, and AC joint separation. Evidence included numerous VA examinations with conflicting findings on range of motion, pain, flare-ups, and the impact of intercurrent injuries. The Board considered both pre- and post-February 7, 2021, rating criteria for DC 5201 (arm limitation of motion) and explored other diagnostic codes like DC 5200 (ankylosis) and DC 5203 (clavicle/scapula impairment). Despite the veteran's persistent pain and functional limitations, the Board found the evidence did not support a rating exceeding 40 percent, nor did it meet the criteria for an extraschedular rating, as the disability picture was adequately contemplated by the schedular standards. The Board denied entitlement to a higher rating for both periods.

Rationale

Evidence did not support a rating in excess of 40 percent under DC 5201.; Veteran's symptoms did not approach ankylosis or functional ankylosis.; Extraschedular consideration was not warranted as schedular standards adequately contemplated the disability.

Full Decision Text

Citation Nr: 26005088
Decision Date: 04/30/26	Archive Date: 04/30/26

DOCKET NO. 11-21 215
DATE: April 30, 2026

ORDER

Entitlement to a right shoulder evaluation in excess of 40 percent, to include on an extraschedular basis, from August 1, 2009, to March 2, 2021, (but excluding September 29, 2015, to November 1, 2015) is denied.

Entitlement to a right shoulder evaluation in excess of 40 percent, to include on an extraschedular basis, after March 2, 2021, is denied.

FINDINGS OF FACT

1. The persuasive weight of the evidence from August 1, 2009, to March 2, 2021, weighs against a finding that the Veteran's right shoulder disability was so exceptional or unusual that an extraschedular analysis was warranted and the Veteran did not have ankylosis, functional ankylosis, or a humerus impairment. 

2. The persuasive weight of the evidence after March 2, 2021, weighs against a finding that the Veteran's right shoulder disability was so exceptional or unusual, that an extraschedular analysis was warranted and the Veteran did not have ankylosis, functional ankylosis, or a humerus impairment. 

CONCLUSIONS OF LAW

1. The criteria for entitlement to a shoulder evaluation in excess of 40 percent from August 1, 2009, to March 2, 2021, have not been met. 38 U.S.C. § 1155, 5107; 38 C.F.R. §§ 3.102, 4.3, 4.7, 4.69, 4.71a, Diagnostic Code (DC) 5201. 

2. The criteria for entitlement to a shoulder evaluation in excess of 40 percent after March 2, 2021, have not been met. 38 U.S.C. § 1155, 5107; 38 C.F.R. §§ 3.102, 4.3, 4.7, 4.69, 4.71a, DC 5201. 

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

The Veteran served on active duty from July 1989 until July 2009. He was honorably discharged. 

The Veteran has two claims for the same right shoulder disability covering two separate periods of time. Each claim was appealed to the Court of Appeals for Veterans Claims (CAVC) which resulted in two separate Joint Motions for Remand (JMR) for the same right shoulder disability but covering separate periods of time.

In August 2023, CAVC vacated an October 18, 2022, Board decision that denied entitlement to an initial evaluation for a right shoulder disability in excess of 40 percent from August 1, 2009, to March 2, 2021 (excluding the temporary 100 percent disability rating from September 29, 2015, to November 1, 2015). A May 2024 CAVC order vacated a September 6, 2023, Board decision which denied entitlement to a right shoulder evaluation in excess of 40 percent after March 2, 2021.

These October 2022 and September 2023 Board decisions were vacated by CAVC on the basis of inadequate VA examinations. Both CAVC orders were based on the same disability but for different periods of time and both issues were determined to have inadequate VA examinations.

The claim was most recently before the Board of Veterans' Appeals (Board) in October 2025, at which time the Board again remanded the claim for further development, to include providing the Veteran with a new examination. The examination and new nexus opinions have been accomplished and there has been substantial compliance with the previous remands in accordance with Stegall v. West, 11 Vet. App. 268, (1998). 

By way of background, the right shoulder claim has been remanded 13 times (October 2014, July 2015, July 2016, November 2017, May 2020, May 2021, January 2022, April 2022, May 2023, January 2024, October 2024, May 2025, and October 2025). There have been three CAVC JMRs and one Joint Motion for Partial Remand (December 2019, January 2023, August 2023, and May 2024).  

This appeal has been advanced on the docket pursuant to 38 C.F.R. § 
268, (1998). 

By way of background, the right shoulder claim has been remanded 13 times (October 2014, July 2015, July 2016, November 2017, May 2020, May 2021, January 2022, April 2022, May 2023, January 2024, October 2024, May 2025, and October 2025). There have been three CAVC JMRs and one Joint Motion for Partial Remand (December 2019, January 2023, August 2023, and May 2024).  

This appeal has been advanced on the docket pursuant to 38 C.F.R. § 20.902(c).

Increased Shoulder Rating

The Veteran's entire history is to be considered when assigning disability ratings. 38 C.F.R. § 4.1; Schafrath v. Derwinski, 1 Vet. App. 589 (1995). A claimant may experience multiple distinct degrees of disability that may result in different levels of compensation from the time the increased rating claim was filed until a final decision is made. Hart v. Mansfield, 21 Vet. App. 505 (2007). The following analysis is undertaken with consideration of the possibility that different ratings may be warranted for different time periods.

The rating of the same disability under various diagnoses is to be avoided. 38 C.F.R. § 4.14. That does not preclude the assignment of separate ratings for separate and distinct symptomatology where none of the symptomatology justifying a rating under one diagnostic code is duplicative of or overlapping with the symptomatology justifying a rating under another diagnostic code. Esteban v. Brown, 6 Vet. App. 259 (1994).

Under DC 5201, limitation of the arm at the shoulder level warrants a 20 percent evaluation whether it is the major or minor extremity. When motion is limited to midway between the side and shoulder level, a 30 percent evaluation is warranted for the major extremity and 20 percent for the minor extremity. When motion is limited to 25 degrees from the side, a 40 percent evaluation is warranted for the major extremity and 30 percent for the minor extremity.

Effective February 7, 2021, VA amended DC 5201 to reflect that limitation of motion may be shown by flexion and/or abduction and clarified the degrees of limitation of motion that correspond to each rating. Under the amended DC 5201, limitation of motion at the shoulder level (flexion and/or abduction limited to 90 degrees) warrants a 20 percent rating for both the major and minor extremity. Limitation of motion of the arm midway between side and shoulder level (flexion and/or abduction limited to 45 degrees) warrants a 20 percent rating for the minor extremity and a 30 percent rating for the major extremity.  Flexion and/or abduction limited to 25 degrees from the side warrants a maximum 30 percent rating for the minor joint and a maximum 40 percent rating for the major joint.

If a law or regulation changes during the course of a claim or an appeal, the version more favorable to the Veteran will apply, to the extent permitted by any stated effective date in the amendment in question.  38 U.S.C. § 5110(g). If the revised version of the regulation is more favorable, the implementation of that regulation under 38 U.S.C. § 5110(g) can be no earlier than the effective date of that change.  If the former version is more favorable, VA can apply the earlier version of the regulation for the period prior to, and from, the effective date of the change.  38 U.S.C. § 5110. Therefore, the Board will consider the Veteran's claim under the old criteria prior to February 7, 2021, and the new rating criteria effective February 7, 2021.

Normal flexion (forward elevation of the arm) and normal abduction (movement of the arm away from the side) of the shoulder are to 180 degrees. Normal internal rotation and external rotations of the shoulder are to 90 degrees. 38 C.F.R. §4.71, Plate 1.

Other potentially relevant diagnostic codes include DC 5200 (ankylosis of the scapulohumeral articulation), DC 5201 (arm limitation of motion), DC 5202 (impairment of the humerus), and DC 5203 (other impairment of the clavicle or scapula, including dislocation).  38 C.F.R. §4.71a.

DC 5200 provides that ankylosis of the scapulohumeral articulation (the scapula and humerus move as one piece)
 180 degrees. Normal internal rotation and external rotations of the shoulder are to 90 degrees. 38 C.F.R. §4.71, Plate 1.

Other potentially relevant diagnostic codes include DC 5200 (ankylosis of the scapulohumeral articulation), DC 5201 (arm limitation of motion), DC 5202 (impairment of the humerus), and DC 5203 (other impairment of the clavicle or scapula, including dislocation).  38 C.F.R. §4.71a.

DC 5200 provides that ankylosis of the scapulohumeral articulation (the scapula and humerus move as one piece) of the major upper extremity is rated 30 percent when it is favorable, with abduction to 60 degrees and able to reach mouth and head. A 40 percent rating is assigned with intermediate ankylosis (between favorable and unfavorable); and it is rated 50 percent when unfavorable, with abduction limited to 25 degrees from side.  See 38 C.F.R. § 4.71a, DC 5200.

Under DC 5202, for impairment of the humerus, a 20 percent rating is granted when there is malunion, with moderate deformity, for the major arm; a 30 percent rating is warranted when there is marked deformity of the major arm.  Also, under Diagnostic Code 5202, for recurrent dislocations of the major arm at the scapulohumeral joint, a 20 percent rating is granted with infrequent episodes and guarding of movement only at shoulder level; a 30 percent rating is granted for the major arm when there are frequent episodes and guarding of all arm movements. For fibrous union of the major arm a 50 percent rating is assigned. A 60 percent rating is warranted for nonunion (false flail joint) of the major arm. An 80 percent rating is warranted for loss of head (flail shoulder) for the major arm. 8 C.F.R. § 4.71a, DC 5202.

Under DC 5203, for impairment of the clavicle or scapula in the major arm, a 10 percent rating is granted for malunion (or rate on impairment of function of contiguous joint) or nonunion without loose movement and a 20 percent rating is granted for nonunion with loose movement or for dislocation.

When a veteran has separate and distinct manifestations attributable to the same injury, compensation under different diagnostic codes may be appropriate. The critical element in permitting the assignment of several ratings under various diagnostic codes is that none of the symptomatology for any one of the conditions is duplicative or overlaps the symptoms of the other disorder.  See Esteban v. Brown, 6 Vet. App. 259 (1994); Fanning v. Brown, 4 Vet. App. 225 (1993). Evaluation of the same disability or the same manifestation under various diagnoses constitutes pyramiding, which is prohibited under the provisions of 38 C.F.R. § 4.14 (2002). A claimant may not be compensated twice for the same symptomatology as "such a result would overcompensate the claimant for the actual impairment of his earning capacity."  Brady v. Brown, 4 Vet. App. 203, 206 (1993).

1. Entitlement to a right shoulder evaluation in excess of 40 percent, to include extraschedular consideration, from August 1, 2009, to March 2, 2021, is denied.

The record reflected that the Veteran was right hand dominant. Therefore, with respect to the right shoulder, the Board will apply the ratings and criteria for the major arm under the relevant Diagnostic Codes.  38 C.F.R. § 4.69.  The diagnostic criteria pertaining to traumatic arthritis are applicable where limitation of motion of the shoulder is noncompensable. 38 C.F.R. § 4.71a, Diagnostic Code 5201.

As noted above, normal forward flexion of the shoulder is from 0 to 180 degrees.  Normal abduction is from 0 to 180 degrees.  Normal internal and external rotation is from 0 to 90 degrees. Forward flexion and abduction to 90 degrees is the equivalent of shoulder level. 38 C.F.R. § 4.71, Plate I. The rating criteria under the former and revised DC 5201 specify that a 40 percent rating is warranted where there is limitation of motion of the major arm flexion or abduction limited to 25 degrees from side. 38 C.F.R. §4.71a, Diagnostic Code 5201.

The Veteran's right (major) shoulder disability is currently assigned a 40 percent rating, effective August
 the shoulder is from 0 to 180 degrees.  Normal abduction is from 0 to 180 degrees.  Normal internal and external rotation is from 0 to 90 degrees. Forward flexion and abduction to 90 degrees is the equivalent of shoulder level. 38 C.F.R. § 4.71, Plate I. The rating criteria under the former and revised DC 5201 specify that a 40 percent rating is warranted where there is limitation of motion of the major arm flexion or abduction limited to 25 degrees from side. 38 C.F.R. §4.71a, Diagnostic Code 5201.

The Veteran's right (major) shoulder disability is currently assigned a 40 percent rating, effective August 1, 2009, pursuant to DC 5201 with the exception of the period from September 29, 2015, to November 1, 2015, when the Veteran was evaluated at 100 percent for post-surgical shoulder recovery. The Veteran contended that he was entitled to an evaluation in excess of 40 percent for this period on appeal, to include on an extraschedular basis. 

In October 2008, the Veteran was diagnosed with right shoulder superior posterior labral tear, subacromial impingement, and arthrosis. As a result, he had a right shoulder arthroscopy with a posterior labral repair, a subacromial decompression, and a right distal clavicle excision. A July 2009 VA treatment record noted that the Veteran's right shoulder flexion and abduction was to 170 degrees and external rotation to 70 degrees and internal rotation "T7."  The August 2009 VA shoulder examiner noted the Veteran's complaints of right shoulder pain after activity was relieved with Vicodin and rest. The Veteran's initial evaluation was zero percent. 

The Veteran filed a notice of disagreement (NOD) in November 2009, a Form 9 in November 2011, and in the interim, his right shoulder disability increased to 10 percent effective January 2014 based on a new VA examination. A January 2014 VA shoulder examiner noted the Veteran's right shoulder abduction and flexion after three repetitions was to 180 degrees and external and internal rotation to 90 degrees. The examiner reported that the Veteran was employed as a distribution facilities manager and that his right shoulder did not have a functional impact on the Veteran's ability to perform his occupational tasks. His current symptoms were constant pain, and movement or lifting over a couple of pounds made it more painful. The Veteran reported that it hurt to hold his right arm on the steering wheel while driving and any activity aggravated the shoulder pain. 

In February 2014, a supplemental statement of the case (SSOC) was issued and in April 2014, the claim was certified for appeal. The Board first remanded the claim for further development in October 2014. The remand was primarily to determine if the residuals from an in-service shoulder injury could be distinguished from a post service shoulder injury which was the subject of a workers compensation claim. The January 2015 VA shoulder examiner opined that the in-service injury caused minimal impairment with only loss of motion of internal and external rotation. The examiner then opined that the post service injury made the in-service injury worse, so the difference was presumed to be the result of the post service workers compensation injury. The examiner then stated that in the examiner's opinion the Veterans right shoulder impairments were as likely as not secondary to his post service workers compensation injury.

A January 2015 VA shoulder examiner, a physician, noted the Veteran's right shoulder abduction and flexion were normal, his internal rotation was to 40 degrees, and his external rotation was to 55 degrees. He had full muscle strength, no muscle atrophy and no ankylosis. The examiner noted there was no humerus impairment and also noted a clavicle resection and labral repair in 2008 and 2011. The residuals were described as some pain with some restriction, but the Veteran was returned to full duty after the 2008 surgery including physical fitness training. 

The January 2015 VA physician further noted that at the time of the examination the Veteran had no functional impact as a result of the Veteran's right shoulder condition to include his ability to perform any type of occupational task such as standing, walking, lifting, and sitting. The physician noted that the Veteran's right shoulder diagnosis was glenohumeral joint arthritis and degenerative joint disease. The examiner noted the Veteran had a workers compensation injury, but those records were not associated with the record. Based on a discussion with the Veteran, the physician opined that the Veteran's current right shoulder condition resulted from the 2010 work-related incident rather than his in-service injury.   

The Board notes that after the 2010 post military
 training. 

The January 2015 VA physician further noted that at the time of the examination the Veteran had no functional impact as a result of the Veteran's right shoulder condition to include his ability to perform any type of occupational task such as standing, walking, lifting, and sitting. The physician noted that the Veteran's right shoulder diagnosis was glenohumeral joint arthritis and degenerative joint disease. The examiner noted the Veteran had a workers compensation injury, but those records were not associated with the record. Based on a discussion with the Veteran, the physician opined that the Veteran's current right shoulder condition resulted from the 2010 work-related incident rather than his in-service injury.   

The Board notes that after the 2010 post military work accident, the Veteran went to physical therapy and had limited duty to include lifting no more than 20 pounds and no overhead reaching. A February 2011 MRI reflected minimal glenohumeral degenerative joint disease. In March 2011, the Veteran had another surgery to perform extensive debridement, repair of anterior and posterior glenoid labral tears and an arthroscopic synovectomy. The postoperative record reflected that under anesthesia, the Veteran had full range of right shoulder motion and no instability. The surgeon noted that the Veteran had fairly extensive synovitis, one extensive degenerative labral tear and another smaller labral tear. The surgeon also noted that he could not elicit instability, and the subscapularis and rotator cuff were intact. 

A February 2015, SSOC explained that the 10 percent evaluation was continued. In July 2015, the Board remanded the issue of a compensable rating prior to January 8, 2014, and a rating in excess of 10 percent after January 8, 2014. 

A July 2015 private orthopedic record noted the Veteran's right shoulder symptoms were aggravated by overhead lifting, "side laying" and work activities. The Veteran stated that nothing relieved his symptoms. The Veteran also noted that in the 1970s he had a subluxation issue but that was corrected with surgery in 2008. He stated that in 2011 he slipped on some ice and reinjured the same shoulder and he was working with workers compensation to have another surgery on his right shoulder. The orthopedic record noted the Veteran had pain with passive and active ranges of motion but did not note the measurements for flexion, abduction or internal and external rotation. Right shoulder rotator cuff syndrome, impingement syndrome and osteoarthrosis were noted as the diagnoses. In October 2015, the Veteran had a third surgery which included right shoulder arthroscopy with subacromial decompression and right shoulder arthroscopy with extensive debridement.

An August 2015 private orthopedic record noted a diagnosis of right rotator cuff strain, right shoulder impingement syndrome, and right shoulder osteoarthritis. August 2015 MRI results were included in this record which noted post operative changes to the right shoulder acromioclavicular (AC) joint, atrophy of the infraspinatus muscle, postoperative changes in biceps tendon, tendinopathy of biceps tendon, irregularity of the superior labrum, and arthritic changes of the glenohumeral joint. 

A September 2015 VA shoulder examiner, a physician, noted that the Veteran complained that his right shoulder hurt all the time and that the pain was worse when he extended his arm over his head. The Veteran again stated that the 2008 surgery had resolved his subluxation issue. He described his functional loss as "overhead activities were difficult." He did not report flareups of the shoulder or arm. His flexion and abduction were normal during this examination, and his external rotation was to 65 degrees and internal rotation to 60 degrees. There was no additional loss of range of motion after three repetitions. The examination report noted that the Veteran was examined immediately after repetitive use over time and pain, weakness, fatigability or incoordination did not significantly limit his functional ability. The Veteran had full muscle strength and no muscle atrophy. The examiner noted there was no ankylosis but that a rotator cuff condition was suspected. The Veteran had no humerus condition or impairment.

The September 2015 VA shoulder examiner opined that it was not possible to clearly separate the right shoulder symptoms or impairment attributable to his intercurrent December 2010 work injury from that of his service-connected right shoulder injury, status post-surgery, because there was no method to make such a determination.

A February 2016 SSOC notified the Veteran that a compensable rating for his right   shoulder prior to January 8, 2014, and greater than 10 percent after January 8, 2014, was denied. 

A March 201
 and no muscle atrophy. The examiner noted there was no ankylosis but that a rotator cuff condition was suspected. The Veteran had no humerus condition or impairment.

The September 2015 VA shoulder examiner opined that it was not possible to clearly separate the right shoulder symptoms or impairment attributable to his intercurrent December 2010 work injury from that of his service-connected right shoulder injury, status post-surgery, because there was no method to make such a determination.

A February 2016 SSOC notified the Veteran that a compensable rating for his right   shoulder prior to January 8, 2014, and greater than 10 percent after January 8, 2014, was denied. 

A March 2016 VA shoulder examination noted diagnoses of right shoulder rotator cuff tendinopathy, acromial clavicular (AC) separation, labrum derangement and humeral spur. The examiner noted that the Veteran's ranges of motion were all normal. The pain that was noted with flexion, abduction and internal rotation did not cause functional loss. The Veteran was able to perform three repetitions without any additional loss of ranges of motion. The examiner further noted that pain, weakness, fatiguability, or incoordination did not significantly limit functional ability with repeated use over time. The examiner noted that the Veteran had a moderate impairment of lifting and manipulating objects. 

In July 2016, the Board remanded the case for further development. The Board noted that the 2015 and 2016 VA examinations did not test passive and active ranges of motion with weight bearing and non-weight bearing or address whether there was ankylosis, or a humerus, clavicle or scapula impairment. 

A March 2016 x-ray report noted a first-degree AC separation in external rotation which reduced internal rotation. A September 2016 VA right shoulder examination report noted diagnoses of shoulder impingement syndrome, labral tear, AC joint separation, and arthritic conditions. The Veteran did not have a humerus condition. The Board notes that under DC 5203, the rating criteria for a clavicle or scapula impairment is based on dislocation, nonunion with loose movement, nonunion without loose movement, or malunion, or rate on impairment of contiguous joint. There is no evidence that the Veteran has any of these clavicle or scapula impairments.  At this time the Veteran had had several injections which did not alleviate the pain. The Veteran reported that his functional loss was that pain increased from four to ten with overhead lifting, carrying objects, holding on to the steering wheel when driving, or sleeping on his right side. 

The Veteran's ranges of motion during the September 2016 examination were normal except for internal rotation which was to 60 degrees. The Veteran was able to perform three repetitions without any loss of range of motion. The examiner noted that the AC joint separation did not affect the Veteran's ranges of motion but there was tenderness. There was no evidence of pain with weight bearing. There was localized tenderness or pain with palpitation on anterior and lateral shoulder. The Veteran had normal muscle strength, no muscle atrophy, and no ankylosis. The examiner noted that the Veteran had two residuals from his surgeries in 2008, 2011, and 2015, which were pain and limited ranges of motion. There were no other physical findings, complications, conditions, signs or symptoms related to any of the diagnoses.  

In a September 2016 shoulder examination addendum, the examiner, a physician,  opined that it was not possible to clearly distinguish between the Veteran's service connected and non-service-connected shoulder injuries as the symptoms associated with each were similar. The examiner additionally noted that there was no technique to discern the symptoms attributable to the military injury versus the post military injury. The examiner further noted that the Veteran's subluxation issue was corrected with surgery in 2008 which was documented in post-surgical notes and by the Veteran in statements to the examiner. The addendum further noted that the Veteran's internal rotation remained limited due to the AC joint separation, but his other ranges of motion had improved. 

The April 2017 SSOC notified the Veteran that a compensable evaluation for his right shoulder prior to January 8, 2014, continued to be denied and an amount in excess of 10 percent after January 8, 2014, was also denied. In November 2017, the Board remanded the claim because the examination report did not test right shoulder passive range of motion or non-weight bearing range of motion. 

The March 2018 VA shoulder examination report noted the Veteran's active range of motion was to 170 degrees for flexion, to 150 degrees for abduction, to 45 degrees for external rotation, and to 45 degrees for internal rotation. Pain was noted with abduction
 of motion had improved. 

The April 2017 SSOC notified the Veteran that a compensable evaluation for his right shoulder prior to January 8, 2014, continued to be denied and an amount in excess of 10 percent after January 8, 2014, was also denied. In November 2017, the Board remanded the claim because the examination report did not test right shoulder passive range of motion or non-weight bearing range of motion. 

The March 2018 VA shoulder examination report noted the Veteran's active range of motion was to 170 degrees for flexion, to 150 degrees for abduction, to 45 degrees for external rotation, and to 45 degrees for internal rotation. Pain was noted with abduction, external rotation, and internal rotation. There was no evidence of pain with weight bearing but there was evidence of pain with passive range of motion testing. The Veteran could perform three repetitions without any loss of range of motion. 

The Veteran did not have muscle atrophy, his strength was 4/5, and he did not have ankylosis. The examiner further noted there was no rotator cuff condition and no scapula, AC joint or humerus impairment. A history of recurrent dislocation of the glenohumeral joint was noted. The Veteran reported that since 2015 his ranges of motion have not improved and he reported constant right shoulder pain. The March 2018 examiner noted that the Veteran currently worked as a manger.  His functional limitations were an inability to perform overhead motion and heavy lifting.

The November 2018 SSOC noted that 20 percent for the Veteran's right shoulder had been awarded effective August 1, 2009, excluding the period from September 29, 2015, to November 1, 2015. The SSOC explained that painful motion of the shoulder was evaluated pursuant to 38 CFR §4.59 which allowed consideration of functional loss due to painful motion to be rated to at least the minimum compensable rating for a particular joint. As the Veteran demonstrated painful motion of the arm at the shoulder, the minimum compensable evaluation of 20 percent was assigned. 

In January 2019, the Board denied a right shoulder rating in excess of 20 percent.  In December 2019, the Veteran appealed the Board decision to CAVC. The parties agreed in a joint motion for remand (JMR) that the March 2018 examination did not substantially comply with the November 2017 Board remand as the examiner failed to provide range of motion testing for pain on both active and passive range of motion and in weight-bearing and non-weight-bearing as well addressing the necessary findings to evaluate functional loss during flare-ups. Correia v. McDonald, 28 Vet. App. 158, 170 (2016). In summary, the VA examiner failed to provide all the range of motion measurements and did not explain why such testing could not or should not be conducted. In May 2020, the Board remanded the claim again for compliance with the JMR. 

In October 2022, the Board increased the Veteran's right shoulder evaluation to 40 percent effective August 1, 2009, to March 2, 2021, excluding the temporary 100 percent disability rating from September 29, 2015, to November 1, 2015. The Board recognized that the Veteran had consistently reported pain on motion and difficulty with performing activities overhead. While his symptoms were duly considered, to include pain as a functional impairment, the record showed that his reported symptoms were adequately contemplated in the assigned evaluation of 40 percent disabling, for the period prior to March 2, 2021. 

The Board further noted that the July 2022 VA examiner measured the Veteran's flexion and abduction to 75 degrees and external rotation to zero degrees and internal rotation to five degrees. The Board reasoned that during a flareup the Veteran's ranges of motion would be much more limited and his functional limitations more severe during a flareup. Therefore, the Board concluded that the Veteran's symptoms more closely approximated motion that is limited to 25 degrees from his side during flareups as contemplated by the 40 percent evaluation criteria in DC 5201. The Board further noted that the Veteran did not have ankylosis, nor a humerus, clavicle or scapula impairment or condition to include a contiguous joint. 

The reports addressing the Veteran's functional impairment consistently reported pain and some activity limitations. The Veteran has not asserted that he was unable to use his shoulders at all. He has stated that he is limited in the amount of weight that he could lift, driving was painful, and he could not do overhead work. Neither the Veteran's reports nor the evidence of record suggested that his right shoulder became fixed in a position during periods of repeated use over time or flare-ups or otherwise
 his side during flareups as contemplated by the 40 percent evaluation criteria in DC 5201. The Board further noted that the Veteran did not have ankylosis, nor a humerus, clavicle or scapula impairment or condition to include a contiguous joint. 

The reports addressing the Veteran's functional impairment consistently reported pain and some activity limitations. The Veteran has not asserted that he was unable to use his shoulders at all. He has stated that he is limited in the amount of weight that he could lift, driving was painful, and he could not do overhead work. Neither the Veteran's reports nor the evidence of record suggested that his right shoulder became fixed in a position during periods of repeated use over time or flare-ups or otherwise approximated ankylosis. 

The Board notes the court held in Chavis v. McDonough, 34 Vet. App. 1, 23 (2021) that flare-ups resulting in symptoms more nearly approximating ankylosis can warrant a higher spine rating. In this case, however, the evidence did not reflect that ankylosis of the right shoulder was present with consideration to functional loss during periods of flare-ups or repeated use over time. Thompson v. McDonald, 815 F.3d 781, 785 (Fed. Cir. 2016) ("[I]t is clear that the guidance of 38 C.F.R. § 4.40 is intended to be used in understanding the nature of the veteran's disability, after which a rating is determined based on the § 4.71a [or 4.73] criteria.").  In this case, the record reflected that the Veteran worked full time until 2019.  While he had pain and some reduced range of motion with activity, the persuasive weight of the evidence did not reflect that the pain and resulting decreased range of motion approached ankylosis. While the Board gave the Veteran every benefit of the doubt in reasoning that during a flareup the Veteran's range of motion would approximate 25 degrees, there was no evidence to reflect that during a flareup the Veteran's movement approximated ankylosis. Accordingly, an evaluation under DC 5200 is not warranted. 

The Board additionally notes that the DC 5200 evaluation criteria are based on limitation of unfavorable abduction to 25 degrees from side, intermediate between unfavorable and favorable, and favorable abduction to 60 degrees. In July 2022, the Board gave the Veteran the benefit of the doubt and evaluated the Veteran as having the equivalent of a range of motion of 25 degrees from the side during a flareup under DC 5201. As noted above, pyramiding is not permitted. The rating of the same disability under various diagnoses is to be avoided. 38 C.F.R. § 4.14.  In addition to the Veteran not having ankylosis or functional ankylosis as the cause of his limitation of motion, the Veteran would be precluded from a rating for  limitation from side under both 5200 ankylosis and 5201, arm limitation of motion. 

The Veteran has asserted that he should be given the benefit of the doubt. The Veteran was given the benefit of every doubt by resolving in the Veteran's favor, the issue of whether the Veteran's current shoulder injuries were due to military service or his workers compensation injury in 2010 which resulted in a surgery.  In October 2022, the Board gave the Veteran every reasonable doubt in evaluating a 40 percent disability based on flareups. During this rating period the Veteran did not have any measurements of 25 degrees for abduction or flexion. The record was unclear whether the Veteran had flareups especially considering that the Veteran advised many examiners that he did not have flare-up but that his condition was one of constant pain with constant limited range of motion which prevented overhead work and heavy lifting and driving was painful. 

The VA examinations have been inconsistent on whether the Veteran had an AC joint impairment. In October 2008, the Veteran was diagnosed with right shoulder subacromial impingement, and during the arthroscopy with a subacromial decompression, and a right distal clavicle excision was performed. An August 2015 MRI report noted post operative changes to the AC joint. A March 2016 x-ray report noted a first-degree AC separation in external rotation which reduced internal rotation. A September 2016 VA right shoulder examination report noted a diagnosis of AC joint separation. As noted above, under DC 5203, the rating criteria for a clavicle or scapula impairment is based on dislocation, nonunion with loose movement, nonunion without loose movement, or malunion, or rate on impairment of contiguous joint. There is no evidence that the Veteran has any of these clavicle or scapula impairments.  

According
romial decompression, and a right distal clavicle excision was performed. An August 2015 MRI report noted post operative changes to the AC joint. A March 2016 x-ray report noted a first-degree AC separation in external rotation which reduced internal rotation. A September 2016 VA right shoulder examination report noted a diagnosis of AC joint separation. As noted above, under DC 5203, the rating criteria for a clavicle or scapula impairment is based on dislocation, nonunion with loose movement, nonunion without loose movement, or malunion, or rate on impairment of contiguous joint. There is no evidence that the Veteran has any of these clavicle or scapula impairments.  

Accordingly, the Board finds the persuasive weight of the evidence weighs against a finding that the Veteran had an impairment of his AC joint warranting evaluation under DC 5203 as DC 5203 evaluations are not based on limitations of internal and external rotation which is the disability the record reflected that the Veteran may have as a result of his previous AC joint separation. 

The record reflected no diagnosis relating to a humerus impairment. Therefore, an evaluation under DC 5202 is not warranted. Additionally, as noted above, the Veteran has advised several examiners that his shoulder instability issue was resolved with the 2008 surgery. Moreover, in 2015, a surgeon noted that he was unable to elicit instability.  Accordingly, the record does not support a finding that the Veteran had right shoulder instability. 

In March 2025, the Veteran's representative asserted that the Veteran was entitled to extraschedular evaluation in excess of 40 percent for the right shoulder disability. In exceptional cases where the schedular ratings are found to be inadequate, an extraschedular rating commensurate with the average earning capacity impairment due exclusively to the service-connected disability will be awarded.  38 C.F.R. § 3.321(b)(1).  For such an award, the case must present such an exceptional or unusual disability picture with related factors such as marked interference with employment or frequent periods of hospitalization as to render the application of the schedular standards impractical. Id. 

Given that the average impairment in earning capacity is the standard, within the current rating schedule, many veterans receiving benefits may experience a greater or lesser impairment of earning capacity than average as a result of their disability. However, extraschedular consideration cannot be used to undo the approximate nature that results from the rating system based on average impairment of earning capacity authorized by Congress. See 38 U.S.C. § 1155 (granting Secretary authority to adopt a schedule based upon the average impairments of earning capacity). Thun v. Peake, 22 Vet. App. 111(April 2008).

A February 2012 VA medical record reflected the Veteran had worked in a sedentary position as a supervisor. The Veteran has asserted that he cannot use a computer because of his right shoulder, and he has also stated for over ten years that it was difficult to drive a car because of shoulder pain, but he did drive. See, January 2026 VA shoulder examination report, July 2022 VA shoulder examination, January 2015 vocational report. 

The record reflected that the Veteran had a Bachelor of Arts degree in accounting and that after he separated from the Navy he worked as a contractor for two years and then worked for the Navy for nine years. He resigned in May 2019. See, May 2023, VA post-traumatic stress examination report, and June 2022 VA mental health treatment record. A May 2022 VA mental health treatment record noted that the Veteran stated that he quit work three years prior because of his depression and other medical issues. 

In this case, the evidence did not support an extraschedular rating. The Veteran is currently evaluated at 40 percent under DC 5201. While he had some limitation of motion with pain, he had no other ratable symptoms. There was no ankylosis and no humerus condition. The was also no evidence to support a finding of functional ankylosis. While the Veteran has had significant internal rotation limitation of motion and some external rotation limitation as a result of his right shoulder disability, the evidence did not support a finding that these limitations prevented the Veteran from working or resulted in an impairment not already taken into consideration by the relevant diagnostic codes.    

The evidence did not reflect that the Veteran's shoulder condition was so exceptional or unusual such that an extraschedular analysis was appropriate. 38 C.F.R. § 3.321. The Board finds that the Veteran's disability picture was adequately contemplated by the rating schedule when the level of severity and symptomatology of the Veteran's disability was compared with the established rating criteria. Extraschedular consideration is not warranted when the disability may be properly evaluated with conventional schedular rating tools
 Veteran has had significant internal rotation limitation of motion and some external rotation limitation as a result of his right shoulder disability, the evidence did not support a finding that these limitations prevented the Veteran from working or resulted in an impairment not already taken into consideration by the relevant diagnostic codes.    

The evidence did not reflect that the Veteran's shoulder condition was so exceptional or unusual such that an extraschedular analysis was appropriate. 38 C.F.R. § 3.321. The Board finds that the Veteran's disability picture was adequately contemplated by the rating schedule when the level of severity and symptomatology of the Veteran's disability was compared with the established rating criteria. Extraschedular consideration is not warranted when the disability may be properly evaluated with conventional schedular rating tools. See, Morgan v. Wilkie, 31 Vet. App. 162, 168 (2019).

The extraschedular referral process was meant to be "exceptional." 38 C.F.R. § 3.321(b)(1). Thus, schedular rating concepts-including, but not limited to, secondary service connection, analogous ratings, the requirement to assign a higher schedular rating if a veteran's disability more nearly approximates the higher rating, the requirement that VA resolve doubt in favor of claimants, ratings based on individual unemployability, special monthly compensation, and the ability to rate a single disability under multiple diagnostic codes without pyramiding-are critical components of the duty to maximize benefits well before an extraschedular analysis is reached. Morgan v. Wilkie, 31 Vet. App. 162, 168 (2019). In this case, the Veteran worked until 2019 and there was no evidence to reflect that the Veteran's shoulder disability prevented him from maintaining substantial employment.

Accordingly, the Board finds that the persuasive weight of the evidence is against the assignment of a rating in excess of 40 percent for a right shoulder disability under DC 5201. Therefore, the Board finds that the weight of the evidence is against the assignment of any higher ratings based on an extraschedular basis. The Board finds that the criteria for a higher rating are not met, the evidence is not in approximate balance, and there is no reasonable doubt to be resolved in favor of the Veteran. Therefore, the appeal must be denied.  38 U.S.C. § 5107; 38 C.F.R. § 3.102.  Lynch v. McDonough, 21 F.4th 776, (Fed. Cir. 2021). 

2. Entitlement to an evaluation in excess of 40 percent after March 2, 2021, for a right shoulder disability is denied.

A March 19, 2021, VA shoulder examination noted the Veteran's symptoms were decreased range of motion and pain as a result of his right shoulder condition. The Veteran reported flareups which further decreased his ranges of motion which affected his ability to lift objects. He stated that a flareup occurred every few weeks and lasted a few days. 

During the March 2021 examination the Veteran had flexion and abduction to 20 degrees, and internal and external rotation to 10 degrees. He had pain with all active and passive ranges of motion and with weight bearing. The examiner reported that the Veteran was able to perform three repetitions without additional loss of function or range of motion. 

Pain, weakness, fatigability or incoordination significantly limited functional ability with repeated use over a period of time. The examiner estimated that the Veteran's range of motion with repeated use over time would be 10 degrees for abduction and flexion and five degrees for external and internal rotation. The  estimated ranges of motion during a flareup were five degrees for flexion, abduction and internal and external rotation. The ranges of motion during this examination were significantly different from any other VA examination in the record.  Additionally, the ranges of motions during this examination were the only ranges of motion in the record meeting the range of motion criteria for a 40 percent evaluation. 

The March 2021 examination report reflected the Veteran had full muscle strength, no muscle atrophy, no ankylosis and there was no rotator cuff condition. A labral pathology was noted without recurrent subluxation, and there was no scapula, clavicle, AC joint impairment and no humerus impairment. The examiner noted that the Veteran's functional impact was that he could not lift his right arm above his shoulder.

The March 2021 SSOC notified the Veteran that effective March 2, 2021, the Veteran's right shoulder evaluation would be increased to 40 percent and that his evaluation prior to March 2, 2021, would remain at 20 percent (excluding the period for shoulder surgery convalescent leave from September 29, 2015, to November 1, 2015) effective August 1, 2009.
ator cuff condition. A labral pathology was noted without recurrent subluxation, and there was no scapula, clavicle, AC joint impairment and no humerus impairment. The examiner noted that the Veteran's functional impact was that he could not lift his right arm above his shoulder.

The March 2021 SSOC notified the Veteran that effective March 2, 2021, the Veteran's right shoulder evaluation would be increased to 40 percent and that his evaluation prior to March 2, 2021, would remain at 20 percent (excluding the period for shoulder surgery convalescent leave from September 29, 2015, to November 1, 2015) effective August 1, 2009.  As noted above, in October 2022,  the Board increased the evaluation to 40 percent for the period August 1, 2009, to March 2, 2021.

The Veteran appealed and in May 2021, the Board remanded the claim. The examiner had not provided the passive range of motion testing results and testing results for weight bearing versus non-weight bearing. The examiner also did not address the VA examination findings of the January and September 2015 examination reports and the February 2016 and March 2018 VA examination reports. 

A July 2021 VA right shoulder examination addendum report was prepared by a physician who opined that the Veteran did not have flareups but instead had use and overuse and loss of function with repetition. The Veteran's internal rotation range of motion was 10 degrees (90 degrees is normal), his flexion and abduction were to 180 degrees, and he had internal rotation to 90 degrees. The Veteran was unable to repeat three repetitions because it was too painful. The physician  estimated that the Veteran's range of motion with repeated use over time was 45 degrees for flexion, abduction, and internal rotation and 0 degrees for external rotation. The abduction and flexion ranges of motion for this examination warranted a 30 percent evaluation under pre-and-post February 7, 2021, DC 5201. 

There was evidence of pain with weight bearing and active and passive ranges of motion. There was also evidence of crepitus and objective evidence of localized tenderness or pain on palpitation. Functional loss was due to pain, fatiguability, weakness, and lack of endurance. The examiner was unable to test for instability due to pain but noted underlying labral pathology. The Veteran had clicking, and a  catching in his right shoulder. The examiner noted the Veteran did not have a clavicle, scapula, acromioclavicular joint, sternoclavicular joint condition or other impairment. The physician further noted that the Veteran did not have a clavicle or scapula condition affecting the Veteran's shoulder range of motion (glenohumeral joint). The Veteran had no impairment of the humerus. The Veteran did not have ankylosis and all testing for rotator cuff conditions were negative. The physician noted that the Veteran's shoulder surgeries were in 2008, 2011, and 2015.  

The physician noted that the functional impairment from the Veteran's right shoulder condition was that he would not be able to work as fire fighter, police officer or electrician or any other occupation requiring full use, lifting capacity and range of motion. The Board notes that the record did not indicate the Veteran was employed in any of these occupations. The record noted he had a Bachelor of Arts degree in accounting and was a manager in a sedentary job.  

With regard to addressing the prior examination reports, the physician noted the findings of all prior exams were inaccurate because they did not accurately characterize the Veteran's disability. See, September 2021 addendum to the July 2021 VA shoulder examination. The examiner also stated that the Veteran did not have flare-ups but had use and overuse with loss function with repetition. 

In January 2022, the Board denied entitlement to a right shoulder evaluation in excess of 40 percent for the period beginning March 2, 2021. The Board remanded for a retrospective opinion of the Veteran's right shoulder condition for an evaluation in excess of 30 percent for the period November 1, 2015, to March 1, 2021, and for an evaluation in excess of 20 percent for the period prior to September 15, 2015. A February 2022 VA disability benefits questionnaire (DBQ) examiner, the same physician that conducted the July 2021 examination, opined  that the Veteran did not have flareups. The examiner explained that symptomatology with repeated use over time was by definition not a flareup. The Veteran's condition worsened with repeated use over time by heavy, prolonged, or overuse. The physician further noted that the fact that the Veteran did not
 opinion of the Veteran's right shoulder condition for an evaluation in excess of 30 percent for the period November 1, 2015, to March 1, 2021, and for an evaluation in excess of 20 percent for the period prior to September 15, 2015. A February 2022 VA disability benefits questionnaire (DBQ) examiner, the same physician that conducted the July 2021 examination, opined  that the Veteran did not have flareups. The examiner explained that symptomatology with repeated use over time was by definition not a flareup. The Veteran's condition worsened with repeated use over time by heavy, prolonged, or overuse. The physician further noted that the fact that the Veteran did not have flareups was documented in the July 2021 VA shoulder examination and that the ranges of motion reported in the July 2021 examination were applicable for all periods on appeal. 

A July 2022 shoulder DBQ noted that the Veteran advised the examiner that he had shoulder pain which was constant with reduced strength which prevented him from putting a glass in a cabinet. The Veteran reported that he was unable to perform overhead work and he was unable to lift anything over 10 pounds with his right arm. Driving was also difficult due to pain which caused fatigue. His flexion and abduction were to 90 degrees, and internal rotation to 20 degrees and external rotation to 10 degrees. The Veteran did not do three repetitions due to pain. His functional loss was due to fatiguability, pain, lack of endurance and weakness. The Veteran's estimated ranges of motion with repeated use over time was to 75 degrees for flexion and abduction endpoints and five degrees for internal rotation and zero degrees for external rotation. There was pain with weight bearing, non-weight bearing, active ranges of motion, and with rest. The examiner noted that passive ranges of motion were contraindicated because the attempt to conduct passive range of motion increased the Veteran's pain and would therefore cause a risk of further injury. 

The Veteran took Celebrex for the pain which was mildly helpful. Functional loss was due to fatiguability, pain, lack of endurance and weakness. The Board notes that an evaluation based on these ranges of motion would warrant a 20 percent evaluation under both the pre- and post-February 7, 2021, DC 5201.

The July 2022 examiner also noted the Veteran did not have ankylosis nor did he have any clavicle, scapula, AC joint or sternoclavicular joint, humerus, or rotator cuff conditions or impairments. The examiner noted that a February 2016 right shoulder x-ray report noted a first-degree AC separation in external rotation which reduced internal rotation.

A July 2022 SSOC notified the Veteran that an evaluation in excess of 30 percent for the period November 1, 2015, to March 1, 2021, and in excess of 20 percent for the period prior to September 15, 2015, were denied. 

As noted above, in October 2022, the Board increased the Veteran's right shoulder evaluation to 40 percent effective August 1, 2009, to March 2, 2021, excluding the temporary 100 percent disability rating from September 29, 2015, to November 1, 2015. The Board noted that the July 2022 VA examination report reflected ranges of motion of 75 degrees flexion and abduction, internal rotation of 5 degrees, and external rotation of 0 degrees. As noted above, the Board reasoned that as the examination was not administered during a flare-up, it was reasonable to conclude that the Veteran's range of motion was much more limited, and his functional limitations and loss more severe during a flare-up. An October 2022 rating decision implemented the Board decision granting 40 percent for a right shoulder condition from August 1, 2009, to March 2, 2021. 

The Veteran appealed to CAVC. The January 2023 CAVC decision vacated the January 2022 Board decision to the extent the Veteran was denied entitlement to an evaluation in excess of 40 percent for his right shoulder disability after March 2, 2021, because it failed to consider the symptom of shoulder instability and determine whether a rating under additional diagnostic codes were appropriate. 

In May 2023, the Board remanded the issue of entitlement to a disability rating in excess of 40 percent from March 2, 2021, to include the symptom of instability. A July 2023 SSOC notified the Veteran that entitlement to an evaluation in excess of 40 percent was denied. The SSOC further stated that an additional evaluation for ankylosis was denied. The Veteran appealed to CAVC. 

The August 2023 CAVC decision required a
 was denied entitlement to an evaluation in excess of 40 percent for his right shoulder disability after March 2, 2021, because it failed to consider the symptom of shoulder instability and determine whether a rating under additional diagnostic codes were appropriate. 

In May 2023, the Board remanded the issue of entitlement to a disability rating in excess of 40 percent from March 2, 2021, to include the symptom of instability. A July 2023 SSOC notified the Veteran that entitlement to an evaluation in excess of 40 percent was denied. The SSOC further stated that an additional evaluation for ankylosis was denied. The Veteran appealed to CAVC. 

The August 2023 CAVC decision required a remand based on the inadequacy of the July 2022 VA examination report asserting that the remand instructions were not complied with regarding range of motion testing and a retrospective opinion concerning functional loss during flareups. The Board notes that the July 2021 examiner found the Veteran did not have flareups. The JMPR noted that the Veteran reported flareups in his September 2016, March 2018 and March 2021 examinations. The examiner was also to address functional ankylosis under DC 5200 and the Board was to discuss the November 2019 JMR directives relating to evidence which reflected instability, subluxation, stiffness, and crepitus and to determine whether the evidence supported a higher rating. The Board was also directed to address diagnostic codes 5202-5203.

The Board notes that the September 2016 VA examination noted that the Veteran stated he had flareups when he attempted to do overhead lifting. He reported the result was increased pain. The Veteran described a flareup in the March 2018 examination as "overhead work increased pain." During the September 2016 and March 2018 examinations, the Veteran did not differentiate between a flareup and activities that made his pain increase. During the March 2018 examination the Veteran also stated he was in constant pain which further reflected that the Veteran was not distinguishing a flareup from his normal state.  

The Veteran was asked whether he had flareups during the March 2021 VA examination and he stated that his right shoulder pain led to decreased range of motion which affected his ability to lift. He then noted that this occurred every few weeks and lasted for a few days. The examiner noted that pain, weakness, fatiguability, or incoordination limited the Veteran's functional ability during a flare up and estimated his range of motion during a flareup as five degrees for all ranges of motion.  As noted above, this is the only examination that assessed the Veteran's ranges of motion with such significant limitations. 

The April 2024 VA examiner noted that the March 2021 examination results were "perplexing" as the measurements were inconsistent with any activities of daily living and noted that the July 2021examination was more medically consistent with the Veteran's typical ranges of motion and the April 2024 examination. The April 2024 active ranges of motion were to 110 degrees for flexion and abduction and to 65 degrees for internal rotation and to 60 degrees for external rotation. The April  2024 examiner noted that the Veteran did not report flareups during this examination. The Board notes that the Veteran also did not report flareups to the  January or September 2015, March 2016, July 2021, and January 2022 VA examiners. 

The July 2021 and February 2022 examiners explained that symptomatology with repeated use over time was by definition not a flareup and opined that the Veteran did not have flare-ups. Furthermore, the record reflected that the Veteran was employed until 2019, and to the extent he had flare ups, the record did not reflect they resulted in lost time such that it interfered with work. The record did reflect that after the Veteran had his workers compensation injury that he was limited to   light duty during a recuperative period. 

An August 2023 treatment report noted the following MRI right shoulder findings: 1) chronic low-grade partial interstitial tear of the supraspinata and infraspinatus tendons. No acute rotator cuff tendon tear was visualized; 2) degenerative tearing along the free edge of the anterior and posterior g1enoid labrum; 3) mild tenosynovitis of the long head biceps tendon; 4) osteoarthritis of the glenohumeral joint with grade IV chondromalacia of the humeral head apex and posterior glenoid. There was a small glenohumeral joint effusion; and 5) postsurgical change of the acromioclavicular joint with subacromial decompression.  

In January 2024, the Board rem
 partial interstitial tear of the supraspinata and infraspinatus tendons. No acute rotator cuff tendon tear was visualized; 2) degenerative tearing along the free edge of the anterior and posterior g1enoid labrum; 3) mild tenosynovitis of the long head biceps tendon; 4) osteoarthritis of the glenohumeral joint with grade IV chondromalacia of the humeral head apex and posterior glenoid. There was a small glenohumeral joint effusion; and 5) postsurgical change of the acromioclavicular joint with subacromial decompression.  

In January 2024, the Board remanded the right shoulder claim for entitlement to an evaluation in excess of 40 percent from August 1, 2009, to March 1, 2021. In May 2024, a CAVC JMPR remanded the issue of a rating in excess of 40 percent after March 2, 2021. The decision stated the Board relied on examinations which did not provide range of motion testing for weight bearing and non-weight bearing and did not address reports of instability.  As noted above, the examiners and the Veteran had opined that the 2008 surgery corrected the Veteran's previous right shoulder instability and several of the examiners opined that all range of motion testing could not be performed either because the Veteran stated it was too painful or the additional range of motion testing was considered medically contraindicated.  

In October 2024, the Board remanded the shoulder claim for evaluations in excess of 40 percent for both periods of time, i.e., between August 1, 2009, until March 2, 2021, and after March 2021.The remand directed evaluation under DCs 5200, 5202-5203 and address instability, subluxation, crepitus, stiffness, right rotator cuff and right AC condition.

During the October 2024 VA right shoulder examination, the Veteran reported daily flareups, but the Veteran stated that he lived with right shoulder pain chronically.  Flareups were precipitated by any use of the right upper extremity and not limited to driving, typing, writing, doing dishes, lifting, or any manual labor using the right arm. The flareup was alleviated by rest. The Veteran's description of flareups appeared to be a description of his constant condition rather than a flareup. As the July 2021 and February 2022 physician previously noted, a flareup is something that is different from constant everyday symptoms and not based on repeated use over time.  

The Veteran's active ranges of motion during the October 2024 examination were to 90 degrees for flexion and abduction and to 45 degrees for internal and external rotation. Pain was exhibited with all ranges of motion to include active ranges of motion, on rest and non-weight bearing. There was no additional loss of range of motion after three repetitions. The examiner estimated that with repeated use over time and during a flareup, the Veteran's estimated range of motion would be to 85 degrees for flexion and abduction and to 40 degrees for internal and external rotation. Passive range of motion testing was not performed because it would have caused the Veteran pain. 

The Veteran had no muscle atrophy and no ankylosis of the scapulohumeral (glenohumeral) articulation. He did have positive rotator cuff testing, a clicking or catching in the shoulder, but no residuals from dislocation of the glenohumeral joint. The examiner further opined there was no AC joint or humerus condition or impairment. The examiner noted that a March 2024 x-ray report noted moderate osteoarthritis and post-surgical changes. His functional impact was described as difficulty with any tasks involving or requiring use of his right upper extremity, especially the shoulder joint. The examiner noted that Veteran had a functional impact of being unable to painlessly perform simple tasks, including but not limited to, washing and putting dishes away, driving and turning the steering wheel, lifting anything heavy or above shoulder height, typing/computer use, pushing, pulling, and reaching. 

The December 2024 VA shoulder examination reported to 90 degrees for flexion and abduction and to 45 degrees for internal and external rotation.  The Veteran's ranges of motion with repeated use over time were estimated to 85 degrees for flexion and abduction and 40 degrees for external and internal rotation. Pain was exhibited with all ranges of motion. The examiner noted that the Veteran's range of motion was not affected by an AC joint condition. 

The January 2025 SSOC notified the Veteran that the claim for an evaluation in excess of 40 percent before and after March 2, 2021,
 turning the steering wheel, lifting anything heavy or above shoulder height, typing/computer use, pushing, pulling, and reaching. 

The December 2024 VA shoulder examination reported to 90 degrees for flexion and abduction and to 45 degrees for internal and external rotation.  The Veteran's ranges of motion with repeated use over time were estimated to 85 degrees for flexion and abduction and 40 degrees for external and internal rotation. Pain was exhibited with all ranges of motion. The examiner noted that the Veteran's range of motion was not affected by an AC joint condition. 

The January 2025 SSOC notified the Veteran that the claim for an evaluation in excess of 40 percent before and after March 2, 2021, was denied. In May 2025, the Board again remanded the case because in the December 2024 VA shoulder examination, the examiner did not provide range of motion measurements for  weight bearing and non-weight bearing conditions and indicate which of these conditions was tested. The examiner did not note at what range of motion measurement the Veteran experienced pain. The examiner noted that the Veteran's ranges of motion was half of the normal ranges of motion but also noted that the Veteran's range of motion did not contribute to his functional loss. Additionally, the Veteran's lay statements regarding shoulder instability were not addressed as required by the previous JMR. 

A July 2025 VA shoulder examiner noted the Veteran's active and passive ranges of motion as flexion and abduction to 160 degrees and internal and external rotation to 70 degrees. Pain was noted with active and passive range of motion and at rest. The functional limitation was difficulty lifting items above the shoulder levels. There was no evidence of crepitus of localized tenderness to palpitation. The Veteran did not report any flareups to the examiner. There was no ankylosis, rotator cuff and instability testing was negative. There were no residuals of recurrent dislocation (subluxation) of the glenohumeral joint. The examiner noted painful motion to AC joint. 

In August 2025, another SSOC was issued which notified the Veteran that the right shoulder claim for both periods of time was denied. In October 2025, the Board remanded the claim again for non-compliance with the previous Board remand. 

The October 2025 VA shoulder examiner noted the Veteran's right shoulder range of motion to 160 degrees for flexion and abduction endpoints, to 80 degrees for internal rotation and to 45 degrees for external rotation. His passive range of motion was the same as his active ranges of motion. The examiner estimated that during a flareup the Veteran would have additional loss of range of motion to 150 degrees for flexion and abduction endpoints and to 70 degrees for internal rotation and 40 degrees for external rotation endpoint. The examiner opined that repeated use over time would result in no additional loss of range of motion. An evaluation based on these ranges of motion would warrant a 20 percent evaluation under both the pre- and post-February 7, 2021, DC 5201.  

There was evidence of pain with weight and non-weight bearing, and active and passive motion, all of which contribute to the functional loss because the Veteran experienced discomfort and mechanical limitations during overhead activities, lifting and repetitive shoulder movements.

The Veteran had flareups two to three times per week lasting two to three hours. During a flareup, he experienced sharp stabbing pain across the anterior and posterior shoulder, with stiffness and a locking sensation with attempted motion. The flareups were precipitated by overhead lifting, cold weather, repetitive motion, prolonged use, or reaching behind his body. The alleviating factors were rest, heat application, Meloxicam, and gentle stretching. During the flareups, the Veteran reported a marked limitation of motion, weakness and inability to perform overhead tasks or lift objects with the right arm. Pain restricted reaching, driving, and sustained use of the affected extremity. He often had to stop an activity and rest the arm until the pain subsided. 

The Veteran described his functional loss as occurring with repeated use of his arm when attempting to lift anything to shoulder level, which precipitated aching and a sensation of tightening. After a while he stated he would lose strength and could not hold things up or out in front of him for long. The shoulder felt weak and unstable, and sometimes he felt a sharp pain that made him stop his activity.  He further stated that he had trouble reaching overhead, carrying heavy objects, or doing repetitive tasks like typing or cleaning because the pain and stiffness would get worse with use. The examiner opined that the abnormal range of motion contributed to functional loss due to status post subluxation fixation surgery with associated posterior and anterior-inferior labral tears, resulting in decreased stability, reduced strength, and limited movement of the affected shoulder.

The examiner opined that there was no right shoulder instability
itated aching and a sensation of tightening. After a while he stated he would lose strength and could not hold things up or out in front of him for long. The shoulder felt weak and unstable, and sometimes he felt a sharp pain that made him stop his activity.  He further stated that he had trouble reaching overhead, carrying heavy objects, or doing repetitive tasks like typing or cleaning because the pain and stiffness would get worse with use. The examiner opined that the abnormal range of motion contributed to functional loss due to status post subluxation fixation surgery with associated posterior and anterior-inferior labral tears, resulting in decreased stability, reduced strength, and limited movement of the affected shoulder.

The examiner opined that there was no right shoulder instability, no residuals of recurrent subluxation, no guarding episodes, or mechanical symptoms such as clicking or catching. No clavicle, scapula acromioclavicular joint, sternoclavicular joint condition or other impairment were found. No humerus impairment was found. 

The examiner noted that the Veteran's status post subluxation fixation surgery with posterior and anterior-inferior labral tears caused persistent pain, weakness, and decreased range of motion of the right shoulder. These impairments limited the Veteran's ability to perform occupational tasks which required lifting, overhead reaching, pushing, pulling, or carrying objects. Repetitive motion and sustained arm elevation exacerbated pain and fatigue, and reduced endurance and overall efficiency in both physical and sedentary work environments that required frequent upper extremity use.

The examiner also noted that medication relieved or reduced the Veteran's symptoms. Functional loss resulted from pain, weakness, and mechanical instability associated with prior subluxation fixation and labral tears. These factors caused limitations in both active and passive range of motion, with increased discomfort and reduced endurance following repetitive use and during flare-ups.

The examiner opined that the Veteran did not have ankylosis. The Board notes that the evidence did not suggest functional ankylosis as the Veteran was able to perform activities albeit with pain and reduced strength over time. Neither the  Veteran nor any VA examiner has opined that the Veteran did not have use of his right arm or shoulder or that his symptoms approached functional ankylosis. The Veteran's rotator cuff and instability tests were negative, and there was no humerus impairment.

The December 2025 VA shoulder examiner opined that it was less likely than not that Veteran's shoulder condition would have functional loss during flareups that would prevent sedentary work prior to March 2, 2021. The examiner further opined that it was at least as likely as not that the Veteran's shoulder condition would cause functional loss in a physically demanding work setting due to pain prior to March 2, 2021. The Board notes that the record did not reflect the Veteran had physically demanding work but instead reflected that he had a sedentary job. Additionally, the available evidence reflected there would be no functional loss during flareups which were equivalent to ankylosis prior to or after March 2, 2021.

Moreover, the evidence of record reflects that the Veteran did not have ankylosis.  For ankylosis, the Board notes the court held in Chavis v. McDonough, 34 Vet. App. 1, 23 (2021) that flare-ups resulting in symptoms more nearly approximating ankylosis can warrant a higher spine rating. Thompson v. McDonald, 815 F.3d 781, 785 (Fed. Cir. 2016) ("[I]t is clear that the guidance of 38 C.F.R. § 4.40 is intended to be used in understanding the nature of the veteran's disability, after which a rating is determined based on the § 4.71a [or 4.73] criteria.").  However, the evidence did not reflect that ankylosis of the right shoulder was present with consideration to functional loss during periods of flare-ups or repeated use over time. Moreover, the evidence was questionable whether the Veteran had flareups or was using the term flareup correctly.  

The December 2025 VA shoulder examination report noted the Veteran's active range of motion for flexion was to 75 degrees and abduction was to 60 degrees. His internal rotation and external rotation endpoints were 30 degrees. The Veteran stated he was not able to perform three repetitions of movements. His estimated range of motion after repeated use over time was to 65 degrees for flexion, to 60 degrees for abduction, and to 30 degrees for internal and external rotation. Passive ranges of motion were not measured because it might cause the Veteran pain. Functional loss was caused by pain, weakness, lack of endurance, and incoordination. The Veteran had no muscle atrophy and no ankylosis. Under both versions of DC 5201(pre and post February
 VA shoulder examination report noted the Veteran's active range of motion for flexion was to 75 degrees and abduction was to 60 degrees. His internal rotation and external rotation endpoints were 30 degrees. The Veteran stated he was not able to perform three repetitions of movements. His estimated range of motion after repeated use over time was to 65 degrees for flexion, to 60 degrees for abduction, and to 30 degrees for internal and external rotation. Passive ranges of motion were not measured because it might cause the Veteran pain. Functional loss was caused by pain, weakness, lack of endurance, and incoordination. The Veteran had no muscle atrophy and no ankylosis. Under both versions of DC 5201(pre and post February 7, 2021), these limitations of motions would warrant a 20 percent evaluation.  

The December 2025 VA examination noted the Veteran did not have a clavicle, scapula, acromioclavicular joint or sternoclavicular joint condition or other impairment. There was no condition or impairment of the humerus. The Veteran did not use a brace or other assistive device. An August 2024 x-ray report noted the Veteran had right shoulder arthritis. 

The Veteran asserted that he was unable to even perform office work with his right shoulder because he would be unable to consistently work on a computer. He stated that he lost one week of time in the last year due to his right shoulder. The Veteran took medicine for his shoulder, but it did not relieve or reduce the severity of the shoulder disability symptoms. The December 2025 VA shoulder examiner opined that it was less likely than not that Veteran's shoulder condition would have functional loss during flareups that would prevent sedentary work after March 2, 2021. It was at least as likely as not that the Veteran's shoulder condition would have functional loss in a physically demanding work setting due to pain after March 2, 2021. Based on the available evidence, there was no functional loss during flareups which was the equivalent to ankylosis that existed after March 2, 2021.

Another December 2025 VA shoulder opinion noted that DC 5200 was not an  appropriate diagnostic code to evaluate the Veteran as there was no diagnosis of favorable or unfavorable ankylosis.  Evaluation under DC 5202, impairment of the humerus was inappropriate as there was no impairment of the humerus. No evidence to date showed that the Veteran had any issues with his humerus. 

This examiner opined that DC 5203 was appropriate as there were issues with the Veteran's clavicle which required a resection of the distal clavicle head. The Board notes that the Veteran has had numerous shoulder examinations and most of the examination reports noted the Veteran did not have a clavicle or scapula condition.  Additionally, as noted above, the rating criteria under DC 5203, is based on dislocation, nonunion with loose movement, nonunion without loose movement, or malunion. or rate on impairment of contiguous joint. There is no evidence that the Veteran has any of these clavicle or scapula impairments.    

The January 2026 VA shoulder examiner noted that the Veteran's service-connected diagnosis of right shoulder degenerative arthritis status post subluxation fixation surgery with tear of the posterior labrum and tear of the anterior inferior labrum remained unchanged. The Veteran declined range-of-motion testing during this examination due to reported pain. The examiner noted that the inability to perform range-of-motion measurements was consistent with the severity of the service-connected right shoulder condition and reflected significant functional limitation. The Board notes that the previous month, during the December 2025 examination, the Veteran permitted active range of motion testing. The Veteran reported chronic pain, stiffness, weakness, and functional impairment with use of the right shoulder, particularly with lifting, reaching, pushing, pulling, and overhead activity. The January 2026 VA shoulder examiner also noted there was no clavicle, scapula acromioclavicular joint and sternoclavicular joint, or humerus condition or impairment. 

During this January 2026 examination, the Veteran denied that he had flareups. He described his limitations as inability to perform overhead work or lift his arm without pain, and he stated he could not lift more than 10 pounds. He noted driving was difficult due to pain. The examiner noted the Veteran had labral pathology and mechanical symptoms of clicking and catching. There were no residuals of subluxation of the glenohumeral (scapulohumeral) joint. The examiner noted that the Veteran did not have any clavicle, scapula, acromioclavicular joint or sternoclavicular joint conditions and no ankylosis. 

Before and after March 2, 2021, the evidence did not
 2026 examination, the Veteran denied that he had flareups. He described his limitations as inability to perform overhead work or lift his arm without pain, and he stated he could not lift more than 10 pounds. He noted driving was difficult due to pain. The examiner noted the Veteran had labral pathology and mechanical symptoms of clicking and catching. There were no residuals of subluxation of the glenohumeral (scapulohumeral) joint. The examiner noted that the Veteran did not have any clavicle, scapula, acromioclavicular joint or sternoclavicular joint conditions and no ankylosis. 

Before and after March 2, 2021, the evidence did not reflect that the Veteran's range of motion for flexion or abduction was 25 degrees. Under the new February 7, 2021, DC 5201 and the DC 5201 that existed prior to February 7, 2021, abduction or flexion limited to 25 degrees of a major shoulder warranted a 40 percent evaluation. The evidence reflected that the Veteran's ranges of motion varied from examination to examination. As recently as October 2025, his abduction and flexion were to 160 degrees. In December 2025 his abduction was to 60 degrees and his flexion was to 75 degrees. Since 2009, the Veteran has only had one examination where his flexion and abduction range of motion warranted a 40 percent evaluation under DC 5201.

The Veteran did not meet the limitation of motion criteria for a 40 percent rating, and his primary symptom was pain which is part and parcel of the limitation of motion rating. In this case, the Veteran's shoulder condition prevented overhead lifting and heavy lifting. In exceptional cases, an extraschedular rating may be assigned.  However, to accord justice, in exceptional cases where the schedular ratings are found to be inadequate, an extraschedular rating commensurate with the average earning capacity impairment due exclusively to the service-connected disability will be awarded.  38 C.F.R. § 3.321(b)(1).  For such an award, the case must present such an exceptional or unusual disability picture with related factors such as marked interference with employment or frequent periods of hospitalization as to render the application of the schedular standards impractical. Id. 

As noted above, given that the average impairment in earning capacity is the standard, within the current rating schedule, many veterans receiving benefits may experience a greater or lesser impairment of earning capacity than average as a result of their disability. However, extraschedular consideration cannot be used to undo the approximate nature that results from the rating system based on average impairment of earning capacity authorized by Congress. See 38 U.S.C. § 1155 (granting Secretary authority to adopt a schedule based upon the average impairments of earning capacity). Thun v. Peake, 22 Vet. App. 111(April 2008).

The Veteran has asserted that he cannot use a computer because of his right shoulder, and he has also stated for over ten years that it was difficult to drive a car because of shoulder pain. See, January 2026 VA shoulder examination report, July 2022 VA shoulder examination, January 2015 vocational report. The Board notes that despite the pain, the evidence reflected that the Veteran did drive and as he worked until 2019 it was likely that he used a computer despite the discomfort. 

The record reflected that the Veteran had a Bachelor of Arts degree in accounting and that after he separated from the Navy he worked as a contractor for two years and then worked for the Navy for nine years.  He resigned in May 2019. See, May 2023, VA post-traumatic stress examination report, and June 2022 VA mental health treatment record. A May 2022 VA mental health treatment record noted that the Veteran stated that he quit work three years prior because of his depression and other medical issues. A February 2012 VA medical record reflected the Veteran had worked in a sedentary position as a supervisor. 

The evidence did not support an extraschedular rating. The Veteran's symptoms equated to less than a 40 percent evaluation under DC 5201. He had limitation of flexion and abduction and pain with motion, but no other ratable symptoms. There was no ankylosis or humerus condition. The was also no evidence to support a finding of functional ankylosis. While the Veteran has had significant internal rotation limitations and some external rotation limitation as a result of his right shoulder disability, the applicable rating codes evaluate flexion and abduction.  

Additionally, the evidence did not reflect an instability symptom after his 2008 surgery.  The Veteran stated during one exam that his shoulder did not feel stable, but he did not note instability and the examiner opined
 extraschedular rating. The Veteran's symptoms equated to less than a 40 percent evaluation under DC 5201. He had limitation of flexion and abduction and pain with motion, but no other ratable symptoms. There was no ankylosis or humerus condition. The was also no evidence to support a finding of functional ankylosis. While the Veteran has had significant internal rotation limitations and some external rotation limitation as a result of his right shoulder disability, the applicable rating codes evaluate flexion and abduction.  

Additionally, the evidence did not reflect an instability symptom after his 2008 surgery.  The Veteran stated during one exam that his shoulder did not feel stable, but he did not note instability and the examiner opined that the shoulder did not have instability.

The examinations were somewhat inconsistent regarding rotator cuff syndrome, but the majority of the examinations noted there was not a rotator cuff issue. In any event, the Veteran described his symptoms for his entire shoulder condition as limited range of motion and pain.  To the extent a rotator cuff issue affected the Veteran's shoulder the Veteran did not describe any symptoms attributable to a rotator cuff issue that were not included in his descriptions of his shoulder disability symptoms in general. 

The evidence did not reflect that the Veteran's shoulder condition was so exceptional or unusual such that an extraschedular analysis was appropriate. 38 C.F.R. § 3.321. The Board finds that the Veteran's disability picture was adequately contemplated by the rating schedule when the level of severity and symptomatology of the Veteran's disability is compared with the established rating criteria. Extraschedular consideration is not warranted when the disability may be properly evaluated with conventional schedular rating tools. See, Morgan v. Wilkie, 31 Vet. App. 162, 168 (2019). 

The extraschedular referral process was meant to be "exceptional." 38 C.F.R. § 3.321(b)(1). Thus, schedular rating concepts-including, but not limited to, secondary service connection, analogous ratings, the requirement to assign a higher schedular rating if a veteran's disability more nearly approximates the higher rating, the requirement that VA resolve doubt in favor of claimants, ratings based on individual unemployability, special monthly compensation, and the ability to rate a single disability under multiple diagnostic codes without pyramiding-are critical components of the duty to maximize benefits well before we reach an extraschedular analysis. Morgan v. Wilkie, 31 Vet. App. 162, 168 (2019). 

In this case, the Veteran's ranges of motion have not warranted a 40 percent evaluation based on limitation of abduction and flexion. No examiner has opined that the Veteran lost the use of his right arm.  Additionally, none of the examiners diagnosed ankylosis or found functional ankylosis. The evidence reflected that the Veteran's ranges of motion varied from examination to examination. As recently as  October 2025, his abduction and flexion were 160 degrees. In December 2025 his abduction was to 60 degrees, and his flexion was 75 degrees. The evidence reflected that the Veteran's ranges of motion fluctuated but there was no evidence that the Veteran's right shoulder disability actually improved, and that any  improvement actually reflected an improvement in the Veteran's ability to function under the ordinary conditions of life and work. Faust v. West, 13 Vet. App. 342, 350 (2000).

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Accordingly, the Board finds that the persuasive weight of the evidence is against the assignment of a rating in excess of 40 percent for a right shoulder disability after March 2, 2021. Therefore, the Board finds that the weight of the evidence is against the assignment of any higher ratings. The Board finds that the criteria for a higher rating are not met, the evidence is not in approximate balance, and there is no reasonable doubt to be resolved in favor of the Veteran. Therefore, the appeal must be denied.  38 U.S.C. § 5107; 38 C.F.R. § 3.102;  Lynch v. McDonough, 21 F.4th 776, (Fed. Cir. 2021). 

 

B. D. WATSON

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board	W. Polk

The Board's decision in this case is binding only with respect to the instant matter decided. This decision is not precedential and does not establish VA policies or interpretations of general applicability. 38 C.F.R. § 20.1303.