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If You Where Rated 10% for Limited or Painful Motion of the Shoulder Before May 2016, You May Be Due an Increase


marathonjon

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The VA raised the minimum rating for diagnostic code 5201, limitation of motion of the arm, from 10% to 20% back in May 2016. If you're still rated 10%, you should request the increase. The VA shouldn't require an exam, unless they have reason to believe your condition has improved. You should also request an effective date of one year prior based on “a liberalizing VA issue approved by the Secretary or by the Secretary’s direction.” Specifically, according to M21-1, III.iv.4.A.1.g. Selecting a DC and Minimum Compensable Evaluation for 38 CFR 4.59 Per Sowers v. McDonald: “- This policy particularly affects painful motion of the shoulder evaluated under 38 CFR 4.71a, DC 5201. Under this DC, painful motion of the shoulder warrants assignment of a 20-percent evaluation. - This decision represents a change in longstanding VA policy in which the minimum compensable evaluation was interpreted as a 10-percent evaluation irrespective of the DC involved. . . . . Effective May 23, 2016, the minimum compensable evaluation refers to the lowest evaluation specified under the DC most applicable to the disability.” Per 38 CFR §3.114 Change of law or Department of Veterans Affairs issue: “(a)(3) If a claim is reviewed at the request of the claimant more than 1 year after the effective date of the law or VA issue, benefits may be authorized for a period of 1 year prior to the date of receipt of such request.”

I was originally rated 10% for both shoulders in 2008 and didn't find out about the increase until last year. I could have been getting the increase for 4 years; not only that, but the bilateral increase to 20% would have raised my overall rating from 80% to 90%. It pisses me off that the VA doesn't notify veterans about changes that might benefit them. I actually think the VA should automatically increase the benefits of every affected veteran effective the date of the change. I've written my senators, congressman, and numerous veterans' organizations about this and urge others to do the same, in addition to requesting any increase that is due to them.

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marathonjon,

Thank you very much for bringing this to my attention.  I, too, was service connected at 10% for my left shoulder in 2008.  I just looked at my file and see that it was coded 5201-5003, and the verbiage say limited motion.  So, I will add this to my next round of claims.

I don't see a 10% rating in the current schedule and I don't have a pre-2016 to compare, but I do remember seeing the less dominant shoulder at 10% in the past.  I wonder how many other ratings have changed without letting the Veteran know are out there?

I will research the 1 year deal, so I can add that as well.

Thanks for keeping us up to date, 

Hamslice

 

Edited by Hamslice
cause I can
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Marathonjon Thank you for posting that info; very informative. I would suggest that it would be great if you right a letter to the chairman of the Veterans Committee (Tester?) and high light what it means to you on this change from a personal basis. Call the VA out for its financial impact to you and your family. At the very lease, it is unethical to make a back door increase on a rating and not notifying the veteran. I mean how hard is it to do a internal search for the active  veterans with with diagnostic code "X"? But, we all know, the VA is non-adversarial. Not paying veterans for disability rating increases doesn't adversely affect veterans, right??? 

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Good suggestion, I will write Rep Jon Tester and invite other veterans to do the same. This doesn't affect just shoulders, it affects anything where the VA increased the benefit in the past or where they might increase it in the future.

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