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C&P Exam Prep: Shoulder and Arm
DBQ Overview
Interview + Physical- Form Name
- Shoulder_and_or_Arm
- Form Code
- Shoulder_and_or_Arm
- Page Count
- 14
- Examiner Type
- Physician or Physician Assistant
- Estimated Duration
- 30-45 minutes
- Exam Format
- Interview + Physical
What to Expect During Your Exam
Exam Overview
To document the current severity of your shoulder condition, including range of motion, ankylosis (frozen joint), functional loss, and any additional disabilities of the shoulder and arm, so that VA can assign an accurate disability rating under 38 CFR 4.71a DC 5200 and related codes.
What the examiner evaluates:
- Presence and type of ankylosis (favorable vs. unfavorable) of the scapulohumeral (glenohumeral) joint
- Degree of abduction limitation - the critical measurement for DC 5200 rating thresholds
- Active and passive range of motion (flexion, abduction, internal rotation, external rotation) before and after repetitive use
- Objective signs of pain, tenderness, crepitus, and guarding during motion
- Functional loss due to pain, fatigue, weakness, incoordination, and flare-ups (DeLuca factors)
- Muscle strength and atrophy of the affected shoulder and arm
- Surgical history including rotator cuff repair, shoulder replacement, or arthroscopy
- Any instability, dislocation, or subluxation of the glenohumeral joint
- Impact on ability to perform activities of daily living and occupational tasks
- Whether ROM testing can be safely performed and whether it was weight-bearing or non-weight-bearing
Exam typically takes place at a VA medical center, a VA contract exam facility (e.g., QTC, LHI, VES), or via telehealth review. You will be asked to remove your shirt or upper-body garment so the examiner can directly observe and palpate the shoulder. Bring any shoulder braces or assistive devices you use regularly. You have the right to request that the exam be recorded in most states - confirm your state's laws in advance and notify the examiner at the start.
Typical duration: 30-45 minutes
Shoulder Abduction (Active ROM)
How far you can raise your arm out to the side away from your body. Normal is 180-. This is the single most critical measurement for DC 5200 rating thresholds.
What to expect:
The examiner will ask you to raise your arm straight out to the side as far as possible without assistance from trunk lean or shoulder shrug. A goniometer may be used for precise measurement. The examiner must also test passive abduction (they move your arm) and note any difference. Testing should be performed on both shoulders.
Key thresholds:
- Abduction limited to 25- or less from side — Unfavorable ankylosis - 50% dominant / 40% non-dominant
- Abduction between 25- and 60- (intermediate position) — Intermediate ankylosis - 40% dominant / 30% non-dominant
- Abduction to 60- or more, can reach mouth and head — Favorable ankylosis - 30% dominant / 20% non-dominant
Tips:
- Perform the test as you would on a typical day, not your absolute best effort - you want to reflect your usual functional capacity.
- If the exam is performed on a good day, tell the examiner that your ROM is typically worse due to pain or flare-ups.
- Do NOT consciously restrict your movement; allow pain to naturally limit you as it would in daily life.
- If you experience significant pain at a certain degree of abduction, stop there and tell the examiner clearly.
- If you can only maintain that abduction angle briefly before pain forces you to lower your arm, state that.
Pain considerations: Under DeLuca v. Brown, pain on motion is itself a form of functional loss. If abduction causes pain before reaching the endpoint, the examiner should note the degree at which pain begins (not just where motion ends). Tell the examiner: 'I feel pain starting at [X] degrees and it limits how long I can hold that position.'
Shoulder Flexion (Active ROM)
How far you can raise your arm forward in front of your body. Normal is 180-.
What to expect:
You will be asked to raise your arm straight forward as far as possible. The examiner records the endpoint in degrees and whether passive flexion differs from active. Both initial and repetitive-use ROM should be noted.
Key thresholds:
- 0-30- flexion — Supports severe functional limitation, relevant to unfavorable position documentation
- 31-90- flexion — Significant limitation affecting reaching overhead and forward tasks
- 91-150- flexion — Moderate limitation affecting sustained overhead work
Tips:
- Flexion limitation supports overall functional loss documentation even when ankylosis is the primary rating mechanism.
- Note if you cannot reach your mouth, face, or the top of your head - these are specific functional benchmarks on the DBQ.
Pain considerations: State specifically if pain prevents forward reaching, such as inability to put on a shirt, reach a shelf, or lift items above waist height.
Internal and External Rotation
The rotational capacity of the shoulder joint. Normal external rotation is 90-; normal internal rotation is 70-90-. In true ankylosis the scapula and humerus move as one piece, eliminating glenohumeral rotation.
What to expect:
The examiner will assess whether any glenohumeral rotation is possible or whether all apparent motion comes from scapulothoracic movement. They will compare active versus passive rotation and document degree endpoints. This directly supports or refutes the presence of ankylosis.
Key thresholds:
- Zero glenohumeral rotation present — Confirms true ankylosis - scapula and humerus moving as one piece per DC 5200 criteria
- Any measurable glenohumeral rotation present — May indicate incomplete ankylosis - rating may shift to DC 5201 or 5203 series depending on overall limitation
Tips:
- Report if you are unable to reach behind your back (internal rotation task) or unable to place your hand behind your head (external rotation task).
- These functional tests are directly relevant to the 'can reach mouth and head' threshold in DC 5200.
Pain considerations: Pain with rotation attempts should be communicated - even if some motion is technically possible, pain-limited rotation contributes to overall functional loss documentation.
Repetitive-Use Testing (Post-Exercise ROM)
Whether your ROM decreases after repetitive use of the shoulder. This is a DeLuca factor that must be considered under Correia v. McDonald (2016) and M21-1 guidance.
What to expect:
After initial ROM measurements, the examiner may ask you to perform the motion three times and re-measure. A decrease in ROM after repetition indicates additional functional loss that must be documented and factored into the rating.
Key thresholds:
- ROM decreases by more than 5- after repetition — Must be documented as additional functional loss that may push rating to higher level
- ROM same after repetition — Examiner notes no additional loss on repetition
Tips:
- Before the exam, think about how your shoulder feels after washing dishes, doing laundry, or working for 20-30 minutes - this is your 'after-repetitive-use' baseline.
- If your shoulder stiffens or hurts significantly more after activity, tell the examiner even if they don't ask.
- State: 'When I perform that motion repeatedly, my range decreases and pain increases significantly after [X] repetitions or [X] minutes.'
Pain considerations: Fatigue, increasing pain with repetition, and weakness after sustained use are all DeLuca factors. Explicitly describe each one if present.
Weight-Bearing vs. Non-Weight-Bearing ROM (Correia Requirements)
For the shoulder, this refers to testing with the arm loaded versus unloaded. Weight-bearing can be simulated by having the veteran hold a light weight or simply use gravity-loaded motion.
What to expect:
The examiner should document both active (veteran moves arm) and passive (examiner moves arm) ROM, and note whether loaded motion differs from unloaded. Any discrepancy must be documented.
Key thresholds:
- Significant difference between active and passive ROM — Suggests pain inhibition or voluntary guarding - passive ROM may not represent true maximum, active ROM reflects functional capacity
Tips:
- Active ROM typically reflects your true functional ability - this is what matters most for daily life.
- If passive ROM is greater than active ROM, this supports pain inhibition and guarding - a recognized form of functional loss.
Pain considerations: If passive ROM causes sharp pain or apprehension, tell the examiner immediately. Pain-limited passive testing is medically significant and must be documented.
Shoulder Special Tests (Hawkins, Empty Can, Crank/Apprehension, Lift-Off, External Rotation Strength)
These orthopedic tests assess for rotator cuff integrity, impingement, labral pathology, instability, and subscapularis function - important for documenting associated diagnoses that may be separately rated.
What to expect:
Hawkins-Kennedy test: arm flexed to 90-, internally rotated - positive if pain. Empty Can test: arm in scapular plane, thumbs down, downward pressure - positive if weakness or pain (supraspinatus). Crank/Apprehension: arm abducted and externally rotated - positive if apprehension or pain (instability). Lift-Off: arm placed behind back, lifted off - positive if weak (subscapularis). External rotation strength test: resisted external rotation - positive if weak (infraspinatus/teres minor).
Key thresholds:
- Positive Hawkins test — Supports subacromial impingement diagnosis - may be separately rated
- Positive Empty Can with weakness — Supports rotator cuff tear or significant tendinopathy - may affect overall shoulder rating
- Positive Apprehension test — Supports glenohumeral instability - separately ratable under DC 5010 series
Tips:
- Report any apprehension, sharp pain, or sense of the shoulder 'wanting to pop out' during these tests.
- Weakness during resistance testing should be quantified - describe it in terms of daily tasks you can no longer do.
Pain considerations: Pain provoked by special tests is itself diagnostically significant - do not suppress your pain response during testing.
Muscle Atrophy Measurement (Circumferential)
Whether the affected shoulder/arm has lost muscle mass compared to the unaffected side. Measured in centimeters at a specified anatomical location.
What to expect:
The examiner may measure circumference of the upper arm at a defined location and compare bilaterally. Any atrophy suggests chronic disuse or denervation.
Key thresholds:
- Circumferential difference greater than 2 cm — Documents significant muscle atrophy - supports functional loss claims and may support separate muscle group rating
Tips:
- Mention if you have noticed your affected arm looks or feels thinner than the other arm.
- Report any activities you have stopped doing with that arm due to pain or weakness - disuse atrophy results from avoiding painful motion.
Pain considerations: Atrophy of disuse is a recognized sign of functional loss on the DBQ and supports the claim that pain and disability have reduced your ability to use the limb.
Rating Criteria Breakdown
| Rating % | Criteria | Key Symptoms |
|---|---|---|
| 50% | Unfavorable ankylosis of the scapulohumeral articulation - dominant arm. The scapula and humerus move as one piece (true bony or fibrous ankylosis), with abduction limited to 25- or less from the side. |
CFR: 38 CFR 4.71a DC 5200: Unfavorable, abduction limited to 25- from side - 50% dominant arm, 40% non-dominant arm. Note: The scapula and humerus move as one piece. |
| 40% | Unfavorable ankylosis - non-dominant arm (40%), OR Intermediate ankylosis - dominant arm (40%). Intermediate position means abduction is between 25- and 60-, or the position of ankylosis is neither clearly favorable nor unfavorable. |
CFR: 38 CFR 4.71a DC 5200: Intermediate between favorable and unfavorable - 40% dominant, 30% non-dominant. Unfavorable ankylosis non-dominant arm - 40%. |
| 30% | Favorable ankylosis - dominant arm (30%), OR Intermediate ankylosis - non-dominant arm (30%). Favorable means the joint is ankylosed in a position allowing the arm to reach the mouth and head, with abduction to 60- possible. |
CFR: 38 CFR 4.71a DC 5200: Favorable, abduction to 60-, can reach mouth and head - 30% dominant, 20% non-dominant. Intermediate non-dominant - 30%. |
| 20% | Favorable ankylosis - non-dominant arm. The joint is ankylosed in a favorable position (can reach mouth and head, abduction to 60-) but this is the non-dominant arm. |
CFR: 38 CFR 4.71a DC 5200: Favorable, abduction to 60-, can reach mouth and head - 20% non-dominant arm. |
50% Unfavorable ankylosis of the scapulohumeral articulation - d ...
Unfavorable ankylosis of the scapulohumeral articulation - dominant arm. The scapula and humerus move as one piece (true bony or fibrous ankylosis), with abduction limited to 25- or less from the side.
Key Symptoms
- Complete or near-complete loss of glenohumeral joint motion
- Scapula and humerus moving as a single rigid unit
- Abduction severely restricted - arm essentially locked at the side
- Unable to reach mouth, face, or head
- Severe functional loss for all overhead and lateral arm activities
- Inability to perform self-care tasks requiring arm elevation
- Significant pain, muscle atrophy, and weakness
CFR: 38 CFR 4.71a DC 5200: Unfavorable, abduction limited to 25- from side - 50% dominant arm, 40% non-dominant arm. Note: The scapula and humerus move as one piece.
40% Unfavorable ankylosis - non-dominant arm (40%), OR Intermedi ...
Unfavorable ankylosis - non-dominant arm (40%), OR Intermediate ankylosis - dominant arm (40%). Intermediate position means abduction is between 25- and 60-, or the position of ankylosis is neither clearly favorable nor unfavorable.
Key Symptoms
- True ankylosis confirmed - no independent glenohumeral rotation
- Abduction restricted to more than 25- but less than 60- from side
- Cannot reach overhead but may reach mouth or face with compensatory motion
- Significant limitation in all functional shoulder tasks
- Pain, fatigue, and weakness contributing to functional loss
- Difficulty with dressing, personal hygiene, and occupational tasks requiring arm use
CFR: 38 CFR 4.71a DC 5200: Intermediate between favorable and unfavorable - 40% dominant, 30% non-dominant. Unfavorable ankylosis non-dominant arm - 40%.
30% Favorable ankylosis - dominant arm (30%), OR Intermediate an ...
Favorable ankylosis - dominant arm (30%), OR Intermediate ankylosis - non-dominant arm (30%). Favorable means the joint is ankylosed in a position allowing the arm to reach the mouth and head, with abduction to 60- possible.
Key Symptoms
- True ankylosis present but arm positioned to allow reaching mouth and head
- Abduction to approximately 60- possible
- Can perform basic self-care (eating, facial hygiene) but limited for overhead tasks
- No overhead reaching capability
- Pain and functional loss present but partially compensated by favorable joint position
- Weakness and fatigue with sustained use
CFR: 38 CFR 4.71a DC 5200: Favorable, abduction to 60-, can reach mouth and head - 30% dominant, 20% non-dominant. Intermediate non-dominant - 30%.
20% Favorable ankylosis - non-dominant arm. The joint is ankylos ...
Favorable ankylosis - non-dominant arm. The joint is ankylosed in a favorable position (can reach mouth and head, abduction to 60-) but this is the non-dominant arm.
Key Symptoms
- True ankylosis of non-dominant shoulder in favorable position
- Abduction to 60-, can reach mouth and head
- Significant but partially functional arm position
- Non-dominant arm limitations less impactful on overall function
- Pain, weakness, and fatigue still present
- Limited ability to use arm for bilateral tasks, carrying, or overhead work
CFR: 38 CFR 4.71a DC 5200: Favorable, abduction to 60-, can reach mouth and head - 20% non-dominant arm.
How to Describe Your Symptoms
Ankylosis and Joint Stiffness
How to describe:
Describe the complete or near-complete loss of independent shoulder joint motion. Explain that your shoulder joint itself does not move - only your entire shoulder blade shifts when you try to raise your arm. Mention how long you have had this stiffness and whether it has worsened.
Worst-day example:
“On my worst days, I cannot lift my arm away from my side at all. The joint feels completely locked. Even trying to raise my arm a few inches causes severe pain, and I can feel my shoulder blade grinding and shifting rather than the actual joint moving. I cannot reach my face, comb my hair, or put on a shirt without using my other arm to assist.”
What the examiner listens for:
Confirmation that glenohumeral joint is fixed (ankylosis), description of scapulothoracic compensation, and functional tasks that are impossible or severely limited due to joint immobility.
Understatements to avoid:
Do not say 'it's just a little stiff' or 'I manage okay.' Describe the complete picture including compensatory movements, what you cannot do, and how the condition affects your daily routine. Do not minimize by comparing yourself to others.
Pain (DeLuca Factor)
How to describe:
Describe pain at rest, pain with initiation of movement, pain at specific degrees of motion, and pain after sustained or repetitive use. Include severity (0-10 scale), character (sharp, burning, aching, throbbing), location (joint, radiating down arm, into neck), and duration of pain episodes.
Worst-day example:
“On my worst days, the pain in my right shoulder is an 8 out of 10 even at rest. The moment I try to lift my arm even slightly, I get a sharp stabbing pain at the joint. After I try to use my arm for any task - even briefly - the pain escalates and stays elevated for hours or through the next day. I wake up at night regularly from the pain.”
What the examiner listens for:
The DBQ asks whether pain was present during ROM testing, at what degree pain began, whether pain was present at rest, and whether it causes functional loss. The examiner documents this in the flare-up and functional loss sections.
Understatements to avoid:
Do not minimize pain by saying 'I can push through it.' Report your actual experience. If pain limits how long you can do something, or prevents you from sleeping, say so. The examiner needs to hear that pain itself causes functional loss, not just ROM limitation.
Weakness (DeLuca Factor)
How to describe:
Describe inability to lift, carry, push, or pull with the affected arm. Quantify what you cannot lift (e.g., cannot lift a gallon of milk overhead, cannot carry groceries, cannot push open a heavy door). Explain whether weakness is constant or worsens with use.
Worst-day example:
“My right arm is so weak I cannot lift even a light object above shoulder height. I cannot carry a bag of groceries with that arm for more than a few steps before dropping it. I have completely stopped using that arm for any tasks requiring force. Even holding a plate with that arm while eating is uncomfortable.”
What the examiner listens for:
The DBQ has specific checkboxes for weakened movement and weakness as functional loss factors. The examiner will also perform resistance testing and assess grip strength and shoulder muscle strength.
Understatements to avoid:
Do not demonstrate your maximum effort during strength testing if doing so causes pain - pain-inhibited strength is medically significant. Do not say 'I manage' without explaining what accommodations you make.
Fatigability (DeLuca Factor)
How to describe:
Describe how quickly your shoulder fatigues with use, and how ROM and pain worsen after activity. Include how long you can perform a task before fatigue forces you to stop, and how long recovery takes.
Worst-day example:
“If I try to wash dishes or do any task that uses my shoulder for more than five minutes, the fatigue becomes overwhelming. The shoulder aches deeply and I cannot continue. It takes hours for the fatigue to resolve, and the next day my shoulder is significantly stiffer and more painful than usual.”
What the examiner listens for:
The DBQ specifically includes fatigability as a functional loss checkbox. The examiner should ask about repetitive-use ROM change and document it. Per DeLuca, fatigability must be considered in the rating.
Understatements to avoid:
Do not say 'I just take a break.' Explain the severity and duration of fatigue and its impact on your ability to work, perform self-care, or engage in normal daily activities.
Incoordination (DeLuca Factor)
How to describe:
Describe any lack of smooth, coordinated movement of the affected arm - jerky motion, inability to control fine placement of the arm, or difficulty with precise upper extremity tasks such as writing, typing, reaching for specific objects, or using tools.
Worst-day example:
“When I try to reach for something specific, my shoulder does not move smoothly. The motion is jerky and unpredictable. I have dropped items because I cannot control the precise positioning of my arm. I cannot reliably place my hand where I intend when my shoulder is involved.”
What the examiner listens for:
The DBQ has a checkbox for incoordination as a functional loss factor. The examiner may observe guarding or awkward compensatory movements during the physical exam.
Understatements to avoid:
If incoordination is present, report it - it is a formally recognized DeLuca factor that can independently support a higher rating level beyond ROM findings alone.
Flare-Ups (DeLuca Factor)
How to describe:
Describe the frequency, duration, triggers, and severity of flare-ups. A flare-up means a period when your shoulder is significantly worse than your baseline. Include what causes flare-ups (weather, activity, lifting, sleeping on the shoulder), what the flare looks like (increased pain, further reduced ROM, swelling, inability to use arm), and how long they last.
Worst-day example:
“I have severe flare-ups approximately 3-4 times per month. During a flare, my shoulder pain goes from a baseline 4/10 to 9/10, and I cannot move the arm at all for 2-3 days. Cold weather, sleeping wrong, or any attempt at overhead motion can trigger a flare. During these periods I am completely unable to work or perform self-care on the affected side.”
What the examiner listens for:
The DBQ has dedicated fields asking about flare-up frequency, severity, and whether the examiner can document the veteran's description of flare-ups. This information directly supports higher ratings when current ROM does not reflect the worst-day picture.
Understatements to avoid:
The exam captures a single snapshot in time. If you are having a relatively good day during the exam, proactively tell the examiner: 'Today is not representative of how my shoulder typically is. I need to describe what a typical day and my worst days look like.'
Functional Impact on Daily Life and Work
How to describe:
Describe specific tasks you cannot do or can no longer do because of your shoulder. Include self-care (dressing, bathing, grooming), household tasks (cooking, cleaning, yard work), vocational tasks, recreation, and sleep. Be specific and concrete.
Worst-day example:
“I cannot put on a button-down shirt without help. I cannot wash my hair with my right hand. I stopped driving long distances because the shoulder cramps from holding the wheel. I cannot reach overhead shelves, cannot carry a bag of groceries, and cannot perform any overhead work. I was a carpenter and had to change careers because I cannot swing a hammer or use power tools safely. I wake up 3-4 times per night from shoulder pain.”
What the examiner listens for:
The DBQ has a dedicated section asking the examiner to document the veteran's description of functional loss. Specific, concrete examples of lost function are far more useful than general statements.
Understatements to avoid:
Do not say 'I just work around it.' If you have changed how you do things, stopped doing things, or asked others for help, that IS functional loss. Every accommodation you make is evidence of disability.
Common Mistakes to Avoid
Performing ROM to maximum effort on a good day without contextualizing typical and worst-day function
The C&P exam captures one data point. If you naturally push through pain during the exam, the recorded ROM may be higher than your functional reality, resulting in an underrated condition.
Instead: Perform the motion as you naturally would. If you reach a point of pain before your mechanical endpoint, stop and tell the examiner the exact degree where pain begins. After the exam, proactively describe what your ROM and pain level look like on a typical day and your worst days.
Impact: All levels - incorrect ROM documentation directly determines which DC 5200 tier applies
Failing to mention flare-ups because the exam day is not during a flare
VA is required under DeLuca to consider functional loss from flare-ups even if they are not observable at the time of examination. If you don't report them, the examiner cannot document them.
Instead: Proactively describe your flare-up history: frequency, duration, severity, triggers, and the functional limitations during a flare. Ask the examiner to document your description of flares in the DBQ.
Impact: Most impactful at the boundary between favorable and unfavorable ankylosis tiers
Not reporting all DeLuca factors - only mentioning pain and ignoring fatigue, weakness, and incoordination
VA must consider all six DeLuca factors (pain, fatigue, weakness, incoordination, lack of endurance, flare-ups) as independent bases for functional loss. Failing to report any of them means the examiner may not document them.
Instead: Before the exam, prepare specific examples of how fatigue, weakness, and incoordination affect your daily function. Bring this information up proactively during the history portion of the exam.
Impact: All levels - DeLuca factors can support rating at a higher level than measured ROM alone would justify
Not clarifying dominant versus non-dominant arm
DC 5200 assigns different rating percentages based on whether the affected shoulder is the dominant or non-dominant arm. If the examiner does not document this, the lower (non-dominant) rating may be applied by default.
Instead: Clearly state which is your dominant hand at the start of the exam. Confirm the examiner records this in the DBQ (field: RG_Dominant_Hand_RG). If your dominant arm is affected, emphasize the greater functional impact.
Impact: 10% difference at every rating tier - critical to document accurately
Saying the shoulder 'dislocates' or 'pops out' without clarifying whether it is true recurrent dislocation versus instability sensation
Glenohumeral joint dislocation and instability are separately ratable conditions. Conflating these with ankylosis symptoms may confuse the examiner and result in incorrect coding.
Instead: Be precise: if your shoulder locks and does not move (ankylosis), describe it that way. If you feel instability or apprehension of dislocation, describe that separately as an additional finding.
Impact: May affect whether additional diagnostic codes (e.g., glenohumeral instability) are added alongside DC 5200
Not bringing all relevant medical records, imaging, and surgical reports to the exam
The examiner is required to review your claims file, but incomplete records can result in an inadequate DBQ. X-rays confirming ankylosis or surgical reports confirming the extent of damage are critical supporting evidence.
Instead: Bring copies of all MRI reports, X-ray reports, operative reports, and physical therapy records. Reference specific findings (e.g., 'my 2021 MRI showed complete rotator cuff tear and joint space loss consistent with ankylosis') during the history portion.
Impact: All levels - objective imaging is often the key evidence confirming true ankylosis versus severe limitation of motion
Assuming the examiner will ask about all relevant symptoms without being prompted
Exams are time-limited (30-45 minutes). Some examiners follow the DBQ form linearly and may not probe for DeLuca factors, flare-ups, or functional impact unless the veteran raises them.
Instead: Prepare a written symptom summary (1-2 pages) covering all DeLuca factors, functional impacts, flare-up history, and what a typical/worst day looks like. Provide this to the examiner at the start and ask that it be included in the record.
Impact: All levels - thorough history documentation affects the overall quality and accuracy of the DBQ
Not requesting that the exam be recorded when legally permitted
Recording the exam creates an objective record of what was said, ensuring the DBQ accurately reflects what you reported. Discrepancies between your statements and the examiner's write-up can be identified and challenged.
Instead: Research your state's recording laws before the exam. In states that permit one-party recording, bring a recording device and notify the examiner at the start of the exam that you will be recording.
Impact: Affects all levels - exam recording is a protective right that safeguards accuracy
Prep Checklist
Before Your Exam
Day Of
During the Exam
After the Exam
Your Rights During a C&P Exam
- You have the right to request that your C&P examination be recorded in most states - check your specific state's laws on one-party or all-party consent recording before the exam.
- You have the right to request a copy of the completed DBQ after the examination through the VA's records request process.
- You have the right to submit a lay statement (VA Form 21-4138) describing your symptoms and functional limitations in your own words - this can supplement or correct the DBQ record.
- You have the right to have your entire claims file reviewed by the examiner before completing the DBQ (Sharp v. Shulkin, 29 Vet.App. 26, 2017).
- You have the right to request a Higher Level Review or Board of Veterans' Appeals review if you believe the C&P examination was inadequate, not based on a thorough review of the record, or failed to address DeLuca factors.
- You have the right to obtain an Independent Medical Opinion (IMO) from a private physician at your own expense, and VA must consider this evidence in your rating decision.
- Under DeLuca v. Brown, VA must consider pain, fatigue, weakness, incoordination, and flare-ups as independent bases for functional loss - not just measured range of motion. You have the right to have all six factors documented and considered.
- You have the right under Correia v. McDonald to have range of motion testing performed both before and after repetitive use, and to have any additional functional loss from repetitive use documented and considered.
- You have the right to a clear explanation of how your rating was determined, including which diagnostic code was applied and why, in your rating decision letter.
- You have the right to bring a representative (VSO, accredited claims agent, or attorney) to your C&P examination - they cannot answer questions on your behalf but can observe and take notes.
- You have the right to report any examiner conduct you believe was inappropriate or inadequate to VA Central Office or the Inspector General.
- You have the right to request a new C&P examination if your condition worsens - file a claim for increase at any time.
Related Conditions
- Limitation of Motion of the Arm (DC 5201) DC 5201 applies when shoulder motion is limited but true ankylosis is not present. Under M21 1, separate evaluations may be given for DC 5200 and DC 5201 if the manifestations are distinct and non overlapping. If ankylosis is not confirmed, VA may rate under 5201 instead.
- Impairment of Supination and Pronation / Fibrous Ankylosis (DC 5202) DC 5202 covers loss of use of the arm due to bone or joint conditions not otherwise specified. May be applicable as an alternative or additional code when DC 5200 does not fully capture the disability picture, particularly when flail or fibrous union is present.
- Rotator Cuff Tear A rotator cuff tear is frequently a co existing diagnosis with shoulder ankylosis and may be separately ratable if it produces distinct symptomatology not captured by DC 5200. The DBQ specifically asks about rotator cuff tear as a separate diagnosis.
- Glenohumeral Joint Instability Recurrent glenohumeral dislocation or instability may coexist with or precede the development of ankylosis. It is separately ratable if distinct from the ankylosis symptomatology and should be claimed if present.
- Shoulder Impingement Syndrome Subacromial impingement syndrome is a distinct diagnosis ratable separately from ankylosis. The DBQ includes specific fields for this diagnosis. It may also be a secondary condition to the primary ankylosis.
- Acromioclavicular Joint Separation or Osteoarthritis AC joint pathology is a distinct anatomical condition from glenohumeral ankylosis. If it produces separate and distinct symptomatology, it may be separately ratable under its own diagnostic code alongside DC 5200.
- Post-Traumatic Arthritis of the Shoulder Post traumatic arthritis frequently underlies shoulder ankylosis. If arthritis exists without full ankylosis, it may be rated under DC 5010 or 5003. With confirmed ankylosis under DC 5200, arthritis based ratings for the same joint would typically not be pyramided.
- Bicipital Tendonitis or Bicipital Tendon Tear Bicipital tendon conditions frequently coexist with shoulder pathology. They are separately ratable if producing distinct symptomatology. The DBQ includes specific diagnostic fields for both bicipital tendonitis and bicipital tendon tear.
- Labral Tear (SLAP Lesion) Superior labrum anterior to posterior (SLAP) tears and other labral pathology frequently coexist with shoulder conditions. Separately ratable if distinct in symptomatology. The DBQ specifically includes labral tear as a diagnostic option.
- Loss of Use of the Arm (Special Monthly Compensation) If the shoulder condition is so severe as to render the arm functionally useless (equivalent to amputation), the veteran may qualify for Special Monthly Compensation under 38 CFR 3.350. This is relevant for the most severe unfavorable ankylosis cases with additional functional loss.
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This C&P exam preparation guide is for educational purposes only and does not constitute legal, medical, or claims advice. Always consult with a qualified Veterans Service Organization (VSO) representative or VA-accredited attorney for guidance specific to your claim. Never exaggerate, minimize, or fabricate symptoms during a C&P examination.