Shoulder Instability and Recurrent Dislocation: DC 5202 Rating Guide

While standard shoulder injuries are rated on motion loss under DC 5201, recurrent dislocations and chronic joint instability are rated under Diagnostic Code 5202 (humerus, other impairment of). The rating schedule establishes two specific tiers for recurrent dislocation at the scapulohumeral joint based on frequency and protective muscle guarding.

Under DC 5202, infrequent dislocations with guarding of movement only at shoulder level receive a 20% rating for either the major or minor arm. Frequent dislocation episodes with guarding of all arm movements receive 30% for the dominant (major) arm and 20% for the nondominant (minor) arm. Guarding refers to involuntary or voluntary muscle spasms that prevent normal joint articulation to prevent subluxation.

Chronic instability frequently stems from structural labral pathology. Superior Labrum Anterior to Posterior (SLAP) tears and Bankart lesions (detachment of the anterior-inferior glenoid labrum caused by traumatic dislocation) impair joint containment. If surgical stabilization fails to resolve laxity, the resulting instability and dislocation episodes continue to be evaluated under DC 5202 or DC 5201 depending on the primary manifestation.

Under 38 CFR 4.14 (avoidance of pyramiding), a veteran cannot receive separate ratings under both DC 5201 (limitation of motion) and DC 5202 (dislocation) for the same shoulder joint unless distinct, non-overlapping functional impairments are proven. In most cases, the VA adjudicator assigns the single diagnostic code that provides the highest compensable evaluation reflecting the veteran's predominant disability.

Lay statements describing a joint popping out are rarely sufficient alone. Claims files must contain contemporaneous emergency room records documenting closed reductions, radiology reports (post-reduction X-rays, MRI arthrograms demonstrating labral avulsion), and physical exam records documenting positive apprehension or relocation tests.