How the Board ruled on shoulder claims, 2021–2025

Shoulder (direct service connection)

Direct (began in or was caused by service), or theory not stated in the Board order

37.2% granted of 4,473 decided cases (margin of error 35.8–38.6%). 1,663 granted, 2,810 denied, 7,032 sent back to VA (remanded, not decided), 856 dismissed.

What convinced the Board in granted cases

• The Board granted when it found the veteran's account of a shoulder injury or pain in service, with symptoms continuing since, competent and credible, often supported by service records, a spouse, or later treatment records. (16 of 20 decisions read; e.g. A24061380, 21032203, 23052068)
• Negative VA opinions were given little or no weight when the examiner ignored the veteran's reports of continuous symptoms, relied only on the absence of records, misstated the history, or used the wrong standard of proof. (10 of 20 decisions read; e.g. 21019202, A24056361, 22046910)
• A private or long-term treating physician's opinion carried weight when it was based on a review of the record and gave a reasoned explanation tied to the veteran's duties, for example a helicopter mechanic's labrum tear, and VA had no adequate contrary opinion. (3 of 20 decisions read; e.g. A24018799, A25012602, 24007835)

Common reasons in denied cases

• The Board found no current shoulder disability, or no shoulder pain causing functional impairment, during the appeal period. (8 of 18 decisions read; e.g. A24014231, 24000865, A24034431)
• A VA examiner's opinion against the claim, based on an accurate history, was unrebutted. The veteran's own view of the cause was not competent medical evidence. (8 of 18 decisions read; e.g. 21077502, 23050852, 21001424)
• The shoulder problem was first recorded decades after service, began after a post-service work injury or fall, or started recently with no in-service event. (5 of 18 decisions read; e.g. 21001424, A21003714, 21031041)

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Shoulder (exposure claims)

Exposure (e.g. Agent Orange, Camp Lejeune, burn pits)

18.9% granted of 37 decided cases (margin of error 9.5–34.2%). 7 granted, 30 denied, 71 sent back to VA (remanded, not decided), 0 dismissed.

What convinced the Board in granted cases

• The Board granted Gulf War shoulder claims as an undiagnosed illness when the shoulder joint pain had no known diagnosis, supported in one case by the only adequate medical opinion and credible symptom reports. (2 of 4 decisions read, few decisions; e.g. A25000334, 22042380)
• The Board granted when the evidence for and against a link between the diagnosed shoulder condition and service was at least in approximate balance, giving the veteran the benefit of the doubt. (2 of 4 decisions read, few decisions; e.g. 24027566, 22030073)

Common reasons in denied cases

• The Board denied when no medical opinion linked the shoulder condition to service or exposure, and the veteran's own belief about a toxic-exposure cause was not competent medical evidence. (3 of 12 decisions read; e.g. 21063565, 21025057, 21033131)
• The Board denied Gulf War undiagnosed-illness claims when thorough VA opinions tied the shoulder pain to a known diagnosis, such as strain or arthritis, which rules out the undiagnosed-illness presumption. (3 of 12 decisions read; e.g. 21025057, 24001843, A21009570)
• The Board denied when there was no current shoulder disability shown, or when records pointed to a post-service cause, such as a fishing injury. (3 of 12 decisions read; e.g. 24020117, A21009570, 21033131)

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Shoulder secondary to any service-connected condition

Secondary (caused or worsened by a service-connected condition)

34% granted of 347 decided cases (margin of error 29.2–39.1%). 118 granted, 229 denied, 842 sent back to VA (remanded, not decided), 32 dismissed.

What convinced the Board in granted cases

• The Board granted when a medical opinion explained how the service-connected condition led to shoulder overuse, such as compensating for the other shoulder or leaning on a cane, often citing medical literature and a full record review. (5 of 12 decisions read; e.g. 21033136, A23015293, 23047263)
• A negative VA opinion lost weight when it ignored the veteran's account of overcompensating, did not address aggravation, or skipped over a documented shoulder diagnosis. (3 of 12 decisions read; e.g. 23047263, A25023274, 22004934)
• Some shoulder grants in this group were on a direct basis instead, resting on credible accounts of in-service injury or heavy duties, arthritis found soon after service, or an examiner who reviewed the record. (3 of 12 decisions read; e.g. A21014489, 21046770, 23005613)

Common reasons in denied cases

• The Board denied when VA examiners reviewed the record and gave a reasoned opinion that the service-connected condition neither caused nor worsened the shoulder, and no comparable opinion supported the claim. (7 of 11 decisions read; e.g. A25022505, 23000049, 21000755)
• Examiners often found another explanation more likely, such as age, body weight, work history, separate injuries, normal progression of arthritis, or a long gap before shoulder complaints. (4 of 11 decisions read; e.g. 22042674, 21000755, 21035892)
• Other claims failed because there was no current shoulder diagnosis, or the veteran's own statements about cause or symptoms were found not competent or not credible. (4 of 11 decisions read; e.g. A24069767, 21048562, 21035843)

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Shoulder secondary to the other shoulder

Secondary (caused or worsened by a service-connected condition)

54.9% granted of 71 decided cases (margin of error 43.4–66.0%). 39 granted, 32 denied, 158 sent back to VA (remanded, not decided), 10 dismissed.

What convinced the Board in granted cases

• The Board gave strong weight to private or other medical opinions that reviewed the full record and explained how overusing one shoulder to protect the service-connected shoulder strained or damaged the other. (6 of 13 decisions read; e.g. 21009033, A24055021, A25022413)
• VA examiner opinions lost weight when they addressed only causation and not aggravation, rested on the absence of records, ignored the veteran's account, or relied on inaccurate facts. (4 of 13 decisions read; e.g. A24061249, 21022618, A25001190)
• Credible statements from the veteran or family about favoring one arm and the onset of pain in the other shoulder supported the grant. (6 of 13 decisions read; e.g. 22042518, 21009033, A24028371)

Common reasons in denied cases

• A thorough VA opinion found no link, pointing to hand dominance, workouts, aging, or a post-service injury, and no medical opinion of record rebutted it. (5 of 12 decisions read; e.g. 22004326, 23017973, 21047224)
• The veteran's own belief that one shoulder caused the other was not competent medical evidence on cause. (3 of 12 decisions read; e.g. 21038580, 21057587, A24060559)
• There was no current diagnosed disability in the claimed shoulder, such as a normal shoulder on imaging. (3 of 12 decisions read; e.g. A24060559, 21048562, A24014445)

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Shoulder secondary to low back (lumbar spine)

Secondary (caused or worsened by a service-connected condition)

20.4% granted of 54 decided cases (margin of error 11.8–32.9%). 11 granted, 43 denied, 153 sent back to VA (remanded, not decided), 5 dismissed.

What convinced the Board in granted cases

• The Board gave less weight to VA opinions that ignored the veteran's account of shoulder strain from compensating for the back, gave unsupported conclusions, or never addressed the secondary theory. (3 of 6 decisions read; e.g. 22052685, 22024044, A23000571)
• The Board credited the veteran's own competent reports, such as injuring the shoulder while catching falls caused by back-related gait problems, or shoulder symptoms going back to service. (4 of 6 decisions read; e.g. 23001528, A24050146, 22024044)

Common reasons in denied cases

• Most denials rested on a thorough VA opinion, based on the full record, finding the shoulder was not caused or worsened by the back, with no medical opinion on the other side. (11 of 12 decisions read; e.g. 23010218, 21031424, 21076047)
• The veteran's own belief that the back caused the shoulder problem was not treated as competent medical evidence on this complex question. (3 of 12 decisions read; e.g. 23010218, 21076047, 21014701)
• Some claims failed because shoulder problems first appeared decades after service, and in one case a private opinion relied on a general article that did not fit the veteran's own history. (4 of 12 decisions read; e.g. 21076047, 21014701, 23036794)

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Shoulder secondary to knee

Secondary (caused or worsened by a service-connected condition)

34.8% granted of 46 decided cases (margin of error 22.7–49.2%). 16 granted, 30 denied, 68 sent back to VA (remanded, not decided), 4 dismissed.

What convinced the Board in granted cases

• The Board granted when a medical opinion, private or VA, explained how the service-connected knee caused the shoulder injury, such as the knee giving way in a fall or shoulder overuse from a cane. (5 of 9 decisions read; e.g. 21066567, A23015293, 23051242)
• Negative VA opinions lost weight when they ignored a shoulder diagnosis or the documented knee instability in the record. (3 of 9 decisions read; e.g. 22004934, A24010146, A24032868)
• Credible lay statements that the knee buckled and caused a fall onto the shoulder, backed by treatment records, supported the claim. (3 of 9 decisions read; e.g. 22000714, A24032868, 23051242)

Common reasons in denied cases

• The Board denied when a thorough VA opinion that reviewed the file, including the veteran's reports of falls, found no link and no contrary medical opinion was offered. (5 of 12 decisions read; e.g. 21040892, A24008188, 21003152)
• The veteran's own belief that the knee caused or worsened the shoulder was not competent medical evidence. (4 of 12 decisions read; e.g. 23003347, 22021652, 22015255)
• Other denials turned on a fall account found not credible, no current diagnosis, or shoulder problems first appearing years after service. (3 of 12 decisions read; e.g. A24041998, 23051551, 22015255)

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Shoulder secondary to neck (cervical spine)

Secondary (caused or worsened by a service-connected condition)

30.3% granted of 33 decided cases (margin of error 17.4–47.3%). 10 granted, 23 denied, 100 sent back to VA (remanded, not decided), 2 dismissed.

What convinced the Board in granted cases

• The Board granted on private opinions that reviewed the records, cited medical literature, and explained how neck problems can change shoulder mechanics, when no medical opinion addressed the secondary theory the other way. (2 of 6 decisions read, few decisions; e.g. 23026788, A25036120)
• VA opinions lost weight when they relied on silent service records, ignored the veteran's reports of symptoms, gave no reason for saying the neck would not affect the shoulder, or addressed only direct service connection. (4 of 6 decisions read; e.g. 23026788, A25036120, 22024044)
• The veteran's credible account of shoulder symptoms continuing since an in-service injury supported the claim. (3 of 6 decisions read; e.g. 22024044, 21022106, 23026788)

Common reasons in denied cases

• A thorough VA opinion found the shoulder was not caused or worsened by the neck condition, for example because shoulder pain was pain radiating from the neck or came from separate injuries, and nothing rebutted it. (6 of 14 decisions read; e.g. 23010218, 21007679, 21000755)
• The only evidence of a link was the veteran's own belief, which the Board did not accept as competent medical evidence. (5 of 14 decisions read; e.g. 23010218, 21035843, 21055357)
• Other claims failed because there was no separate shoulder diagnosis, the neck condition was not service-connected, or the veteran's account of an in-service injury was not found credible. (5 of 14 decisions read; e.g. 23029854, 24003810, 21025117)

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Shoulder secondary to foot (flat feet / plantar fasciitis)

Secondary (caused or worsened by a service-connected condition)

Small sample: 11 decided cases, too few for a reliable percentage. 1 granted, 10 denied, 6 sent back to VA (remanded, not decided), 0 dismissed.

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