The rotator cuff holds the humeral head in the glenoid fossa of the scapula and consists of the muscles surrounding the scapula. Acute excessive force can tear the rotator cuff.

Tearing can occur in sports, and chronic irritation can cause erosion of the tendons. If a person falls forward and puts out a hand to break the fall, the weight of the body can put the tendons under tension.

Manifestations of the condition include:

• inability to abduct and raise the arm;

• incidence of pain in pushing items away; and

• severe pain caused by adducting the arm across the chest.

A complete tear can be diagnosed by magnetic resonance imaging (MRI). X-rays may show a humeral head resting lower than the opposite shoulder. Computed tomography (CT) and ultrasonography are two additional noninvasive tests that may be performed.

A small tear can be treated with rest, immobilization, and nonsteroidal anti-inflammatory drugs (NSAIDs). Some tears can be repaired with a debridement during an arthroscopy, and large tears will require an open operation when symptomatic, and in cases refractory to conservative treatment.

Open repairs will require rehabilitation for several months.

• To properly rate disability, accurate measurement of rotator cuff ranges of motion (ROM) is required and must be reported in degrees.

• The rating schedule for musculoskeletal was updated on February 7, 2021. Protection still does apply and should be considered with existing evaluations (38 CFR 3.951(a)).

• Description of any instability and frequency of any dislocations is required.

• Multiple precedential decisions have impacted the application of 38 CFR 4.59 for musculoskeletal disabilities.  Refer to the M21-1 musculoskeletal disabilities section for a listing of impactful precedential court holdings, a brief description of the impact, and the applicability date (date of decision) for each.

• Separate evaluations may be given for disabilities of the shoulder and arm under 38 CFR 4.71a, diagnostic codes (DCs) 5201, 5202, or 5203 if the manifestations represent separate and distinct symptomatology that are neither duplicative nor overlapping. Refer to the M21-1 for examples of separate evaluations for disabilities of the shoulder and arm.  

• It is the responsibility of the rating specialist to interpret reports of examination in the light of the whole recorded history, reconciling the various reports into a consistent picture so that the current rating may accurately reflect the elements of disability present. See 38 CFR 4.2 – Interpretation of examination reports. If the report or examination is inadequate, the rating agency may return for a supplementary report. See 38 CFR 4.70 – Inadequate examinations. 

• None.