A shoulder nexus letter for your VA claim, from your imaging and service records

What the clinician looks for in your shoulder records

For the flat $500, the clinician reviews your records for a shoulder diagnosis, the in-service event or overuse behind it, and how the shoulder moves now. Shoulder records often spread across urgent care, orthopedics and physical therapy, so upload all of them.

• A named diagnosis: rotator cuff tendinopathy or tear, impingement, a labral tear, AC joint separation, recurrent dislocation or instability, frozen shoulder, or arthritis.
• Imaging reports, such as an X-ray for arthritis or joint separation and an MRI for the rotator cuff or labrum.
• Range-of-motion measurements in degrees for raising the arm forward and out to the side, and notes on pain, weakness, or the shoulder slipping out of place.
• Which arm is your dominant one. VA's rating schedule treats the major and minor arm differently, so the records should say.
• Service records of the shoulder: dislocations, falls, overhead lifting, weapons and equipment handling, contact training, and any profile, sling or physical therapy.
• Operative reports if the shoulder was repaired, in service or after.

Common service-connection routes for a shoulder condition

Direct service connection under 38 CFR 3.303 is the common route: a documented shoulder injury or repeated overhead strain in service, and a current diagnosis a clinician can link to it. A dislocation in service matters even if it was put back in place right away, because one dislocation can leave the joint less stable afterward.

Secondary service connection under 38 CFR 3.310 may fit when a service-connected condition forced the shoulder to do extra work. A clinician may consider whether years on crutches or a cane for a service-connected leg condition strained a shoulder, or whether favoring a service-connected shoulder overloaded the other one, when the records show that use over time.

Surgery after service does not break the chain on its own; the question is still what caused the condition that needed repair.

Is there a DBQ for a shoulder condition?

Yes. VA's public Shoulder and/or Arm DBQ covers the shoulder. Commander Health completes it for a flat $200, or with the nexus letter for $550. The licensed clinician completes and signs it only when your records hold recent range-of-motion measurements, notes on stability and flare-ups, and your dominant arm.

If your recent records have the diagnosis but no measured motion, the screen names that gap before you pay. VA may still order an exam of its own and decides the rating.

What it is not

• Physical conditions only: Commander Health does not write PTSD or other mental health opinions, or secondary opinions that run through a mental health condition.
• Not an exam or an appointment. There are no calls or video visits; the clinician works from your records, and any follow-up comes by email.
• Not a filing service. Commander Health does not file claims and is not a VSO, a law firm, or a VA-accredited representative. Free help filing a claim is available from a VA-accredited Veterans Service Organization.
• Not a guarantee. Clinical review never guarantees an outcome. A clinician signs only if your records support the opinion, and VA decides the claim.

Frequently asked questions

Does it matter which arm is my dominant one?

Yes, for the rating. VA rates the major and minor arm differently, so the records and any DBQ should say which shoulder is on your dominant side.

I dislocated my shoulder in service and it healed. Can that support a claim now?

It can, if a clinician finds today's shoulder condition is at least as likely as not tied to it. The in-service dislocation record and later complaints are what the opinion rests on.

I had shoulder surgery after I got out. Does that hurt my claim?

Not on its own. The operative report often helps, because it describes the damage. The opinion addresses what caused that damage.

Can using crutches for a service-connected knee cause a shoulder problem?

A clinician may consider it under 38 CFR 3.310 when your records show long-term crutch or cane use and shoulder problems that followed. If the records and the medical literature do not support it, the clinician declines and you get your money back.