Shoulder Impingement
Repetitive overhead load, heavy lifting, and training/combat trauma driving rotator-cuff and shoulder instability injuries in service members.
38 CFR diagnostic codes 5024, 5201, 5202, 5203
Peer-reviewed evidence (5)
The verified studies behind a Shoulder Impingement claim — each links to its real PubMed or DOI record. These are sources our nexus drafts can draw from; none are invented.
- Christensen DL, Elsenbeck MJ, Wolfe JA, Nickel WN, Roach W, Waltz RA, Dickens JF, LeClere LE. Risk Factors for Failure of Nonoperative Treatment of Posterior Shoulder Labral Tears on Magnetic Resonance Imaging. Mil Med. 2020;185(9-10):e1556-e1561. PMID:32601668. doi:10.1093/milmed/usaa122.
- Green CK, Scanaliato JP, Turner RC, Sandler AB, Dunn JC, Parnes N. Prevalence and Risk Factors of Glenoid Bone Loss in Combined Shoulder Instability in Young, Active-Duty Military Patients. Orthop J Sports Med. 2023;11(7):23259671231181906. PMID:37435424. doi:10.1177/23259671231181906.
- Scanaliato JP, Dunn JC, Fares AB, Czajkowski H, Parnes N. Outcomes of 270° Labral Repair for Combined Shoulder Instability in Active-Duty Military Patients: A Retrospective Study. Am J Sports Med. 2022;50(2):334-340. PMID:34898288. doi:10.1177/03635465211061602.
- Leggit JC, Wu H, Janvrin M, Korona-Bailey J, Koehlmoos TP, Schneider EB. Non-Operative Shoulder Dysfunction in the United States Military. Mil Med. 2023;188(5-6):e1003-e1009. PMID:34865115. doi:10.1093/milmed/usab468.
- Parnes N, Perrine J, DeFranco MJ. Outcomes of Simultaneous Arthroscopic Rotator Cuff Repair and Inferior Labral Repair Among Active Patients Younger Than 40 Years. Orthopedics. 2021;44(3):e326-e330. PMID:34039192. doi:10.3928/01477447-20210414-01.
Controlling law
The CFR sections and cases the theories relevant to this condition rest on — the legal standard raters evaluate against, never a prediction about any claim.
Direct (§ 3.303)
Regulation
38 C.F.R. § 3.303
Direct service connection — a current disability linked to service. (Continuity of symptomatology under § 3.303(b) is limited by case law to the § 3.309(a) chronic diseases — Walker.)
Case law
Shedden v. Principi, 381 F.3d 1163 (Fed. Cir. 2004)
The three-element test: current disability, in-service event, and a nexus between them.
Holton v. Shinseki, 557 F.3d 1363 (Fed. Cir. 2009)
Federal Circuit restatement of the same three direct-service-connection elements.
Caluza v. Brown, 7 Vet. App. 498 (1995)
The evidentiary framework a rater weighs each element against.
Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013)
Continuity of symptomatology (§ 3.303(b)) is available ONLY for a chronic disease listed in § 3.309(a); any other condition must use the medical-nexus pathway.
Davidson v. Shinseki, 581 F.3d 1313 (Fed. Cir. 2009)
A categorical 'a medical opinion is always required for nexus' is legal error — competent lay evidence can suffice.
Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007); Layno v. Brown, 6 Vet. App. 465 (1994)
A veteran is competent to report symptoms they personally observe (Layno), and lay evidence can even establish a simple diagnosis in the right case (Jandreau).
McLendon v. Nicholson, 20 Vet. App. 79 (2006)
A LOW threshold — evidence that merely indicates a nexus MAY exist obligates VA to provide a C&P exam.
38 U.S.C. § 5107(b); Gilbert v. Derwinski, 1 Vet. App. 49 (1990)
When the evidence is in relative equipoise, the tie goes to the veteran — the preponderance must be AGAINST the claim to deny it.
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