A repaired rotator cuff rated zero? How the shoulder is measured, and what to check

The shoulder is rated by how it moves

Range of motion is nearly the whole method.

Permanent disabilityPD Permanent Disability. Compensation for lasting impairment. A different and much lower weekly rate — 2026 maximum $290/week. starts with a number called whole person impairmentWPI — Whole Person Impairment The percentage from the AMA Guides that a rating is built from. Extremity percent is not whole person percent: 100% upper extremity = 60% whole person, 100% lower extremity = 40%. This is the most common source of confusion in a rating.. A physician produces it, usually your treating physician or a Qualified Medical EvaluatorQME Qualified Medical Evaluator. A state-certified physician who resolves disputes. Unrepresented workers get a panel of three by random draw. (a QME, the doctor chosen from a state panel when the two sides disagree), under the AMA Guides to the Evaluation of Permanent Impairment, 5th Edition. The state’s 2005 Permanent Disability Rating Schedule, adopted effective January 1, 2005, builds the Guides into the rating.

Impairment is not disability. The schedule treats the impairment as that of a theoretical average worker aged 39, and then adjusts it for your occupation and your age. But every adjustment works on the impairment. If it is zero, there is nothing to adjust.

The shoulder has essentially one method. Chapter 16 of the Guides covers the upper extremity, the arm from the shoulder to the fingertips. For the shoulder it gives essentially one method, range of motion, plus a short table for a joint replacement and for bone removed in surgery. The schedule lists two shoulder lines, “Shoulder – Range of motion” (16.02.01.00) and “Shoulder – Other” (16.02.02.00), and the first field of your rating stringRating string The row of numbers encoding your entire permanent disability calculation. Checkable arithmetic. tells you which was used.

What is not on the list. There is no entry for a rotator cuff tear, and none for a labral or SLAP tear, a tear in the rim of the socket. A documented full-thickness supraspinatus tear, surgically repaired, with the motion recovered, has a strict rating of zero. That is not an oversight by your doctor or the adjusterClaims administrator / adjuster The person handling your claim for the insurer or self-insured employer.’s doing. It is what the book says.

Shoulder injuries Permanent disability

How a good repair measures zero

The examination measures the motion, not the tear.

The measurement. The evaluator measures the shoulder’s motion plane by plane and records each direction in degrees, with an instrument such as a goniometer, a hinged ruler for angles, not by eye. The Guides turn the degrees into a percentage of the upper extremity through their own charts. Motion the Guides treat as full carries no impairment. Only the motion you have lost carries a value.

Why a good repair lands at zero. A rotator cuff repair is designed to give back exactly what the method measures. When it works, the arm goes up, out and around again, and the degrees look like an unhurt shoulder’s. The tear, the anchors in the bone, the months of therapy and the ache that remains have no entry of their own. A repair with a good result often rates 0–3% of the upper extremity, and full motion is a strict 0%.

One day, in one room. A medical-legal evaluator examines you once. The rating measures what the shoulder can do on the day of the examination, not the repair done to it, which is why your effort in that room matters.

Surgical success and functional success are different things. A repair can heal perfectly on the imaging and still leave you unable to reach overhead. That is lost motion, which is exactly what this method rates, so it belongs in the report as degrees. The same rule runs through the chapter: tennis elbow and trigger finger have no diagnosis value either.

What the strict rating leaves out

Pain, weakness, and the surgery itself.

Pain can supplement a rating. It cannot create one. Chapter 18 of the Guides allows an add-on for pain, and the rating schedule caps it: “The maximum allowance for pain resulting from a single injury is 3% WPI regardless of the number of impairments resulting from that injury.” And the add-on cannot be included where the underlying rating for the industrial condition is 0% whole person impairment. The workers with the most disappointing ratings are the ones least able to use it.

Weakness is rated only in the rare case. The Guides permit a strength rating only in the rare case, and not where there is decreased motion, pain or deformity. Nearly every shoulder case has one of those, so a shoulder that has lost much of its lifting strength usually gets nothing for the weakness itself. It is a real rule, not an evaluator’s choice.

Sleep. For injuries on or after January 1, 2013, the law bars increasing the rating for sleep dysfunction, however often the shoulder wakes you.

What a zero does not take away. A zero is a finding about permanent impairment, not a finding that nothing happened. The injury is still compensable. The treatment it needed was owed, and so was temporary disabilityTD / TTD / TPD Temporary Disability, Total or Partial. Wage replacement while recovering. Two-thirds of average weekly earnings; 2026 maximum $1,764.11/week. while you could not work. Future medical care stays part of the claim unless you settle it away. And your work restrictions are a separate question from the rating: a shoulder that rates zero can still need them, stated in pounds, hours, positions and frequencies.

My pain is worse than my rating

What does carry a value

Lost motion, removed bone, a replaced joint.

Because the tear has no entry, a shoulder rating is built from what the Guides do measure:

• Rotator cuff repair, good result. Motion only. Often 0–3% of the upper extremity.
• Rotator cuff repair, stiffness left. Motion only, and the stiffness is the value.
• Decompression alone, for impingement. Motion only. Full motion is a strict zero.
• Labral or SLAP repair. Motion only. No diagnosis value exists.
• Distal clavicle resection. A fixed 10% of the upper extremity, combined with any motion loss, however the shoulder moves on the day of the examination.
• Frozen shoulder (adhesive capsulitis). Rated on motion, and it rates well, because it is motion loss.
• Total shoulder replacement. A table value, combined with motion.
• Reverse total shoulder replacement. Not addressed by the Guides at all.

The resection. A distal clavicle resection removes the end of the collarbone. Surgeons often perform it at the same time as a cuff repair, and it gets buried in the middle of the operative report. It is frequently the largest single component of a shoulder rating, and it is routinely omitted.

From degrees to dollars

Upper extremity, whole person, the 1.4, the weeks.

Upper extremity is not whole person. The schedule converts an upper extremity percentage by multiplying by 0.6, so 100% of the upper extremity is 60% of the whole person. A report saying “20% upper extremity impairment” is 12% whole person, not 20% disability.

The 1.4. For injuries on or after January 1, 2013, the whole person impairment is multiplied by 1.4 and rounded: 12 × 1.4 = 16.8, which rounds to 17.

Occupation and age. Your occupational group is assigned by what you actually did all day, not your job title, and a variant letter adjusts it for the body part; variant F is neutral. Your age is your age on the date of injuryDate of injury For a cumulative or occupational disease claim, the law sets it as when you first suffered disability and knew or should have known it was work-related — not when the wear began. Almost every deadline runs off this., and the neutral bracket is 37 to 41.

Weeks and dollars. The final percentage converts to weeks, 3 a point at the bottom of the scale rising to 16 at the top, and the weeks accumulate as the rating climbs. For an injury in 2014 or later, each week pays two-thirds of your average weekly earnings, at least $160 and at most $290, a range unchanged since January 1, 2014. Anyone earning about $435 a week or more is paid the $290.

Three readings of one surgery. Take an illustrative worker hurt in 2014 or later, 39 on the date of injury, in a job whose variant is neutral, and paid the $290 maximum. Three reports describe the same repair:

1. Motion recovered, nothing else. 0% of the upper extremity, 0% whole person, 0 after the 1.4. No weeks, $0.
2. Motion recovered, and a distal clavicle resection. 10% of the upper extremity, 6% whole person, and 6 × 1.4 = 8.4, which rounds to 8. That is 24.00 weeks, or $6,960.
3. Stiffness measured at 20% of the upper extremity. 12% whole person, 17 after the 1.4, 60.50 weeks, or $17,545.

The first two rows describe the same clinical outcome. They differ only in whether the examiner read the operative report closely enough to find the resection.

Two parts of one arm. The schedule converts and adjusts each part of an arm before combining it with the others, so a shoulder and an elbow on the same arm should not be merged into one number and adjusted once.

The permanent disability calculator The rating string decoder

When a zero is wrong on its face

Errors a careful read and a calculator can find.

These errors need no medical opinion to spot.

• The resection is missing. The operative report shows one, and the rating string has no value for it.
• The motion was never recorded. A shoulder that was stiff at the examination should have degrees in the report, plane by plane, because those degrees are the rating. A number, or a zero, given without the chapter, table and method behind it cannot be checked, which is itself a reason to challenge it.
• The string does not add up. For an injury from 2013 on, whole person impairment × 1.4, rounded, must equal the adjusted figure. A 12 next to an adjusted 12 is wrong on its face, because 12 × 1.4 rounds to 17.
• A body part is missing. A shoulder in your treatment records but never addressed with findings contributes nothing. So does the other shoulder or the neck that started hurting because you were compensating, if nobody claimed it.
• The stiffness was never rated. A frozen shoulder after surgery is motion loss. A report that rates the repair and ignores the stiffness has rated the wrong thing.

The rating measures what the shoulder can do on the day of the examination, not the repair done to it.

How to read your medical-legal report I don’t agree with the QME report

When the strict number plainly fails

Almaraz/GuzmanAlmaraz/Guzman The doctrine permitting a physician to depart from the strict AMA rating where it does not accurately reflect the impairment, using another method inside the “four corners” of the Guides.: a better method, from inside the Guides.

What the Appeals Board held. In Almaraz/Guzman II, an en banc decision of the Workers’ Compensation Appeals BoardWCAB Workers’ Compensation Appeals Board. The court system that decides these cases. 23 district offices statewide. (one made by the full Board) issued on September 3, 2009, the Board held that a permanent disability rating established by the schedule is rebuttable, and that the burden of rebutting it rests with the party disputing it. A physician may use any chapter, table or method in the AMA Guides that most accurately reflects the injured worker’s impairment. But it is not permissible to go outside the four corners of the Guides.

What followed. The Court of Appeal affirmed in Milpitas Unified School District v. WCAB (Guzman), decided in 2010, reasoning that the Guides’ own instructions call for clinical judgment. The section of the Labor Code that sets the 1.4 for injuries from 2013 says the Legislature did not intend to overrule that decision.

What the opinion has to do. A valid opinion does four things:

1. Gives the strict rating first, and states it.
2. Explains why it does not accurately capture your impairment, with facts about you.
3. Identifies the alternative method inside the Guides, naming the chapter, table or figure.
4. Explains why the alternative is more accurate for you.

What fails. The opinion must set out the facts and reasoning that justify it, or it is not substantial evidenceSubstantial evidence The standard a medical opinion must meet to support a finding.. A bare assertion that the strict rating “does not reflect” the impairment is rejected, and the Board said a physician may not pick a method “simply to achieve a desired result.”

Where it fits a shoulder. A reverse total shoulder replacement, which was not in general use when the Fifth Edition was published, deliberately trades motion for stability, so rating it on motion alone badly understates it. A repaired rotator cuff that rates zero is the classic example of a strict rating that may not describe the person, but the zero alone is not the argument. The argument is what the shoulder cannot do, documented, and a method inside the Guides that captures it better. Pain far out of proportion to the rating is argued here, not in the pain add-on.

What is Almaraz/Guzman?

The apportionment paragraph

Disability, not pathology.

Apportionment divides permanent disability between the work injury and other causes, and the employer pays only for the share the work injury directly caused. A zero has nothing to apportion. Once a shoulder rates, apportionment to degeneration is the standard defense move.

The argument to expect. Asymptomatic rotator cuff tears are common with age, above 50% prevalence in people over 60, so the evaluator calls your tear degenerative and assigns a large share to pre-existing disease.

The answer. The epidemiology cuts both ways. If more than half of people over sixty have asymptomatic cuff tears and are not disabled, the tear by itself does not produce disability. Apportionment is to disability, not to pathology.

The percentage has to be explained. In EscobedoEscobedo The en banc decision requiring an apportionment opinion to explain how and why. A percentage without reasoning is not substantial evidence. v. Marshalls, an en banc decision of the Appeals Board in 2005, the Board held that a physician who blames part of a disability on another cause has to explain how and why. A percentage with no reasoning is not substantial evidence. An evaluator who reviewed no pre-injury records has no factual basis for any number.

Not every rule runs your way. In City of Petaluma v. WCAB (Lindh), decided in 2018, the Court of Appeal held that a pre-existing condition that never disabled anyone can support apportionment. What the law still requires is substantial medical evidence that the condition caused part of this disability.

The imaging. The defense uses fatty infiltration of the muscle and retraction of the tendon to argue a tear is old. Their absence, with fluid signal, muscle edema, an acute mechanism and an immediate loss of function, supports an acute traumatic tear.

A frozen shoulder after surgery. It is frequently the largest part of a shoulder’s impairment. In Hikida v. WCAB, decided in 2017, the Court of Appeal held that disability caused by industrial medical treatment is industrial. But in County of Santa Clara v. WCAB (Justice), decided in 2020, the court held that Hikida bars apportionment only where the industrial medical treatment is the sole cause of the permanent disability. Where the old tear also contributes, apportionment can still apply.

Apportionment The surgery made it worse

Before and at the evaluation

The measurement happens once. Prepare for it.

1. Read the operative report first. Search it for the four phrases, and make sure it is among the records the evaluator receives.
2. Find the baseline. Motion, strength and function documented before the surgery are what the findings after it get measured against.
3. List every body part. Including the other shoulder or the neck that started hurting because you were compensating. A body part you do not mention will not be in the report.
4. Write down what the shoulder cannot do, in numbers. “I can reach overhead about twice, and then the shoulder is done for the day” is a usable finding. “It hurts” is not. These facts do not change the degrees, but restrictions and any Almaraz/Guzman opinion are built from them.
5. Describe the work. What you did at or above shoulder height, how often, with what weight, for how many years.
6. Give your genuine best effort. Move as far as you actually can, and say out loud when pain stops you. A documented “stopped due to pain” is data. A worker who holds back to protect a painful arm can be scored as invalid, which can void the impairment finding entirely.
7. Be accurate, including the good days. “On a good day I can do this, and then I’m down for the rest of the day” is truthful, and a surveillance video cannot contradict it.
8. Disclose every prior injury. Hiding one is an expensive and avoidable mistake.

Afterward, write down what happened. How long the examination took, and whether the motion was measured with an instrument. If the report later records motion you did not show, that note is where the correction starts.

What happens at my QME appointment Sent to a QME? From the panel to the report

After the report, before the settlement conference

Where a zero can still be fixed, and when to leave it alone.

If you have no lawyer. The Disability Evaluation UnitDEU Disability Evaluation Unit. Produces formal ratings from medical reports. of the Division of Workers’ Compensation rates the medical report and must serve the rating within 20 days of receiving a complete package. You have 30 days from receiving a QME’s report to request factual correction on QME Form 37, and 30 days from receiving the summary rating to ask, in writing, for reconsideration.

If you have a lawyer. The routes are a supplemental report, a deposition of the evaluator, and an argument that the report is not substantial evidence.

The practical deadline. Discovery closes at the mandatory settlement conferenceMSC Mandatory Settlement Conference. Where most cases end — and where discovery closes., and a supplemental report or deposition obtained after it is generally not admissible.

When you do not need a lawyer for this. If the motion came back, no bone was removed, the string adds up and every body part is addressed, the zero is probably the book working as written. Every district office of the Division of Workers’ Compensation has a free Information & Assistance officer for unrepresented workers. A consultation with this office costs nothing, and if there is nothing worth doing, we will tell you that.

A settlement offer, read line by line When you don’t need a lawyer

A file to keep for a shoulder rating

One folder, started before the examination.

• The operative report — Searched for the four phrases, with the page marked.
• The baseline — Any record of your motion, strength and function before the surgery.
• Your own list — Every body part, what the shoulder cannot do, and what your job asked of it.
• Your note of the examination — The date, and how the motion was measured.
• The degrees — The page of the report that records the motion, plane by plane, or a note that there is none.
• The conversion and the string — Upper extremity and whole person side by side, and whole person impairment × 1.4, rounded, against the adjusted figure.
• The apportionment paragraph — And the list of records the evaluator reviewed.
• The dates — The day you received the report and the rating, 30 days on from each, and the settlement conference once it is set.