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5201 – Limitation of Motion of Arm

Rating Criteria Major Minor
5201 Arm, limitation of motion of:
Flexion and/or abduction limited to 25° from side 40 30
Midway between side and shoulder level (flexion and/or abduction limited to 45°) 30 20
At shoulder level (flexion and/or abduction limited to 90°) 20 20