[Code of Federal Regulations]

[Title 38, Volume 1]

[Revised as of July 1, 2005]

From the U.S. Government Printing Office via GPO Access

[CITE: 38CFR4.56]



[Page 377-378]

 

            TITLE 38--PENSIONS, BONUSES, AND VETERANS' RELIEF

 

                CHAPTER I--DEPARTMENT OF VETERANS AFFAIRS

 

PART 4_SCHEDULE FOR RATING DISABILITIES--Table of Contents

 

                      Subpart B_Disability Ratings

 

Sec. 4.56  Evaluation of muscle disabilities.



    (a) An open comminuted fracture with muscle or tendon damage will be 

rated as a severe injury of the muscle group involved unless, for 

locations such as in the wrist or over the tibia, evidence establishes 

that the muscle damage is minimal.

    (b) A through-and-through injury with muscle damage shall be 

evaluated as no less than a moderate injury for each group of muscles 

damaged.

    (c) For VA rating purposes, the cardinal signs and symptoms of 

muscle disability are loss of power, weakness, lowered threshold of 

fatigue, fatigue-pain, impairment of coordination and uncertainty of 

movement.

    (d) Under diagnostic codes 5301 through 5323, disabilities resulting 

from muscle injuries shall be classified as slight, moderate, moderately 

severe or severe as follows:

    (1) Slight disability of muscles--(i) Type of injury. Simple wound 

of muscle without debridement or infection.

    (ii) History and complaint. Service department record of superficial 

wound with brief treatment and return to duty. Healing with good 

functional results. No cardinal signs or symptoms of muscle disability 

as defined in paragraph (c) of this section.

    (iii) Objective findings. Minimal scar. No evidence of fascial 

defect, atrophy, or impaired tonus. No impairment of function or 

metallic fragments retained in muscle tissue.

    (2) Moderate disability of muscles--(i) Type of injury. Through and 

through or deep penetrating wound of short track from a single bullet, 

small shell or shrapnel fragment, without explosive effect of high 

velocity missile, residuals of debridement, or prolonged infection.

    (ii) History and complaint. Service department record or other 

evidence of in-service treatment for the wound. Record of consistent 

complaint of one or more of the cardinal signs and symptoms of muscle 

disability as defined in paragraph (c) of this section, particularly 

lowered threshold of fatigue after average use, affecting the particular 

functions controlled by the injured muscles.

    (iii) Objective findings. Entrance and (if present) exit scars, 

small or linear, indicating short track of missile through muscle 

tissue. Some loss of deep fascia or muscle substance or impairment of 

muscle tonus and loss of power or lowered threshold of fatigue when 

compared to the sound side.

    (3) Moderately severe disability of muscles--(i) Type of injury. 

Through and through or deep penetrating wound by small high velocity 

missile or large



[[Page 378]]



low-velocity missile, with debridement, prolonged infection, or 

sloughing of soft parts, and intermuscular scarring.

    (ii) History and complaint. Service department record or other 

evidence showing hospitalization for a prolonged period for treatment of 

wound. Record of consistent complaint of cardinal signs and symptoms of 

muscle disability as defined in paragraph (c) of this section and, if 

present, evidence of inability to keep up with work requirements.

    (iii) Objective findings. Entrance and (if present) exit scars 

indicating track of missile through one or more muscle groups. 

Indications on palpation of loss of deep fascia, muscle substance, or 

normal firm resistance of muscles compared with sound side. Tests of 

strength and endurance compared with sound side demonstrate positive 

evidence of impairment.

    (4) Severe disability of muscles--(i) Type of injury. Through and 

through or deep penetrating wound due to high-velocity missile, or large 

or multiple low velocity missiles, or with shattering bone fracture or 

open comminuted fracture with extensive debridement, prolonged 

infection, or sloughing of soft parts, intermuscular binding and 

scarring.

    (ii) History and complaint. Service department record or other 

evidence showing hospitalization for a prolonged period for treatment of 

wound. Record of consistent complaint of cardinal signs and symptoms of 

muscle disability as defined in paragraph (c) of this section, worse 

than those shown for moderately severe muscle injuries, and, if present, 

evidence of inability to keep up with work requirements.

    (iii) Objective findings. Ragged, depressed and adherent scars 

indicating wide damage to muscle groups in missile track. Palpation 

shows loss of deep fascia or muscle substance, or soft flabby muscles in 

wound area. Muscles swell and harden abnormally in contraction. Tests of 

strength, endurance, or coordinated movements compared with the 

corresponding muscles of the uninjured side indicate severe impairment 

of function. If present, the following are also signs of severe muscle 

disability:

    (A) X-ray evidence of minute multiple scattered foreign bodies 

indicating intermuscular trauma and explosive effect of the missile.

    (B) Adhesion of scar to one of the long bones, scapula, pelvic 

bones, sacrum or vertebrae, with epithelial sealing over the bone rather 

than true skin covering in an area where bone is normally protected by 

muscle.

    (C) Diminished muscle excitability to pulsed electrical current in 

electrodiagnostic tests.

    (D) Visible or measurable atrophy.

    (E) Adaptive contraction of an opposing group of muscles.

    (F) Atrophy of muscle groups not in the track of the missile, 

particularly of the trapezius and serratus in wounds of the shoulder 

girdle.

    (G) Induration or atrophy of an entire muscle following simple 

piercing by a projectile.



(Authority: 38 U.S.C. 1155



[62 FR 30238, June 3, 1997]