[Code of Federal Regulations]
[Title 38, Volume 1]
[Revised as of January 1, 2007]
From the U.S. Government Printing Office via GPO Access
[CITE: 38CFR4.56]

[Page 382-384]
 
            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.

[[Page 383]]

    (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 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

[[Page 384]]

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]