Schedule for Rating Disabilities; Muscle Injuries

DEPARTMENT OF VETERANS AFFAIRS

38 CFR Part 4

RIN 2900-AE89

Schedule for Rating Disabilities; Muscle Injuries

AGENCY: Department of Veterans Affairs.

ACTION: Final rule.

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SUMMARY: This document amends the Department of Veterans Affairs (VA)

Schedule for Rating Disabilities of Muscle Injuries. These amendments

are made because medical science has advanced, and commonly used

medical terms have changed. The effect of these amendments is to update

this portion of the rating schedule to ensure that it uses current

medical terminology and unambiguous criteria, and that it reflects

medical advances that have occurred since the last review.

EFFECTIVE DATE: July 3, 1997.

FOR FURTHER INFORMATION CONTACT: Caroll McBrine, M.D., Consultant,

Regulations Staff, Compensation and Pension Service (213A), Veterans

Benefits Administration, Department of Veterans Affairs, 810 Vermont

Ave., NW, Washington DC, 20420 (202) 273-7230.

SUPPLEMENTARY INFORMATION: VA published in the Federal Register of June

16, 1993 (58 FR 33235), a proposal to amend those sections of 38 CFR

part 4, subpart B, concerning muscle injuries. Interested persons were

invited to submit written comments, suggestions or objections on or

before July 16, 1993. We received comments from Disabled American

Veterans, Veterans of Foreign Wars, Paralyzed Veterans of America and

two individuals.

Before this amendment, several sections preceding Sec. 4.71a,

``Schedule of ratings-musculoskeletal system,'' contained loosely

organized and ambiguous medical discussions of injuries and general

physiology of the muscles. We proposed to delete redundant material and

reorganize the rest.

Three of the commenters suggested that the sections preceding the

evaluation criteria be retained without change, since the information

in those sections is neither redundant nor readily available elsewhere,

especially to the public.

Much of the material in the sections preceding the musculoskeletal

portion of the rating schedule was background medical information, and

some of it was directed toward medical examiners. We

[[Page 30236]]

proposed to remove that material because it neither prescribed VA

policy nor established procedures a rating board must follow and was,

therefore, not appropriate in a regulation, which is an agency

statement of general applicability and future effect that the agency

intends to have the force and effect of law. Excluding this material

enhances the clarity of the regulations, and we make no change based on

these comments. Those portions of the deleted sections that were

substantive rules, such as the requirement in former Sec. 4.49 to

review the complete history of an injury, are contained elsewhere in

VA's regulations and need not be repeated here.

One commenter suggested that the sections concerning only muscle

injuries or diseases be moved to immediately precede Sec. 4.73,

``Schedule of ratings-muscle injuries.''

Although the commenter has a valid point, previously, Secs. 4.40

through 4.73 dealt with various aspects of the musculoskeletal system

as a whole. With this rulemaking we have begun the process of

addressing ``muscle injuries'' and ``the orthopedic system''

separately. We will address the orthopedic system in a separate

rulemaking and will review the remaining introductory sections in that

rulemaking.

Proposed Sec. 4.55(d) would have limited the combined evaluation

for muscle groups acting on a single unankylosed joint to the

evaluation for intermediate ankylosis of that joint. One commenter

pointed out that Sec. 4.71a, diagnostic code (DC) 5256, provides two

evaluations for intermediate ankylosis of the knee, and suggested that

Sec. 4.55(d) specify which of those two evaluations would be assigned

under these circumstances.

As the commenter noted, ankylosis of a joint that is less severe

than unfavorable ankylosis is not always expressed as ``intermediate

ankylosis.'' For the sake of clarity, we have revised Sec. 4.55(d) to

require that the combined evaluation of muscle groups acting upon a

single unankylosed joint must be lower than the evaluation for

unfavorable ankylosis of that joint. This is not a substantive change.

We proposed to state the principles of combined ratings for muscle

injuries in Sec. 4.55. Proposed paragraph (e) states that for

compensable muscle group injuries which are in the same anatomical

region but do not act on the same joint, the evaluation for the most

severely injured muscle group will be increased by one level and used

as the combined evaluation for the affected muscle groups. A commenter

suggested removing proposed Sec. 4.55(e) because it would provide a

lower evaluation than Sec. 4.55(d) would for an equally disabled

veteran.

The combined evaluation for muscle injuries in the same anatomical

region and the combined evaluation for muscle injuries affecting a

single joint represent assessments of two different types of disability

and are not directly comparable. In both cases, however, the intent of

Sec. 4.55 is to assure that the combined evaluation of muscle injuries

will not exceed the highest evaluation that the schedule assigns for

other types of musculoskeletal or neurologic disabilities affecting a

single joint or anatomical region. Proposed Sec. 4.55(e) was derived

from former Sec. 4.55(a) and involves no substantive change from the

earlier provision, and we make no change based on this comment.

Proposed Sec. 4.56 provides guidelines for evaluating certain

muscle disabilities and gives detailed descriptions of the expected

history and findings in muscle injuries of various degrees of severity.

One commenter suggested that retaining ``evidence of unemployability

because of inability to keep up with work requirements'' in proposed

Sec. 4.56(d) (3)(ii) and (4)(ii) under the ``History and complaints''

headings for moderately severe and severe muscle disability is

inappropriate because evidence of unemployability should entitle a

veteran to a total rating on an extraschedular basis.

We agree that evidence of unemployability is not an appropriate

criterion for less than total evaluations, so we have revised Sec. 4.56

to delete the references to unemployability.

Proposed Sec. 4.56(d)(3)(iii) required that an entrance scar be

large to qualify for moderately severe muscle disability. One commenter

pointed out the incongruity between requiring a large entrance scar

when a small, high velocity missile will qualify for moderately severe

muscle disability under proposed Sec. 4.56(d)(3)(i) and suggested that

the word ``large'' be repositioned so as to apply only to exit scars.

We agree that there is an incongruity. We have therefore changed

Sec. 4.56(d)(3)(iii) to require an entrance scar without specifying its

size.

One commenter stated that the rearrangement of language in proposed

Sec. 4.56(d)(4)(i) in effect requires a more serious injury than former

Sec. 4.56(d) did to qualify for severe muscle disability.

Since we did not intend to propose a substantive change, we have

revised the wording in Sec. 4.56(d)(4)(i) to retain the requirement of

former Sec. 4.56(d) with only minor editorial changes for clarity.

One commenter stated that changing the degree of impairment of

function required under ``Objective findings'' in severe muscle

disability (in proposed Sec. 4.56(d)(4)(iii)) from ``severe'' to

``extreme'' is a substantive change to a more stringent requirement.

The commenter thought that ``severe'' should be replaced with an

objective and quantifiable synonym for severe.

The use of ``extreme'' rather than ``severe'' was inadvertent and

not intended to be a substantive change. Section 4.56(d)(4) objectively

defines ``severe'' disability of muscles, and for the sake of

consistency, and to prevent any misunderstanding about the extent of

functional impairment required, we have changed ``extreme'' back to

``severe.''

One commenter feared that the evaluation instructions for proposed

DC 5325, ``Muscle injury, facial muscles,'' could easily be

misinterpreted to require cranial nerve injury for a compensable rating

for facial muscle injury. The commenter suggested that the instructions

be changed back to the instructions in former Sec. 4.54: ``Facial

muscles will be rated in accordance with interference with the

functions supplied by the cranial nerves.'' The commenter also

suggested an appropriate cross-reference under DC 5325 to DC 7800,

``Scars, disfiguring, head, face or neck.''

We agree that the evaluation instructions under proposed DC 5325

were ambiguous and have revised them in response to the comment by

directing that functional impairment due to injury to facial muscles be

evaluated as seventh (facial) cranial nerve neuropathy (DC 8207),

disfiguring scar (DC 7800), etc.

Two commenters suggested that we retain the footnote that refers to

special monthly compensation, which we proposed to delete.

We agree and have reinstated a footnote following the 50-percent

evaluation for DC 5317, muscle group XVII, reminding the rater to refer

to Sec. 3.350(a)(3) to determine whether the veteran may be entitled to

special monthly compensation. We are also retaining the note at the

beginning of Sec. 4.73, referring to Sec. 3.350, to clearly remind

rating specialists that there is potential entitlement to special

monthly compensation when evaluating any muscle injuries resulting in

loss of use of any extremity or of both buttocks.

One commenter stated that proposed Sec. 4.73, DC's 5327 and 5329,

should provide a one-year convalescent period following cessation of

treatment for malignant growths of the muscles. Another commenter

pointed out that

[[Page 30237]]

total ratings might be assigned under those diagnostic codes after the

expiration of the six-month period at which a VA examination is

mandated, and questioned how such cases will be processed under the

proposed rule.

We make no change based on the first comment. Former Sec. 4.73,

DC's 5327 and 5329, provided a total rating that would extend to six

months after cessation of treatment, when, in the absence of local

recurrence or metastasis, a rating was to be made on residuals. As

proposed, these diagnostic codes would provide that a total rating

continue following cessation of treatment with a VA examination

required after the expiration of six months. In the absence of local

recurrence or metastasis, the rating would be based on residual

impairment of function. However, the total rating will continue as long

as the findings on examination warrant it.

The second commenter's concern appears to be whether medical

information justifying a convalescence evaluation submitted months

after the event would require application of the provisions of

Sec. 3.105(e). Since Sec. 3.105(e) applies only to reductions in

``compensation payments currently being made,'' it would not apply in

cases where a total evaluation is assigned and reduced retroactively.

One commenter suggested that there should be specific instructions

for rating muscle impairment associated with muscle disease, such as

multiple sclerosis.

Some muscle diseases, such as muscle neoplasms, are likely to

produce impairment similar to that produced by muscle injuries.

Disability resulting from such diseases should be evaluated under the

provisions of Sec. 4.73, as neoplasms are under DC 5327-5329. Other

muscle diseases, however, produce impairment more similar to that

produced by neurological diseases than that produced by muscle

injuries. Disability resulting from those muscle diseases should be

evaluated under appropriate criteria in Sec. 4.124a. Furthermore,

nothing in Sec. 4.73 precludes evaluation of disability resulting from

a muscle disease if the impairment is more similar to that produced by

muscle injuries. Therefore, we make no change based on this comment.

One commenter stated that ``absence of impairment of function'' is

an objective finding and should, therefore, be under ``Objective

findings'' in Sec. 4.56(d)(1)(iii) rather than ``Type of injury'' in

Sec. 4.56(d)(1)(i).

We agree and have removed this reference to impairment of function

from the ``Type of injury'' subparagraph. It is already included in the

``Objective findings'' subparagraph.

One commenter stated that proposed Sec. 4.55(c)(2) is a substantive

change in that it, unlike former Sec. 4.50, does not provide a separate

rating for the extrinsic muscles of an ankylosed shoulder where these

muscles are less than severely disabled.

We do not agree. Former Sec. 4.50 did not authorize a rating for

less-than-severely disabled extrinsic muscles of the shoulder girdle

acting on an ankylosed joint. Former Sec. 4.50 must be read with former

Sec. 4.55(d). Read together, they clearly limit the assignment of a

separate rating for extrinsic muscles of the shoulder girdle acting on

an ankylosed joint to such muscles at least severely disabled. The

provisions of proposed Sec. 4.55(c) are derived directly from former

Sec. 4.55 (b) and (d), which stated that severe injury to the extrinsic

muscles of the shoulder (groups I and II) with ankylosis of the

shoulder may elevate the rating of the shoulder to that for unfavorable

ankylosis of the joint. Thus, former Sec. 4.50, when read with former

Sec. 4.55 (b) and (d), did not provide for a separate rating for less-

than-severely disabled extrinsic muscles acting on an ankylosed

shoulder. The reorganization of these instructions has helped clarify

these exceptions to the rule precluding a separate rating for muscle

groups which act upon an ankylosed joint but is nothing more than an

editorial change.

We have made several other nonsubstantive, editorial changes to the

proposed rule based on our own review of the proposed regulation.

We also corrected the proposed list of the plantar group of

intrinsic muscles of the foot under Group X (DC 5310) by adding

``adductor hallucis'' (which was inadvertently omitted in the proposed

rule), removing ``opponens digiti V'' (a hand muscle), moving ``dorsal

interossei'' from the dorsal group (the plantar and dorsal interossei

are both considered plantar muscles in standard anatomy textbooks), and

changing ``flexor hallucis'' to ``flexor hallucis brevis,'' its more

complete name, in order to distinguish it from ``flexor hallucis

longus,'' a muscle in another group. We added ``peroneus brevis'' and

``plantaris'' to the proposed list of posterior and lateral crural

muscles and muscles of the calf in Group XI (DC 5311) because they were

not included in the proposed rule, and standard anatomy textbooks place

them in this group. We corrected the proposed list of muscles in Group

XII (DC 5312) by removing ``flexor digitorum longus,'' which does not

belong in this group, and adding ``extensor digitorum longus'' and

``extensor hallucis longus.''

VA appreciates the comments submitted in response to the proposed

rule, which is now adopted with the amendments noted above.

The Secretary hereby certifies that this regulatory amendment will

not have a significant economic impact on a substantial number of small

entities as they are defined in the Regulatory Flexibility Act, 5

U.S.C. 601-612. This amendment would not directly affect any small

entities. Only VA beneficiaries could be directly affected. Therefore,

pursuant to 5 U.S.C. 605(b), this amendment is exempt from the initial

and final flexibility analysis requirements of sections 603 and 604.

This regulatory action has been reviewed by the Office of Management

and Budget under Executive Order 12866.

The Catalog of Federal Domestic Assistance numbers are 64.104 and

64.109.

List of Subjects in 38 CFR Part 4

Disability benefits, Individuals with disabilities, Pensions,

Veterans.

Approved: March 5, 1997.

Jesse Brown,

Secretary of Veterans Affairs.

For the reasons set out in the preamble, 38 CFR part 4, subpart B,

is amended as set forth below:

PART 4--SCHEDULE FOR RATING DISABILITIES

1. The authority citation for part 4 continues to read as follows:

Authority: 38 U.S.C. 1155.

Subpart B--Disability Ratings

Secs. 4.47--4.54 [Removed and reserved]

2. Sections 4.47 through 4.54 are removed and reserved.

3. Section 4.55 is revised to read as follows:

Sec. 4.55 Principles of combined ratings for muscle injuries.

(a) A muscle injury rating will not be combined with a peripheral

nerve paralysis rating of the same body part, unless the injuries

affect entirely different functions.

(b) For rating purposes, the skeletal muscles of the body are

divided into 23 muscle groups in 5 anatomical regions: 6 muscle groups

for the shoulder girdle and arm (diagnostic codes 5301 through 5306); 3

muscle groups for the forearm and hand (diagnostic codes 5307 through

5309); 3 muscle groups for the foot and leg (diagnostic codes 5310

through 5312); 6 muscle groups for the

[[Page 30238]]

pelvic girdle and thigh (diagnostic codes 5313 through 5318); and 5

muscle groups for the torso and neck (diagnostic codes 5319 through

5323).

(c) There will be no rating assigned for muscle groups which act

upon an ankylosed joint, with the following exceptions:

(1) In the case of an ankylosed knee, if muscle group XIII is

disabled, it will be rated, but at the next lower level than that which

would otherwise be assigned.

(2) In the case of an ankylosed shoulder, if muscle groups I and II

are severely disabled, the evaluation of the shoulder joint under

diagnostic code 5200 will be elevated to the level for unfavorable

ankylosis, if not already assigned, but the muscle groups themselves

will not be rated.

(d) The combined evaluation of muscle groups acting upon a single

unankylosed joint must be lower than the evaluation for unfavorable

ankylosis of that joint, except in the case of muscle groups I and II

acting upon the shoulder.

(e) For compensable muscle group injuries which are in the same

anatomical region but do not act on the same joint, the evaluation for

the most severely injured muscle group will be increased by one level

and used as the combined evaluation for the affected muscle groups.

(f) For muscle group injuries in different anatomical regions which

do not act upon ankylosed joints, each muscle group injury shall be

separately rated and the ratings combined under the provisions of

Sec. 4.25. (Authority: 38 U.S.C. 1155)

4. Section 4.56 is revised to read as follows:

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 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)

[[Page 30239]]

5. Section 4.69 is revised to read as follows:

Sec. 4.69 Dominant hand.

Handedness for the purpose of a dominant rating will be determined

by the evidence of record, or by testing on VA examination. Only one

hand shall be considered dominant. The injured hand, or the most

severely injured hand, of an ambidextrous individual will be considered

the dominant hand for rating purposes.

(Authority: 38 U.S.C. 1155)

Sec. 4.72 [Removed and Reserved]

6. Section 4.72 is removed and reserved.

7. Section 4.73 is revised to read as follows:

Sec. 4.73 Schedule of Ratings--Muscle Injuries.

Note: When evaluating any claim involving muscle injuries

resulting in loss of use of any extremity or loss of use of both

buttocks (diagnostic code 5317, Muscle Group XVII), refer to

Sec. 3.350 of this chapter to determine whether the veteran may be

entitled to special monthly compensation.

The Shoulder Girdle and Arm

------------------------------------------------------------------------

Rating

----------------------

Dominant Nondominant

------------------------------------------------------------------------

5301 Group I. Function: Upward rotation of

scapula; elevation of arm above shoulder level.

Extrinsic muscles of shoulder girdle: (1)

Trapezius; (2) levator scapulae; (3) serratus

magnus..........................................

Severe....................................... 40 30

Moderately Severe............................ 30 20

Moderate..................................... 10 10

Slight....................................... 0 0

5302 Group II. Function: Depression of arm from

vertical overhead to hanging at side (1, 2);

downward rotation of scapula (3, 4); 1 and 2 act

with Group III in forward and backward swing of

arm. Extrinsic muscles of shoulder girdle: (1)

Pectoralis major II (costosternal); (2)

latissimus dorsi and teres major (teres major,

although technically an intrinsic muscle, is

included with latissimus dorsi); (3) pectoralis

minor; (4) rhomboid.............................

Severe....................................... 40 30

Moderately Severe............................ 30 20

Moderate..................................... 20 20

Slight....................................... 0 0

5303 Group III. Function: Elevation and

abduction of arm to level of shoulder; act with

1 and 2 of Group II in forward and backward

swing of arm. Intrinsic muscles of shoulder

girdle: (1) Pectoralis major I (clavicular); (2)

deltoid.........................................

Severe....................................... 40 30

Moderately Severe............................ 30 20

Moderate..................................... 20 20

Slight....................................... 0 0

5304 Group IV. Function: Stabilization of

shoulder against injury in strong movements,

holding head of humerus in socket; abduction;

outward rotation and inward rotation of arm.

Intrinsic muscles of shoulder girdle: (1)

Supraspinatus; (2) infraspinatus and teres

minor; (3) subscapularis; (4) coracobrachialis..

Severe....................................... 30 20

Moderately Severe............................ 20 20

Moderate..................................... 10 10

Slight....................................... 0 0

5305 Group V. Function: Elbow supination (1)

(long head of biceps is stabilizer of shoulder

joint); flexion of elbow (1, 2, 3). Flexor

muscles of elbow: (1) Biceps; (2) brachialis;

(3) brachioradialis.............................

Severe....................................... 40 30

Moderately Severe............................ 30 20

Moderate..................................... 10 10

Slight....................................... 0 0

5306 Group VI. Function: Extension of elbow

(long head of triceps is stabilizer of shoulder

joint). Extensor muscles of the elbow: (1)

Triceps; (2) anconeus...........................

Severe....................................... 40 30

Moderately Severe............................ 30 20

Moderate..................................... 10 10

Slight....................................... 0 0

------------------------------------------------------------------------

The Forearm and Hand

------------------------------------------------------------------------

Rating

----------------------

Dominant Nondominant

------------------------------------------------------------------------

5307 Group VII. Function: Flexion of wrist and

fingers. Muscles arising from internal condyle

of humerus: Flexors of the carpus and long

flexors of fingers and thumb; pronator..........

Severe....................................... 40 30

Moderately Severe............................ 30 20

Moderate..................................... 10 10

Slight....................................... 0 0

5308 Group VIII. Function: Extension of wrist,

fingers, and thumb; abduction of thumb. Muscles

arising mainly from external condyle of humerus:

Extensors of carpus, fingers, and thumb;

supinator.......................................

Severe....................................... 30 20

Moderately Severe............................ 20 20

Moderate..................................... 10 10

Slight....................................... 0 0

5309 Group IX. Function: The forearm muscles act

in strong grasping movements and are

supplemented by the intrinsic muscles in

delicate manipulative movements. Intrinsic

muscles of hand: Thenar eminence; short flexor,

opponens, abductor and adductor of thumb;

hypothenar eminence; short flexor, opponens and

abductor of little finger; 4 lumbricales; 4

dorsal and 3 palmar interossei..................

Note: The hand is so compact a structure that

isolated muscle injuries are rare, being nearly

always complicated with injuries of bones,

joints, tendons, etc. Rate on limitation of

motion, minimum 10 percent.

------------------------------------------------------------------------

The Foot and Leg

------------------------------------------------------------------------

Rating

------------------------------------------------------------------------

5310 Group X. Function: Movements of forefoot and toes;

propulsion thrust in walking. Intrinsic muscles of the foot:

Plantar: (1) Flexor digitorum brevis; (2) abductor hallucis;

(3) abductor digiti minimi; (4) quadratus plantae; (5)

lumbricales; (6) flexor hallucis brevis; (7) adductor

hallucis; (8) flexor digiti minimi brevis; (9) dorsal and

plantar interossei. Other important plantar structures:

Plantar aponeurosis, long plantar and calcaneonavicular

ligament, tendons of posterior tibial, peroneus longus, and

long flexors of great and little toes........................

Severe.................................................... 30

Moderately Severe......................................... 20

Moderate.................................................. 10

Slight.................................................... 0

Dorsal: (1) Extensor hallucis brevis; (2) extensor digitorum

brevis. Other important dorsal structures: cruciate, crural,

deltoid, and other ligaments; tendons of long extensors of

toes and peronei muscles.....................................

Severe.................................................... 20

Moderately Severe......................................... 10

Moderate.................................................. 10

Slight.................................................... 0

Note: Minimum rating for through-and-through wounds of the

foot--10.

5311 Group XI. Function: Propulsion, plantar flexion of foot

(1); stabilization of arch (2, 3); flexion of toes (4, 5);

lexion of knee (6). Posterior and lateral crural muscles, and

muscles of the calf: (1) Triceps surae (gastrocnemius and

soleus); (2) tibialis posterior; (3) peroneus longus; (4)

peroneus brevis; (5) flexor hallucis longus; (6) flexor

digitorum longus; (7) popliteus; (8) plantaris...............

Severe.................................................... 30

Moderately Severe......................................... 20

Moderate.................................................. 10

Slight.................................................... 0

[[Page 30240]]

5312 Group XII. Function: Dorsiflexion (1); extension of toes

(2); stabilization of arch (3). Anterior muscles of the leg:

(1) Tibialis anterior; (2) extensor digitorum longus; (3)

extensor hallucis longus; (4) peroneus tertius...............

Severe.................................................... 30

Moderately Severe......................................... 20

Moderate.................................................. 10

Slight.................................................... 0

------------------------------------------------------------------------

The Pelvic Girdle and Thigh

------------------------------------------------------------------------

Rating

------------------------------------------------------------------------

5313 Group XIII. Function: Extension of hip and flexion of

knee; outward and inward rotation of flexed knee; acting with

rectus femoris and sartorius (see XIV, 1, 2) synchronizing

simultaneous flexion of hip and knee and extension of hip and

knee by belt-over-pulley action at knee joint. Posterior

thigh group, Hamstring complex of 2-joint muscles: (1) Biceps

femoris; (2) semimembranosus; (3) semitendinosus.............

Severe.................................................... 40

Moderately Severe......................................... 30

Moderate.................................................. 10

Slight.................................................... 0

5314 Group XIV. Function: Extension of knee (2, 3, 4, 5);

simultaneous flexion of hip and flexion of knee (1); tension

of fascia lata and iliotibial (Maissiat's) band, acting with

XVII (1) in postural support of body (6); acting with

hamstrings in synchronizing hip and knee (1, 2). Anterior

thigh group: (1) Sartorius; (2) rectus femoris; (3) vastus

externus; (4) vastus intermedius; (5) vastus internus; (6)

tensor vaginae femoris.......................................

Severe.................................................... 40

Moderately Severe......................................... 30

Moderate.................................................. 10

Slight.................................................... 0

5315 Group XV. Function: Adduction of hip (1, 2, 3, 4);

flexion of hip (1, 2); flexion of knee (4). Mesial thigh

group: (1) Adductor longus; (2) adductor brevis; (3) adductor

magnus; (4) gracilis.........................................

Severe.................................................... 30

Moderately Severe......................................... 20

Moderate.................................................. 10

Slight.................................................... 0

5316 Group XVI. Function: Flexion of hip (1, 2, 3). Pelvic

girdle group 1: (1) Psoas; (2) iliacus; (3) pectineus........

Severe.................................................... 40

Moderately Severe......................................... 30

Moderate.................................................. 10

Slight.................................................... 0

5317 Group XVII. Function: Extension of hip (1); abduction of

thigh; elevation of opposite side of pelvis (2, 3); tension

of fascia lata and iliotibial (Maissiat's) band, acting with

XIV (6) in postural support of body steadying pelvis upon

head of femur and condyles of femur on tibia (1). Pelvic

girdle group 2: (1) Gluteus maximus; (2) gluteus medius; (3)

gluteus minimus..............................................

Severe.................................................... *50

Moderately Severe......................................... 40

Moderate.................................................. 20

Slight.................................................... 0

5318 Group XVIII. Function: Outward rotation of thigh and

stabilization of hip joint. Pelvic girdle group 3: (1)

Pyriformis; (2) gemellus (superior or inferior); (3)

obturator (external or internal); (4) quadratus femoris......

Severe.................................................... 30

Moderately Severe......................................... 20

Moderate.................................................. 10

Slight.................................................... 0

------------------------------------------------------------------------

* If bilateral, see Sec. 3.350(a)(3) of this chapter to determine

whether the veteran may be entitled to special monthly compensation.

The Torso and Neck

------------------------------------------------------------------------

Rating

------------------------------------------------------------------------

5319 Group XIX. Function: Support and compression of

abdominal wall and lower thorax; flexion and lateral motions

of spine; synergists in strong downward movements of arm (1).

Muscles of the abdominal wall: (1) Rectus abdominis; (2)

external oblique; (3) internal oblique; (4) transversalis;

(5) quadratus lumborum.......................................

Severe.................................................... 50

Moderately Severe......................................... 30

Moderate.................................................. 10

Slight.................................................... 0

5320 Group XX. Function: Postural support of body; extension

and lateral movements of spine. Spinal muscles: Sacrospinalis

(erector spinae and its prolongations in thoracic and

cervical regions)............................................

Cervical and thoracic region:.............................

Severe.................................................... 40

Moderately Severe......................................... 20

Moderate.................................................. 10

Slight.................................................... 0

Lumbar region:............................................

Severe.................................................... 60

Moderately Severe......................................... 40

Moderate.................................................. 20

Slight.................................................... 0

5321 Group XXI. Function: Respiration. Muscles of

respiration: Thoracic muscle group...........................

Severe or Moderately Severe............................... 20

Moderate.................................................. 10

Slight.................................................... 0

5322 Group XXII. Function: Rotary and forward movements of

the head; respiration; deglutition. Muscles of the front of

the neck: (Lateral, supra-, and infrahyoid group.) (1)

Trapezius I (clavicular insertion); (2) sternocleidomastoid;

(3) the ``hyoid'' muscles; (4) sternothyroid; (5) digastric..

Severe.................................................... 30

Moderately Severe......................................... 20

Moderate.................................................. 10

Slight.................................................... 0

5323 Group XXIII. Function: Movements of the head; fixation

of shoulder movements. Muscles of the side and back of the

neck: Suboccipital; lateral vertebral and anterior vertebral

muscles......................................................

Severe.................................................... 30

Moderately Severe......................................... 20

Moderate.................................................. 10

Slight........................................................ 0

------------------------------------------------------------------------

Miscellaneous

------------------------------------------------------------------------

Rating

------------------------------------------------------------------------

5324 Diaphragm, rupture of, with herniation. Rate under

diagnostic code 7346.........................................

5325 Muscle injury, facial muscles. Evaluate functional

impairment as seventh (facial) cranial nerve neuropathy

(diagnostic code 8207), disfiguring scar (diagnostic code

7800), etc. Minimum, if interfering to any extent with

mastication--10..............................................

5326 Muscle hernia, extensive. Without other injury to the

muscle--10...................................................

5327 Muscle, neoplasm of, malignant (excluding soft tissue

sarcoma)--100................................................

Note: A rating of 100 percent shall continue beyond the

cessation of any surgery, radiation treatment, antineoplastic

chemotherapy or other therapeutic procedures. Six months after

discontinuance of such treatment, the appropriate disability

rating shall be determined by mandatory VA examination. Any

change in evaluation based upon that or any subsequent

examination shall be subject to the provisions of Sec.

3.105(e) of this chapter. If there has been no local

recurrence or metastasis, rate on residual impairment of

function.

5328 Muscle, neoplasm of, benign, postoperative. Rate on

impairment of function, i.e., limitation of motion, or scars,

diagnostic code 7805, etc....................................

5329 Sarcoma, soft tissue (of muscle, fat, or fibrous

connective tissue)--100......................................

Note: A rating of 100 percent shall continue beyond the

cessation of any surgery, radiation treatment, antineoplastic

chemotherapy or other therapeutic procedures. Six months after

discontinuance of such treatment, the appropriate disability

rating shall be determined by mandatory VA examination. Any

change in evaluation based upon that or any subsequent

examination shall be subject to the provisions of Sec.

3.105(e) of this chapter. If there has been no local

recurrence or metastasis, rate on residual impairment of

function.

------------------------------------------------------------------------

(Authority: 38 U.S.C. 1155)

[FR Doc. 97-14350 Filed 6-2-97; 8:45 am]

BILLING CODE 8320-01-P