**§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)

\[29 FR 6718, May 22, 1964, as amended at 43 FR 45349, Oct. 2, 1978; 62
FR 30238, June 3, 1997\]

**Supplement *Highlights* reference**: 20(1)

Reserved