[Federal Register Volume 62, Number 106 (Tuesday, June 3, 1997)]
[Rules and Regulations]
[Pages 30235-30240]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 97-14350]
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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