[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