Ratings Schedule for The Forearm and Hand Muscles
The muscles in the forearm and hand are divided into three groups (VII-IX).
PYRAMIDING NOTES:
Muscle ratings CANNOT be awarded with a separate Nerve rating for the same body part UNLESS they affect completely different functions (the nerve condition affects the flexion and the muscle condition affects the extension).
If the same functions are affected. The Veteran will NOT get an injured muscle rating.
Injured muscles that connect to a joint that is cannot be moved at all (ankylosis) CANNOT receive an additional rating for their injured muscles.
If a joint can move, then the Combined rating for all the injured muscles that connect to to the joint must be lower than the highest rating for that joint if it were ankylosed. e.g. the highest rating for an ankylosed wrist is 50% (if dominant wrist) or 40% (if non-dominant wrist), so the combined rating of all the injured muscles connecting to the wrist joint must be lower than 50% or 40%, respectively.
If there are injured muscles in the same body region but are not attached to the same joint (all in the arm but not all attached to the elbow joint), then the rating for the worst injured muscle in the arm will be increased to the next higher available rating and used as a singular rating for ALL muscle injuries in the arm.
If the muscle is already at the highest rating in the schedule. Then that is that, you keep that one rating. You will not automatically be given Extra scheduler consideration.
Otherwise, if your muscle group injuries are not related to each other and don't fall into any of the above situations. You can get a singular rating for each of the muscle groups.
Severity Definitions
Severity ranges between Slight to Severe. The severity of a muscle disability is determined by “cardinal signs and symptoms.” These include:
Decreased muscle control;
Easily fatigued;
Lack of coordination;
Loss of power;
Pain with fatigue; and
Weakness
Below are the criteria your rater will look over when determining the severity of your muscle injuries:
NOTES:
You do NOT need to meet every criteria in order to qualify for a level of severity. Just whatever severity most closely resembles the totality of the disability.
A through and through wound WILL BE considered to be of a minimum severity of moderate!
A compound fracture (bone broke the skin) that also results in damage to the muscles or tendons WILL BE considered to be of a severity of severe!
UNLESS, the muscle group involves the wrist OR involving the shinbone (tibia) IF there is evidence that shows the muscle damage is minimal.
SLIGHT
Type of injury:
A simple wound that does not contain debris (bits of bone, shrapnel, etc.) or infection.
Veteran complaints:
NO cardinal signs or symptoms.
Examiner can see:
Wound healed well and muscle can still function properly.
Small scar may be present
MODERATE
Type of injury:
A through and through or deep penetrating wound without long period of infection or debris.
Veteran complaints:
Regularly experience at least one or more cardinal signs or symptoms.
Particularly are easily fatigued and have decreased muscle control.
Examiner can see:
Entrance and if present, exit scars.
Loss of muscle tone or muscle mass.
If the paired side is uninjured, injured muscles are weaker.
MODERATELY SEVERE
Type of injury:
A through and through or deep penetrating wound with long period of infection, containing debris, or physical loss of muscle tissue with the development of scar tissue within the muscle tissue itself.
Veteran complaints:
Regularly experiences cardinal signs or symptoms significant enough to interfere with the ability to work.
Examiner can see:
Scars could cover more than one muscle group or the majority of one group.
Loss of muscle mass and tone.
Definite decrease in muscle function.
SEVERE
Type of injury:
A through and through or deep penetrating wound with shattered bones, long period of infection, containing LOTS of debris, or physical loss of muscle tissue with the development of significant scar tissue within the muscle tissue itself.
Veteran complaints:
Regularly experiences cardinal signs or symptoms significant enough to definitely interfere with the ability to work.
Examiner can see:
Very large area of scarring.
Significant interference with muscle function.
Serious loss of muscle mass and tone (skin may look flabby due to missing muscle).
Skin attached directly to the bone instead
Decreased muscular response to electric shocks
Other muscle groups are over strengthened due to compensating for the injured muscle group.
Other muscle groups not directly connected to the damaged muscle group are smaller than would be expected.
Entire muscle becomes smaller or stays constantly firm following what would be considered a simple through and through wound.
5307 Group VII Function: Flexion of Wrist and Fingers
Muscles arising from internal condyle of humerus:
Brachioradialis
Flexor carpi radialis
Flexor carpi ulnaris
Flexor digitorum profundus
Flexor digitorum superficialis
Flexor pollicis brevis
Flexor pollicis longus
Flexor tendon digitorum
Palmaris longus
Pronator teres
Functions:
Bend the hand downwards.
Curl your fingers into your palm.
PYRAMIDING NOTE:
The Veteran CANNOT have a rating for Limitation of ROM of the Wrist or Limitation of ROM of the fingers AND for this muscle group. The Veteran will get a single rating under whichever provides the highest rating.
| Dominant Rating | Non-Dominate Rating | Severity |
|---|---|---|
| 0% | 0% | Slight. |
| 10% | 10% | Moderate. |
| 30% | 20% | Moderately severe. |
| 40% | 30% | Severe. |
5308 Group VIII Function: Extension of Wrist, Fingers, Thumb
Muscles arising mainly from external condyle of humerus:
Extensor carpi radialis brevis
Extensor carpi radialis longus
Extensor carpi ulnaris
Extensor digiti minimi
Extensor digitorum
Extensor indicis
Extensor pollicis brevis
Extensor pollicis longus
Supinator
Functions:
Moves the hand and fingers to point up and back at the wrist.
Moves the thumb directly away from the palm of the hand.
PYRAMIDING NOTE:
The Veteran CANNOT have a rating for Limitation of ROM of the Wrist or Limitation of ROM of the fingers AND for this muscle group. The Veteran will get a single rating under whichever provides the highest rating.
| Dominant Rating | Non-Dominate Rating | Severity |
|---|---|---|
| 0% | 0% | Slight. |
| 10% | 10% | Moderate. |
| 20% | 20% | Moderately severe. |
| 30% | 20% | Severe. |
5309 Group IX Function: Forearm Muscles
Intrinsic muscles of hand:
The fine little muscles in the hand.
Functions:
Move the hand toward the fingers.
The various small and precise finger movements.
Due to the the small size of the muscles involved in this group they are not actually rateable. As such, the Veteran would be rated based upon Limitation of ROM of the fingers.
Miscellaneous Rating
The Veteran will NOT receive an additional rating if they fit the criteria of pain with motion. The Veteran will get a single rating for the pain or the muscle; Whichever rating is higher!
Pain with Motion
| Rating |
Description |
|---|---|
| 10% | Pain with motion. |
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