Rating Schedule for the Shoulder and Upper Arm Muscles
The muscles in the shoulder and upper arm are divided into six groups (I-VI).
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.
If the Veteran has a joint issue and the muscle injury also impairs that same joint; separate evaluations are NOT allowed!
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
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; or
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; or
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; or
Entire muscle becomes smaller or stays constantly firm following what would be considered a simple through and through wound.
5301 Group I Function: Upward Rotation of Scapula
Extrinsic muscles of shoulder girdle:
Levator scapulae
Serratus magnus
Trapezius
Function:
Raising the arm forward, above the shoulder (Hitler salute)
| Dominant Rating | Non-dominant Rating | Severity |
|---|---|---|
| 0% | 0% | Slight. |
| 10% | 10% | Moderate. |
| 30% | 20% | Moderately severe. |
| 40% | 30% | Severe. |
5304 Group IV Function: Stabilization of Shoulder
Intrinsic muscles of shoulder girdle:
Coracobrachialis
Infraspinatus
Subscapularis
Supraspinatus
Teres minor
Functions:
Inward and outward rotation of the arm.
Keep shoulders in their sockets.
| Dominant Rating | Non-dominant Rating | Severity |
|---|---|---|
| 0% | 0% | Slight. |
| 10% | 10% | Moderate. |
| 20% | 20% | Moderately severe. |
| 30% | 20% | Severe. |
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