When filing a claim for residuals of a shell fragment wound, it is important to pay close attention to how the VA ultimately rates your condition. This is because, ratings for residuals of shell fragment wounds can be difficult since these injuries cause damage to muscles, but can also damage bones, joints, and nerves.
Cardinal signs that a shell fragment wound resulted in a muscle disability include:
- Loss of power
- Lowered threshold of fatigue
- Impairment of coordination
- Uncertainty of movement
The skeletal muscles are divided into 23 different groups in 5 anatomical regions. The 5 regions are:
- Shoulder girdle and arm
- Forearm and hand
- Foot and leg
- Pelvic girdle and thigh
- Torso and neck
Evaluating Muscle Disabilities
When evaluating muscle disabilities, the VA looks to diagnostic codes 5301 through 5323. The following classifications apply when rating a muscle injury:
- Slight – A slight muscle disability involves a simple would without infection or debris (for example, bits of bone or shrapnel); the wound was easily treated and had good healing and function; there are no cardinal signs or symptoms, and there is small scar with no resulting impairment of function.
- Moderate – A moderate muscle disability involves a through-and-through (the bullet or projectile went in one side and straight out the other) or a deep penetrating wound (the bullet or projectile entered the body in one side and penetrated deep into the body, but did not come out the other side of the body) without serious infection; there is a regular presence of one or more of the cardinal signs or symptoms of a muscle injury; and there are small scars present with some loss of muscle tone or substance.
- Moderately severe – A moderately severe muscle disability involves a through-and-through or deep penetrating wound with debris, prolonged infection, and development of limiting scar tissue in the muscles; the wound would have needed hospitalization for treatment, have constant presence of cardinal signs and symptoms, and would significantly interfere with the ability to work; there are significant scars that go across one or more of the muscle groups resulting in loss of muscle substance and ton, and a definite decrease in function and use.
- Severe – A severe muscle disability involves a through-and-through or deep penetrating wound with shattered bones and a lot of debris; prolonged infection; seriously limited scarring in the muscles; the wound would have required lengthy hospitalization for treatment; constant and serious presence of cardinal signs and symptoms; definitely inability of the muscle to work; large, jagged scars going across a large area; serious loss of muscle substance and tone causing significantly abnormal muscle function.
Separate Ratings Involving Muscle Injuries
Because residuals of shell fragment wounds can involve different parts of the body the principle of pyramiding often comes into play. Generally, all disabilities, including those that result from a single disease or injury are rated separately. However, the rule against pyramiding states that a veteran cannot receive compensation more than once for the same disability or the same manifestation of symptoms. In other words, if a veteran has two disabilities that result in the same symptoms, the veteran cannot receive separate ratings for each disability and in turn, can only be compensated for one of those disabilities.
If there are muscle injuries in different anatomical regions they can be rated separately. There are also instances where a separate rating can be given for a joint disability and a muscle disability in the same anatomical area. For example, if there is a joint disability that causes traumatic arthritis and there is a muscle injury in the same anatomical area that doesn’t act on the joint there can be a separate rating for both the joint disability and the muscle disability. Also, if the scar is superficial and painful on examination, but does not have underlying soft tissue damage, then the scar can be rated separately under diagnostic code 7804.
The key to separate ratings when dealing with muscle injuries is to look at the specific manifestations of the disabilities. If there is impairment not accounted for by the muscle injury rating, then you may be entitled to a separate rating for that impairment.