Muscle Group XIX — VA Diagnostic Code 5319

Note (2) of § 4.73: Ratings of slight, moderate, moderately severe, or severe for diagnostic codes 5301 through 5323 will be determined based upon the criteria contained in § 4.56.

Section 4.56(c) says 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.

Section 4.56(d) says that under diagnostic codes 5301 through 5323, disabilities resulting from muscle injuries shall be classified as slight, moderate, moderately severe or severe as follows. There is no comma before “or severe.”

Slight, type of injury: simple wound of muscle without debridement or infection. 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. Objective findings: minimal scar; no evidence of fascial defect, atrophy, or impaired tonus; no impairment of function or metallic fragments retained in muscle tissue.

Moderate, 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. History and complaint includes a record of consistent complaint of one or more of the cardinal signs and symptoms, particularly lowered threshold of fatigue after average use, affecting the particular functions controlled by the injured muscles. Objective findings include entrance and (if present) exit scars, small or linear, indicating short track of missile through muscle tissue, and 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.

Moderately severe, 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. History and complaint includes hospitalization for a prolonged period for treatment of wound, consistent complaint of cardinal signs and symptoms, and, if present, evidence of inability to keep up with work requirements. Objective findings include 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; and tests of strength and endurance compared with sound side that demonstrate positive evidence of impairment.

Severe, 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. The history-and-complaint paragraph says the cardinal signs and symptoms are worse than those shown for moderately severe muscle injuries. Objective findings include ragged, depressed and adherent scars indicating wide damage to muscle groups in missile track; loss of deep fascia or muscle substance, or soft flabby muscles in the wound area; muscles that swell and harden abnormally in contraction; and tests of strength, endurance, or coordinated movements compared with the uninjured side that indicate severe impairment of function.

Section 4.56(d)(4)(iii) also lists signs of severe muscle disability, if present: (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.

DC 5319 prints 50, 30, 10, and 0. Section 4.56 is the classification for those four words. This page does not say the muscle form replaces either text.

Section 3.309 does not name Muscle Group XIX. This page does not add DC 5319 to a presumptive row.

A separate question, when a presumption does not decide it, is a medical question on the facts under 38 CFR § 3.310. Paragraph (a) covers disability proximately due to or the result of a service-connected disease or injury. Paragraph (b) covers increase in severity and requires a medical baseline.