Understanding the Slight to Severe Scale for Rating Muscles

The majority of muscle conditions are rated on either limited motion or the Slight to Severe Scale, whichever gives the higher rating.  

The Slight to Severe Scale offers four different levels (Slight, Moderate, Moderately Severe, and Severe) that are associated with different ratings for each muscle group, depending on the functional impact of the damage to that muscle group.

For example, Group III for the muscles that control raising the arm out to the side is rated 40% for the dominant hand’s Severe level, while Group IV for the muscles that control the rotation of the arm is rated 30% for the dominant hand’s Severe level. Basically, the inability to raise the arm out to the side is considered a more serious disability than being unable to rotate the arm and so is given higher ratings for the Slight to Severe Scale levels.

But how does the Slight to Severe Scale work? Let’s start by talking about the Cardinal Signs and Symptoms.

 The Cardinal Signs and Symptoms

One of the criterion looked at when determining the Slight to Severe Scale level is the Cardinal Signs and Symptoms. 

The Cardinal Signs and Symptoms include:

• Loss of power. This is the inability to actively use the muscle in a proactive task, like pushing or lifting in the shortest amount of time possible.
• Weakness. This is different than the loss of power in that weakness isn’t just active, but passive. There is an overall lack of strength in the muscles. 
• Easily fatigued. The muscle has no endurance, but gets tired much faster than it should. 
• Pain with fatigue.  The muscle hurts when it gets tired. 
• Lack of coordination. This means that the muscle isn’t able to perform movements with as much precision of time, effort, and direction as it should. 
• Decreased movement control. This is similar to lack of coordination, but is more about the communication between the brain and the muscle. The nervous system is telling the muscle to move (either directly or as a reflex), but the muscle is unable to follow the instructions like it should

The Criteria

Each level on the Slight to Severe Scale has a variety of criteria that cover things like the type of wound, the Cardinal Signs and Symptoms, scarring, limitation of function, the ability to work, etc. 

Since muscles can be damaged in many different ways and result in many different symptoms and limitations, it’s important to remember that the criteria used for each level are meant to give an overall idea of the functional disability for that level.

A condition does not have to match each of the criterion perfectly, but generally reflect the same overall disability. 

For example, each level has a criterion that defines the type of external wound that would qualify for that level, but many muscle conditions are not caused by external forces and so won’t have an external wound at all. In those cases, this criterion simply does not apply. 

When assigning a level, the VA will focus only on the criteria that applies to the type of injury and the symptoms present. 

The Slight to Severe Scale Levels

We aren’t going to go criterion by criterion through each level, since you can find the entire Slight to Severe Scale on our site, but let’s discuss how to choose the right level. 

There are four levels:

• Slight. This disability will have little to no functional limitations.
• Moderate. This disability will have symptoms and some limitations. 
• Moderately Severe. This disability will have significant limitations and the constant presence of serious symptoms. 
• Severe. This disability will have constant severe limitations and symptoms. Basically, these muscles no longer function in any helpful or meaningful way. 

In order to choose the right level, the symptoms and circumstances of the muscle damage needs to be compared to the criteria for each level. 

Remember, ignore the criteria that does not apply. Instead, focus on the described severity of the criteria that does apply.  

Start at the Severe level. If any of the applicable criteria does not match the level described here, then move down to Moderately Severe, etc., until you find the level that best covers the overall severity of the condition. 

Once the Slight to Severe Scale level is identified, the rating associated with that level for the muscle group is assigned. 

Special Circumstances 

There are a couple rules that cover two special circumstances.  

The first states that any muscle damage that is the result of an open comminuted fracture (in the initial injury, the bone is crushed or splintered and there is an open wound above it) will be rated at the Severe level. 

The only time this rule doesn’t apply is when the open comminuted fracture is in a purely boney spot, like the wrist, where there isn’t much muscle. No muscle damage, no muscle rating. But as long as a muscle is clearly involved, then the damage to it will always be considered Severe. 

The second states that a through-and-through muscle injury (in the initial injury, a bullet or projectile went in one side and straight out the other) will be rated no less than Moderate, but can be rated more if the symptoms qualify.  

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