The Shoulder and Upper Arm Muscles
Overview for Rating Shoulder and Upper Arm Muscle Conditions
The VA awards disability compensation for injuries to the Shoulder and Upper Arm Muscles that are service-connected. The DoD will also rate service-connected muscle injuries as long as they also make the service member Unfit for Duty. For Reservists, the injury must have occurred in the Line of Duty to qualify.
The Shoulder and Upper Arm Muscles are divided into six groups for rating purposes:
- Group I includes the muscles that raise the arm forward
- Group II includes the muscles that lower the arm
- Group III includes the muscles that raise the arm to the side
- Group IV includes the muscles that rotate the arm
- Group V includes the muscles that flex the elbow
- Group VI includes the muscles that extend the elbow
Only a single rating can be given for each muscle group, regardless of the number of individual muscles damaged in the group. All symptoms for each group will be considered together and a single overall rating given for each group.
See the Combined Ratings for Muscle Injuries principle for other special circumstances that limit when muscle conditions can be rated.
All muscle conditions are either rated on the Slight to Severe Scale or on limited motion of the affected joints, whichever gives the higher rating, but a rating for both cannot be given unless a completely different condition causes the limited motion (see the Pyramiding Principle).
The Slight to Severe Scale
The severity of a muscle disability is decided by the presence of the cardinal signs and symptoms, the type of wound, and the effect of any scars. Not all muscle injuries are caused by external injuries, like a bullet wound, so it is important to remember that not all bullet points must be met in order for a wound to qualify for a severity. This scale paints a picture of the type of muscle damage that should be present for each severity. To determine the correct severity, choose the level that best describes the symptoms and level of disability caused by the injury.
The Cardinal Signs and Symptoms include:
- loss of power
- easily fatigued
- pain with fatigue
- lack of coordination
- decreased movement control
The Slight to Severe Scale
SLIGHT muscle disability:
- A simple wound without infection or debris (bits of bone, shrapnel, etc.).
- An easily treated wound with good healing and function.
- No Cardinal Signs and Symptoms.
- Small scar with no impairment of function.
MODERATE muscle disability:
- A through-and-through or deep penetrating wound without serious infection or debris.
- The regular presence of one or more of the Cardinal Signs and Symptoms.
- Small scars with some loss of muscle tone or substance. Some loss of power and a bit more easily fatigued.
MODERATELY SEVERE muscle disability:
- A through-and-through or deep penetrating wound with debris, prolonged infection, and the development of limiting scar tissue in the muscles.
- This wound would need hospitalization for treatment, have the constant presence of the Cardinal Signs and Symptoms, and would significantly interfere with the ability to work.
- Significant scars that stretch across one or more muscle groups. Loss of muscle substance and tone would be present, and there would be a definite decrease in function and use.
SEVERE muscle disability:
- A through-and-through or deep penetrating wound with shattered bones and lots of debris, prolonged infection, and seriously limiting scarring in the muscles.
- This wound would need lengthy hospitalization for treatment, have the constant and very serious presence of the Cardinal Signs and Symptoms, and a definite inability to work.
- Scars would be very large and jagged and would stretch across a large area. Serious loss of muscle substance and tone (even causing muscles to be flabby and weak) would cause significantly abnormal muscle function.
- Other evidence of severe disability could include X-ray evidence of foreign bodies in the muscles, skin attaching directly to the bone instead of the bone being covered by muscle, decreased response in the muscles to electric shocks, significant Atrophy, other muscle groups having to compensate for the injured muscle group, and atrophy of connected muscles not directly damaged.
- If the condition is an open comminuted fracture with muscle damage (if the wound is open, it will almost always have muscle damage unless it is strictly over a purely boney spot like the wrist), then it will be rated as severe damage to the muscles affected.
- A through-and-through muscle injury will be no less than moderate for each group of muscles damaged.
Check out The Ratings of the Shoulder and Upper Arm Muscles page for the exact ratings for each severity for each muscle group.