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Monday, December 1, 2014

How to Apply the Slight to Severe Scale when Rating Muscle Disabilities

The majority of muscle conditions are either rated on the Slight to Severe Scale or on limited motion of the affected joint, whichever gives a higher Military Disability Rating.  Limited motion is pretty straightforward, but the VASRD’s original wording for the Slight to Severe Scale can be a bit confusing, so I want to break it down a bit further.

The way the Slight to Severe Scale reads seems to imply that the muscle injury must have been caused by a projectile entering the body in order to be rated. If this were accurate, then there would be a great number of muscle conditions that could not be rated.  

When looking at the Slight to Severe Scale, the VASRD tries to paint a picture of the kind of disability that would be seen under each severity.

For example, a SLIGHT disability is described as follows:
  • A simple wound without infection or debris (bits of bone, shrapnel, etc.).

  • An easily treated wound with good healing and function. No cardinal signs or symptoms.
  • Small scar with no impairment of function.

While a MODERATE disability is described as follows:
  • 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. 

These lists are NOT checklists. Your condition does not have to match each bullet point exactly in order to be listed under that category. It simply needs to be a similar condition.

The most important thing to consider when categorizing your condition is the presence of the cardinal signs and symptoms (loss of muscle power, weakness in the muscle, the muscle tires easily, there is pain in the muscle with tiredness, lack of coordination, and decreased movement control).

Each severity requires a certain number of the cardinal signs and symptoms to be present in order for the condition to qualify under that severity. These should be the number one priority. If your condition seems to fit most in the SLIGHT category, but there is one of the cardinal signs and symptoms, then your condition would qualify for the MODERATE category, even if the other qualifiers don’t match.

We were recently contacted by a soldier with a complete rupture of his pectoralis major (helps control the shoulder; Muscle Group II). The condition was not caused by a projectile, and there was no break in the skin. After healing from treatment, he had full range of motion, but also had weakness and loss of muscle tone.

Looking at the Slight to Severe Scale, the condition would be rated as MODERATE. The first bullet point (a through-and-through or deep penetrating wound) isn’t present at all, but both of the second bullet points are. Weakness is one of the cardinal signs and symptoms, so that satisfies the second bullet point, and loss of muscle tone satisfies the third.

Overall, when trying to categorize your muscle condition on the Slight to Severe Scale, remember that the requirements under each severity are simply painting a picture of the type of condition. The most important qualification is the presence of any cardinal signs and symptoms. Beyond that, simply match your condition to the category that most closely describes it.


  1. I have had several MRI's and each result stated that moderate to severe what should I expect at my C & P examine?

    1. Hi Donald -

      What is your condition that is shown on the MRI? Without knowing the diagnosis of your condition, it's impossible to really say what to expect.

  2. Dr. Johnson, All of the following information is in my medical record. This happen while in basic training. (1973) I broke my right hand (fifth metacarpal) The VA just rated it as 0% finally, it is my domain hand. I am having some numbness in my little and ring finger, my forearm cramps from time to time, I just had a MRI done on my right shoulder. The PA said it was not torn completely, however he was going to get with the Dr. to see what's next. I take Ibuprofen daily before I go to work. I am working two jobs (part time). It is hard for me to go to the doctor every time I hurt. I get up at 02:45 I work 6 hrs. go home change clothes go to next job work until 1730. I was given 10% tinnitus. I have gastro-intestinal issue which is another issue that's on my medical record, I don't know what to do, I need some advise how to fight this battle. I cannot afford an attorney

    1. Hi Walter -

      I need a bit more info before I can best guide you.

      So the only condition that occurred while on active duty was the broken metacarpal, correct? How long after separation did the other conditions develop? I'm trying to figure out exactly which conditions are truly service-connected because that seems to be the real issue at play. If you can provide more information, that would help.

  3. What I am filing claim for are Hypertension not service connected, hearing loss right ear 0%, service connected, tinnitus 10% service connected, left hearing loss denied not service connected, right hand 0% service connected, this was just given to me.

    This was the explanation given. Service connection for hand condition right(claimed as right hand broken in basic training) is denied since this condition neither occurred in nor was cause by service. While your service treatment records reflect complaints, treatment, or a diagnosis similar to that claimed, the medical evidence supports the conclusion that a persistent disability was not present in service. We did not find a link between your medical condition and military service. The evidence does not show a current diagnosed disability.

    Hypertension is not on my medical record. I had a visited with the QTS staff in Atlanta. My hand has always bothered me off and on. The doctor who did my evaluation ask what kind of work did I do, I told her a Police Officer with over 30 years, she then ask my highest position Chief. She then ask which was my dominant hand right, then she wanted to know if I still was certified as a Officer.

    The other issues occurred on my ship. I was aboard the USS Enterprise Air division. It took me a long time to file, My pride was stopping me. If you need any more information

    1. The issue is that it seems on paper as though your hand fully healed and is no longer a disability. You had the original injury but then had a full career with no real additional medical treatment of that hand. You currently do not have a condition diagnosed in that hand or any treatments being done, correct? Then to the VA, there is no disability. If you still have problems, the only way to qualify for VA disability is for you to get a diagnosis and start receiving treatment. You'll need your diagnosing physician to claim that the current condition is "more likely than not" caused by the original injury in basic training. Without this statement, it is just as likely that time and/or other things caused the current condition, not your military service.

      Overall, I think this is going to be a tough case to win, but if you follow the above advice, you'll have a chance.

  4. I just found the letter I got back on 12/08/2015 in
    reference to my right hand. X-ray was done and the finding was scattered changes related to osteoarthritis. Thanks for all of your advise and information

    1. With this evidence, you need a specialist to state that they believe that your current osteoarthritis is "more likely than not" the result of the basic training injury, and you should be good to go.

  5. Hello Dr. Johnson, I have several health issues, but I received a P3 for my feet and now referred to MEB. I have osteoarthritis in both feet. The right foot was so severe the bone began to grow over the tendons, making it extremely painful. I had surgery to shave the bone down, but this did nothing to alleviate the pain. I recently had a second surgery and had an implant inserted in the large toe. This is more painful than before I started the entire process. I have not been able to wear boots in a year. I was told I will eventually need surgery on the other foot. Just for this, I am not quite sure what the rating is based on, the arthritis? ROM? I have been going to PT for about 8 months with no pain alleviation. Any advice would be extremely appreciated.

    1. This is a tricky condition to rate. Osteoarthritis is usually rated on limited motion as degenerative arthritis, but there technically isn't a limited motion rating for the feet. If you can't use both feet at all (non-weight bearing, wheelchair bound, etc.), then it would be rated 100%.

      Since I don't believe this is your case, finding the best rating is difficult.

      Most foot ratings aren't very high. The rating or bone spurs (which you clearly have), is only 10% per foot. They could rate you there, but with the level of pain you're having that may not be enough.

      Ultimately, they are going to look at your overall functioning. How well can you walk on it, even with the pain? Do you have to have a cane or assistive device? If you are fairly limited, they might push it and have you rated 30% under the broken bone code (5283), but this would only be if it were incredibly severe, close to full loss of use.

      Ultimately, I won't be able to fully predict what they will do. They'll look at your overall functioning and then determine which code best reflects the condition and symptoms.

  6. Dr. Johnson:

    I am currently rated 10% for both knees. My right knee has worsened and my doctor wants to go in arthroscopically and clean up the cartilage.

    My doctor believes this will provide relief for 3 to 5 years before I need a total knee replacement. Would the surgery and later TKR meet the criteria to change my rating?

    1. The VA will temporarily increase your rating to 100% during your convalescent period after the surgery.

      After the convalescent period, the VA will re-evaluated your condition and determine the new rating based on any remaining symptoms. It's impossible to predict what this rating will be because it is impossible to predict the outcome of the surgery. If the surgery fixes everything and you have no symptoms at all (unlikely), it will be rated 0%. If there are symptoms, it will be rated on their severity.

      Once the TKR occurs, however, it will then be rated under code 5055.

      The minimum rating for this is 30%.