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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.