Muscle injuries: groups, severity and the exam

How VA rates muscle injuries

38 CFR 4.56, 4.73

Muscle injuries are rated by muscle group (23 groups, codes 5301 to 5323) and by severity: slight, moderate, moderately severe or severe. The shoulder, arm, forearm and hand groups have separate dominant and non-dominant columns.

The regulation names six cardinal signs and symptoms of muscle disability: loss of power, weakness, lowered threshold of fatigue, fatigue-pain, impairment of coordination and uncertainty of movement.

Two rules set a floor: an open comminuted fracture with muscle or tendon damage is rated as severe for the muscle group involved, unless the evidence shows the muscle damage is minimal (for example at the wrist or over the tibia), and a through-and-through injury with muscle damage is rated no less than moderate for each muscle group damaged.

What slight, moderate, moderately severe and severe mean

38 CFR 4.56(d)

• Slight: a simple wound without debridement or infection, healing with good functional results, no cardinal signs, minimal scar, and no fascial defect, atrophy or impaired tone.
• Moderate: a through-and-through or deep penetrating wound with a short track from a single bullet or small fragment, without explosive effect of a high-velocity missile, residuals of debridement or prolonged infection. Records show in-service treatment and consistent complaint of one or more cardinal signs, particularly lowered fatigue threshold. Small or linear scars, some loss of deep fascia or muscle substance, or impaired tone and loss of power compared with the sound side.
• Moderately severe: a through-and-through or deep penetrating wound by a small high-velocity missile or large low-velocity missile, with debridement, prolonged infection or sloughing of soft parts and intermuscular scarring. Records show prolonged hospitalization and consistent complaint of cardinal signs, and tests of strength and endurance show positive evidence of impairment compared with the sound side.
• Severe: a through-and-through or deep penetrating wound from a high-velocity missile, large or multiple low-velocity missiles, shattering fracture or open comminuted fracture with extensive debridement, prolonged infection or sloughing. Records show prolonged hospitalization and cardinal signs worse than moderately severe. Findings include ragged, depressed and adherent scars, loss of deep fascia or muscle substance, and severe impairment on strength and endurance tests. Further signs listed include scattered foreign bodies on X-ray, scar adhered to bone, diminished muscle excitability on electrodiagnostic tests, visible or measurable atrophy, and adaptive contraction of an opposing muscle group.

Shoulder girdle, arm, forearm and hand groups

38 CFR 4.73, DC 5301 to 5309

Each group below has a dominant and non-dominant rating for each severity, shown here as severe / moderately severe / moderate / slight for the dominant arm.

• Group I (5301), trapezius, levator scapulae and serratus magnus: 40 / 30 / 10 / 0.
• Group II (5302), pectoralis major, latissimus dorsi, teres major, pectoralis minor and rhomboid: 40 / 30 / 20 / 0.
• Group III (5303), deltoid and clavicular pectoralis major: 40 / 30 / 20 / 0.
• Group IV (5304), the rotator cuff muscles and coracobrachialis: 30 / 20 / 10 / 0.
• Group V (5305), elbow flexors (biceps, brachialis, brachioradialis): 40 / 30 / 10 / 0.
• Group VI (5306), elbow extensors (triceps, anconeus): 40 / 30 / 10 / 0.
• Group VII (5307), wrist and finger flexors: 40 / 30 / 10 / 0.
• Group VIII (5308), wrist and finger extensors: 30 / 20 / 10 / 0.
• Group IX (5309), intrinsic muscles of the hand: rate on limitation of motion, with a minimum of 10%, because isolated hand muscle injuries are rare.

The non-dominant ratings are lower by 10 points in most cells and equal in some. See the schedule for each cell.

Foot, leg, thigh, torso and neck groups

38 CFR 4.73, DC 5310 to 5323

These groups have one column, shown as severe / moderately severe / moderate / slight.

• Foot (5310): plantar muscles 30 / 20 / 10 / 0. Dorsal muscles 20 / 10 / 10 / 0. Through-and-through wounds of the foot have a minimum of 10%.
• Calf (5311, Group XI): 30 / 20 / 10 / 0. Front of the leg (5312, Group XII): 30 / 20 / 10 / 0.
• Hamstrings (5313) and front of the thigh (5314): 40 / 30 / 10 / 0.
• Inner thigh (5315): 30 / 20 / 10 / 0. Hip flexors (5316): 40 / 30 / 10 / 0.
• Gluteal muscles (5317): 50 / 40 / 20 / 0. If bilateral, see 38 CFR 3.350(a)(3) for special monthly compensation. Deep hip rotators (5318): 30 / 20 / 10 / 0.
• Abdominal wall (5319): 50 / 30 / 10 / 0.
• Spinal muscles (5320): cervical and thoracic 40 / 20 / 10 / 0; lumbar 60 / 40 / 20 / 0.
• Muscles of respiration (5321): severe or moderately severe 20; moderate 10; slight 0.
• Front of the neck (5322) and side and back of the neck (5323): 30 / 20 / 10 / 0.

When muscle injury causes loss of use of an extremity, the regulation says to check special monthly compensation under 38 CFR 3.350.

Facial muscles, hernia, tumors, rhabdomyolysis and compartment syndrome

38 CFR 4.73, DC 5324 to 5331

• Diaphragm rupture with herniation (5324): rated under 7346. Facial muscles (5325): rate on facial nerve effects or disfigurement, with a minimum of 10% if mastication is affected. Extensive muscle hernia (5326): 10%.
• Malignant muscle tumor (5327) and soft tissue sarcoma (5329): 100%, continuing past treatment, with a mandatory exam six months after treatment stops. If there is no recurrence or spread, rate on residual impairment.
• Benign muscle tumor after surgery (5328): rate on impairment of function, such as limited motion or scars.
• Rhabdomyolysis residuals (5330) and compartment syndrome (5331): rate each affected muscle group separately and combine under 38 CFR 4.25. Chronic kidney complications are rated separately. See kidney ratings.

What VA’s muscle injury exam form covers

VA Muscle Injuries DBQ (updated 2024-09-05)

• Diagnosis by side, and whether the injury was penetrating (such as a gunshot or shell fragment) or non-penetrating (such as a strain or torn tendon).
• Checkboxes for each of the 23 muscle groups by side, plus diaphragm rupture, muscle hernia, facial muscle injury, rhabdomyolysis and compartment syndrome.
• Entrance and exit scars and adhesions, fascial defects, muscle tone, atrophy and adaptive contraction.
• The six cardinal signs, each marked occasional, consistent, or consistent at a more severe level.
• Strength testing from 0/5 to 5/5 on the affected and unaffected sides, and atrophy measurements on both sides.
• Assistive devices, remaining effective function, imaging including retained metal fragments, electrodiagnostic results and functional impact on work.

See Preparing for Your C&P Exam.

What I could not verify

• Rating levels come from the eCFR text of 38 CFR 4.73 and 4.56, current as of October 16, 2026. eCFR is unofficial, and the official text wins over me.
• I did not read 38 CFR 4.55, which has the principles for combining ratings of different muscle groups, or the rules on gunshot and shell fragment wounds in 4.72. Ask an accredited representative how muscle ratings combine with joint, nerve and scar ratings.
• The non-dominant ratings for the arm and hand groups are in the schedule, not restated for every cell here.
• I checked the exam form through a text reader, not line by line. The form itself is the authority.