VASRD: Musculoskeletal System

The Veteran Affairs Schedule for Rating Disabilities (VASRD) has a section covering the musculoskeletal system and injuries and/or medical conditions there may be VA compensation for depending on the nature, severity and permanence of the condition.

There are too many sections of the musculoskeletal system portion of the schedule to list comprehensively. The purpose of this article is to give you an idea of what VA disability claim evaluators are looking for, and how much compensation has historically been available for such conditions.

Not all conditions are rated the same, or with the same percentage ranges. Some medical issues cannot be rated above a certain percentage, and others may earn a 0% rating depending on circumstances.

Musculoskeletal Categories

The VA schedule for the musculoskeletal system includes the following categories:

• Osteomyelitis
• The Bones
• The Joints
• Principles of Combined Ratings for Muscle Injuries
• Evaluation of Muscle Disabilities
• Static Foot Deformities/Arthritis Due to Strain
• Painful Motion
• Circulatory Disturbances
• Loss of Use of Hand or Foot/Loss of Use of Both Buttocks/[Reserved]
• Sacroiliac Joint/Pelvic Bones
• Amputation Rule/Dominant Hand/Inadequate Examinations
• Measurement of Ankylosis and Joint Motion
• Muscle Injuries

How Thorough Is The VA Examination Process?

When evaluating a veteran for injuries and conditions that may be compensable by the Department of Veterans Affairs, the exam process can be quite thorough. Depending on the nature of a given condition, injury, or disease, there may be a variety of issues to examine.

Consider, for example, how complete the VA rating schedule is when addressing injuries such as the loss of multiple fingers. The VASRD breaks down the possible variations in possible injuries associated with it:

• Amputation of five digits of one hand
• Amputation of thumb, index, long and ring fingers
• Amputation of thumb, index and long
• Amputation of thumb, index and ring
• Amputation of thumb, index and little
• Amputation of thumb, long and ring
• Amputation of thumb, long and little
• Amputation of thumb, ring and little
• Amputation of index, long and ring
• Amputation of index, long and little
• Amputation of index, ring and little
• And more

 As you can see, the VA places a premium on specifics, and if you aren’t sure whether to include more supporting documentation in your VA medical claims application, you should always lean toward more supporting evidence.

It’s important to make sure your supporting documentation is directly related to the claims you are making. In cases where your claim may not be directly supported by your military medical records, the VA advice is to submit statements from others that can support your claim.

Civilian doctors, family members, co-workers, clergy and any others who may have firsthand knowledge of your medical issues (in a treatment or non-treatment capacity) can all submit written statements to help shore up your claim with the VA. Establishing dates, times, locations, and other specific details will be a priority for such written statements where applicable.

VA Policy On Rating The Musculoskeletal System

To facilitate the disability rating process, the VA has divided the human body into 23 muscle groups over five regions of the body:

• Six muscle groups for the shoulder girdle and arm
• Three muscle groups for the forearm and hand
• Three muscle groups for the foot and leg
• Six muscle groups for the pelvic girdle and thigh
• Five muscle groups for the torso and neck

VA Policy On Rating Musculoskeletal System Injuries: Medical History

The approach used by the Department of Veterans Affairs to evaluate and rate service-connected medical conditions includes tracing the history of a given medical problem starting with the original injury or illness.

According to the VASRD, “it is essential” to know the “medical-industrial history of the disabled person from the original injury, considering the nature of the injury and the attendant circumstances.”

The duration of musculoskeletal problems, the length of incapacitation and the nature of the condition (swelling, inflammation, any recommended surgical intervention if required) must be taken into account when evaluating and rating the veteran.

VA policy, in cases where there is an “absence of clear cut evidence of injury,” may find the VA evaluators rating a given disability as “not of traumatic origin.”

VA Policy On Whole Person Medical Examinations When Reviewing Musculoskeletal System Issues

The Department of Veterans Affairs has made clear it is not enough to review the musculoskeletal system alone; a more holistic approach is required to make a complete VA review.

VASRD literature instructs VA staff, “The importance of complete medical examination of injury cases at the time of first medical examination by the Department of Veterans Affairs cannot be overemphasized.”

VA regulations dictate when feasible a VA examination should include:

• A complete neurological examination
• A psychiatric examination
• Any “special examinations” that may be required by the medical issue

Why does the VA approach the exam in this manner? VASRD guidelines say that in cases where there is not a “top-down” examination, “it is impossible to visualize the nature and extent of the service connected disability.”

It’s the stated position of the Department of Veterans Affairs that such “incomplete examinations” are a predictable source of misdiagnosis, leaving the VA “in doubt as to the presence or absence” of legitimately disabling conditions at exam time.

VA Policy On Rating Muscle Injuries

There are individual ratings for certain muscle injuries, but in some injury cases, overall the VA may offer a combined rating depending on circumstances. But there are some cases where the VA definitely does NOT offer a combined rating.

One such area – when a veteran has a muscle injury and also may qualify for a VA rating for “peripheral nerve paralysis” which affects the same body part as the muscle injury. In such cases, a combined rating is not possible unless “the injuries affect entirely different functions.”

VA Policy On Rating Muscle Disabilities

According to the VA official site, a muscle disability results in the following symptoms for VA rating purposes:

• Loss of power
• Weakness
• Lowered fatigue threshold
• A combination of fatigue and pain
• Problems with coordination
• Uncertainty of movement

The VA guidelines for ratings includes classification (depending on the diagnostic codes used and other variables) of certain injuries as slight, moderate, moderately severe or severe.

What do these ratings mean in practical terms? Remember that this section focuses on muscle and skeletal issues only. With that in mind:

Slight Disability: A “simple” wound that is not infected, and does not require debridement (such as would be required for a burn victim, for example). The VA findings typical for “slight” muscle disability would include minimal scarring, short recovery time, and quick return to duty after the injury or condition is identified. No fragments, atrophy, or functional problems.

Moderate Disability: Described as a deep wound such as that from a single bullet, shrapnel, or other comparatively small device “without explosive effect of high-velocity missile, residuals of debridement, or prolonged infection.”

The VA requires “evidence of in-service treatment” and the medical record should reflect at least one of the symptoms listed above at the top of this section. There should be an entrance and exit wound, scarring, muscle impairment, lowered endurance in the muscle, etc.

Moderately Severe Disability: Described by the VA as a deep wound “by small high velocity missile or large low-velocity missile, with debridement, prolonged infection, or sloughing of soft parts, and intermuscular scarring.”

This requires the veteran’s service record to show a prolonged hospital stay or prolonged treatment for the injury. Entry and exit wounds should be evident, there may be loss of muscle mass or substance, loss of “firm resistance” or other issues associated with deep muscle wounds.

Severe Disability: A deep wound that may be the result of high-velocity munitions, “or with shattering bone fracture or open comminuted fracture with extensive debridement, prolonged infection, or sloughing of soft parts, intermuscular binding and scarring.”

Prolonged treatment, evidence of muscle loss, loss of muscle tone, loss of motion or endurance, etc. With severe disability ratings, evidence of muscle swelling and/or hardening abnormally may be present. A strength test may reveal impairment of coordination, difficulty coordinating with other muscles, etc.

The VA ‘Amputation Rule’

It is stated VA policy that combined ratings for service-connected medical issues of any extremity of the human body “shall not exceed the rating for the amputation at the elective level, were amputation to be performed.”

The VA offers an example, noting that combined VA medical evaluations for any medical disability below the knee must not exceed a 40% evaluation (the maximum based on the rating for an amputation affecting the same area.)

According to the VA, it may be possible to take the 40% rating and combine it “with evaluation for disabilities above the knee but not to exceed the above the knee amputation elective level.”

The VA ‘Inadequate Examinations’ Rule

In some cases, there may not be enough information to make a determination if an exam is not performed to VA standards. In such cases, the VA reserves the right to request a supplementary report from the examiner to get more information.

Those details may include how the veteran’s quality of life is affected by the injury or medical issue, whether the ability to work or hold a job is impaired, etc. VA policy is to request such follow-up in cases where “the best interests of the service will be advanced by personal conference with the examiner.”