Penetrating muscle injuries such as gunshot and shell fragment wounds, plus compartment syndrome and rhabdomyolysis, are documented for VA disability claims on this 12-page questionnaire. The clinician identifies each injured muscle group using VA's groups I to XXIII, describes entrance and exit scars, fascial defects and loss of muscle substance, records cardinal signs such as loss of power and lowered fatigue threshold, tests strength against the uninjured side, and notes retained metallic fragments on x-ray.
The Veteran's treating or examining clinician completes the form, including the dominant hand, and signs the Section XII examiner's certification. The Veteran completes no part of it.
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Muscle Injuries Disability Benefits Questionnaire
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Mainly penetrating injuries, such as gunshot or shell fragment wounds, plus compartment syndrome. The form also asks about diaphragm rupture with herniation, extensive muscle hernia, facial muscle injury and rhabdomyolysis. Strains and tendon tears without a foreign object entering the muscle are rated on the relevant joint questionnaire.
Item 4D lists loss of power, weakness, lowered threshold of fatigue, fatigue or pain, impairment of coordination and uncertainty of movement. For each sign checked, the examiner records the side, the muscle group from I to XXIII if possible, and how often and how severe it is.