Muscle Group XIX VA Disability Rating
Diagnostic Code 5319 · 38 CFR §4.73
What Is It?
Muscle Group XIX is the abdominal wall. The schedule describes its function as "support and compression of abdominal wall and lower thorax; flexion and lateral motions of spine; synergists in strong downward movements of arm," and lists the muscles as the rectus abdominis, external oblique, internal oblique, transversalis, and quadratus lumborum. It sits in the torso and neck region of 38 CFR 4.73, and it is evaluated at 50, 30, 10 or 0 percent for severe, moderately severe, moderate and slight injury. What those four words mean is not left to judgment. 38 CFR 4.56 defines each level, and two of its rules decide a great many muscle claims before any grading argument starts. Under 4.56(a), an open comminuted fracture with muscle or tendon damage is rated as a severe injury of the muscle group involved, unless — for locations such as the wrist or over the tibia — the evidence establishes that the muscle damage is minimal. Under 4.56(b), a through-and-through injury with muscle damage is evaluated as no less than a moderate injury for each group of muscles damaged. That second rule is worth reading twice: it sets a floor, it applies per muscle group, and it turns on the mechanism of the wound rather than on the current examination. 38 CFR 4.56(c) then lists what the schedule calls the cardinal signs and symptoms of muscle disability: loss of power, weakness, lowered threshold of fatigue, fatigue-pain, impairment of coordination, and uncertainty of movement. Those six terms are the vocabulary the grading levels are written in, and a claim described in them is a claim a rater can grade. Veterans reach this code through penetrating wounds and fragmentation injuries of the abdomen, blast trauma, and the surgical damage that follows — including the laparotomies done to treat the original injury. The consequences are chronic: the abdominal wall stabilises the spine and holds pressure for lifting, coughing and bearing down, so damage to it reaches nearly every physical task.
Rating Criteria
| Rating | Criteria |
|---|---|
| 50% | Severe. Under 38 CFR 4.56(d), a through-and-through or deep penetrating wound due to a high-velocity missile, or large or multiple low-velocity missiles, or one with shattering bone fracture or open comminuted fracture with extensive debridement, prolonged infection or sloughing of soft parts, and intermuscular binding and scarring — with a history of prolonged hospitalization, consistent complaint of the cardinal signs and symptoms worse than at the moderately severe level, ragged depressed and adherent scars, loss of deep fascia or muscle substance or soft flabby muscles, and severe impairment on strength and endurance testing compared with the sound side. |
| 30% | Moderately severe. A through-and-through or deep penetrating wound by a small high-velocity missile or a large low-velocity missile, with debridement, prolonged infection or sloughing of soft parts and intermuscular scarring — with a hospitalization record for a prolonged period, consistent complaint of the cardinal signs and symptoms worse than at the moderate level, indications on deep palpation of loss of deep fascia or muscle substance or of soft flabby muscles in the wound area, and positive evidence of impairment on strength and endurance testing compared with the sound side. |
| 10% | Moderate. A through-and-through or deep penetrating wound of short track by a single bullet or small shell or shrapnel fragment, without the explosive effect of a high-velocity missile and without residuals of debridement or prolonged infection — with consistent complaint of one or more of the cardinal signs and symptoms, and on examination some loss of deep fascia or muscle substance, or impairment of muscle tonus and loss of power or lowered threshold of fatigue when compared with the sound side. |
| 0% | Slight. A simple wound of muscle without debridement or infection, healed with good functional results and no cardinal signs or symptoms — a minimal scar, no evidence of fascial defect, atrophy or impaired tonus, and no impairment of function or retained metallic fragments. |
Evidence Needed
- The wound mechanism, in the words the schedule uses. Whether the injury was through-and-through, what struck you, and whether it was high or low velocity are the facts 38 CFR 4.56 grades on — and a through-and-through injury with muscle damage is no less than moderate for each group damaged under 4.56(b).
- The original treatment record: debridement, infection, sloughing of soft parts, and the length of hospitalization. Prolonged hospitalization appears in both the moderately severe and severe definitions.
- Abdominal wall strength testing compared with the sound side where a sound side exists, and a functional assessment of trunk flexion and rotation.
- Examination findings on deep palpation — loss of deep fascia or muscle substance, soft flabby muscle in the wound area, and any fascial defect.
- Imaging or operative evidence of herniation, since a weakened abdominal wall commonly gives way and the hernia may be separately evaluated.
- Retained metallic fragments on imaging. Their absence is part of the definition of a slight injury, and their presence is evidence against it.
- Scar findings — size, whether the scar is ragged, depressed or adherent, and whether it is painful or unstable. Scars are separately evaluated under the skin codes.
- Statements describing the cardinal signs and symptoms in the schedule's own terms: loss of power, weakness, lowered threshold of fatigue, fatigue-pain, impairment of coordination, uncertainty of movement.
C&P Exam Tips
- Describe the wound before you describe the symptoms. The grading levels are written around the mechanism, the debridement, the infection and the hospitalization, and those facts often place the evaluation before the current examination does.
- Use the schedule's vocabulary. Saying that you have loss of power, a lowered threshold of fatigue and fatigue-pain lands in the criteria in a way that "my stomach hurts when I lift" does not.
- Ask the examiner to palpate for loss of deep fascia or muscle substance and to state the finding. That specific finding separates moderate from moderately severe.
- Have abdominal wall strength tested and compared with the sound side, and have the comparison written down.
- Report bulging or herniation on straining, and ask to be examined standing and while bearing down rather than only lying flat.
- Point out every scar and say whether it is painful, unstable, adherent or depressed. Scars are evaluated separately under the skin codes.
- Say what your lifting and carrying limits are, and whether coughing, sneezing or bearing down is affected. Those are core-pressure functions this muscle group performs.
- Mention low back pain. The abdominal wall stabilises the spine, and back strain from core weakness is a common and claimable consequence.
How to File
File for the muscle group, not just for the scar. The scar and the muscle injury are separate evaluations, and a claim that names only the scar is routinely decided as a skin case. Put the wound mechanism in the claim in the schedule's terms. 38 CFR 4.56(b) makes a through-and-through injury with muscle damage no less than a moderate injury for each group of muscles damaged, and 4.56(a) makes an open comminuted fracture with muscle or tendon damage a severe injury unless the muscle damage is minimal. Both operate off the original wound record, so attaching the service treatment records that describe the wound, the debridement, the infection and the length of hospitalization does more work than a current examination usually can. Where the wound crossed more than one muscle group, claim each. 38 CFR 4.55(f) provides that muscle injuries in different anatomical regions are separately rated and combined under 38 CFR 4.25, while 4.55(e) provides that for compensable injuries in the same anatomical region that do not act on the same joint, the most severely injured group's evaluation is raised one level and used as the combined evaluation. And note 38 CFR 4.55(a): a muscle injury rating is not combined with a peripheral nerve paralysis rating of the same body part unless the injuries affect entirely different functions. Claim any hernia and any adhesions separately under the digestive codes.
Common Mistakes
Filing the scar and forgetting the muscle group. They are different evaluations under different parts of the schedule and both can be assigned. Arguing severity from current symptoms only. The definitions in 38 CFR 4.56(d) are built substantially out of the wound history — mechanism, debridement, infection, hospitalization — and the service treatment records are usually the strongest evidence in the file. Missing 4.56(b). A through-and-through injury with muscle damage is no less than moderate for each group damaged, which is a floor a great many claims meet without argument. Describing symptoms in ordinary words instead of the cardinal signs and symptoms the regulation names. Not claiming a hernia that developed through the weakened wall, or the adhesions that followed abdominal surgery. Assuming muscle and nerve evaluations always stack. Under 38 CFR 4.55(a) they are not combined for the same body part unless the injuries affect entirely different functions.
Frequently Asked Questions
What percentages are available under DC 5319?
Four: 50 percent for severe, 30 percent for moderately severe, 10 percent for moderate, and 0 percent for slight injury of Muscle Group XIX. Unlike the upper-extremity codes in 38 CFR 4.71a, there is no separate dominant and non-dominant column — the abdominal wall is a single-column code.
Who decides whether my injury is moderate or moderately severe?
The definitions are in 38 CFR 4.56(d) and they are quite specific. Moderate contemplates a short-track wound from a single bullet or small fragment without the explosive effect of a high-velocity missile and without residuals of debridement or prolonged infection. Moderately severe contemplates debridement, prolonged infection or sloughing of soft parts, intermuscular scarring, prolonged hospitalization, and positive evidence of strength impairment on testing against the sound side.
I had a through-and-through abdominal wound. Does that guarantee anything?
38 CFR 4.56(b) provides that a through-and-through injury with muscle damage shall be evaluated as no less than a moderate injury for each group of muscles damaged. That is a floor rather than a ceiling, and it applies per muscle group, so a wound that crossed two groups engages the rule twice. The service treatment record describing the wound track is the evidence that establishes it.
Can I be rated for the hernia and the muscle injury both?
A hernia that developed through the damaged abdominal wall is a distinct disability evaluated under the hernia codes in the digestive schedule, and it can be claimed alongside the muscle group evaluation. What you cannot do is have the same impairment counted twice — 38 CFR 4.14 bars that. Claim both, describe them as separate consequences, and let the rater apply the anti-pyramiding rule.
What about the scar from the wound?
Scars are evaluated separately under the skin codes on their size, and on whether they are painful or unstable. A muscle group evaluation does not include the scar, and a scar evaluation does not include the muscle damage. Both should be claimed and both should be examined.
My wound crossed into the muscles of my back as well. How is that handled?
Muscle Group XX covers the spinal muscles and is a separate code. Under 38 CFR 4.55(f), muscle injuries in different anatomical regions are separately rated and combined under 38 CFR 4.25. Where two compensable injuries are in the same anatomical region but do not act on the same joint, 38 CFR 4.55(e) instead raises the most severely injured group's evaluation by one level and uses that as the combined evaluation.