e. Fractures All fractures associated with a GSW and/or shell fragment wound (SFW) will Associated be considered open because all of them involve an opening to the outside. With Most GSW/SFW fractures are also comminuted due to the shattering nature GSW/SFW of the injury. applies to certain combinations of muscle injuries and joint conditions. f. Determining Whether 38 Consider the provisions of if CFR 4.55 Applies to there are multiple MGs involved Muscle Injuries the MG acts on a joint or joints, and/or there is peripheral nerve damage to the same body part affected by the muscle. If more than one MG is injured or affected or if the injured MG acts on a g. Applying 38 CFR 4.55 to joint, conduct a preliminary review of the evidence to gather information Muscle Injuries needed to properly apply the provisions of . The information needed will include whether the affected MGs are in the same or different anatomic regions whether the MGs are acting on a single joint or multiple joints, and whether the joint or joints is/are ankylosed. After the preliminary review is complete, use the evidence gathered and apply the following table to determine how affects the evaluation of the muscle injury. Step Action 1 Does the MG(s) act on an ankylosed joint? If go to Step 2. yes, If go to Step 4 no, 2 For MG(s) that act on an ankylosed joint, is the joint an ankylosed knee is MG XIII disabled? and If grant separate evaluations for the ankylosed knee and the yes, MG XIII injury. For the MG XIII injury, assign the next lower level than that which would otherwise be assigned. Then go to Step 3. If then is the ankylosed joint the shoulder are MGs I no, and and II disabled? severely If then assign a single evaluation for the muscle injury yes, and the shoulder ankylosis under DC 5200. The evaluation will be at the level of unfavorable ankylosis. If then no evaluation will be assigned for the muscle no, injury. The combined disability arising from the ankylosis and the muscle injury will be evaluated as ankylosis.
e. Fractures Associated With GSW/SFW All fractures associated with a GSW and/or shell fragment wound (SFW) will be considered open because all of them involve an opening to the outside. Most GSW/SFW fractures are also comminuted due to the shattering nature of the injury. f. Determining Whether 38 CFR 4.55 Applies to Muscle Injuries applies to certain combinations of muscle injuries and joint conditions. Consider the provisions of if there are multiple MGs involved the MG acts on a joint or joints, and/or there is peripheral nerve damage to the same body part affected by the muscle. g. Applying 38 CFR 4.55 to Muscle Injuries If more than one MG is injured or affected or if the injured MG acts on a joint, conduct a preliminary review of the evidence to gather information needed to properly apply the provisions of . The information needed will include whether the affected MGs are in the same or different anatomic regions whether the MGs are acting on a single joint or multiple joints, and whether the joint or joints is/are ankylosed. After the preliminary review is complete, use the evidence gathered and apply the following table to determine how affects the evaluation of the muscle injury. Step Action 1 Does the MG(s) act on an ankylosed joint? If yes, go to Step 2. If no, go to Step 4 2 For MG(s) that act on an ankylosed joint, is the joint an ankylosed knee and is MG XIII disabled? If yes, grant separate evaluations for the ankylosed knee and the MG XIII injury. For the MG XIII injury, assign the next lower level than that which would otherwise be assigned. Then go to Step 3. If no, then is the ankylosed joint the shoulder and are MGs I and II severely disabled? If yes, then assign a single evaluation for the muscle injury and the shoulder ankylosis under DC 5200. The evaluation will be at the level of unfavorable ankylosis. If no, then no evaluation will be assigned for the muscle injury. The combined disability arising from the ankylosis and the muscle injury will be evaluated as ankylosis.