VA disability ratings for hand and finger conditions range from 0% to 70% under 38 CFR 4.71a (DC 5125 to 5156 amputations and DC 5216 to 5230 ankylosis or motion loss). Evaluations depend on whether the impairment involves the major or minor hand, specific digit amputations, joint ankylosis, thumb-to-fingertip gap measurements, or total loss of use of the hand.
Condition Overview & Clinical Scope
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The published hand and finger schedule uses several separate pathways. Some describe loss of use of the whole hand or amputation of one or more digits, others describe ankylosis, a fixed joint position, of one or more digits, and others describe limitation of motion of an individual digit. The dominant hand can matter because many levels distinguish the major and minor extremity. Some multi-digit combination routes are not yet fully detailed in this hub and are flagged below rather than estimated.
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What are you trying to understand about hand / fingers?
The published hand and finger schedule uses several separate pathways. Some describe loss of use of the whole hand or amputation of one or more digits, others describe ankylosis, a fixed joint position, of one or more digits, and others describe limitation of motion of an individual digit. The dominant hand can matter because many levels distinguish the major and minor extremity. Some multi-digit combination routes are not yet fully detailed in this hub and are flagged below rather than estimated.
Regulatory authority: 38 CFR 4.71a, DC 5125-5156 and DC 5216-5230
38 CFR 4.71a's amputation general note (d) requires a 10 percent rating to be added to (not combined with) the ratings for multiple finger amputations when metacarpal resection applies in multiple fingers, subject to the amputation rule applied to the forearm; RatingScope's current calculator does not implement this addition (see 'Multi-digit combination routes are not yet enumerated in this hub' below). This guide is educational only. RatingScope does not currently provide a Hand / Fingers record-comparison assessment, does not diagnose a hand or finger condition, does not infer missing measurements, does not determine service connection, and does not predict a VA decision. Six multi-digit combination routes (four-digit amputation, three-digit amputation, two-digit amputation, multiple unfavorable ankylosis, multiple favorable ankylosis, and the unspecified multi-digit combination guard) are not yet enumerated in this hub and are pending digit-combination table expansion; see 'Multi-digit combination routes are not yet enumerated in this hub' below.
Percentage Guides
Understanding Your Percentage
Select a pathway to see what the published criteria ask about, what records may clarify it, and what should not be assumed.
0%
Next: 10% major / 10% minor
The 0% level can describe ring or little finger ankylosis, the least restricted thumb limitation-of-motion gap, or noncompensable index, long, ring, or little finger limitation of motion.
What separates the next level: Higher levels move into compensable thumb, index, or long finger limitation-of-motion thresholds, or into ankylosis or amputation routes for the same or other digits, rather than a further degree of ring or little finger limitation.
Review CFR criteria, examples, and evidence
Official CFR language
DC 5227 lists unfavorable or favorable ankylosis of the ring or little finger at 0 percent for either extremity. DC 5228 lists thumb limitation of motion with a gap of less than one inch between the thumb pad and the fingers at 0 percent for either extremity. DC 5229 lists index or long finger limitation of motion below the compensable gap or extension threshold at 0 percent for either extremity. DC 5230 lists any limitation of motion of the ring or little finger at 0 percent for either extremity. DC 5227 carries a Note: also consider whether evaluation as amputation is warranted and whether an additional evaluation is warranted for resulting limitation of motion of other digits or interference with overall function of the hand.
Qualification explanation
These are four separate routes under different diagnostic codes. RatingScope should not blend a ring or little finger finding with a thumb, index, or long finger finding unless the record documents that specific route.
Examples
The ring finger is ankylosed, either favorably or unfavorably.; The thumb pad-to-finger gap measures less than one inch.; The little finger has some limitation of motion but no other digit finding is documented.
Medical evidence
Hand and Finger DBQ range-of-motion section; Goniometer or gap measurements; Physical therapy range-of-motion notes
Functional impact examples
Grip or fine motor tasks may still be affected even at a noncompensable level.; Pain or activity limits may be real even when the record only supports a 0% pathway.; Ring and little finger findings frequently remain noncompensable under the individual-digit schedule.
Common misconceptions
A 0% level does not mean no impairment is documented, only that this specific route does not reach a compensable percentage.; Ring and little finger ankylosis and limitation of motion are rated at 0% regardless of favorable or unfavorable position.; A missing measurement is not the same as a noncompensable measurement.
Related topics
ring finger; little finger; thumb gap; noncompensable limitation
Source context
38 CFR 4.71a; 5227, 5228, 5229, 5230; Current educational Hand / Fingers guide; deterministic assessment support is not active.
10% major / 10% minor
Next: 20% major / 20% minor
This level can describe index finger amputation through the middle phalanx or at the distal joint, long, ring, or little finger amputation without metacarpal resection, favorable thumb ankylosis, index or long finger ankylosis, a mid-range thumb limitation gap, or compensable index or long finger limitation of motion.
What separates the next level: Higher levels require a more proximal amputation level, metacarpal resection, unfavorable thumb ankylosis, or a larger thumb limitation gap, rather than this entry level of finding.
Review CFR criteria, examples, and evidence
Official CFR language
DC 5153 lists index finger amputation through the middle phalanx or at the distal joint at 10 percent for either extremity. DC 5154-5156 list long, ring, or little finger amputation without metacarpal resection, at or proximal to the proximal interphalangeal joint, at 10 percent for either extremity. DC 5224 lists favorable thumb ankylosis at 10 percent for either extremity. DC 5225-5226 list index or long finger ankylosis, unfavorable or favorable, at 10 percent for either extremity. DC 5228 lists thumb limitation of motion with a gap of one to two inches between the thumb pad and the fingers at 10 percent for either extremity. DC 5229 lists index or long finger limitation of motion with a gap of one inch or more, or extension limited by more than 30 degrees, at 10 percent for either extremity. DC 5224 and DC 5225-5226 each carry a Note: also consider whether evaluation as amputation is warranted and whether an additional evaluation is warranted for resulting limitation of motion of other digits or interference with overall function of the hand.
Qualification explanation
These are several separate routes across different diagnostic codes that happen to share the same percentage. RatingScope should not blend an amputation finding with an ankylosis finding or a limitation-of-motion finding, and the record needs to document the specific route and digit involved.
Examples
The index finger is amputated through the middle phalanx.; The long finger is amputated without metacarpal resection at the proximal interphalangeal joint.; The thumb is fixed in a favorable ankylosis position.; The index finger has extension limited by more than 30 degrees.
Medical evidence
Hand and Finger DBQ amputation and ankylosis sections; Operative report for amputation level; Imaging confirming ankylosis position; Goniometer measurements for extension
Functional impact examples
Difficulty with pinch grip, buttoning, or fine manipulation tasks.; Reduced ability to fully extend the affected finger for typing or gripping.; Functional limits may still be real even when the record supports only this entry-level route.
Common misconceptions
Amputation level, ankylosis position, and limitation-of-motion gap are different findings and are not interchangeable.; A general finger injury is not automatically an amputation, ankylosis, or a specific limitation-of-motion route.; Long, ring, and little finger amputation share the same percentages, but the specific digit should still be documented.
Related topics
index finger amputation; long finger amputation; favorable ankylosis; thumb gap; extension limitation
Source context
38 CFR 4.71a; 5153, 5154-5156, 5224, 5225-5226, 5228, 5229; Current educational Hand / Fingers guide; deterministic assessment support is not active.
20% major / 20% minor
Next: 30% major / 20% minor
This level can describe thumb amputation at the distal joint or distal phalanx, index finger amputation without metacarpal resection at a proximal level, long, ring, or little finger amputation with metacarpal resection, unfavorable thumb ankylosis, or the largest thumb limitation-of-motion gap.
What separates the next level: Higher levels require thumb amputation with metacarpal resection, a more proximal index amputation level, or a five-digit or multi-digit combination route rather than this single-digit level.
Review CFR criteria, examples, and evidence
Official CFR language
DC 5152 lists thumb amputation at the distal joint or through the distal phalanx at 20 percent for either extremity. DC 5153 lists index finger amputation without metacarpal resection, at or proximal to the proximal interphalangeal joint, at 20 percent for either extremity. DC 5154-5156 list long, ring, or little finger amputation with metacarpal resection, more than one-half the bone lost, at 20 percent for either extremity. DC 5224 lists unfavorable thumb ankylosis at 20 percent for either extremity. DC 5228 lists thumb limitation of motion with a gap of more than two inches between the thumb pad and the fingers at 20 percent for either extremity. DC 5224 carries a Note: also consider whether evaluation as amputation is warranted and whether an additional evaluation is warranted for resulting limitation of motion of other digits or interference with overall function of the hand.
Qualification explanation
These are several separate routes across different diagnostic codes and digits that share the same percentage. The record needs to identify the specific digit, amputation level, ankylosis position, or limitation-of-motion gap rather than assuming any one route from a general finding.
Examples
The thumb is amputated through the distal phalanx.; The index finger is amputated at the proximal interphalangeal joint without metacarpal resection.; The ring finger is amputated with metacarpal resection.; The thumb is fixed in an unfavorable ankylosis position.; The thumb pad-to-finger gap measures more than two inches.
Medical evidence
Hand and Finger DBQ amputation and ankylosis sections; Operative report identifying amputation level and metacarpal involvement; Imaging confirming ankylosis position; Thumb opposition gap measurements
Functional impact examples
Marked difficulty with pinch grip, opposition, and fine manipulation.; Reduced grip strength and object manipulation when a digit is amputated at this level.; Dressing, grooming, and tool-use tasks may be substantially affected.
Common misconceptions
Metacarpal resection is a specific surgical finding, not simply a description of a severe injury.; Thumb, index, and long/ring/little amputation routes use different diagnostic codes even where percentages match.; This level does not require every digit to be affected; it can apply to a single amputated, ankylosed, or limited digit.
Related topics
thumb amputation; index finger amputation; metacarpal resection; unfavorable ankylosis; thumb limitation of motion
Source context
38 CFR 4.71a; 5152, 5153, 5154-5156, 5224, 5228; Current educational Hand / Fingers guide; deterministic assessment support is not active.
30% major / 20% minor
Next: 40% major / 30% minor
This level can describe thumb amputation at the metacarpophalangeal joint or proximal phalanx, or index finger amputation with metacarpal resection.
What separates the next level: The next higher level requires thumb amputation with metacarpal resection, which is a more proximal loss than this level, or a multi-digit combination route affecting additional digits.
Review CFR criteria, examples, and evidence
Official CFR language
DC 5152 lists thumb amputation at the metacarpophalangeal joint or through the proximal phalanx at 30 percent for the major extremity and 20 percent for the minor extremity. DC 5153 lists index finger amputation with metacarpal resection, more than one-half the bone lost, at 30 percent for the major extremity and 20 percent for the minor extremity.
Qualification explanation
These are two separate routes under different diagnostic codes. The record needs to identify whether the finding involves the thumb or the index finger and the specific amputation level.
Examples
The thumb is amputated at the metacarpophalangeal joint.; The index finger is amputated with metacarpal resection, more than one-half the bone lost.
Medical evidence
Hand and Finger DBQ amputation section; Operative report identifying amputation level and metacarpal involvement; Imaging confirming residual bone length
Functional impact examples
Substantial loss of pinch grip and opposition when the thumb is affected at this level.; Significant reduction in grip strength and hand span when the index finger is affected at this level.; Occupational tasks requiring fine manipulation may be substantially limited.
Common misconceptions
Thumb and index finger amputation at this level use different diagnostic codes even though the major-extremity percentage matches.; A proximal phalanx amputation is not automatically the same as a metacarpal resection.; This level does not depend on additional digits being affected.
Related topics
thumb amputation; index finger amputation; metacarpal resection
Source context
38 CFR 4.71a; 5152, 5153; Current educational Hand / Fingers guide; deterministic assessment support is not active.
40% major / 30% minor
Next: 50% major / 40% minor
This level describes thumb amputation with metacarpal resection.
What separates the next level: Higher levels move into five-digit or multi-digit combination amputation routes affecting the thumb together with other digits, rather than a further degree of thumb-only amputation.
Review CFR criteria, examples, and evidence
Official CFR language
DC 5152 lists thumb amputation with metacarpal resection at 40 percent for the major extremity and 30 percent for the minor extremity.
Qualification explanation
The record needs to document metacarpal resection specifically, not just an amputation at a distal or proximal phalanx level.
Examples
The thumb is amputated with metacarpal resection documented in the operative report.; No other digits are documented as amputated.
Medical evidence
Hand and Finger DBQ amputation section; Operative report confirming metacarpal resection; Postoperative follow-up records
Functional impact examples
Severe loss of opposition and pinch grip when the thumb is amputated with metacarpal resection.; Major reduction in the ability to grasp, hold, or manipulate objects.; Occupational and daily-living tasks that depend on thumb opposition may be substantially affected.
Common misconceptions
Metacarpal resection means more than one-half the bone is lost, not simply a high-level amputation.; This level does not require additional digits to be affected.; A prosthetic thumb does not change this diagnostic-code-based percentage.
Related topics
thumb amputation; metacarpal resection
Source context
38 CFR 4.71a; 5152; Current educational Hand / Fingers guide; deterministic assessment support is not active.
50% major / 40% minor
Next: 60% major / 50% minor
This level describes favorable ankylosis of all five digits of one hand.
What separates the next level: Unfavorable ankylosis of all five digits is rated higher than this favorable five-digit level. Combinations affecting fewer than five digits are addressed by separate multi-digit ankylosis routes that are not yet enumerated in this hub.
Review CFR criteria, examples, and evidence
Official CFR language
DC 5220 lists favorable ankylosis of five digits of one hand at 50 percent for the major extremity and 40 percent for the minor extremity.
Qualification explanation
All five digits of the same hand need to be documented as ankylosed in a favorable position. Combinations of fewer than five digits use separate multi-digit ankylosis routes.
Examples
All five digits of the dominant hand are documented as ankylosed in a favorable position.; Imaging or examination confirms a fixed favorable position across all five digits.
Medical evidence
Hand and Finger DBQ ankylosis section; Imaging confirming fixed position across all five digits; Orthopedic specialist notes
Functional impact examples
Severe limits on grip, grasp, and fine manipulation when all five digits are fixed.; Substantial difficulty with dressing, grooming, and two-handed tasks.; Occupational tasks requiring hand use may be substantially affected.
Common misconceptions
This level requires all five digits, not just several digits, to be documented as ankylosed.; Favorable and unfavorable five-digit ankylosis are rated at different percentages and are not interchangeable.; Combinations of fewer than five digits use separate multi-digit routes, which this hub does not yet enumerate.
38 CFR 4.71a; 5220; Current educational Hand / Fingers guide; deterministic assessment support is not active.
60% major / 50% minor
Next: 70% major / 60% minor
This level describes unfavorable ankylosis of all five digits of one hand.
What separates the next level: Five-digit amputation or loss of use of the hand are rated higher than this five-digit unfavorable ankylosis level. Combinations affecting fewer than five digits are addressed by separate multi-digit ankylosis routes that are not yet enumerated in this hub.
Review CFR criteria, examples, and evidence
Official CFR language
DC 5216 lists unfavorable ankylosis of five digits of one hand at 60 percent for the major extremity and 50 percent for the minor extremity.
Qualification explanation
All five digits of the same hand need to be documented as ankylosed in an unfavorable position. Combinations of fewer than five digits use separate multi-digit ankylosis routes.
Examples
All five digits of the nondominant hand are documented as ankylosed in an unfavorable position.; Imaging or examination confirms a fixed unfavorable position across all five digits.
Medical evidence
Hand and Finger DBQ ankylosis section; Imaging confirming fixed unfavorable position across all five digits; Orthopedic specialist notes describing severity
Functional impact examples
Very severe limits on grip, grasp, and fine manipulation when all five digits are fixed unfavorably.; Marked difficulty with virtually all two-handed and fine-motor tasks.; Functional impact approaching that of a nonfunctional hand may be documented, though loss of use is a separate, higher route.
Common misconceptions
This level requires all five digits, not just several digits, to be documented as ankylosed unfavorably.; Unfavorable five-digit ankylosis is not the same as loss of use of the hand, which is rated separately at a higher level.; Combinations of fewer than five digits use separate multi-digit routes, which this hub does not yet enumerate.
Related topics
five-digit ankylosis; unfavorable ankylosis; loss of use; multi-digit combination routes pending
Source context
38 CFR 4.71a; 5216; Current educational Hand / Fingers guide; deterministic assessment support is not active.
70% major / 60% minor
Highest listed pathway
This is the highest documented level in this hub. It can describe loss of use of the whole hand, or amputation of all five digits of one hand.
What separates the next level: Four-digit, three-digit, and two-digit amputation combinations are addressed by separate multi-digit amputation routes that are not yet enumerated in this hub, pending digit-combination table expansion. Combination routes should not be estimated from this five-digit or loss-of-use level.
Review CFR criteria, examples, and evidence
Official CFR language
DC 5125 lists loss of use of a hand at 70 percent for the major extremity and 60 percent for the minor extremity. DC 5126 lists amputation of five digits of one hand at 70 percent for the major extremity and 60 percent for the minor extremity.
Qualification explanation
These are two separate routes with different underlying findings. Loss of use is a functional determination that the hand cannot be used as though it were amputated, while five-digit amputation is an actual surgical or traumatic loss of all five digits. The record needs to identify which route actually applies.
Examples
All five digits of one hand are amputated.; The hand is so severely affected that no effective function remains, supporting a loss-of-use determination.; Prosthetic or surgical records document the amputation level.
Medical evidence
Hand and Finger DBQ amputation and functional-impact sections; Operative report for amputation; Orthopedic specialist notes supporting a loss-of-use determination; Functional-impact documentation
Functional impact examples
The hand cannot perform grasping, gripping, or fine manipulation tasks.; Two-handed tasks require substantial adaptation or reliance on the other hand.; Occupational tasks requiring hand use are severely limited or precluded.
Common misconceptions
Loss of use requires a functional determination, not simply severe pain or weakness.; Four-digit, three-digit, and two-digit amputation combinations are not the same as five-digit amputation and are not yet enumerated in this hub.; A missing digit-combination table entry should not be estimated from this five-digit level.
Related topics
loss of use; five-digit amputation; multi-digit combination routes pending
Source context
38 CFR 4.71a; 5125, 5126; Current educational Hand / Fingers guide; deterministic assessment support is not active.
Learn
Understand the details behind the criteria
Use these short guides to connect published terms with the records and observations that may clarify them.
Loss of use of the hand and finger amputation levels
DC 5125 addresses loss of use of the whole hand, while DC 5126 and DC 5152-5156 address amputation of five digits or an individual thumb or finger by level.
Loss of use is a functional determination that the hand cannot be used as though it were amputated, separate from an actual amputation.
Five-digit amputation under DC 5126 requires all five digits of one hand to be amputated.
Individual thumb and finger amputation levels under DC 5152-5156 depend on whether metacarpal resection occurred and how proximal the amputation is.
Long, ring, and little finger amputation share the same percentage structure under DC 5154-5156, but the specific digit should still be documented.
DC 5214 (wrist ankylosis, a separate diagnostic code) notes that extremely unfavorable wrist ankylosis, amounting to loss of use of the hand, is not rated as a further step within that code and may instead be evaluated under DC 5125, loss of use of the hand, the same loss-of-use route addressed in this hub.
Records to review: Hand and Finger DBQ; operative report; orthopedic specialist notes.
Thumb, index, long, ring, and little finger ankylosis patterns
Ankylosis means a fixed joint position, and the hand and finger schedule separates five-digit, thumb, index/long, and ring/little ankylosis into different routes.
Five-digit ankylosis under DC 5216 and DC 5220 separates favorable and unfavorable fixed positions across all five digits.
Thumb ankylosis under DC 5224 separately lists unfavorable and favorable positions.
Index and long finger ankylosis under DC 5225-5226 is rated the same whether unfavorable or favorable.
Ring and little finger ankylosis under DC 5227 is rated at 0 percent regardless of favorable or unfavorable position.
38 CFR 4.71a's evaluation notes for single or multiple digits define exactly when a joint finding legally counts as favorable versus unfavorable ankylosis. For the index, long, ring, and little fingers: if both the metacarpophalangeal and proximal interphalangeal joints of a digit are ankylosed, evaluate as unfavorable ankylosis, even if each joint is individually fixed in a favorable position. The same both-joints rule applies to the thumb's carpometacarpal and interphalangeal joints.
When only one joint of a digit is ankylosed (not both), a gap of more than two inches (5.1 cm) -- between the fingertip and the palm for the index, long, ring, or little finger, or between the thumb pad and the fingers for the thumb -- is evaluated as unfavorable ankylosis; a gap of two inches (5.1 cm) or less is evaluated as favorable ankylosis.
If both joints of a digit are ankylosed and either joint is in extension or full flexion, or there is rotation or angulation of a bone, the finding is evaluated as amputation instead of ankylosis (without metacarpal resection, at the proximal interphalangeal joint or proximal thereto for the fingers; at the metacarpophalangeal joint or through the proximal phalanx for the thumb).
Records to review: Hand and Finger DBQ ankylosis section; imaging confirming fixed position; orthopedic specialist notes.
Thumb, index, long, ring, and little finger limitation of motion
Limitation of motion of individual digits is measured differently than ankylosis and uses gap or extension-limit measurements rather than a fixed-position finding.
Thumb limitation of motion under DC 5228 is measured by the gap between the thumb pad and the fingers.
Index and long finger limitation of motion under DC 5229 is measured by a fingertip gap or by extension limited by more than 30 degrees.
Ring and little finger limitation of motion under DC 5230 is rated at 0 percent regardless of the specific measurement.
Limitation of motion describes a joint that still moves but not through the full range, distinct from ankylosis, which describes a fixed joint.
38 CFR 4.71a's evaluation note (5) states: if there is limitation of motion of two or more digits, evaluate each digit separately and combine the evaluations. This is a fully computable rule under the standard combined ratings table (38 CFR 4.25), distinct from the amputation and ankylosis multi-digit combination tables that are not yet enumerated in this hub.
Records to review: Hand and Finger DBQ range-of-motion section; goniometer or gap measurements; physical therapy notes.
Why dominant and nondominant hand matter
Many hand and finger percentages differ depending on whether the affected extremity is major or minor.
Major usually means the dominant upper extremity.
Minor usually means the nondominant upper extremity.
The affected side and dominance should be documented rather than guessed.
Some individual-digit routes, such as ring and little finger ankylosis and limitation of motion, do not differ by dominance because they are rated at 0 percent for either extremity.
Records to review: DBQ dominant-hand section; clinical history; veteran statement when appropriate.
Flare-ups, repeated use, and functional loss
Hand and finger function can change with repeated use, flare-ups, pain, weakness, fatigability, incoordination, or lack of endurance.
The DBQ may ask how flare-ups affect movement and ordinary tasks.
Repeated-use findings may identify whether motion changes after repetitive testing or over time.
Functional impact can include grip, pinch, fine manipulation, dressing, grooming, tool use, and repetitive work tasks.
RatingScope uses functional-loss language as educational context and does not infer absent medical findings.
Records to review: DBQ flare-up section; repeated-use testing; treatment notes; lay descriptions of functional impact.
Multi-digit combination routes are not yet enumerated in this hub
The hand and finger schedule includes several combination routes for four, three, or two affected digits, and for unspecified multi-digit combinations, that depend on exactly which digits are involved. This hub does not yet enumerate their specific percentages.
This pending status applies to amputation and ankylosis multi-digit combinations only. Pure limitation-of-motion combinations of two or more digits are different: 38 CFR 4.71a's evaluation note (5) already makes those computable today by evaluating each digit separately and combining the evaluations under the standard combined ratings table (38 CFR 4.25); see the finger-limitation-of-motion topic above.
Four-digit amputation combinations (DC 5127-5131) depend on which four digits of the hand are affected and are not yet enumerated in this hub, pending digit-combination table expansion.
Three-digit amputation combinations (DC 5132-5141) depend on which three digits of the hand are affected and are not yet enumerated in this hub, pending digit-combination table expansion.
Two-digit amputation combinations (DC 5142-5151) depend on which two digits of the hand are affected and are not yet enumerated in this hub, pending digit-combination table expansion.
Multiple-digit unfavorable ankylosis combinations (DC 5217-5219) depend on which digits are affected and are not yet enumerated in this hub, pending digit-combination table expansion.
Multiple-digit favorable ankylosis combinations (DC 5221-5223) depend on which digits are affected and are not yet enumerated in this hub, pending digit-combination table expansion.
Combinations of ankylosis or limitation of motion across multiple digits that are not otherwise specified are evaluated under a representative-disability-level guard (38 CFR 4.71a, evaluation of ankylosis or limitation of motion of single or multiple digits, note 2), and the specific representative-level determination is not yet enumerated in this hub, pending digit-combination table expansion.
None of these six pending combination routes should be estimated from the single-digit or five-digit routes documented elsewhere in this hub.
Separately, 38 CFR 4.71a's amputation general note (d) requires a 10 percent rating to be added to (not combined with) the ratings for multiple finger amputations when metacarpal resection applies in multiple fingers, subject to the forearm amputation rule. This is disclosed as an open computational gap; RatingScope's current calculator does not implement this addition.
Records to review: 38 CFR 4.71a digit-combination notes; Hand and Finger DBQ; orthopedic specialist notes describing every affected digit.
Measurement Guide
How hand and finger findings are measured
Measurements should come from medical records, examinations, DBQs, or other documented clinical findings. RatingScope does not estimate a gap, extension limit, or fixed position from symptoms.
Thumb opposition gap
The gap between the tip of the thumb and the fingers when the thumb attempts to touch or oppose the fingers.
Normal reference: The DBQ records the gap in inches between the thumb pad and the fingers.
Why it matters: DC 5228 uses this gap measurement to identify the thumb limitation-of-motion pathway.
Index or long finger fingertip gap
The gap between the fingertip and the proximal transverse crease of the palm on maximal flexion.
Normal reference: The DBQ records this gap in inches for the index or long finger.
Why it matters: DC 5229 uses this gap measurement, or an extension limit, to identify the index or long finger limitation-of-motion pathway.
Index or long finger extension limitation
How far the index or long finger is limited from full extension.
Normal reference: The DBQ records extension limitation in degrees.
Why it matters: DC 5229 lists extension limited by more than 30 degrees as an alternate route to the fingertip gap measurement.
Digit ankylosis position
Whether a digit is fixed in a favorable or unfavorable position rather than moving through a range.
Normal reference: The DBQ records ankylosis position for each affected digit.
Why it matters: DC 5216, DC 5220, DC 5224, and DC 5225-5227 use the specific digit and favorable-or-unfavorable position to identify the applicable ankylosis pathway.
How an examination adds context
Dominant hand
The examiner may record whether the affected extremity is dominant because several percentages differ for major and minor extremities.
Active and passive motion
Records may distinguish motion the veteran performs from motion the examiner moves through passively.
Repeated-use testing
The DBQ may ask whether repeated use causes additional loss of function or range of motion.
Flare-ups
Flare-up descriptions help explain whether function changes during worse episodes, but they should not be converted into measurements unless documented.
Painful motion
Pain can matter when it affects documented function or motion. RatingScope does not treat pain as a stand-alone rating calculation.
Evidence
Evidence that may clarify the published criteria
Hand and Finger DBQ
The DBQ organizes diagnosis, dominant side, amputation level, ankylosis position, limitation-of-motion gaps, pain, and functional impact for each affected digit.
A DBQ is useful context, but RatingScope does not require uploads and this hub does not accept records.
Diagnosis and treatment records
Treatment notes can show the current condition, course over time, therapy, medication, brace use, surgery, and clinician observations.
A diagnosis alone does not identify which percentage pathway applies.
X-rays, MRI, CT, or operative imaging
Imaging may help document a fixed ankylosis position, amputation level, metacarpal resection, or other structural findings.
Imaging severity should not be substituted for a route-specific CFR finding.
Range-of-motion and gap measurements
Thumb opposition gap and index or long finger fingertip gap measurements help clarify which limitation-of-motion pathway is being discussed.
RatingScope does not estimate gaps or degrees from words such as stiff, sore, or limited.
Dominant-hand documentation
Dominance helps separate major and minor extremity criteria where the schedule lists different percentages.
Dominance should not be guessed from right or left side alone.
Amputation and surgery records
Operative and orthopedic records can clarify amputation level, metacarpal resection, and residual findings for each affected digit.
A general hand injury history is not the same as a documented amputation level.
Personal and firsthand lay evidence
Plain descriptions can explain grip, pinch, fine manipulation, dressing, grooming, tool use, and flare-up impact.
Lay evidence can describe observed impact, but it should not invent medical measurements or diagnoses.
Functional-loss descriptions
Records describing pain, weakness, fatigability, incoordination, lack of endurance, flare-ups, or repeated-use limits help connect symptoms to function.
Functional loss is context; it does not let RatingScope infer absent CFR findings.
Official VA Forms & DBQs
Downloadable DBQs & Supporting Claim Forms
Take the public DBQ to your private physician or review it prior to your C&P examination.
Terminology
Plain-English terms
Loss of use
The hand functions so poorly that it is treated as though it cannot be used at all.
DC 5125 rates loss of use of the hand separately from an actual amputation.
When more than one but fewer than five digits are affected, the schedule uses combination tables that depend on exactly which digits are involved.
DC 5127-5131 (four-digit amputation), DC 5132-5141 (three-digit amputation), DC 5142-5151 (two-digit amputation), DC 5217-5219 (multiple-digit unfavorable ankylosis), DC 5221-5223 (multiple-digit favorable ankylosis), and the note 2 representative-level guard for unspecified multi-digit combinations are not yet enumerated in this hub, pending digit-combination table expansion.
Even if the schedular rating for Hand / Fingers does not reach 100 percent, TDIU may still provide a pathway to compensation at the 100 percent rate, based on unemployability from this and/or other service-connected disabilities combined.
A lower schedular percentage does not by itself foreclose TDIU eligibility -- this hub computes only the schedular percentage for this specific condition and does not determine TDIU eligibility.
What is the difference between loss of use of the hand and five-digit amputation?
Loss of use under DC 5125 is a functional determination that the hand cannot be used as though it were amputated, even though the digits may still be physically present. Five-digit amputation under DC 5126 is an actual surgical or traumatic loss of all five digits. Both are rated at the same percentage, but they are different findings.
Does metacarpal resection change the percentage for finger amputation?
Yes. DC 5152-5156 list a higher percentage when metacarpal resection, meaning more than one-half the bone is lost, is documented, compared with a more distal amputation of the same digit.
Are ring and little finger ankylosis and limitation of motion ever compensable?
Under DC 5227 and DC 5230, ring and little finger ankylosis and limitation of motion are rated at 0 percent for either extremity, regardless of favorable or unfavorable position or the specific measurement.
What about combinations of several affected digits?
The schedule includes separate combination routes for four, three, or two affected digits, and for unspecified multi-digit combinations, that depend on exactly which digits are involved. This hub does not yet enumerate the specific percentages for those six combination routes and flags them as pending digit-combination table expansion rather than estimating them. Pure limitation-of-motion combinations across two or more digits are different: 38 CFR 4.71a's evaluation note (5) already makes those computable today by evaluating each digit separately and combining the evaluations, so they are not part of the six pending routes described above.
Does dominant hand matter for hand and finger conditions?
It can. Many levels distinguish major and minor extremity values, so records should identify the affected side and whether that side is dominant. Some individual-digit routes, such as ring and little finger findings, do not differ by dominance.
What is the difference between ankylosis and limitation of motion for a finger?
Ankylosis means the digit is fixed in a position. Limitation of motion means the digit still moves but not through the full range, measured by a gap or an extension limit depending on the digit.
Does pain automatically increase a hand or finger percentage?
Pain matters when it affects documented motion or function, but pain by itself does not identify a route. The record still needs the specific finding the schedule asks about.
Is this an active RatingScope assessment?
No. This Hand / Fingers hub is educational only. Do not enter hand or finger findings into another condition's assessment.
Does metacarpal resection in a multi-finger amputation change the math, not just the percentage?
Yes, and this is a genuinely different kind of math than most of the rest of this schedule. 38 CFR 4.71a's amputation-group general note (d) states that amputation or resection of metacarpal bones (more than one-half the bone lost) in multiple fingers injuries requires a rating of 10 percent ADDED TO (not combined with) the ratings for the multiple finger amputations, subject to the amputation rule applied to the forearm. This is a direct addition, unlike the combine-style math (38 CFR 4.25/4.55) used elsewhere in this schedule. RatingScope's current calculator does not implement this addition; it only selects the multi-digit amputation combination table entry and does not apply this separate 10 percent add-on.
How does the same-hand "most representative grade" rule interact with the bilateral factor?
This hub's amputation general note (e) and ankylosis general note (2) direct that when multiple digits of the SAME hand are affected, the finding is rated at whichever grade best represents the overall disability. Separately, 38 CFR 4.26's bilateral factor can apply when BOTH hands have compensable findings. How these two rules interact has not been examined and is not resolved in this hub. This is disclosed as an open question, not answered here.
If my schedular rating for Hand / Fingers is below 100%, can I still be compensated at the 100% rate?
Possibly, through TDIU (Total Disability rating based on Individual Unemployability, 38 CFR 4.16) -- a separate pathway to 100 percent compensation based on unemployability, from this and/or other service-connected disabilities combined, independent of whether the schedular rating itself reaches 100 percent. This hub computes only the schedular percentage and does not determine TDIU eligibility.
What separates the 0% rating from adjacent levels?
Higher levels move into compensable thumb, index, or long finger limitation-of-motion thresholds, or into ankylosis or amputation routes for the same or other digits, rather than a further degree of ring or little finger limitation.
What separates the 10% major / 10% minor rating from adjacent levels?
Higher levels require a more proximal amputation level, metacarpal resection, unfavorable thumb ankylosis, or a larger thumb limitation gap, rather than this entry level of finding.
What separates the 20% major / 20% minor rating from adjacent levels?
Higher levels require thumb amputation with metacarpal resection, a more proximal index amputation level, or a five-digit or multi-digit combination route rather than this single-digit level.
What separates the 30% major / 20% minor rating from adjacent levels?
The next higher level requires thumb amputation with metacarpal resection, which is a more proximal loss than this level, or a multi-digit combination route affecting additional digits.
What separates the 40% major / 30% minor rating from adjacent levels?
Higher levels move into five-digit or multi-digit combination amputation routes affecting the thumb together with other digits, rather than a further degree of thumb-only amputation.
What separates the 50% major / 40% minor rating from adjacent levels?
Unfavorable ankylosis of all five digits is rated higher than this favorable five-digit level. Combinations affecting fewer than five digits are addressed by separate multi-digit ankylosis routes that are not yet enumerated in this hub.
What separates the 60% major / 50% minor rating from adjacent levels?
Five-digit amputation or loss of use of the hand are rated higher than this five-digit unfavorable ankylosis level. Combinations affecting fewer than five digits are addressed by separate multi-digit ankylosis routes that are not yet enumerated in this hub.
What separates the 70% major / 60% minor rating from adjacent levels?
Four-digit, three-digit, and two-digit amputation combinations are addressed by separate multi-digit amputation routes that are not yet enumerated in this hub, pending digit-combination table expansion. Combination routes should not be estimated from this five-digit or loss-of-use level.
If more than one condition is involved, combined-rating math is educational context and does not simply add percentages.
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RatingScope currently provides this Hand / Fingers hub as education only. Do not enter hand or finger findings into another condition's assessment. Use the supported assessment list only when your condition is available.
Informational guidance only. RatingScope does not predict, decide, or guarantee VA outcomes.
Official regulation source for DC 5125-5156 and DC 5216-5230. Use the official source for current rule text, including the full digit-combination tables.
Separate public VA DBQ used to record amputation level and metacarpal resection findings, including finger amputation levels the Hand and Finger Conditions DBQ does not capture.
38 CFR 4.16 - Total disability ratings for compensation based on unemployability (TDIU)
Official source for TDIU, a separate pathway to 100 percent compensation based on unemployability, independent of the schedular percentage. This hub does not determine TDIU eligibility.