VA Hand and Finger Amputation Ratings: Schedular Tiers and Loss of Use

Amputations of the upper extremity are systematically structured under 38 CFR 4.71a across four distinct diagnostic tiers: total hand loss of use (DC 5125), multiple digit amputations (DC 5126 through 5151), single digit amputations (DC 5152 through 5156), and forearm or arm amputations (DC 5120 through 5124). Evaluations consistently differentiate between the major (dominant) and minor (nondominant) extremity, assigning higher percentages to the dominant side.

Single finger amputations are evaluated based on the anatomical level of bone removal and whether the metacarpal bone is resected. Amputation of the thumb (DC 5152) rates at 30% major / 20% minor with metacarpal resection, or 20% for either hand at the distal joint. The index finger (DC 5153) rates at 30% major / 20% minor with metacarpal resection, 20% for either hand at the metacarpophalangeal joint, and 10% through the middle phalanx. The long (DC 5154), ring (DC 5155), and little fingers (DC 5156) each rate at 20% for either hand with metacarpal resection, or 10% without metacarpal resection at or proximal to the proximal interphalangeal joint. Furthermore, under the general rating instructions for digit ankylosis, specific severe joint fusions (such as unfavorable ankylosis of both the MCP and PIP joints with rotation or angulation) expressly direct evaluation under these single-digit amputation codes, even without surgical removal.

A specialized provision in 38 CFR 4.71a General Note (d) applies to multiple finger amputations involving metacarpal bone loss. When metacarpal resection applies to multiple digits, a 10% rating is added directly to (not combined with) the base multi-finger amputation rating. However, this addition is strictly subject to the Amputation Rule under 38 CFR 4.68, which dictates that the combined rating for multiple finger amputations cannot exceed the schedular evaluation for amputation of the entire hand or forearm.

Under 38 CFR 4.63, when an extremity is so severely injured that its remaining functional usefulness is no better than that of an amputation stump, the VA assigns a rating for complete loss of use. For the hand, complete loss of use under DC 5125 is rated at 70% for the major hand and 60% for the minor hand. Loss of use requires clinical documentation that the hand cannot perform grasping, holding, or basic daily functional tasks.

Schedular percentage ratings must be kept strictly separate from statutory Special Monthly Compensation (SMC) under 38 U.S.C. 1114. While schedular ratings compensate for average impairment in earning capacity, SMC-K provides an independent monthly allowance for anatomical loss or loss of use of a single hand or specialized creative organ. For bilateral loss of both hands (DC 5106 anatomical loss or DC 5109 loss of use), the schedule establishes a flat 100% disability evaluation and triggers higher statutory SMC allowances under SMC-M, N, or O. Schedular ratings do not automatically confer SMC entitlement without meeting specific statutory criteria.