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Hand VA Rating Criteria for Thumb and Finger Conditions (DC 5216–5230)

By Truth Veteran Benefits Desk · Reviewed by Truth Veteran Benefits Desk on

The VA assigns a hand VA rating under 38 CFR 4.71a using Diagnostic Codes 5216–5227 for thumb and finger ankylosis and DCs 5228–5230 for limitation of motion under Plate III. Single-digit motion loss is rated up to 20% for the thumb and 10% for the index or long finger, while multi-digit ankylosis ranges from 10% to 60% based on position and hand dominance.

Older veteran sitting at a wooden workbench flexing his hand and fingers in natural window light
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How the VA evaluates hand and finger conditions under 38 CFR 4.71a

Determining how a hand va rating is calculated starts with 38 CFR 4.71a (Evaluation of Ankylosis or Limitation of Motion of Single or Multiple Digits of the Hand) and 38 CFR 4.71 (Plate III). All upper-extremity claims follow the statutory VA disability ratings framework.

Distal to the carpal wrist bones, the hand contains five metacarpals and 14 phalanges, designated by Roman numerals:

  • Digit I (Thumb): Articulated by the carpometacarpal (CMC), metacarpophalangeal (MCP), and interphalangeal (IP) joints (10% or 20% for single-digit limitation or ankylosis).
  • Digit II (Index) and Digit III (Long / middle): Articulated by MCP, proximal interphalangeal (PIP), and distal (terminal) interphalangeal (DIP) joints (10% per digit for compensable limitation or ankylosis).
  • Digit IV (Ring) and Digit V (Little): Articulated by MCP, PIP, and DIP joints (0% for single-digit ankylosis under DC 5227 or limitation of motion under DC 5230, unless rated under multi-digit ankylosis, amputation, or minor-joint-group arthritis).

Once service connected (38 CFR 3.303), hand conditions are rated under DCs 5216–5219 (multi-digit unfavorable ankylosis, 20%–60%), DCs 5220–5223 (multi-digit favorable ankylosis, 10%–50%), DCs 5224–5227 (single-digit ankylosis, 0%–20%), DCs 5228–5230 (single-digit limitation of motion, 0%–20%), DCs 5126–5156 (amputation-equivalent ankylosis), DC 5003 / 38 CFR 4.45 (minor-joint-group arthritis, 10%), or DC 5125 (loss of use of the hand, 70% Major / 60% Minor).

Complete hand and finger VA rating tables (38 CFR 4.71a)

Table 1: Single-digit limitation of motion and ankylosis (DCs 5224–5230 and 38 CFR 4.45 / 4.59)

CodeRegulatory Criteria (38 CFR 4.71a / 38 CFR 4.45 & 4.59)Major / Minor
DC 5228Thumb, limitation of motion: Gap > 2 in. (5.1 cm) between thumb pad and fingers on opposition20% / 20%
DC 5228Gap of 1–2 in. (2.5–5.1 cm) between thumb pad and fingers on opposition (or painful motion under 38 CFR 4.59)10% / 10%
DC 5228Gap < 1 in. (2.5 cm) between thumb pad and fingers on opposition0% / 0%
DC 5229Index or long finger, limitation of motion: Gap ≥ 1 in. (2.5 cm) between fingertip and proximal palm crease on full flexion, or extension limited by > 30° (or painful motion)10% / 10%
DC 5229Gap < 1 in. (2.5 cm) to proximal palm crease on full flexion, and extension limited by ≤ 30°0% / 0%
DC 5230Ring or little finger, limitation of motion: Any limitation of motion0% / 0%
DC 5224Thumb, ankylosis of: Unfavorable (or 30% / 20% as DC 5152 amputation under Note 4(i))20% / 20%
DC 5224Thumb, ankylosis of: Favorable (single CMC or IP joint ankylosed with opposition gap ≤ 2 in. / 5.1 cm)10% / 10%
DC 5225Index finger, ankylosis of: Unfavorable or favorable (or 20% as DC 5153 amputation under Note 3(i))10% / 10%
DC 5226Long finger, ankylosis of: Unfavorable or favorable (also consider DC 5154 amputation or digit interference)10% / 10%
DC 5227Ring or little finger, ankylosis of: Unfavorable or favorable (or 10% as DC 5155/5156 amputation under Note 3(i))0% / 0%
DC 5003 / 4.45Minor joint group arthritis: Multiple interphalangeal, metacarpal, or carpal joints of one hand with X-ray arthritis and painful/limited motion10% / 10%

Table 2: Multiple-digit ankylosis (DCs 5216–5223) and loss of use of the hand (DC 5125)

Digits of One Hand Ankylosed (38 CFR 4.71a)Unfavorable (Major / Minor)Favorable (Major / Minor)
Five digits: All 5 digitsDC 5216: 60% / 50%DC 5220: 50% / 40%
Four digits: Thumb and any three fingersDC 5217: 60% / 50%DC 5221: 50% / 40%
Four digits: Index, long, ring, and littleDC 5217: 50% / 40%DC 5221: 40% / 30%
Three digits: Thumb and any two fingersDC 5218: 50% / 40%DC 5222: 40% / 30%
Three digits: Index, long, and ring; index, long, and little; or index, ring, and littleDC 5218: 40% / 30%DC 5222: 30% / 20%
Three digits: Long, ring, and littleDC 5218: 30% / 20%DC 5222: 20% / 20%
Two digits: Thumb and any fingerDC 5219: 40% / 30%DC 5223: 30% / 20%
Two digits: Index and long; index and ring; or index and littleDC 5219: 30% / 20%DC 5223: 20% / 20%
Two digits: Long and ring; long and little; or ring and littleDC 5219: 20% / 20%DC 5223: 10% / 10%
Hand, loss of use of (DC 5125, plus SMC-K): No effective function beyond prosthesisDC 5125: 70% / 60%—

Monthly rates (veteran alone, effective 2025-12-01): 10% = $180.42, 20% = $356.66, 30% = $552.47, 40% = $795.84, 50% = $1,132.90, 60% = $1,435.02, and 70% = $1,808.45.

Plate III and the five rules for measuring hand ranges of motion

Under 38 CFR 4.71 (Plate III) and Notes (1)–(5) to DCs 5216–5230 in 38 CFR 4.71a:

  • Zero degrees and normal finger ranges (Note 1): For digits II–V (index, long, ring, and little), 0° of flexion is full extension in a straight line with the hand. Normal flexion is 0°–90° (MCP), 0°–100° (PIP), and 0°–70° or 80° (DIP).
  • Favorable “position of function” (Note 1): A joint is in a favorable position only when the wrist is dorsiflexed 20°–30°, finger MCP and PIP joints are flexed to 30°, and the thumb (digit I) is abducted and rotated facing the finger pads.
  • Thumb opposition gap (Plate III and DC 5228): Gap between thumb pad and fingers on opposition: > 2 in. (5.1 cm) = 20%; 1–2 in. (2.5–5.1 cm) = 10%; < 1 in. (2.5 cm) = 0% (unless painful motion applies under 38 CFR 4.59).
  • Palm-crease gap and extension lag (Plate III and DC 5229): For the index or long finger, DC 5229 awards 10% if either the fingertip stops ≥ 1 in. (2.5 cm) from the proximal transverse crease of the palm at full flexion, or extension is limited by > 30°.

How the VA evaluates finger and thumb ankylosis (Notes 2, 3, and 4)

Ankylosis is complete fusion or immobilization of a joint. Notes (3)–(4) to DCs 5216–5230 determine whether ankylosis is favorable, unfavorable, or amputation:

  • Note (3) — Fingers (Digits II–V, MCP and PIP joints):
    • (3)(i) Amputation-equivalent (DCs 5153–5156): If both MCP and PIP are ankylosed and either is in extension (0°) or full flexion, or has bone rotation/angulation, rate as amputation without metacarpal resection at the PIP joint or proximal thereto (20% index under DC 5153; 10% long, ring, or little under DCs 5154–5156).
    • (3)(ii) Two-joint ankylosis: If both MCP and PIP are ankylosed, rate as unfavorable ankylosis, even if fixed at 30°.
    • (3)(iii)–(iv) Single-joint ankylosis: If only MCP or PIP is ankylosed, a palm-crease gap > 2 in. (5.1 cm) is unfavorable, and ≤ 2 in. (5.1 cm) is favorable.
  • Note (4) — Thumb (Digit I, CMC and IP joints):
    • (4)(i) Amputation-equivalent (DC 5152): If both CMC and IP are ankylosed and either is in extension or full flexion, or has bone rotation/angulation, rate as thumb amputation at the MCP joint or through the proximal phalanx (DC 5152, 30% Major / 20% Minor).
    • (4)(ii) Two-joint ankylosis: If both CMC and IP are ankylosed, rate as unfavorable ankylosis (20% under DC 5224, or DCs 5216–5219 with other digits).
    • (4)(iii)–(iv) Single-joint ankylosis: If only CMC or IP is ankylosed, an opposition gap > 2 in. (5.1 cm) is unfavorable (20%, DC 5224), and ≤ 2 in. (5.1 cm) is favorable (10%, DC 5224).
  • Combining multiple digits (Notes 2 and 5): Under Note (5), limitation of motion of 2+ digits is rated separately and combined (38 CFR 4.25). Under Note (2) (and rule (e)), mixed amputation, ankylosis, or limitation of motion across 2+ digits is rated at the representative grade (selecting the higher level when equally balanced).

Why ring and little finger codes show 0%—and four paths to 10%+

Although single-digit ankylosis (DC 5227) and limitation of motion (DC 5230) for the ring or little finger list 0%, four rules provide 10% or higher:

  1. Minor-joint-group arthritis (38 CFR 4.45, 38 CFR 4.59, DC 5003 / 5010): Under 38 CFR 4.45, multiple involvements of the interphalangeal, metacarpal, and carpal joints of one hand form a group of minor joints, ratable on a parity with major joints. With X-ray arthritis in 2+ hand joints and 0% motion under DCs 5228–5230, DC 5003 awards 10% when supported by swelling, spasm, or painful motion (38 CFR 4.59).
  2. Two-finger ankylosis (DC 5219 / DC 5223): Ankylosis of both ring and little fingers (or long and ring/little) warrants 10% (DC 5223, favorable) or 20% (DC 5219, unfavorable).
  3. Note (3)(i) amputation-equivalent ankylosis (DC 5155 / DC 5156): Ankylosis of both MCP and PIP of a ring or little finger in extension, full flexion, or with rotation/angulation warrants 10% (20% with >50% metacarpal resection).
  4. Interference with adjacent digits (Note to DCs 5224–5227): If a contracted or malunited ring/pinky finger tethers the long or index finger or impairs overall hand function, raters consider DC 5229 (10%) or multi-digit codes.

Common hand conditions, hand dominance (38 CFR 4.69), and the DBQ exam

  • Trigger finger (DC 5024), Dupuytren’s contracture, and fractures: Under the Note to DCs 5013–5024, trigger finger, Dupuytren’s contracture, Boxer’s/Bennett’s fractures, and gamekeeper’s thumb are rated on thumb opposition gaps (DC 5228, 10% or 20%), index/long finger flexion gaps ≥1 in. or extension loss >30° (DC 5229, 10%), painful motion (38 CFR 4.59), minor-joint-group arthritis (DC 5003 / 5010, 10%), or ankylosis (DCs 5216–5226).
  • Loss of use of the hand (DC 5125 — 70% Major / 60% Minor): Under 38 CFR 4.71a (rule (f)) and 38 CFR 3.350(a)(2), when no effective function remains beyond an amputation prosthesis, DC 5125 awards 70% / 60% plus SMC-K, and caps combined finger ratings on one hand (Note to DCs 5205–5213).
  • Dominant hand (38 CFR 4.69): Only one hand is dominant (Major); for ambidextrous veterans, the injured or most severely injured hand is dominant. Multi-digit ankylosis with the thumb/index (DCs 5216–5223), thumb/index amputation (DCs 5152–5153), and DC 5125 award 10% more to the Major hand.
  • C&P exam and Hand and Fingers DBQ: Records handedness and flare-ups (Sections I–II); goniometer motion for thumb (CMC, MCP, IP) and fingers (MCP 0°–90°, PIP 0°–100°, DIP 0°–70°/80°), Plate III thumb opposition and palm-crease gaps (<1 in., 1–2 in., or >2 in.), painful motion endpoints, and three repetitions (Section III); and strength, ankylosis angles/rotation, loss of use (Section VIII), and X-ray arthritis (Sections IV–X). Stop moving when pain begins.

Secondary conditions, combined ratings, and accredited help

Under 38 CFR 3.310(a), conditions caused or aggravated by a service-connected hand disability may qualify for secondary service connection with a medical nexus opinion, including carpal tunnel syndrome (DC 8515, 10%–70%), ulnar neuropathy (DC 8516, 10%–60%) (38 CFR 4.124a), painful scars (DC 7804, 10%–30%) (38 CFR 4.118), and contralateral hand or wrist overuse.

Ratings combine under 38 CFR 4.25 (VA combined rating calculator), and compensable disabilities in both arms receive the 10% bilateral factor (38 CFR 4.26). Estimate past-due pay with our VA back pay calculator. Veterans Service Organizations (VSOs) (DAV, VFW, American Legion) provide free representation, and VA-accredited agents or attorneys assist with appeals (VA Accreditation Search).

This guide explains the rules; it is not legal or medical advice. VA decisions depend on your records. Free help is available from accredited Veterans Service Organizations.

Frequently asked questions

How does the VA measure thumb and finger range of motion during a C&P exam?

Under 38 CFR 4.71 (Plate III) and Note (1) to DCs 5216–5230 in 38 CFR 4.71a, examiners measure goniometer flexion (MCP 0–90°, PIP 0–100°, DIP 0–70°/80°) and distance gaps from the thumb pad to the fingers on opposition (DC 5228) and from the fingertips to the proximal palm crease on full flexion (DC 5229).

Why does the ring or little finger receive a 0% rating under DC 5227 and DC 5230, and when can it be compensated?

Isolated ankylosis (DC 5227) or limitation of motion (DC 5230) of one ring or little finger is 0%, but warrants 10%+ when: (1) 2+ digits are ankylosed (DCs 5216–5223); (2) both MCP and PIP are ankylosed in extension, full flexion, or with rotation/angulation (10% under Note 3(i) and DC 5155/5156); (3) the digit restricts adjacent fingers; or (4) multiple hand joints have painful arthritis rated at 10% as a minor joint group (38 CFR 4.45 and DC 5003).

What is the difference between favorable and unfavorable ankylosis of the hand?

Under Note (1) to DCs 5216–5230, the favorable position requires the wrist dorsiflexed 20–30°, finger MCP/PIP joints flexed to 30°, and the thumb abducted/rotated facing the finger pads. Under Notes (3) and (4), ankylosis of both MCP and PIP (finger) or both CMC and IP (thumb) is always unfavorable; with one joint ankylosed, a gap ≤2 in. (5.1 cm) is favorable and >2 in. is unfavorable.

Can you get separate VA ratings for multiple injured fingers on the same hand?

Under Note (5) to DCs 5216–5230, when two or more digits have limitation of motion (such as the thumb under DC 5228 and index/long finger under DC 5229), each digit is rated separately and combined under 38 CFR 4.25. Multiple ankylosed digits on one hand are rated under a single code (DCs 5216–5223).

How does the VA rate trigger finger, Dupuytren's contracture, or Boxer's fracture?

Under the Note to DCs 5013–5024 in 38 CFR 4.71a, trigger finger (DC 5024), Dupuytren's contracture, and healed metacarpal fractures are rated on digit limitation of motion (DCs 5228–5230, including extension limited by >30° under DC 5229), ankylosis (DCs 5216–5227), or painful minor-joint-group arthritis (DC 5003 and 38 CFR 4.59).

When does a hand injury qualify for loss of use of the hand under Diagnostic Code 5125?

Under 38 CFR 4.71a (DC 5125, rule (f)) and 38 CFR 3.350(a)(2), loss of use of the hand exists when no effective function remains beyond an amputation stump with prosthesis, awarding 70% (major) or 60% (minor) plus SMC-K.

Sources

  1. 38 CFR 4.71a, Schedule of ratings - musculoskeletal system
  2. 38 CFR 4.71, Measurement of ankylosis and joint motion (Plate III)
  3. 38 CFR 4.45 and 38 CFR 4.59, Painful motion
  4. 38 CFR 4.69, Dominant hand
  5. 38 CFR 4.25 and 38 CFR 4.26, Bilateral factor
  6. 38 CFR 3.303 and 3.310, Service connection
  7. VA Hand and Fingers DBQ