Ankylosis of Five Digits of One Hand — VA Disability Rating Criteria (DC 5216)
Diagnostic Code 5216 · 38 CFR §4.71a
What Is It?
DC 5216 is the highest of the multiple-digit ankylosis codes: unfavorable ankylosis of all five digits of one hand, thumb included. Every finger joint is fixed, and the hand cannot grip, grasp, or manipulate. This code is scored by handedness. The schedule gives it two columns — 60 percent for the major (dominant) hand and 50 percent for the minor (non-dominant) hand. Under 38 CFR 4.69 handedness is determined by the evidence of record or by testing at the VA examination, and only one hand is treated as dominant. There is no third figure and no intermediate step: whichever hand is involved, the evaluation is one of those two numbers. The Note attached to this code is short and important — "Also consider whether evaluation as amputation is warranted." A hand fixed in an unusable position can sometimes be evaluated more favorably under the amputation codes than under ankylosis, and the schedule tells the rater to look. Running in the other direction is 38 CFR 4.68, the amputation rule: the combined rating for disabilities of an extremity cannot exceed the rating for amputation at the elective level. So amputation values act as both an alternative and a ceiling on everything else claimed for that hand. Ankylosis means the joint does not move at all. That is a different finding from severe limitation of motion, and the distinction decides which part of the schedule applies. If any of the joints retain measurable motion, the limitation-of-motion codes for individual digits apply instead, and those pay considerably less. Veterans reach five-digit ankylosis through crush injuries, blast trauma, severe burns with contracture, compartment syndrome, and failed reconstruction after multiple fractures.
Rating Criteria
| Rating | Criteria |
|---|---|
| 60% | Unfavorable ankylosis of five digits of one hand — major (dominant) hand. This is the maximum available under DC 5216. |
| 50% | Unfavorable ankylosis of five digits of one hand — minor (non-dominant) hand. The criteria are identical; only the handedness column differs, and 38 CFR 4.69 decides which column applies. |
Evidence Needed
- Range of motion testing on every joint of every digit, recorded in degrees, showing zero motion. Ankylosis is the absence of motion, and "severely limited" is not the same finding.
- Imaging showing the fusion, fixation, or destruction of the joints — plain films are usually enough, and operative reports serve where the fusion was surgical.
- A statement of the position each digit is fixed in, and whether that position is favorable or unfavorable for hand function. DC 5216 is written for unfavorable ankylosis; favorable ankylosis of five digits is DC 5220, which pays 50 percent major and 40 percent minor.
- Documentation of handedness in the record. This is worth ten percentage points and it is often established by a single sentence at the examination.
- A functional assessment of what the hand can still do — whether it can hold a cup, turn a key, fasten a button, carry weight, or serve as a helper hand at all.
- Any evaluation for loss of use of the hand. Where the hand retains no effective function, special monthly compensation may be in play under 38 CFR 3.350, which is a separate benefit from the schedular percentage.
- Service treatment records covering the original injury, plus the full surgical history of any reconstruction attempts and their outcomes.
C&P Exam Tips
- Make sure the examination establishes which hand is dominant and records it. The difference between the two columns of this code is ten percentage points and it turns on that finding.
- Ask the examiner to document zero degrees of motion joint by joint rather than describing the hand as a whole. "No functional motion" is a clinical impression; "zero degrees at the MCP, PIP, and DIP of all five digits" is a rating finding.
- Have the fixed position of each digit described. Whether the ankylosis is favorable or unfavorable decides between DC 5216 and DC 5220, and unfavorable is the higher-paying picture.
- Bring the objects you struggle with. Demonstrating that you cannot hold a pen, a fork, or a water bottle documents function better than any adjective.
- Say plainly whether the hand does anything at all, including whether you use it as a passive helper. That description is what a loss-of-use determination is built from.
- Ask whether evaluation as amputation would be more favorable. The Note to this code tells the rater to consider it, and asking at the examination puts the question in the record.
- Describe what the other hand and arm have taken on. Overuse of the sound side is a common and claimable consequence.
- Mention grip and pinch strength testing if it was done, and ask for it if it was not.
How to File
File for ankylosis of the hand and state which hand is dominant in the claim itself rather than leaving it to the examination. The schedule's major and minor columns differ by ten percentage points here, and handedness under 38 CFR 4.69 is settled on the evidence of record or by testing — putting it in writing early removes the question. Provide range of motion findings showing zero degrees at each joint, and a description of the position each digit is fixed in. Unfavorable ankylosis of five digits is DC 5216 at 60 or 50 percent; favorable ankylosis of the same five digits is DC 5220 at 50 or 40 percent. The difference is whether the fixed position leaves any usable hand function, so that description carries real weight. Ask in the claim that evaluation as amputation be considered, which is what the Note to this code directs. And be aware of the other direction: 38 CFR 4.68 caps the combined rating for disabilities of an extremity at the value for amputation at the elective level, so separate evaluations for the wrist, the scars, and the nerves cannot together exceed that ceiling. Where the hand has no remaining effective function, ask separately about special monthly compensation for loss of use under 38 CFR 3.350 — that is paid in addition to, not instead of, the schedular evaluation.
Common Mistakes
Expecting a 70 percent evaluation. DC 5216 has exactly two figures, 60 and 50, and 70 percent is not available under this code for either hand. Letting handedness go undocumented. It is the only variable in this code, and an unrecorded dominant hand can cost ten percentage points. Treating severe limitation of motion as ankylosis. Ankylosis is zero motion. If the joints still move, the individual-digit limitation codes apply and they pay far less. Not distinguishing favorable from unfavorable ankylosis, which is the line between DC 5216 and DC 5220. Overlooking the amputation comparison the Note requires, and equally, being surprised by 38 CFR 4.68 when separate hand and wrist evaluations are capped. Assuming the schedular percentage is the whole benefit. Loss of use of a hand is addressed through special monthly compensation, which is claimed and decided separately.
Frequently Asked Questions
Is DC 5216 rated at 70 percent for the dominant hand?
No. The schedule assigns 60 percent for the major (dominant) hand and 50 percent for the minor (non-dominant) hand. Those are the only two figures under this diagnostic code. Higher evaluations for the same hand come from a different route — evaluation as amputation, which the Note to the code directs the rater to consider, or special monthly compensation for loss of use.
How does VA decide which hand is dominant?
Under 38 CFR 4.69, handedness is determined by the evidence of record or by testing on VA examination, and only one hand is considered dominant. If you are left-handed and the disability is in your left hand, the major column applies. Stating it in the claim and confirming it at the examination is worth doing, because it is the single variable in this code.
What is the difference between favorable and unfavorable ankylosis here?
Unfavorable ankylosis means the digits are fixed in positions that impair hand function or interfere with the other digits; that is DC 5216, at 60 or 50 percent. Favorable ankylosis means the digits are fixed in positions that still permit some useful function; that is DC 5220, at 50 or 40 percent. The examination description of the fixed position is what decides between them.
Why does the code tell the rater to consider amputation?
Because a hand fixed in a completely unusable position can be worth more under the amputation codes than under ankylosis, and the schedule does not want that missed. The same comparison runs the other way through 38 CFR 4.68, the amputation rule, which caps the combined rating for disabilities of an extremity at the evaluation for amputation at the elective level.
Can I also be paid for loss of use of the hand?
Loss of use is addressed through special monthly compensation under 38 CFR 3.350, which is a separate benefit from the percentage assigned under the rating schedule. It is decided on whether the remaining function of the hand is such that a person would be equally well served by an amputation stump with a suitable prosthesis. Ask about it explicitly, because it is not automatic.
Can I get separate ratings for my wrist and my scars on the same arm?
Separate evaluations for distinct disabilities are allowed, but 38 CFR 4.68 limits the total: the combined rating for disabilities of an extremity cannot exceed the rating for amputation at the elective level. So separate wrist, scar, and nerve evaluations can be assigned and combined, and then the amputation rule sets the ceiling for that extremity as a whole.