Ankylosis of Four Digits of One Hand — VA Disability Rating Criteria (DC 5217)

Diagnostic Code 5217 · 38 CFR §4.71a

What Is It?

DC 5217 is the four-digit step of the multiple-digit ankylosis block in 38 CFR 4.71a, and it is written for unfavorable ankylosis — four digits of one hand fixed in positions that leave the hand unable to do useful work. The code lists two combinations and they do not pay the same. Unfavorable ankylosis of the thumb and any three fingers is 60 percent on the major (dominant) hand and 50 percent on the minor hand. Unfavorable ankylosis of the index, long, ring and little fingers — four fingers with the thumb spared — is 50 percent major and 40 percent minor. Handedness is settled under 38 CFR 4.69 on the evidence of record or by testing at the examination, and only one hand is treated as dominant. The schedule calls the middle finger the long finger throughout this block. Favorable ankylosis of four digits is a different diagnostic code: DC 5221, at 50 percent major and 40 minor for the thumb and any three fingers, and 40 and 30 for the index, long, ring and little fingers. The fixed position is what decides between them, and 38 CFR 4.71a defines it. For the fingers, if both the metacarpophalangeal and proximal interphalangeal joints of a digit are ankylosed the schedule calls that unfavorable even where each joint is individually fixed in a favorable position; where only one of those joints is ankylosed, a gap of more than two inches (5.1 cm) between the fingertip and the proximal transverse crease of the palm, with the finger flexed as far as it will go, is unfavorable, and a gap of two inches or less is favorable. The Note under this code is a single line — also consider whether evaluation as amputation is warranted. It runs the other way as well: 38 CFR 4.68, the amputation rule, caps the combined rating for disabilities of one extremity at the evaluation for amputation at the elective level.

Rating Criteria

Evidence Needed

• Range of motion testing on every joint of every affected digit, recorded in degrees, showing zero motion. Ankylosis is the absence of motion; severely limited motion is a different finding and it is rated under different codes.
• The four digits named individually. The schedule pays the thumb-and-three-fingers combination ten points more than the four-fingers combination, so "four digits" on its own does not decide the evaluation.
• A description of the position each digit is fixed in, and whether the ankylosis is favorable or unfavorable. Unfavorable four-digit ankylosis is DC 5217; favorable four-digit ankylosis is DC 5221, at 50 and 40 percent or 40 and 30 percent.
• Whether both the metacarpophalangeal and proximal interphalangeal joints of a digit are ankylosed. Under 38 CFR 4.71a that combination is unfavorable by definition, even if each joint is individually in a favorable position.
• Where only one of those joints is fused, the measured gap between the fingertip and the proximal transverse crease of the palm with the finger flexed as far as possible. More than two inches is unfavorable; two inches or less is favorable.
• Documentation of handedness in the record. It is worth ten percentage points under this code and is often settled by a single sentence at the examination.
• Imaging showing the fusion or destruction of the joints, operative reports where the fusion was surgical, and the service treatment records covering the original injury.

C&P Exam Tips

• Ask the examiner to record zero degrees joint by joint rather than describing the hand as a whole. "No functional motion" is a clinical impression; "zero degrees at the MCP and PIP of the thumb, index, long and ring" is a rating finding.
• Have each ankylosed digit named. Whether the thumb is one of the four is the difference between the 60/50 row and the 50/40 row.
• Ask for the fixed position of each digit to be described. Favorable and unfavorable are defined terms in 38 CFR 4.71a, not impressions.
• If only one joint of a finger is fused, ask for the fingertip-to-palm gap to be measured with the finger flexed as far as it will go, and written down in inches or centimetres. That measurement decides favorable against unfavorable.
• Make sure the examination establishes which hand is dominant and records it.
• 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.
• 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.

How to File

File for ankylosis of the hand, name the four digits that are fixed, and state which hand is dominant in the claim itself rather than leaving it to the examination. Under 38 CFR 4.69 handedness is settled on the evidence of record or by testing, and it is worth ten percentage points at every level of this code. Provide range of motion findings showing zero degrees at each joint and a description of the position each digit is fixed in, because that description is what separates DC 5217 from DC 5221. 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.

Common Mistakes

• Reading DC 5217 as a single figure. It carries three — 60, 50 and 40 — and which one applies turns on the digits involved and on handedness.
• Not naming the four digits. A decision written from "ankylosis of four digits" alone cannot tell the thumb combination from the four-finger combination.
• Treating severe limitation of motion as ankylosis. Ankylosis is zero motion; where the joints still move, the limitation-of-motion codes for individual digits apply and they pay far less.
• Missing the line between favorable and unfavorable ankylosis, which is the line between DC 5217 and DC 5221.
• Leaving handedness undocumented, which can cost ten percentage points.
• Overlooking the amputation comparison the Note requires — and being surprised by 38 CFR 4.68 when separate hand, wrist and nerve evaluations are capped.
• Expecting special monthly compensation for the digits themselves. 38 CFR 3.350(a) lists anatomical loss or loss of use of one hand, not of digits; a hand reaches that benefit only through a loss-of-use finding for the hand as a whole.

Frequently Asked Questions

How many rating levels does DC 5217 have?

Three. Unfavorable ankylosis of the thumb and any three fingers is 60 percent on the major hand and 50 on the minor hand; unfavorable ankylosis of the index, long, ring and little fingers is 50 percent major and 40 minor. Those four column entries produce three distinct percentages: 60, 50 and 40.

Does it matter which four digits are fused?

Yes. The schedule separates the thumb and any three fingers from the index, long, ring and little fingers, and the difference is ten percentage points in each column. Naming the digits individually in the record is what allows the higher row to be assigned.

What is the difference between DC 5217 and DC 5221?

Favourability. DC 5217 is unfavorable ankylosis of four digits and DC 5221 is favorable ankylosis of the same four digits, at 50 and 40 percent for the thumb combination and 40 and 30 for the four-finger combination. 38 CFR 4.71a defines both terms by joint position and by the fingertip-to-palm gap, so the examination description decides which code applies.

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. Where a veteran is ambidextrous, the injured hand — or the more severely injured hand — is treated as the dominant one.

Why does the code tell the rater to consider amputation?

Because a hand fixed in an 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.