Ankylosis of the Index Finger — VA Disability Rating Criteria (DC 5225)

Diagnostic Code 5225 · 38 CFR §4.71a

What Is It?

DC 5225 is the individual-digit code for ankylosis of the index finger, and it has one row. The schedule reads "unfavorable or favorable" and assigns 10 percent, the same in the major and the minor column. Position does not change it and handedness does not change it, which makes this code unusual in a block where both normally matter. That single row is worth understanding before a claim is filed, because the ways past it are specific. Where both the metacarpophalangeal and the proximal interphalangeal joints of the finger are ankylosed and either is in extension or full flexion, or there is rotation or angulation of a bone, 38 CFR 4.71a directs that the finger be evaluated as amputation without metacarpal resection, at the proximal interphalangeal joint or proximal thereto — DC 5153, which is 30 percent on the major hand and 20 on the minor. And where a second digit is ankylosed, the two-digit codes take over: DC 5219 for unfavorable ankylosis, at 40 or 30 percent with the thumb and 30 or 20 with another finger, and DC 5223 for favorable ankylosis at 30 and 20 or 20 percent on either hand. Ankylosis means the joint does not move at all. If the index finger still has measurable motion, this code does not apply — limitation of motion of the index or long finger is DC 5229. Where two or more digits have limitation of motion, 38 CFR 4.71a directs that each digit be evaluated separately and the evaluations combined. The Note under each of the individual-digit codes is longer than the one under the multiple-digit codes: 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. Running the other way, 38 CFR 4.68 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 at the metacarpophalangeal, proximal interphalangeal and distal interphalangeal joints of the index finger, in degrees, showing zero motion. Ankylosis is the absence of motion; limitation of motion of the index finger is DC 5229.
• Which joints of the finger are ankylosed. Both the metacarpophalangeal and the proximal interphalangeal joint being fused is the entry point for the amputation instruction that pays more than this code.
• Whether either ankylosed joint is fixed in extension or in full flexion, or whether there is rotation or angulation of a bone. Those findings direct evaluation as amputation under DC 5153 rather than under this code.
• Whether any other digit on the same hand is ankylosed, since a second digit moves the claim to DC 5219 or DC 5223.
• Measurements of any limitation of motion in the digits that still move. The Note to this code contemplates an additional evaluation for interference with overall hand function.
• A functional account of what the hand can no longer do — pinch, pointing, typing, tools, buttons — and of the strain the other hand has taken on.
• Service treatment records covering the original injury, plus operative reports for any fusion or reconstruction.

C&P Exam Tips

• Ask the examiner to record zero degrees at each named joint of the index finger rather than describing the finger as "fixed."
• Have the position of each ankylosed joint described — in particular whether either is in extension or full flexion, and whether there is rotation or angulation of a bone. Those findings are the route to the amputation evaluation.
• Ask whether evaluation as amputation is warranted, which the Note to this code directs. It is the only way past 10 percent for a single ankylosed index finger.
• Ask that the other digits be examined and their motion measured, and report any interference the fixed index finger causes.
• Do not expect handedness to change this code, but make sure it is recorded anyway — it matters if a second digit is ever involved.
• Bring the objects and tasks that fail, and demonstrate them.
• Mention grip and pinch strength testing if it was done, and ask for it if it was not.
• Describe what the other hand has taken on. Overuse of the sound side is a common and claimable consequence.

How to File

File for ankylosis of the index finger, name the joints that are fused, and state the position each is fixed in. The code itself has a single figure — 10 percent, favorable or unfavorable, either hand — so the work in this claim is establishing whether one of the routes past it applies. Ask in the claim that evaluation as amputation be considered: where both the metacarpophalangeal and proximal interphalangeal joints are ankylosed and either is in extension or full flexion, or a bone is rotated or angulated, 38 CFR 4.71a directs evaluation as amputation without metacarpal resection at the proximal interphalangeal joint or proximal thereto, which is DC 5153 at 30 or 20 percent. Report any other ankylosed digit, since that moves the claim to the two-digit codes. Expect 38 CFR 4.68 in the other direction: the combined rating for that extremity cannot exceed the evaluation for amputation at the elective level.

Common Mistakes

• Expecting 20 percent for unfavorable ankylosis. DC 5225 has one row — 10 percent, unfavorable or favorable, in both the major and the minor column.
• Arguing about favorable against unfavorable position under this code. It changes nothing here, though it matters a great deal on the multiple-digit codes.
• Treating limited motion as ankylosis. Ankylosis is zero motion; limitation of motion of the index or long finger is DC 5229.
• Missing the amputation instruction, which is the only route past 10 percent for a single ankylosed index finger.
• Not reporting a second ankylosed digit, which moves the claim to DC 5219 or DC 5223 and pays substantially more.
• Expecting special monthly compensation for the finger itself. 38 CFR 3.350(a) lists anatomical loss or loss of use of one hand, not of digits.

Frequently Asked Questions

Is unfavorable ankylosis of the index finger rated at 20 percent?

No. 38 CFR 4.71a lists one row for DC 5225 — "unfavorable or favorable" — at 10 percent on the major hand and 10 on the minor. Position and handedness both make no difference to this code.

Is there any way to be rated higher than 10 percent for one ankylosed index finger?

Yes, through the amputation route. Where both the metacarpophalangeal and the proximal interphalangeal joints are ankylosed and either is in extension or full flexion, or there is rotation or angulation of a bone, the schedule directs evaluation as amputation without metacarpal resection at the proximal interphalangeal joint or proximal thereto — DC 5153, at 30 percent major and 20 minor.

What happens if another finger is ankylosed too?

The two-digit codes take over. Unfavorable ankylosis of the index finger with the long, ring or little finger is DC 5219 at 30 percent major and 20 minor; with the thumb it is 40 and 30. Favorable ankylosis of two digits is DC 5223.

What if my index finger still moves a little?

Then it is not ankylosis and this code does not apply. Limitation of motion of the index or long finger is DC 5229. Where two or more digits have limitation of motion, 38 CFR 4.71a directs that each digit be evaluated separately and the evaluations combined.

Does a 10 percent rating still matter?

It establishes service connection for the finger, which preserves the effective date, opens VA health care for the condition and means a later increase does not require proving the service link again. It also matters if the hand worsens, because the multiple-digit codes pay considerably more and the claim is already in the system.