Ankylosis of Two Digits — Index Finger and Another — VA Disability Rating Criteria (DC 5219)

Diagnostic Code 5219 · 38 CFR §4.71a

What Is It?

This page covers ankylosis of the index finger together with one of the long, ring or little fingers. In 38 CFR 4.71a that is the second row of DC 5219, two digits of one hand with unfavorable ankylosis: 30 percent on the major (dominant) hand and 20 percent on the minor hand. Where the thumb is the second digit, the higher first row of the same code applies instead, at 40 and 30 percent. The number 5220 in this page's address is a legacy of how the site first filed it, and it is not this page's diagnostic code. In 38 CFR 4.71a, DC 5220 is five digits of one hand with favorable ankylosis, at 50 percent major and 40 minor — a different condition, covered on the five-digit ankylosis page. The condition this page describes, ankylosis of two digits of one hand, is DC 5219 where the ankylosis is unfavorable and DC 5223 where it is favorable. Favorable ankylosis of the index finger with another finger is DC 5223 at 20 percent on either hand — the same figure this code assigns the minor hand, which is why the position finding matters most to a veteran whose dominant hand is involved. 38 CFR 4.71a defines the two terms rather than leaving them to impression. A finger with both the metacarpophalangeal and the proximal interphalangeal joint ankylosed is unfavorable even where each joint is individually fixed in a favorable position; where only one of those joints is fused, 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 two inches or less is favorable. For the thumb the measurement is taken between the thumb pad and the fingers with the thumb attempting to oppose them, at the carpometacarpal and interphalangeal joints. The Note under this code directs the rater also to consider whether evaluation as amputation is warranted. 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, and 38 CFR 3.350(a) pays special monthly compensation for anatomical loss or loss of use of a hand, not of digits — a digit reaches that benefit only through a loss-of-use finding for the hand as a whole.

Rating Criteria

Evidence Needed

• Range of motion testing on both affected digits, joint by joint and 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.
• Both digits named. The index finger paired with the long, ring or little finger is the middle row of DC 5219; the index finger paired with the thumb is the higher first row.
• A description of the position each digit is fixed in, and whether the ankylosis is favorable or unfavorable. Unfavorable two-digit ankylosis is DC 5219; favorable two-digit ankylosis is DC 5223, and for this pairing that is 20 percent on either hand.
• Whether both the metacarpophalangeal and proximal interphalangeal joints of a finger 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, which 38 CFR 4.69 settles on the evidence of record or by testing at the examination.
• A record of what the digits that still move can do, and whether the fused pair interferes with them. The Notes to this part of the schedule contemplate an additional evaluation for that interference.
• Imaging showing the fusion, 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" is a rating finding.
• Have both ankylosed digits named. Which two they are is what selects the row of DC 5219 that applies.
• Confirm which finger is fused with the index finger. If it is the thumb, the higher first row of DC 5219 applies rather than this one.
• Ask for the fixed position of each digit to be described, and if only one joint of a finger is fused, for the fingertip-to-palm gap to be measured with the finger flexed as far as it will go. That measurement is what separates DC 5219 from DC 5223.
• Make sure the examination establishes and records which hand is dominant.
• Report whether the fused pair interferes with the motion of the digits that still move, and ask that any limitation of those digits be measured as well.
• Ask whether evaluation as amputation would be more favorable, which is what the Note to this code directs.
• Bring the objects you struggle with. Demonstrating what the hand can no longer hold documents function better than any adjective.

How to File

File for ankylosis of the index finger and the second digit by name, and state which hand is dominant in the claim itself. On this row the major hand is worth ten percentage points more, and 38 CFR 4.69 settles handedness on the evidence of record or by testing. Provide range of motion findings showing zero degrees at each joint, a description of the position both fingers are fixed in, and — where only one joint of a finger is fused — the measured gap between the fingertip and the proximal transverse crease of the palm. That measurement separates DC 5219 from DC 5223. Ask that evaluation as amputation be considered, which the Note to this code directs, and 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

• Reading DC 5219 as one figure. It carries three rows — the thumb and any finger at 40 and 30 percent, the index finger with another at 30 and 20, and the long, ring and little pairings at 20 percent on either hand.
• Not naming both digits. The index pairing is the middle row of the code, and an index-and-thumb pairing belongs to the higher row above it.
• 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.
• Reading the diagnostic code out of this page's web address. The address still carries 5220 for historical reasons; DC 5220 is five digits of one hand with favorable ankylosis, and the code that governs this condition is DC 5219.
• Missing the line between favorable and unfavorable ankylosis, which is the line between DC 5219 and DC 5223 — for this pairing, unfavorable is 30 or 20 percent and favorable is 20 percent on either hand.
• 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.

Frequently Asked Questions

Which pairings does this row of DC 5219 cover?

The index finger with the long finger, the index finger with the ring finger, or the index finger with the little finger — 30 percent on the major hand and 20 on the minor hand where the ankylosis is unfavorable. The index finger fused together with the thumb is the row above, at 40 and 30 percent.

Why does the web address for this page say 5220?

It is a legacy of how the page was first filed, and the address is kept so that existing links and bookmarks keep working. DC 5220 in 38 CFR 4.71a is five digits of one hand with favorable ankylosis, at 50 percent major and 40 minor, which is a different condition on a different page. The code for two digits is DC 5219 when the ankylosis is unfavorable and DC 5223 when it is favorable.

What is the difference between DC 5219 and DC 5223 for this pairing?

Unfavorable ankylosis of the index finger with another finger is DC 5219 at 30 percent major and 20 minor. Favorable ankylosis of the same pair is DC 5223 at 20 percent on either hand. The difference shows up on the dominant hand, and it is decided by the position of the fused joints.

What counts as unfavorable ankylosis of a finger?

Under 38 CFR 4.71a, a finger with both the metacarpophalangeal and the proximal interphalangeal joint ankylosed is unfavorable, even if each joint is individually fixed in a favorable position. Where only one of those joints is ankylosed, a gap of more than two inches between the fingertip and the proximal transverse crease of the palm, with the finger flexed as far as possible, is unfavorable.

Can the other digits be rated as well?

The Notes to this part of 38 CFR 4.71a contemplate an additional evaluation for resulting limitation of motion of other digits or interference with overall function of the hand, and where two or more digits show limitation of motion each is evaluated separately and the evaluations combined. All of it remains subject to the amputation rule in 38 CFR 4.68.