Ankylosis of Two Digits — Long, Ring or Little Finger Pairs — VA Disability Rating Criteria (DC 5219)

Diagnostic Code 5219 · 38 CFR §4.71a

What Is It?

This page covers unfavorable ankylosis of any two of the long, ring and little fingers of one hand — long finger is the schedule's name for the middle finger. In 38 CFR 4.71a all three of those pairings are a single line of DC 5219, two digits of one hand with unfavorable ankylosis, reading "long and ring; long and little; or ring and little fingers", and that line is 20 percent in both the major and the minor column, so handedness makes no difference to it. Where one of these three fingers is fused with the thumb the first row of the code applies at 40 or 30 percent, and where it is fused with the index finger the second row applies at 30 or 20. The number 5221 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 5221 is four digits of one hand with favorable ankylosis, 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 — a different condition, covered on the four-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 same pairing is DC 5223 at 10 percent on either hand, so the position finding is worth ten percentage points here. DC 5223 is two digits of one hand with favorable ankylosis — the same two digits, fixed in positions that still leave the hand some use — and it runs 30 percent major and 20 minor for the thumb and any finger, 20 percent on either hand for the index finger with another, and 10 percent on either hand for the long, ring and little pairings, which is the row that matches this page. 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. 38 CFR 4.71a rates every pairing of the long, ring and little fingers the same way — one row reading "long and ring; long and little; or ring and little fingers" — so which two of the three are fused does not change the evaluation. It is one row and one figure whether the pair is long and ring, long and little, or ring and little. 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 long, ring and little pairings are the bottom row of DC 5219; a pairing that includes the thumb or the index finger belongs to a higher row of the same code.
• 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 10 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 two digits are fused. If one of them is the thumb or the index finger, a higher 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 both fused digits by name — the long (middle), ring or little finger, whichever two they are. This row pays 20 percent on either hand, so handedness does not change it, but the position of the fused joints does: unfavorable ankylosis is DC 5219 at 20 percent and favorable ankylosis of the same pair is DC 5223 at 10. 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. Ask that evaluation as amputation be considered, which the Note to this code directs, and ask that any limitation of motion of the digits that still move be measured, since the schedule contemplates an additional evaluation for it.

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. A pairing that includes the thumb or the index finger belongs to a higher row of DC 5219, not to this one.
• 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 5221 for historical reasons; DC 5221 is four 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 20 percent and favorable is 10 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

Does the dominant hand pay more on this row?

No. The schedule lists 20 percent in both the major and the minor column for the long, ring and little pairings, so handedness does not change the evaluation here. It does change it on the two rows above, where the thumb or the index finger is involved.

Does it matter which two of the three fingers are fused?

No. 38 CFR 4.71a writes the long and ring, long and little, and ring and little combinations as one line of DC 5219, at 20 percent on either hand, so any two of those three fingers reach the same row and the same figure. It changes only where the thumb or the index finger is one of the two, which moves the claim to a higher row of the same code.

Why does the web address for this page say 5221?

It is a legacy of how the page was first filed, and the address is kept so that existing links keep working. DC 5221 in 38 CFR 4.71a is four digits of one hand with favorable ankylosis, 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 does favorable ankylosis of this pairing pay?

10 percent on either hand, under DC 5223. That code is two digits of one hand with favorable ankylosis and it runs 30 percent major and 20 minor for the thumb and any finger, 20 percent on either hand for the index finger with another, and 10 percent on either hand for the long, ring and little pairings. Unfavorable ankylosis of the same two fingers is 20 percent under DC 5219, so the description of the fixed position is worth ten percentage points on this pairing.

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.