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

Diagnostic Code 5219 · 38 CFR §4.71a

What Is It?

This page covers ankylosis of the thumb and one other finger of the same hand. In 38 CFR 4.71a that is the first row of DC 5219, two digits of one hand with unfavorable ankylosis: 40 percent on the major (dominant) hand and 30 percent on the minor hand. The schedule writes the row as "thumb and any finger," so the figure is the same whether the second digit is the index, long, ring or little finger. DC 5219 is not split by which digits are involved — it is the two-digit step of a block the schedule organises by how many digits are ankylosed and by whether the ankylosis is favorable or unfavorable. The code's other rows cover the index finger with another finger at 30 and 20 percent, and the long, ring and little pairings at 20 percent on either hand. Handedness is settled under 38 CFR 4.69, and the schedule calls the middle finger the long finger. Favorable ankylosis of the same two digits is a different code: DC 5223, where the thumb and any finger is 30 percent major and 20 percent minor. 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 thumb pairing is the highest-paying row of DC 5219, and it applies whichever finger is fused with it.
• 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 30 percent on the major hand and 20 on the minor.
• 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.
• For the thumb, ask that the gap between the thumb pad and the fingers be measured with the thumb attempting to oppose them. More than two inches is unfavorable ankylosis; two inches or less is favorable.
• 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 thumb and the second digit by name, and state which hand is dominant in the claim itself. Under 38 CFR 4.69 handedness is settled on the evidence of record or by testing, and it is worth ten percentage points on this row. Provide range of motion findings showing zero degrees at each joint, together with a description of the position both digits are fixed in and — where only one joint of a digit is fused — the measured gap that 38 CFR 4.71a uses to separate favorable from unfavorable ankylosis. That measurement is what decides between DC 5219 at 40 or 30 percent and DC 5223 at 30 or 20. Ask that evaluation as amputation be considered, which the Note to this code directs, and expect 38 CFR 4.68 in the other direction: everything assigned for that extremity is capped at 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 thumb pairing is the top row of the code; a decision written from "ankylosis of two digits" alone cannot tell it from the 20 percent row.
• 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 5219 and DC 5223 — for this pairing, unfavorable is 40 or 30 percent and favorable is 30 or 20.
• 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 it matter which finger is fused with the thumb?

Not for this row. The schedule writes it as "thumb and any finger," so unfavorable ankylosis of the thumb with the index, long, ring or little finger is 40 percent on the major hand and 30 on the minor hand in every case.

What is the difference between DC 5219 and DC 5223?

Favourability. DC 5219 is unfavorable ankylosis of two digits and DC 5223 is favorable ankylosis of the same two digits. For the thumb and any finger that is 40 and 30 percent against 30 and 20. The examination description of the fixed position, and the measured gap where only one joint is fused, is what decides which code applies.

Why is the thumb pairing worth more than the others?

The schedule places it in the top row of the code because the thumb carries opposition, which is what allows pinch and grasp. The other rows of DC 5219 are the index finger with another finger at 30 and 20 percent, and the long, ring and little pairings at 20 percent on either hand.

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 or more severely injured hand is treated as the dominant one.

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 the schedule directs that each be evaluated separately and combined. All of it stays subject to the amputation rule in 38 CFR 4.68.