VA Disability Rating for Wrist Ankylosis

Diagnostic Code 5214 · 38 CFR §4.71a

What Is It?

Wrist ankylosis means the wrist has no motion — surgically fused, or fixed by trauma, infection, or arthritis that destroyed the joint. DC 5214 evaluates it on two variables and nothing else: the position the wrist is fixed in, and which hand it is. The schedule gives this code three criteria and two handedness columns, which is why four different percentages appear. Unfavorable ankylosis — any degree of palmar flexion, or with ulnar or radial deviation — is 50 percent on the major hand and 40 on the minor. Any other position except favorable is 40 major and 30 minor. Favorable ankylosis, meaning 20 to 30 degrees of dorsiflexion, is 30 major and 20 minor. Under 38 CFR 4.69 only one hand is dominant, and that determination decides which column applies. Position is doing most of the work here, and the reason is functional. Grip is strongest with the wrist slightly extended, so a wrist fused in 20 to 30 degrees of dorsiflexion leaves a usable hand — that is why the schedule calls it favorable and pays the least. A wrist fused in palmar flexion turns the hand inward and away from the work, which is why it pays the most. A surgeon choosing a fusion angle is choosing your rating, and the operative report is often the cleanest evidence of what that angle was. The Note to this code sets an outer limit: extremely unfavorable ankylosis will be rated as loss of use of hands under DC 5125. That is a different and much higher evaluation, and it is the reason a wrist fused in a position that renders the hand useless should not simply be filed as a 50 percent claim and left there.

Rating Criteria

Evidence Needed

• The fusion angle in degrees, stated as dorsiflexion, palmar flexion, or deviation. This is the fact the entire code turns on, and it is usually recorded in the operative report or measurable on a lateral X-ray even when no examination has stated it.
• Range of motion findings confirming zero wrist motion. Ankylosis is the absence of motion; severe limitation of motion is DC 5215, which pays 10 percent.
• Documentation of any ulnar or radial deviation in the fused position, because deviation puts the wrist into the unfavorable category regardless of the flexion angle.
• Handedness in the record. Each criterion carries two figures ten percentage points apart, and 38 CFR 4.69 settles dominance on the evidence of record or by testing on examination.
• Operative reports for the fusion, including hardware, graft, and any revision surgery.
• Grip strength testing and a functional description — what the hand can lift, hold, turn, and carry with the wrist fixed.
• Findings on the fingers and forearm. A fused wrist commonly costs finger motion and forearm rotation, and both are separately evaluated.
• Where the hand has no useful remaining function, evidence directed at the Note — extremely unfavorable ankylosis is rated as loss of use of hands under DC 5125.

C&P Exam Tips

• Bring the operative report and ask that the fusion angle be recorded in degrees. "Fused in slight extension" is not a rating finding; "fused in 25 degrees of dorsiflexion" is, and it is the difference between the favorable and unfavorable columns.
• Ask specifically whether there is ulnar or radial deviation. Deviation moves the wrist into the unfavorable criterion on its own, independent of the flexion angle.
• Confirm which hand is dominant and make sure it is written down. Every criterion in this code has a major and a minor figure.
• Demonstrate grip with the fused wrist rather than describing it. Show what happens when you try to hold a tool, turn a doorknob, or lift from a low shelf.
• Have finger motion measured with the wrist in its fixed position. Tendon length changes after fusion and the fingers often lose range that is separately ratable.
• Ask for forearm supination and pronation to be measured — those are rated under DC 5213 and are commonly affected.
• If the hand is functionally useless, say so plainly and ask whether the loss of use standard is met. The Note routes extremely unfavorable ankylosis to DC 5125.
• Report what the opposite arm has taken over, and any pain or overuse symptoms developing on that side.

How to File

File for wrist ankylosis and put two facts in the claim: the fusion angle and your dominant hand. Those two facts choose among the four percentages available under DC 5214, and both are commonly missing from the record when the claim is decided. Get the fusion angle from the operative report if you have it. Where there is no operative report — a wrist fixed by trauma or arthritis rather than surgery — a lateral X-ray with a measured angle serves the same purpose. What the rater needs is a number in degrees plus a statement of whether there is ulnar or radial deviation, because deviation is independently disqualifying from the favorable category. Claim the downstream conditions separately: finger limitation of motion, loss of forearm supination and pronation under DC 5213, nerve involvement, and strain on the opposite side. Then keep 38 CFR 4.68 in mind, which caps the combined rating for disabilities of an extremity at the value for amputation at the elective level. And if the hand does no useful work at all, ask about the Note to this code, which directs that extremely unfavorable ankylosis be rated as loss of use of hands under DC 5125 rather than under 5214 at all.

Common Mistakes

Letting the fusion angle go unrecorded. It is the primary variable in this code and the one most often missing, and without it a rater has no basis for anything above the favorable figure. Assuming the four percentages are four severity levels. They are three criteria crossed with two handedness columns, which is why 40 and 30 percent each appear for two different situations. Missing ulnar or radial deviation. Deviation places the wrist in the unfavorable criterion on its own, whatever the flexion angle. Filing severe limitation of motion as ankylosis. If the wrist retains measurable motion the applicable code is DC 5215 at 10 percent, and the claim will be decided there. Not claiming the fingers and the forearm. Fusion changes what the digits and the forearm can do, and those are separate evaluations. Stopping at 50 percent when the hand is functionally lost. The Note sends extremely unfavorable ankylosis to loss of use of hands under DC 5125.

Frequently Asked Questions

Why are there four percentages for three criteria?

Because each criterion carries a major and a minor figure. Unfavorable ankylosis is 50 percent dominant and 40 non-dominant; any other position except favorable is 40 dominant and 30 non-dominant; favorable ankylosis in 20 to 30 degrees of dorsiflexion is 30 dominant and 20 non-dominant. The 40 and 30 percent figures each cover two different situations, which is why the table reads as four steps rather than three.

What makes a fused wrist position favorable?

The schedule defines it precisely: favorable ankylosis is fixation in 20 to 30 degrees of dorsiflexion. Anything else is either unfavorable — any degree of palmar flexion, or with ulnar or radial deviation — or falls into the middle criterion of any other position except favorable. Grip is strongest with the wrist slightly extended, which is why that narrow band is the one the schedule treats as least disabling.

How do I find out what angle my wrist was fused at?

The operative report usually states it. If you do not have one, or the wrist was fixed by trauma or arthritis rather than surgery, a lateral X-ray can be measured — ask the examiner or your treating provider to state the angle in degrees and to note any ulnar or radial deviation. That one measurement decides which criterion applies.

Does deviation matter if my wrist is fused in extension?

Yes. The unfavorable criterion reads "in any degree of palmar flexion, or with ulnar or radial deviation." Deviation qualifies on its own, so a wrist fused with significant ulnar or radial deviation is unfavorable even where the flexion angle by itself would not be. That is a finding worth asking for explicitly at the examination.

Can I get more than 50 percent for one wrist?

Not under DC 5214, which stops at 50 percent for the dominant hand. The Note provides the route beyond it: extremely unfavorable ankylosis is rated as loss of use of hands under DC 5125. Separately, 38 CFR 4.68 caps the combined rating for all disabilities of that extremity at the evaluation for amputation at the elective level, so the ceiling for the arm as a whole comes from the amputation codes.

Are my fingers rated separately after a wrist fusion?

They can be. A fused wrist changes tendon mechanics and commonly costs finger range of motion, and limitation of motion of individual digits is separately evaluated. So is loss of forearm supination and pronation under DC 5213. Ask that the fingers and forearm be measured with the wrist in its fixed position, since that is the condition they actually function in.