Wrist, hand and fingers: ankylosis, motion and the exam

How VA rates wrist, hand and finger conditions

38 CFR 4.69, 4.71a, DC 5214 to 5230

Like the shoulder, wrist and hand codes have a dominant (major) column and a non-dominant (minor) column, except the finger limited-motion codes, which are the same for both. Handedness is set by the record or by testing on the exam. For an ambidextrous person, the injured hand is treated as dominant.

The regulation sets a position of function for the hand: wrist dorsiflexed 20 to 30 degrees, the finger joints at the base and middle flexed to 30 degrees, and the thumb abducted and rotated so the pad faces the finger pads. Only joints in those positions count as favorable. For the fingers, the base joint ranges 0 to 90 degrees of flexion and the middle joint 0 to 100 degrees.

Wrist ankylosis and limited motion

38 CFR 4.71a, DC 5214 and 5215

• Ankylosis, unfavorable (any degree of palmar flexion, or with ulnar or radial deviation): 50% dominant, 40% non-dominant.
• Ankylosis in any other position, except favorable: 40% dominant, 30% non-dominant.
• Ankylosis, favorable in 20 to 30 degrees of dorsiflexion: 30% dominant, 20% non-dominant.
• Limited motion (5215): 10% for either wrist if dorsiflexion is less than 15 degrees, or palmar flexion is limited in line with the forearm.

Extremely unfavorable wrist ankylosis is rated as loss of use of the hand (5125). Multiple finger movements limited by tendon tie-up, muscle or nerve injury in forearm and wrist injuries are rated separately and combined, not to exceed the rating for loss of use of the hand.

Ankylosis of the fingers and thumb

38 CFR 4.71a, DC 5216 to 5227

Unfavorable ankylosis of several digits (dominant / non-dominant):

• Five digits (5216): 60% / 50%.
• Four digits (5217): thumb and any three fingers 60% / 50%; index, long, ring and little 50% / 40%.
• Three digits (5218): thumb and any two fingers 50% / 40%; index, long and ring (or index, long and little; or index, ring and little) 40% / 30%; long, ring and little 30% / 20%.
• Two digits (5219): thumb and any finger 40% / 30%; index and long, index and ring, or index and little 30% / 20%; long and ring, long and little, or ring and little 20% / 20%.

Favorable ankylosis of several digits is rated lower: five digits (5220) 50% / 40%; four digits (5221) 50% / 40% with the thumb, 40% / 30% for the four fingers; three digits (5222) 40% / 30%, 30% / 20% or 20% / 20% by which digits; two digits (5223) 30% / 20% for thumb and a finger, 20% / 20% or 10% / 10% for finger pairs.

Single digits: thumb (5224) unfavorable 20%, favorable 10%. Index (5225) or long finger (5226), either position, 10%. Ring or little finger (5227), either position, 0%. Each single-digit code says to consider rating as an amputation, and whether an additional rating is warranted for limited motion of other digits or interference with overall hand function.

Limited motion of the thumb and fingers

38 CFR 4.71a, DC 5228 to 5230

• Thumb (5228): a gap of more than 2 inches (5.1 cm) between the thumb pad and the fingers, with the thumb attempting to oppose, 20%; a gap of 1 to 2 inches, 10%; a gap of less than 1 inch, 0%.
• Index or long finger (5229): 10% with a gap of 1 inch (2.5 cm) or more between the fingertip and the proximal transverse crease of the palm with the finger flexed as far as possible, or extension limited by more than 30 degrees. 0% when the gap is under 1 inch and extension is limited by no more than 30 degrees.
• Ring or little finger (5230): any limitation of motion, 0%.

When two or more digits are affected, the regulation says the evaluation is the level that best represents the overall disability, and gives the higher level when it is equally balanced. Limited motion of two or more digits is evaluated digit by digit and combined. These ratings are the same for both hands.

Amputation of the arm, hand and fingers

38 CFR 4.71a, DC 5120 to 5156

• Forequarter amputation: 100%. Disarticulation at the shoulder: 90%.
• Arm: above the insertion of the deltoid 90% dominant and 80% non-dominant; below it 80% / 70%.
• Forearm: above the insertion of the pronator teres 80% / 70%; below it 70% / 60%.
• Loss of use of the hand (5125): 70% dominant, 60% non-dominant.
• Five digits, or four digits that include the thumb: amputation is rated 70% / 60%.
• A single finger: only the single-finger amputation ratings apply, so a little finger with metacarpal resection (more than half the bone lost) is 20%, and without it at or above the middle joint is 10%.

Amputation of the arm, forearm, hand and the multiple-finger levels carry a footnote that the Veteran is entitled to special monthly compensation. See the paired extremities rule.

How wrist and hand ratings fit with other ratings

38 CFR 4.25

Nerve damage such as carpal tunnel syndrome, scars and arthritis are rated under their own codes when the effects are separate. See nerve damage ratings, skin and scar ratings and combined rating math.

What VA’s wrist and hand exam forms cover

VA Hand and Fingers DBQ (updated 2024-09-27), Wrist DBQ (updated 2024-10-16)

• Hand form: dominant hand; active and passive motion of each finger and the thumb with the gap measurements; repetitive-use testing and estimates for repeated use and flare-ups; muscle strength and grip; ankylosis by joint; assistive devices; and remaining effective function.
• Wrist form: active and passive dorsiflexion, palmar flexion, ulnar deviation and radial deviation; pain and tenderness; repetitive use; flare-ups; atrophy; ankylosis; surgery; imaging; and functional impact.

See Preparing for Your C&P Exam.

What I could not verify

• Rating levels come from the eCFR text of 38 CFR 4.71a and 4.69, current as of October 16, 2026. eCFR is unofficial, and the official text wins over me.
• I summarized the favorable-ankylosis and two-digit levels in a sentence each. For the exact digit combinations, read the schedule.
• I did not restate the rules on how ankylosis of a single joint of a digit is evaluated (the note under the codes), or the single-finger amputation levels other than the little finger.
• I did not cover the amputation rating of the thumb, the rules on functional loss (38 CFR 4.40, 4.45 and 4.59), or carpal tunnel and other nerve codes.
• I checked the exam forms through a text reader, not line by line. The forms themselves are the authority.