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C&P Exam Prep: Unfavorable Ankylosis - 3 Digits
DBQ Overview
Interview + Physical- Form Name
- Hand_and_Finger
- Form Code
- Hand_and_Finger
- Page Count
- 17
- Examiner Type
- Physician or Physician Assistant
- Estimated Duration
- 30-45 minutes
- Exam Format
- Interview + Physical
What to Expect During Your Exam
Exam Overview
To document the degree of ankylosis (fixed immobility) affecting three digits of one hand, determine whether ankylosis is favorable or unfavorable, identify the specific digit combination affected, and assess functional loss for rating purposes under DC 5218.
What the examiner evaluates:
- Which three digits are ankylosed and on which hand (dominant vs. non-dominant)
- Whether ankylosis is unfavorable (gap >2 inches between fingertip and proximal transverse palmar crease, or both MCP and PIP joints of a digit are ankylosed, or rotation/angulation present)
- Position of each ankylosed joint (flexion, extension, or neutral) and exact angle in degrees
- Active and passive range of motion for all affected finger joints (MCP, PIP, DIP, thumb CMC and IP)
- Grip strength of affected hand compared to the more normal side
- Presence of angulation, rotation, or deformity at ankylosed joints
- Whether amputation criteria (DC 5153-5156, 5152) would yield a higher rating
- DeLuca factors: pain on active/passive motion, fatigability, weakness, incoordination, and flare-up behavior
- Fingertip-to-palm gap measurement in centimeters when fingers are flexed to maximum extent possible
- Atrophy of disuse in the affected hand/forearm
- Whether the condition affects the dominant or non-dominant hand
- Functional impact on activities of daily living and occupational tasks
Examination is typically conducted in person. The examiner will visually inspect the hand, physically measure joint positions with a goniometer, measure fingertip-to-palm gap with a ruler, perform grip strength testing (dynamometer), and document range of motion for each affected digit. If you use any assistive devices such as splints or braces, bring them to the exam. You have the right to request the exam be recorded in most states - check your state's consent laws beforehand.
Typical duration: 30-45 minutes
Fingertip-to-Proximal Transverse Palmar Crease Gap
The distance in centimeters between the fingertip(s) and the proximal transverse crease of the palm when the affected finger(s) are flexed to the maximum extent possible. This is the primary determinant of favorable vs. unfavorable ankylosis for index, long, ring, and little fingers.
What to expect:
The examiner will ask you to bend your ankylosed finger(s) as far as possible toward your palm, then use a ruler or caliper to measure the gap between the fingertip and the proximal palmar crease. A gap greater than 5.1 cm (2 inches) indicates unfavorable ankylosis. If both the MCP and PIP joints of a single digit are ankylosed, it is automatically unfavorable regardless of gap measurement.
Key thresholds:
- >5.1 cm (>2 inches) — Confirms unfavorable ankylosis - required for rating under DC 5218
- -5.1 cm (-2 inches) — Indicates favorable ankylosis - rated under DC 5219 or 5228-5230 series, not DC 5218
- Both MCP and PIP ankylosed on same digit — Automatically unfavorable under M21-1 regardless of gap measurement
Tips:
- Flex your fingers as much as you can during measurement - do not resist or hold back; this measurement must reflect your true maximum
- If pain prevents full flexion, that reduced flexion due to pain still counts toward the gap measurement
- The measurement is taken on the most severely restricted finger(s) - ensure each ankylosed digit is measured separately
- For thumb evaluation, the examiner measures the gap between the thumb pad and the fingers when attempting opposition - a gap >5.1 cm indicates unfavorable ankylosis
Pain considerations: If pain limits how far you can flex the ankylosed fingers, communicate this clearly. The examiner should note pain-limited motion. Under DeLuca v. Brown, additional functional loss due to pain must be documented and may increase the effective degree of limitation.
Active Range of Motion (ROM) - MCP, PIP, DIP, and Thumb Joints
The degrees of active movement possible at each joint of the affected digits. For ankylosed joints, the angle at which the joint is fixed is documented. Normal MCP flexion is 0-90-; PIP flexion 0-100-; DIP flexion 0-70-; Thumb CMC and IP joints have their own normal ranges.
What to expect:
The examiner uses a goniometer to measure the fixed angle of each ankylosed joint and any residual motion in partially affected joints. You will be asked to actively flex and extend each finger. The specific degree values are recorded for each joint. For fully ankylosed joints, only the fixed position angle is recorded - no motion is expected.
Key thresholds:
- MCP or PIP fixed in flexion >15- or extension — Supports unfavorable ankylosis finding
- Both MCP and PIP of same digit fixed at any angle — Automatically unfavorable ankylosis
- Joint fixed at 0- (neutral/functional position) — Suggests favorable ankylosis - would be rated differently
- Rotation or angulation of bone present — May support amputation-equivalent rating under DC 5152-5156
Tips:
- Report your worst-day level of motion - if your joints are stiffer after activity, rest, or during flare-ups, communicate this
- Inform the examiner if you cannot fully flex or extend any digit due to pain, stiffness, or mechanical blockage
- Do not push through severe pain to show more motion than you typically have - accurately represent your functional limitation
- If one exam shows better motion than usual (a 'good day'), verbally note that and describe your typical and worst-day function
Pain considerations: Under 38 CFR 4.40 and 4.45 (DeLuca factors), pain with motion must be documented. If you experience pain at the onset of motion, pain throughout the range, or pain that stops motion, tell the examiner exactly where in the range of motion the pain occurs and how severe it is on a 0-10 scale.
Passive Range of Motion
The degrees of movement achievable when the examiner gently moves your finger joints without your active muscular effort. Passive ROM in excess of active ROM indicates muscle weakness or pain-inhibited motion rather than true mechanical joint block.
What to expect:
The examiner will gently attempt to move your ankylosed and adjacent finger joints. For truly ankylosed joints, passive motion will equal active motion (zero). If passive ROM exceeds active ROM, the examiner should note this discrepancy. Passive motion testing helps distinguish true bony/fibrous ankylosis from soft-tissue contracture or pain-inhibited motion.
Key thresholds:
- Passive = Active (no difference) — Consistent with true ankylosis - supports DC 5218 rating
- Passive > Active — Suggests pain or weakness is limiting active motion - document pain on motion carefully
Tips:
- Relax your hand completely during passive testing - do not resist or assist the examiner
- Communicate immediately if passive movement causes pain or discomfort
- Passive ROM results are compared to active ROM to assess DeLuca factors
Pain considerations: If passive motion causes pain, state this clearly. Pain on passive motion is relevant to the severity determination and should be documented in the DBQ.
Grip Strength (Dynamometer)
The maximum hand grip force in kilograms or pounds. Grip strength reduction in the affected hand compared to the contralateral side reflects functional impairment from ankylosis.
What to expect:
You will be asked to squeeze a handheld dynamometer as hard as possible with each hand, typically three times per hand. Results are averaged and compared between hands. Reduced grip strength in the ankylosed hand supports functional loss documentation.
Key thresholds:
- Affected hand significantly weaker than normal side — Supports DeLuca weakness factor and additional functional loss documentation
Tips:
- Squeeze as hard as you can - do not deliberately reduce effort, but if pain limits your grip, communicate that
- If the grip test increases your pain, inform the examiner before or during testing
- Grip strength loss is relevant to the functional impact section of the DBQ
Pain considerations: If squeezing causes significant pain in the ankylosed digits, tell the examiner. Pain-limited grip reflects a DeLuca factor and should be noted as contributing to functional loss beyond the mechanical ankylosis.
Thumb Opposition Gap Measurement
For claims involving the thumb as one of the three ankylosed digits: the distance between the thumb pad and the finger pads or palm when attempting maximum opposition. Determines favorable vs. unfavorable thumb ankylosis per M21-1 criteria.
What to expect:
The examiner will ask you to bring your thumb toward your fingers as if trying to pinch or oppose, then measure the gap between the thumb pad and the closest finger. A gap >5.1 cm is unfavorable for the thumb.
Key thresholds:
- >5.1 cm gap during attempted opposition — Unfavorable thumb ankylosis - applies to DC 5218 thumb-inclusive combinations (rated 50%/40% for thumb + 2 fingers)
- Both CMC and IP joints of thumb ankylosed — Automatically unfavorable thumb ankylosis regardless of gap
Tips:
- Attempt to bring your thumb as close to your fingers as possible during testing
- If the thumb is in a rotated or angulated position, point this out to the examiner
- Document any difficulty pinching, grasping small objects, or performing fine motor tasks in your personal statement
Pain considerations: If thumb opposition causes pain, state the pain level and whether it limits the movement. Pain-limited opposition should be documented as a DeLuca factor.
Rating Criteria Breakdown
| Rating % | Criteria | Key Symptoms |
|---|---|---|
| 50% | Unfavorable ankylosis of three digits including the thumb and any two other fingers of one hand. The dominant hand or a digit combination that severely impacts function. |
CFR: DC 5218: 'Thumb and any two fingers' - 50% (without regard to dominant/non-dominant hand distinction in the rating schedule, though dominance is relevant to functional impact documentation). 38 CFR 4.71a Note: Also consider whether evaluation as amputation is warranted. |
| 40% | Unfavorable ankylosis of three digits in one of these combinations: (1) Index, long, and ring fingers; (2) Index, long, and little fingers; (3) Index, ring, and little fingers. OR: Thumb and any two fingers combination rated at the lower end under specific adjudicative circumstances. |
CFR: DC 5218: 'Index, long, and ring; index, long, and little; or index, ring, and little fingers' - 40%. Also the lower rating for 'Thumb and any two fingers' combination - 40%. |
| 30% | Unfavorable ankylosis of the long, ring, and little fingers (the three ulnar digits) of one hand. |
CFR: DC 5218: 'Long, ring, and little fingers' - 30%. |
| 20% | Unfavorable ankylosis of the long, ring, and little fingers - lower evaluation level. This is the minimum rating for DC 5218 three-digit unfavorable ankylosis. |
CFR: DC 5218: 'Long, ring, and little fingers' - 20% (lower evaluation within the long/ring/little combination). |
50% Unfavorable ankylosis of three digits including the thumb an ...
Unfavorable ankylosis of three digits including the thumb and any two other fingers of one hand. The dominant hand or a digit combination that severely impacts function.
Key Symptoms
- Thumb plus any two additional fingers (e.g., thumb + index + long; thumb + index + ring; thumb + index + little; thumb + long + ring; thumb + long + little; thumb + ring + little) are all fixed in unfavorable positions
- Gap >5.1 cm between thumb pad and fingers on attempted opposition, or both CMC and IP joints of thumb are ankylosed
- Gap >5.1 cm between fingertip(s) and proximal transverse palmar crease on the two non-thumb digits, or both MCP and PIP of each non-thumb digit are ankylosed
- Severely impaired grip, pinch, and fine motor function
- Inability to perform opposition or key pinch
- Major occupational and daily living impairment
CFR: DC 5218: 'Thumb and any two fingers' - 50% (without regard to dominant/non-dominant hand distinction in the rating schedule, though dominance is relevant to functional impact documentation). 38 CFR 4.71a Note: Also consider whether evaluation as amputation is warranted.
40% Unfavorable ankylosis of three digits in one of these combin ...
Unfavorable ankylosis of three digits in one of these combinations: (1) Index, long, and ring fingers; (2) Index, long, and little fingers; (3) Index, ring, and little fingers. OR: Thumb and any two fingers combination rated at the lower end under specific adjudicative circumstances.
Key Symptoms
- Three of the four non-thumb digits (any combination of index, long, ring, little) ankylosed in unfavorable position
- Gap >5.1 cm between fingertip(s) and proximal transverse palmar crease for each affected digit, or both MCP and PIP joints of each digit ankylosed
- Significant grip strength reduction affecting grasping and holding
- Difficulty with typing, writing, tool use, and other fine motor tasks
- Pain with any attempted use of the affected hand
- Fatigability with repetitive hand activities
CFR: DC 5218: 'Index, long, and ring; index, long, and little; or index, ring, and little fingers' - 40%. Also the lower rating for 'Thumb and any two fingers' combination - 40%.
30% Unfavorable ankylosis of the long, ring, and little fingers ...
Unfavorable ankylosis of the long, ring, and little fingers (the three ulnar digits) of one hand.
Key Symptoms
- Long (middle), ring, and little fingers all fixed in unfavorable position
- Gap >5.1 cm between fingertip(s) and proximal transverse palmar crease for affected digits, or both MCP and PIP of each affected digit ankylosed
- Impaired grip strength particularly affecting power grip and ring/ulnar side function
- Difficulty with gripping, carrying, and tool use requiring ulnar-side digits
- Preserved thumb and index finger function (allows for some pinch function)
CFR: DC 5218: 'Long, ring, and little fingers' - 30%.
20% Unfavorable ankylosis of the long, ring, and little fingers ...
Unfavorable ankylosis of the long, ring, and little fingers - lower evaluation level. This is the minimum rating for DC 5218 three-digit unfavorable ankylosis.
Key Symptoms
- Long, ring, and little fingers ankylosed in unfavorable position with lesser functional impairment documentation
- Some preserved grip and hand function
- Moderate reduction in grip strength
- Interference with certain occupational and daily tasks but not complete impairment
CFR: DC 5218: 'Long, ring, and little fingers' - 20% (lower evaluation within the long/ring/little combination).
How to Describe Your Symptoms
Pain
How to describe:
Describe pain location (which joints, which fingers), character (aching, sharp, burning, throbbing), severity on a 0-10 scale both at rest and during use, what activities trigger it, and how long it lasts. Distinguish between pain at rest and pain with attempted movement of the ankylosed joints or the hand as a whole.
Worst-day example:
“On my worst days, my ankylosed fingers cause a constant 7/10 aching pain even at rest, which spikes to 9/10 if I accidentally bump the hand or try to use it for anything requiring grip. The pain radiates from the fixed joints up my hand and sometimes into my wrist. It wakes me up at night if I roll onto the hand, and I have to take pain medication before any activity that involves the affected hand.”
What the examiner listens for:
Location and radiation pattern of pain, pain at rest vs. with motion, pain severity with specific activities, whether pain limits motion or use beyond the mechanical restriction of the ankylosis, pain during the exam itself when joints are touched or manipulated.
Understatements to avoid:
Do not say 'it is not that bad' or minimize pain to seem stoic. Do not report only your best-day pain level. Accurately report your typical and worst-day pain. The examiner needs to document pain that limits function - this is a rated factor under DeLuca.
Weakness
How to describe:
Describe reduced grip and pinch strength in specific terms: what you can no longer hold, lift, or grip that you previously could. Quantify if possible (e.g., 'I can no longer open a jar,' 'I drop objects heavier than a coffee cup,' 'I cannot grip a steering wheel for more than 5 minutes'). Note whether the weakness is constant or worsens with use.
Worst-day example:
“On my worst days my grip on the affected side is so weak I cannot hold a coffee mug with that hand alone. I drop things frequently - keys, utensils, tools. I have had to switch everything to my other hand. My hand gives out immediately when I try to grip a wrench or carry groceries.”
What the examiner listens for:
Specific activities limited by weakness, comparison to the unaffected hand, progressive weakness with repetitive use, whether weakness is present at rest or only with exertion, documented atrophy of intrinsic hand muscles.
Understatements to avoid:
Do not say 'I can still manage' if you have significantly modified how you perform tasks. Compensatory strategies (using the other hand, using tools) represent functional loss - describe what you cannot do naturally, not just whether the task eventually gets done.
Fatigability and Lack of Endurance
How to describe:
Describe how quickly the hand fatigues with use, how long you can sustain grip or pinch before the hand gives out or becomes painful, and how long recovery takes. Compare to your unaffected hand and to your pre-service or pre-injury baseline.
Worst-day example:
“I cannot perform any repetitive hand activity - typing, writing, using a screwdriver - for more than 2 to 3 minutes before the affected hand becomes too painful and fatigued to continue. It then takes 20-30 minutes of rest before I can attempt again. This severely limits my ability to work, especially tasks that require sustained hand use.”
What the examiner listens for:
Time before fatigue onset, whether fatigue worsens throughout the day, impact on sustained occupational tasks, whether rest relieves fatigue and how much rest is needed.
Understatements to avoid:
Do not omit fatigue symptoms because they feel less severe than pain or weakness. Fatigability is an explicit DeLuca factor that can increase your rating when properly documented.
Incoordination and Fine Motor Loss
How to describe:
Describe specific fine motor tasks you cannot perform or perform only with great difficulty: buttoning clothing, writing, typing, picking up small objects, using utensils. The ankylosed fingers cannot move independently, affecting dexterity significantly.
Worst-day example:
“I cannot button a shirt or tie a shoe with the affected hand - I have to use my other hand or adaptive equipment. Writing is essentially impossible with the affected dominant hand; I had to re-train myself to write with the non-dominant hand. Picking up small items like coins or pills requires multiple attempts.”
What the examiner listens for:
Specific fine motor tasks affected, adaptive behaviors developed, whether dominant hand is involved, impact on occupational function and daily activities requiring dexterity.
Understatements to avoid:
Do not omit incoordination because the joints are mechanically fixed rather than spastic. Fixed joints disrupt coordinated hand movement just as severely - describe how the inability to move the digits independently affects your precision tasks.
Flare-Ups
How to describe:
Describe what triggers a flare-up (activity, cold weather, prolonged use, stress on the joint), how often they occur, how long they last, what symptoms worsen during a flare (pain, stiffness, swelling), and how much the flare increases your functional limitation beyond your baseline.
Worst-day example:
“After using my affected hand for even moderate activity, I experience a flare-up lasting 1-3 days where the entire hand swells, pain increases from a baseline of 4/10 to 8-9/10, and I am essentially unable to use the hand at all. During these flares I cannot perform basic self-care tasks with the affected hand and need assistance.”
What the examiner listens for:
Frequency and duration of flare-ups, specific triggers, symptom profile during flares versus baseline, functional limitation during flares, whether flares require additional treatment or activity restriction.
Understatements to avoid:
Do not fail to mention flare-ups if the examiner does not ask. Under M21-1 and DeLuca, flare-up severity is considered in the rating analysis. If your worst days are significantly worse than your exam-day baseline, this must be on record.
Joint Position and Deformity
How to describe:
Describe the position your ankylosed fingers are fixed in - flexed, extended, rotated, or angulated. Explain how the fixed position prevents you from placing your hand flat on a surface, reaching into a pocket or bag, wearing gloves, or performing other specific tasks.
Worst-day example:
“My index and long fingers are fixed in flexion - they cannot be straightened. This means I cannot place my hand flat on a table, wear a normal glove, type on a keyboard, or reach into a pocket or bag without injuring myself on the curled fingers. The ring finger is fixed in extension, making it impossible to close my hand into a fist.”
What the examiner listens for:
Exact fixed position of each ankylosed joint, whether position causes secondary problems (skin breakdown, contracture of adjacent structures), whether rotation or angulation is present (relevant to amputation-equivalent rating consideration).
Understatements to avoid:
Do not assume the examiner can see all relevant aspects of your deformity. Verbally describe how the fixed position impacts specific functional tasks even if the deformity is visible on examination.
Common Mistakes to Avoid
Not knowing or clearly stating which three digits are ankylosed
The specific combination of three digits determines the rating percentage under DC 5218. Thumb-inclusive combinations rate higher (50%/40%) than non-thumb combinations (40%/30%/20%). If the wrong digits are documented, you may receive a lower rating.
Instead: Before your exam, clearly identify and be able to name the three affected digits (thumb, index/2nd, long/3rd, ring/4th, little/5th). Confirm which hand is affected and which digits are ankylosed. Bring prior medical records that document the specific diagnosis.
Impact: All levels - determines 50% vs. 40% vs. 30% vs. 20%
Not distinguishing between favorable and unfavorable ankylosis when describing symptoms
DC 5218 applies only to unfavorable ankylosis. Favorable ankylosis is rated under different codes (DC 5219-5230 series). If the examiner documents your condition as favorable ankylosis, you will not qualify for DC 5218 ratings.
Instead: Understand and communicate that your joints are fixed in positions that impair function: either the fingertip cannot reach within 5.1 cm (2 inches) of the palm when flexed, or both MCP and PIP joints of one or more digits are fixed. Review your medical records before the exam to confirm prior documentation of unfavorable ankylosis.
Impact: All levels - determines applicability of DC 5218
Performing better on exam day than typical due to a 'good day' effect
The examiner documents what they observe on the day of the exam. If your condition varies and the exam day happens to be a better day, the documented findings may underrepresent your actual disability level.
Instead: Verbally inform the examiner that today's exam represents a relatively good day (if applicable) and describe your typical day and worst day in detail. Provide a personal statement documenting your worst-day functional level. Ask the examiner to document your reported typical and worst-day symptoms alongside the objective findings.
Impact: All levels
Failing to mention all DeLuca factors (pain, fatigue, weakness, incoordination, flare-ups)
Under DeLuca v. Brown, the examiner must consider these factors in the rating analysis. If you only describe the mechanical limitation of the ankylosed joints without reporting functional loss from pain, fatigue, or flare-ups, important compensable factors may be omitted from the DBQ.
Instead: Proactively address each DeLuca factor during the exam even if the examiner does not specifically ask. Describe pain with and without motion, how quickly your hand fatigues, grip weakness, fine motor incoordination, and the frequency/severity of flare-ups.
Impact: All levels - especially relevant for ensuring the highest applicable rating within each combination tier
Not mentioning the impact on the dominant hand
Although the rating schedule does not create separate dominant/non-dominant percentages under DC 5218, dominance is documented in the DBQ and can affect overall disability determination, unemployability considerations, and functional impact documentation.
Instead: Clearly state which hand is dominant and whether the ankylosed hand is your dominant hand. Describe how the disability affects your ability to perform dominant-hand-dependent tasks in your occupation and daily life.
Impact: All levels - relevant to functional impact and secondary unemployability considerations
Forgetting to bring or mention assistive devices, splints, or adaptive equipment
The use of splints, braces, or adaptive equipment demonstrates the severity of functional loss. If you have adapted your daily life with assistive devices, this is evidence of the disability's impact that must be documented.
Instead: Bring any splints, braces, or adaptive equipment to the exam. Report what assistive devices you use, why you use them, and what tasks you cannot perform even with these devices.
Impact: All levels
Not considering whether amputation equivalent criteria apply
DC 5218 includes a note to also consider whether evaluation as amputation is warranted (DCs 5152-5156). If both MCP and PIP joints are ankylosed with rotation, angulation, or either joint in full extension or full flexion, an amputation-equivalent rating may be higher. Failure to raise this may result in a lower rating.
Instead: If you have rotation or angulation of the ankylosed digits, or if both MCP and PIP joints are fixed in extreme positions, ask whether the examiner is considering the amputation-equivalent note. Document any bone angulation or rotation during the exam.
Impact: Primarily affects cases potentially qualifying for higher amputation-equivalent ratings
Under-reporting the fingertip-to-palm gap measurement
The gap measurement is the single most critical objective factor distinguishing favorable from unfavorable ankylosis for index, long, ring, and little fingers. If you flex your fingers harder than you naturally can during measurement, the gap may appear smaller and suggest favorable ankylosis.
Instead: Flex your fingers only to the extent that is natural - do not force beyond your comfortable maximum. The measurement should reflect your functional flexion range. If pain limits flexion, that pain-limited position produces the accurate gap. Tell the examiner if pain is preventing full flexion.
Impact: All levels - determines unfavorable vs. favorable ankylosis classification
Prep Checklist
Before Your Exam
Day Of
During the Exam
After the Exam
Your Rights During a C&P Exam
- You have the right to have a Veteran Service Organization (VSO) representative accompany you to the C&P examination.
- You have the right to record your C&P examination in most states - check your state's one-party or two-party consent laws before the exam.
- You have the right to receive a copy of the completed DBQ examination report by submitting a records request to the VA.
- You have the right to request a new C&P examination if you believe the original examination was inadequate, the examiner did not consider all relevant symptoms, or the findings are inconsistent with your actual condition.
- You have the right to submit a personal statement (lay evidence) describing your symptoms, functional limitations, and worst-day experiences - this evidence must be considered by VA raters.
- You have the right to submit buddy statements from individuals who have observed your functional limitations; these are considered lay evidence and carry probative value.
- Under 38 CFR 4.40 and 4.45 (DeLuca factors), the examiner is required to document pain, fatigability, weakness, and incoordination as they contribute to functional loss beyond mechanical limitation - you have the right to have these factors properly evaluated.
- You have the right to have flare-up symptoms considered in the rating, even if a flare is not occurring on the day of the examination - per M21-1 and DeLuca v. Brown.
- You have the right to request the examiner consider whether an amputation-equivalent rating under DCs 5152-5156 would be more appropriate if your joints are ankylosed in extreme positions with rotation or angulation.
- You have the right to appeal a rating decision you believe is inaccurate through a Supplemental Claim, Higher-Level Review (HLR), or Board of Veterans' Appeals (BVA) appeal.
- You have the right to have the benefit of the doubt applied in your favor when there is an approximate balance of positive and negative evidence (38 CFR 3.102).
- You have the right to request that the VA assist in obtaining relevant medical records and evidence under the Duty to Assist (38 CFR 3.159).
Related Conditions
- Favorable Ankylosis - Digits If ankylosis is found to be favorable (joint fixed in neutral position, gap 5.1 cm), the condition is rated under DC 5219 5230 series instead of DC 5218. Understanding the distinction is critical to ensuring the correct code is applied.
- Unfavorable Ankylosis - 4 Digits of One Hand DC 5217 applies when four digits of one hand have unfavorable ankylosis. If you have a fourth digit ankylosed in addition to the three rated under DC 5218, a higher rating under DC 5217 may apply.
- Unfavorable Ankylosis - 5 Digits of One Hand DC 5216 applies when all five digits of one hand have unfavorable ankylosis, rated at 60%/50%. If all five digits are affected, DC 5216 should be applied instead of DC 5218.
- Amputation - Fingers (DC 5152-5156) Per the note in DC 5218, VA raters must also consider whether evaluation as amputation is warranted. If both MCP and PIP joints of an ankylosed digit are in full extension, full flexion, or have rotation or angulation, an amputation equivalent rating may yield a higher compensation. This is specifically noted at DC 5218.
- Post-Traumatic Arthritis - Hand Post traumatic arthritis is a common underlying cause of digital ankylosis. If the ankylosis resulted from traumatic injury, the post traumatic arthritis diagnosis may be listed as a secondary diagnosis in the DBQ (DC 5010 or 5003 coded as DC 5018).
- Degenerative Arthritis - Hand Degenerative arthritis can progress to ankylosis. If degenerative arthritis is the underlying etiology, it may be listed as a secondary diagnosis. The ankylosis is the primary rated condition under DC 5218.
- Dupuytren's Contracture Dupuytren's contracture causes progressive finger flexion contracture that may develop into functional ankylosis. It may be listed as a secondary diagnosis in the hand DBQ.
- Boutonniere Deformity Boutonniere deformity involves fixed flexion of the PIP joint and extension of the DIP joint and may contribute to unfavorable ankylosis findings. It is a separately documentable diagnosis in the hand DBQ.
- Swan Neck Deformity Swan neck deformity involves hyperextension of the PIP joint and may contribute to unfavorable ankylosis documentation. It is a separately documentable diagnosis in the hand DBQ.
- Mallet Finger Mallet finger involves a fixed flexion deformity of the DIP joint and may be present in conjunction with other ankylosed joints, contributing to the three digit unfavorable ankylosis picture.
- Total Disability Individual Unemployability (TDIU) Severe unfavorable ankylosis of three digits, especially of the dominant hand, may prevent substantially gainful employment. Veterans should consider whether to file for TDIU if the hand disability prevents them from working, even if the combined rating does not reach 100%.
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This C&P exam preparation guide is for educational purposes only and does not constitute legal, medical, or claims advice. Always consult with a qualified Veterans Service Organization (VSO) representative or VA-accredited attorney for guidance specific to your claim. Never exaggerate, minimize, or fabricate symptoms during a C&P examination.