Plates I and II provide a standardized description of ankylosis and joint motion measurement. The anatomical position is considered as 0[deg], with two major exceptions: (a) Shoulder rotation--arm abducted to 90[deg], elbow flexed to 90[deg] with the position of the forearm reflecting the midpoint 0[deg] between internal and external rotation of the shoulder; and (b) supination and pronation--the arm next to the body, elbow flexed to 90[deg], and the forearm in midposition 0[deg] between supination and pronation. Motion of the thumb and fingers should be described by appropriate reference to the joints (See Plate III) whose movement is limited, with a statement as to how near, in centimeters, the tip of the thumb can approximate the fingers, or how near the tips of the fingers can approximate the proximal transverse crease of palm. [GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT] [GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT] [29 FR 6718, May 22, 1964, as amended at 43 FR 45349, Oct. 2, 1978; 67 FR 48785, July 26, 2002] Sec. 4.71a Schedule of ratings--musculoskeletal system.
Acute, Subacute, or Chronic Diseases------------------------------------------------------------------------
Rating------------------------------------------------------------------------5000 Osteomyelitis, acute, subacute, or chronic:
Of the pelvis, vertebrae, or extending into major joints, or 100
with multiple localization or with long history of
intractability and debility, anemia, amyloid liver changes,
or other continuous constitutional symptoms..................
Frequent episodes, with constitutional symptoms............... 60
With definite involucrum or sequestrum, with or without 30
discharging sinus............................................
With discharging sinus or other evidence of active infection 20
within the past 5 years......................................
Inactive, following repeated episodes, without evidence of 10
active infection in past 5 years.............................
Note (1): A rating of 10 percent, as an exception to the
amputation rule, is to be assigned in any case of active
osteomyelitis where the amputation rating for the affected
part is no percent. This 10 percent rating and the other
partial ratings of 30 percent or less are to be combined with
ratings for ankylosis, limited motion, nonunion or malunion,
shortening, etc., subject, of course, to the amputation rule.
The 60 percent rating, as it is based on constitutional
symptoms, is not subject to the amputation rule. A rating for
osteomyelitis will not be applied following cure by removal
or radical resection of the affected bone.
Note (2): The 20 percent rating on the basis of activity
within the past 5 years is not assignable following the
initial infection of active osteomyelitis with no subsequent
reactivation. The prerequisite for this historical rating is
an established recurrent osteomyelitis. To qualify for the 10
percent rating, 2 or more episodes following the initial
infection are required. This 20 percent rating or the 10
percent rating, when applicable, will be assigned once only
to cover disability at all sites of previously active
infection with a future ending date in the case of the 20
percent rating.5001 Bones and joints, tuberculosis of, active or inactive:
Active........................................................ 100
Inactive: See Sec. Sec. 4.88b and 4.89..................... ......5002 Arthritis rheumatoid (atrophic) As an active process:
With constitutional manifestations associated with active 100
joint involvement, totally incapacitating....................
Less than criteria for 100% but with weight loss and anemia 60
productive of severe impairment of health or severely
incapacitating exacerbations occurring 4 or more times a year
or a lesser number over prolonged periods....................
Symptom combinations productive of definite impairment of 40
health objectively supported by examination findings or
incapacitating exacerbations occurring 3 or more times a year
One or two exacerbations a year in a well-established 20
diagnosis....................................................For chronic residuals:
For residuals such as limitation of motion or ankylosis,
favorable or unfavorable, rate under the appropriate
diagnostic codes for the specific joints involved. Where,
however, the limitation of motion of the specific joint or
joints involved is noncompensable under the codes a rating of
10 percent is for application for each such major joint or
group of minor joints affected by limitation of motion, to be
combined, not added under diagnostic code 5002. Limitation of
motion must be objectively confirmed by findings such as
swelling, muscle spasm, or satisfactory evidence of painful
motion.
Note: The ratings for the active process will not be combined
with the residual ratings for limitation of motion or
ankylosis. Assign the higher evaluation.5003 Arthritis, degenerative (hypertrophic or osteoarthritis):
Degenerative arthritis established by X-ray findings will be
rated on the basis of limitation of motion under the
appropriate diagnostic codes for the specific joint or joints
involved (DC 5200 etc.). When however, the limitation of
motion of the specific joint or joints involved is
noncompensable under the appropriate diagnostic codes, a
rating of 10 pct is for application for each such major joint
or group of minor joints affected by limitation of motion, to
be combined, not added under diagnostic code 5003. Limitation
of motion must be objectively confirmed by findings such as
swelling, muscle spasm, or satisfactory evidence of painful
motion. In the absence of limitation of motion, rate as
below:
With X-ray evidence of involvement of 2 or more major joints 20
or 2 or more minor joint groups, with occasional
incapacitating exacerbations...............................
With X-ray evidence of involvement of 2 or more major joints 10
or 2 or more minor joint groups............................
Note (1): The 20 pct and 10 pct ratings based on X-ray
findings, above, will not be combined with ratings based on
limitation of motion.
Note (2): The 20 pct and 10 pct ratings based on X-ray
findings, above, will not be utilized in rating conditions
listed under diagnostic codes 5013 to 5024, inclusive.5004 Arthritis, gonorrheal.5005 Arthritis, pneumococcic.5006 Arthritis, typhoid.5007 Arthritis, syphilitic.5008 Arthritis, streptococcic.5009 Arthritis, other types (specify).
With the types of arthritis, diagnostic codes 5004 through
5009, rate the disability as rheumatoid arthritis.5010 Arthritis, due to trauma, substantiated by X-ray findings:
Rate as arthritis, degenerative.5011 Bones, caisson disease of: Rate as arthritis, cord
involvement, or deafness, depending on the severity of
disabling manifestations.5012 Bones, new growths of, malignant 100
Note: The 100 percent rating will be continued for 1 year
following the cessation of surgical, X-ray, antineoplastic
chemotherapy or other therapeutic procedure. At this point,
if there has been no local recurrence or metastases, the
rating will be made on residuals.5013 Osteoporosis, with joint manifestations.5014 Osteomalacia.5015 Bones, new growths of, benign.5016 Osteitis deformans.5017 Gout.5018 Hydrarthrosis, intermittent.5019 Bursitis.5020 Synovitis.5021 Myositis.5022 Periostitis.5023 Myositis ossificans.5024 Tenosynovitis.
The diseases under diagnostic codes 5013 through 5024 will be
rated on limitation of motion of affected parts, as
arthritis, degenerative, except gout which will be rated
under diagnostic code 5002.5025 Fibromyalgia (fibrositis, primary fibromyalgia syndrome)
With widespread musculoskeletal pain and tender points, with
or without associated fatigue, sleep disturbance, stiffness,
paresthesias, headache, irritable bowel symptoms, depression,
anxiety, or Raynaud's-like symptoms:
That are constant, or nearly so, and refractory to therapy.. 40
That are episodic, with exacerbations often precipitated by 20
environmental or emotional stress or by overexertion, but
that are present more than one-third of the time...........
That require continuous medication for control.............. 10
Note: Widespread pain means pain in both the left and right
sides of the body, that is both above and below the waist,
and that affects both the axial skeleton (i.e., cervical
spine, anterior chest, thoracic spine, or low back) and the
extremities.------------------------------------------------------------------------
Prosthetic Implants------------------------------------------------------------------------
Rating
---------------
Major Minor------------------------------------------------------------------------5051 Shoulder replacement (prosthesis).
Prosthetic replacement of the shoulder joint:
For 1 year following implantation of prosthesis..... 100 100
With chronic residuals consisting of severe, painful 60 50
motion or weakness in the affected extremity.......
With intermediate degrees of residual weakness, pain
or limitation of motion, rate by analogy to
diagnostic codes 5200 and 5203.
Minimum rating...................................... 30 205052 Elbow replacement (prosthesis).
Prosthetic replacement of the elbow joint:
For 1 year following implantation of prosthesis..... 100 100
With chronic residuals consisting of severe painful 50 40
motion or weakness in the affected extremity.......
With intermediate degrees of residual weakness, pain
or limitation of motion rate by analogy to
diagnostic codes 5205 through 5208.
Minimum evaluation.................................. 30 205053 Wrist replacement (prosthesis).
Prosthetic replacement of wrist joint:
For 1 year following implantation of prosthesis..... 100 100
With chronic residuals consisting of severe, painful 40 30
motion or weakness in the affected extremity.......
With intermediate degrees of residual weakness, pain
or limitation of motion, rate by analogy to
diagnostic code 5214.
Minimum rating...................................... 20 20
Note: The 100 pct rating for 1 year following
implantation of prosthesis will commence after
initial grant of the 1-month total rating assigned
under Sec. 4.30 following hospital discharge.5054 Hip replacement (prosthesis).
Prosthetic replacement of the head of the femur or of
the acetabulum:
For 1 year following implantation of prosthesis..... ...... 100
Following implantation of prosthesis with painful ...... \1\ 90
motion or weakness such as to require the use of
crutches...........................................
Markedly severe residual weakness, pain or ...... 70
limitation of motion following implantation of
prosthesis.........................................
Moderately severe residuals of weakness, pain or ...... 50
limitation of motion...............................
Minimum rating...................................... ...... 305055 Knee replacement (prosthesis).
Prosthetic replacement of knee joint:
For 1 year following implantation of prosthesis..... ...... 100
With chronic residuals consisting of severe painful ...... 60
motion or weakness in the affected extremity.......
With intermediate degrees of residual weakness, pain
or limitation of motion rate by analogy to
diagnostic codes 5256, 5261, or 5262.
Minimum rating...................................... ...... 305056 Ankle replacement (prosthesis).
Prosthetic replacement of ankle joint:
For 1 year following implantation of prosthesis..... ...... 100
With chronic residuals consisting of severe painful ...... 40
motion or weakness.................................
With intermediate degrees of residual weakness, pain
or limitation of motion rate by analogy to 5270 or
5271.
Minimum rating...................................... ...... 20
Note (1): The 100 pct rating for 1 year following
implantation of prosthesis will commence after
initial grant of the 1-month total rating assigned
under Sec. 4.30 following hospital discharge.
Note (2): Special monthly compensation is assignable
during the 100 pct rating period the earliest date
permanent use of crutches is established.------------------------------------------------------------------------
combinations of disabilities------------------------------------------------------------------------5104 Anatomical loss of one hand and loss of use of one ...... \1\
foot................................................... 1005105 Anatomical loss of one foot and loss of use of one ...... \1\
hand................................................... 1005106 Anatomical loss of both hands...................... ...... \1\
1005107 Anatomical loss of both feet....................... ...... \1\
1005108 Anatomical loss of one hand and one foot........... ...... \1\
1005109 Loss of use of both hands.......................... ...... \1\
1005110 Loss of use of both feet........................... ...... \1\
1005111 Loss of use of one hand and one foot............... ...... \1\
100------------------------------------------------------------------------\1\ Also entitled to special monthly compensation.
Table II--Ratings for Multiple Losses of Extremities With Dictator's Rating Code and 38 CFR Citation--------------------------------------------------------------------------------------------------------------------------------------------------------
Impairment of other extremity
-----------------------------------------------------------------------------------------------------------------------
Anatomical loss or Anatomical loss or Anatomical loss Anatomical loss
Impairment of one extremity Anatomical loss or Anatomical loss or loss of use above loss of use above near shoulder near hip
loss of use below loss of use below elbow (preventing knee (preventing (preventing use of (preventing use of
elbow knee use of prosthesis) use of prosthesis) prosthesis) prosthesis)--------------------------------------------------------------------------------------------------------------------------------------------------------Anatomical loss or loss of use M Codes M-1 a, b, L Codes L-1 d, e, M\1/2\ Code M-5, L\1/2\ Code L-2 c, N Code N-3, 38 CFR M Code M-3 c, 38
below elbow. or c, 38 CFR f, or g, 38 CFR 38 CFR 3.350 38 CFR 3.350 3.350 (f)(1)(xi). CFR 3.350
(1)(i). 3.350(b). (f)(1)(x). (f)(1)(vi). (f)(1)(viii)Anatomical loss or loss of use .................. L Codes L-1 a, b, L\1/2\ Code L-2 b, L\1/2\ Code L-2 a, M Code M-3 b, 38 M Code M-3 a, 38
(1)(i). 3.350(b). (f)(1)(x). (f)(1)(vi). (f)(1)(viii)Anatomical loss or loss of use .................. L Codes L-1 a, b, L\1/2\ Code L-2 b, L\1/2\ Code L-2 a, M Code M-3 b, 38 M Code M-3 a, 38
below knee. or c, 38 CFR 38 CFR 3.350 38 CFR 3.350 CFR 3.350 CFR 3.350
(1)(iii). (f)(1)(i). (f)(1)(iv). (f)(1)(ii)Anatomical loss or loss of use .................. .................. N Code N-1, 38 CFR M Code M-2 a, 38 N\1/2\ Code N-4, M\1/2\ Code M-4 c,
(i). (f)(1)(iv). (f)(1)(ii)Anatomical loss or loss of use .................. .................. N Code N-1, 38 CFR M Code M-2 a, 38 N\1/2\ Code N-4, M\1/2\ Code M-4 c,
(1)(iv). (f)(1)(ii)Anatomical loss or loss of use .................. .................. N Code N-1, 38 CFR M Code M-2 a, 38 N\1/2\ Code N-4, M\1/2\ Code M-4 c,
(1)(iv). (f)(1)(ii)Anatomical loss or loss of use .................. .................. N Code N-1, 38 CFR M Code M-2 a, 38 N\1/2\ Code N-4, M\1/2\ Code M-4 c,
above elbow (preventing use of 3.350 (d)(1). CFR 3.350 38 CFR 3.350 38 CFR 3.350
(1)(iii). (f)(1)(ix). (f)(1)(xi)Anatomical loss or loss of use .................. .................. .................. M Code M-2 a, 38 M\1/2\ Code M-4 b, M\1/2\ Code M-4 a,
(1)(iii). (f)(1)(ix). (f)(1)(xi)Anatomical loss or loss of use .................. .................. .................. M Code M-2 a, 38 M\1/2\ Code M-4 b, M\1/2\ Code M-4 a,
(1)(iii). (f)(1)(ix). (f)(1)(xi)Anatomical loss or loss of use .................. .................. .................. M Code M-2 a, 38 M\1/2\ Code M-4 b, M\1/2\ Code M-4 a,
above knee (preventing use of CFR 3.350 38 CFR 3.350 38 CFR 3.350
(1)(ii). (f)(1)(vii). (f)(1)(v)Anatomical loss near shoulder .................. .................. .................. .................. O Code O-1, 38 CFR N Code N-2 b, 38
(1)(ii). (f)(1)(vii). (f)(1)(v)Anatomical loss near shoulder .................. .................. .................. .................. O Code O-1, 38 CFR N Code N-2 b, 38
(1)(ii). (f)(1)(vii). (f)(1)(v)Anatomical loss near shoulder .................. .................. .................. .................. O Code O-1, 38 CFR N Code N-2 b, 38
(preventing use of prosthesis). 3.350 (e)(1)(i). CFR 3.350 (d)(3)Anatomical loss near hip .................. .................. .................. .................. .................. N Code N-2 a, 38
(preventing use of prosthesis). CFR 3.350 (d)(2)--------------------------------------------------------------------------------------------------------------------------------------------------------Note.--Need for aid attendance or permanently bedridden qualifies for subpar. L. Code L-1 h, i (38 CFR 3.350(b)). Paraplegia with loss of use of both
lower extremities and loss of anal and bladder sphincter control qualifies for subpar. O. Code O-2 (38 CFR 3.350(e)(2)). Where there are additional
disabilities rated 50% or 100%, or anatomical or loss of use of a third extremity see 38 CFR 3.350(f) (3), (4) or (5). (Authority: 38 U.S.C. 1115)
Amputations: Upper Extremity------------------------------------------------------------------------
Rating
---------------
Major Minor------------------------------------------------------------------------
Arm, amputation of:5120 Disarticulation.................................... \1\ 90 \1\ 905121 Above insertion of deltoid......................... \1\ 90 \1\ 805122 Below insertion of deltoid......................... \1\ 80 \1\ 70
Forearm, amputation of:5123 Above insertion of pronator teres.................. \1\ 80 \1\ 705124 Below insertion of pronator teres.................. \1\ 70 \1\ 605125 Hand, loss of use of............................... \1\ 70 \1\ 60------------------------------------------------------------------------
multiple finger amputations------------------------------------------------------------------------5126 Five digits of one hand, amputation of............. \1\ 70 \1\ 60
Four digits of one hand, amputation of:5127 Thumb, index, long and ring........................ \1\ 70 \1\ 605128 Thumb, index, long and little...................... \1\ 70 \1\ 605129 Thumb, index, ring and little...................... \1\ 70 \1\ 605130 Thumb, long, ring and little....................... \1\ 70 \1\ 605131 Index, long, ring and little....................... 60 50
Three digits of one hand, amputation of:5132 Thumb, index and long.............................. 60 505133 Thumb, index and ring.............................. 60 505134 Thumb, index and little............................ 60 505135 Thumb, long and ring............................... 60 505136 Thumb, long and little............................. 60 505137 Thumb, ring and little............................. 60 505138 Index, long and ring............................... 50 405139 Index, long and little............................. 50 405140 Index, ring and little............................. 50 405141 Long, ring and little.............................. 40 30
Two digits of one hand, amputation of:5142 Thumb and index.................................... 50 405143 Thumb and long..................................... 50 405144 Thumb and ring..................................... 50 405145 Thumb and little................................... 50 405146 Index and long..................................... 40 305147 Index and ring..................................... 40 305148 Index and little................................... 40 305149 Long and ring...................................... 30 205150 Long and little.................................... 30 205151 Ring and little.................................... 30 20
(a) The ratings for multiple finger amputations apply
to amputations at the proximal interphalangeal joints
or through proximal phalanges........................
(b) Amputation through middle phalanges will be rated
as prescribed for unfavorable ankylosis of the
fingers..............................................
(c) Amputations at distal joints, or through distal
phalanges, other than negligible losses, will be
rated as prescribed for favorable ankylosis of the
fingers..............................................
(d) Amputation or resection of metacarpal bones (more
than one-half the bone lost) in multiple fingers
injuries will require a rating of 10 percent added to
(not combined with) the ratings, multiple finger
amputations, subject to the amputation rule applied
to the forearm.
(e) Combinations of finger amputations at various
levels, or finger amputations with ankylosis or
limitation of motion of the fingers will be rated on
the basis of the grade of disability; i.e.,
amputation, unfavorable ankylosis, most
representative of the levels or combinations. With an
even number of fingers involved, and adjacent grades
of disability, select the higher of the two grades.
(f) Loss of use of the hand will be held to exist when
no effective function remains other than that which
would be equally well served by an amputation stump
with a suitable prosthetic applicance.------------------------------------------------------------------------
single finger amputations------------------------------------------------------------------------5152 Thumb, amputation of:
With metacarpal resection............................. 40 30
At metacarpophalangeal joint or through proximal 30 20
phalanx..............................................
At distal joint or through distal phalanx............. 20 205153 Index finger, amputation of
With metacarpal resection (more than one-half the bone 30 20
lost)................................................
Without metacarpal resection, at proximal 20 20
interphalangeal joint or proximal thereto............
Through middle phalanx or at distal joint............. 10 105154 Long finger, amputation of:
With metacarpal resection (more than one-half the bone 20 20
lost)................................................
Without metacarpal resection, at proximal 10 10
interphalangeal joint or proximal thereto............5155 Ring finger, amputation of:
With metacarpal resection (more than one-half the bone 20 20
lost)................................................
Without metacarpal resection, at proximal 10 10
interphalangeal joint or proximal thereto............5156 Little finger, amputation of:
With metacarpal resection (more than one-half the bone 20 20
lost)................................................
Without metacarpal resection, at proximal 10 10
interphalangeal joint or proximal thereto............
Note: The single finger amputation ratings are the
only applicable ratings for amputations of whole or
part of single fingers.------------------------------------------------------------------------\1\ Entitled to special monthly compensation. [GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
Amputations: Lower Extremity------------------------------------------------------------------------
Rating------------------------------------------------------------------------
Thigh, amputation of:5160 Disarticulation, with loss of extrinsic pelvic girdle \2\ 90
muscles........................................................5161 Upper third, one-third of the distance from perineum to \2\ 80
knee joint measured from perineum..............................5162 Middle or lower thirds..................................... \2\ 60
Leg, amputation of:5163 With defective stump, thigh amputation recommended......... \2\ 605164 Amputation not improvable by prosthesis controlled by \2\ 60
natural knee action............................................5165 At a lower level, permitting prosthesis.................... \2\ 405166 Forefoot, amputation proximal to metatarsal bones (more \2\ 40
than one-half of metatarsal loss)..............................5167 Foot, loss of use of....................................... \2\ 405170 Toes, all, amputation of, without metatarsal loss.......... 305171 Toe, great, amputation of:
With removal of metatarsal head............................... 30
Without metatarsal involvement................................ 105172 Toes, other than great, amputation of, with removal of
metatarsal head:
One or two.................................................... 20
Without metatarsal involvement................................ 05173 Toes, three or four, amputation of, without metatarsal
involvement:
Including great toe........................................... 20
Not including great toe....................................... 10------------------------------------------------------------------------\2\ Also entitled to special monthly compensation. [GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
The Shoulder and Arm------------------------------------------------------------------------
Rating
---------------
Major Minor------------------------------------------------------------------------5200 Scapulohumeral articulation, ankylosis of:
Note: The scapula and humerus move as one piece.
Unfavorable, abduction limited to 25[deg] from side... 50 40
Intermediate between favorable and unfavorable........ 40 30
Favorable, abduction to 60[deg], can reach mouth and 30 20
head.................................................5201 Arm, limitation of motion of:
To 25[deg] from side.................................. 40 30
Midway between side and shoulder level................ 30 20
At shoulder level..................................... 20 205202 Humerus, other impairment of:
Loss of head of (flail shoulder)...................... 80 70
Nonunion of (false flail joint)....................... 60 50
Fibrous union of...................................... 50 40
Recurrent dislocation of at scapulohumeral joint.
With frequent episodes and guarding of all arm 30 20
movements..........................................
With infrequent episodes, and guarding of movement 20 20
only at shoulder level.............................
Malunion of:
Marked deformity.................................... 30 20
Moderate deformity.................................. 20 205203 Clavicle or scapula, impairment of:
Dislocation of........................................ 20 20
Nonunion of:
With loose movement................................. 20 20
Without loose movement.............................. 10 10
Malunion of........................................... 10 10
Or rate on impairment of function of contiguous joint.------------------------------------------------------------------------
The Elbow and Forearm------------------------------------------------------------------------
Rating
---------------
Major Minor------------------------------------------------------------------------5205 Elbow, ankylosis of:
Unfavorable, at an angle of less than 50[deg] or with 60 50
complete loss of supination or pronation.............
Intermediate, at an angle of more than 90[deg], or 50 40
between 70[deg] and 50[deg]..........................
Favorable, at an angle between 90[deg] and 70[deg].... 40 305206 Forearm, limitation of flexion of:
Flexion limited to 45[deg]............................ 50 40
Flexion limited to 55[deg]............................ 40 30
Flexion limited to 70[deg]............................ 30 20
Flexion limited to 90[deg]............................ 20 20
Flexion limited to 100[deg]........................... 10 10
Flexion limited to 110[deg]........................... 0 05207 Forearm, limitation of extension of:
Extension limited to 110[deg]......................... 50 40
Extension limited to 100[deg]......................... 40 30
Extension limited to 90[deg].......................... 30 20
Extension limited to 75[deg].......................... 20 20
Extension limited to 60[deg].......................... 10 10
Extension limited to 45[deg].......................... 10 105208 Forearm, flexion limited to 100[deg] and extension 20 20
to 45[deg].............................................5209 Elbow, other impairment of Flail joint............. 60 50
Joint fracture, with marked cubitus varus or cubitus 20 20
valgus deformity or with ununited fracture of head of
radius...............................................5210 Radius and ulna, nonunion of, with flail false 50 40
joint..................................................5211 Ulna, impairment of:
Nonunion in upper half, with false movement:
With loss of bone substance (1 inch (2.5 cms.) or 40 30
more) and marked deformity.........................
Without loss of bone substance or deformity......... 30 20
Nonunion in lower half.............................. 20 20
Malunion of, with bad alignment..................... 10 105212 Radius, impairment of:
Nonunion in lower half, with false movement:
With loss of bone substance (1 inch (2.5 cms.) or 40 30
more) and marked deformity.........................
Without loss of bone substance or deformity......... 30 20
Nonunion in upper half.............................. 20 20
Malunion of, with bad alignment..................... 10 105213 Supination and pronation, impairment of:
Loss of (bone fusion):
The hand fixed in supination or hyperpronation...... 40 30
The hand fixed in full pronation.................... 30 20
The hand fixed near the middle of the arc or 20 20
moderate pronation.................................
Limitation of pronation:
Motion lost beyond middle of arc.................... 30 20
Motion lost beyond last quarter of arc, the hand 20 20
does not approach full pronation...................
Limitation of supination:
To 30[deg] or less.................................. 10 10
Note: In all the forearm and wrist injuries, codes
5205 through 5213, multiple impaired finger movements
due to tendon tie-up, muscle or nerve injury, are to
be separately rated and combined not to exceed rating
for loss of use of hand.------------------------------------------------------------------------
The Wrist------------------------------------------------------------------------
Rating
---------------
Major Minor------------------------------------------------------------------------5214 Wrist, ankylosis of:
Unfavorable, in any degree of palmar flexion, or with 50 40
ulnar or radial deviation............................
Any other position, except favorable.................. 40 30
Favorable in 20[deg] to 30[deg] dorsiflexion.......... 30 20
Note: Extremely unfavorable ankylosis will be rated as
loss of use of hands under diagnostic code 5125.5215 Wrist, limitation of motion of:
Dorsiflexion less than 15[deg]........................ 10 10
Palmar flexion limited in line with forearm........... 10 10------------------------------------------------------------------------
Evaluation of Ankylosis or Limitation of Motion of Single or Multiple
Digits of the Hand------------------------------------------------------------------------
Rating
---------------
(1) For the index, long, ring, and little fingers ...... ......
(digits II, III, IV, and V), zero degrees of flexion
represents the fingers fully extended, making a
straight line with the rest of the hand. The position
of function of the hand is with the wrist dorsiflexed
20 to 30 degrees, the metacarpophalangeal and proximal
interphalangeal joints flexed to 30 degrees, and the
thumb (digit I) abducted and rotated so that the thumb
pad faces the finger pads. Only joints in these
positions are considered to be in favorable position.
For digits II through V, the metacarpophalangeal joint
has a range of zero to 90 degrees of flexion, the
proximal interphalangeal joint has a range of zero to
100 degrees of flexion, and the distal (terminal)
interphalangeal joint has a range of zero to 70 or 80
degrees of flexion.....................................(2) When two or more digits of the same hand are ...... ......
affected by any combination of amputation, ankylosis,
or limitation of motion that is not otherwise specified
in the rating schedule, the evaluation level assigned
will be that which best represents the overall
disability (i.e., amputation, unfavorable or favorable
ankylosis, or limitation of motion), assigning the
higher level of evaluation when the level of disability
is equally balanced between one level and the next
higher level...........................................(3) Evaluation of ankylosis of the index, long, ring,
and little fingers:
(i) If both the metacarpophalangeal and proximal ...... ......
interphalangeal joints of a digit are ankylosed,
and either is in extension or full flexion, or
there is rotation or angulation of a bone, evaluate
as amputation without metacarpal resection, at
proximal interphalangeal joint or proximal thereto.
(ii) If both the metacarpophalangeal and proximal
interphalangeal joints of a digit are ankylosed,
evaluate as unfavorable ankylosis, even if each
joint is individually fixed in a favorable position
(iii) If only the metacarpophalangeal or proximal ...... ......
interphalangeal joint is ankylosed, and there is a
gap of more than two inches (5.1 cm.) between the
fingertip(s) and the proximal transverse crease of
the palm, with the finger(s) flexed to the extent
possible, evaluate as unfavorable ankylosis........
(iv) If only the metacarpophalangeal or proximal ...... ......
interphalangeal joint is ankylosed, and there is a
gap of two inches (5.1 cm.) or less between the
fingertip(s) and the proximal transverse crease of
the palm, with the finger(s) flexed to the extent
possible, evaluate as favorable ankylosis..........(4) Evaluation of ankylosis of the thumb:
(i) If both the carpometacarpal and interphalangeal ...... ......
joints are ankylosed, and either is in extension or
full flexion, or there is rotation or angulation of
a bone, evaluate as amputation at
metacarpophalangeal joint or through proximal
phalanx............................................
(ii) If both the carpometacarpal and interphalangeal ...... ......
joints are ankylosed, evaluate as unfavorable
ankylosis, even if each joint is individually fixed
in a favorable position............................
(iii) If only the carpometacarpal or interphalangeal ...... ......
joint is ankylosed, and there is a gap of more than
two inches (5.1 cm.) between the thumb pad and the
fingers, with the thumb attempting to oppose the
fingers, evaluate as unfavorable ankylosis.........
(iv) If only the carpometacarpal or interphalangeal ...... ......
joint is ankylosed, and there is a gap of two
inches (5.1 cm.) or less between the thumb pad and
the fingers, with the thumb attempting to oppose
the fingers, evaluate as favorable ankylosis.......(5) If there is limitation of motion of two or more ...... ......
digits, evaluate each digit separately and combine the
evaluations............................................------------------------------------------------------------------------
I. Multiple Digits: Unfavorable Ankylosis------------------------------------------------------------------------5216 Five digits of one hand, unfavorable ankylosis of.. 60 50Note: Also consider whether evaluation as amputation is
warranted.5217 Four digits of one hand, unfavorable ankylosis of:
Thumb and any three fingers......................... 60 50
Index, long, ring, and little fingers............... 50 40Note: Also consider whether evaluation as amputation is
warranted.5218 Three digits of one hand, unfavorable ankylosis of:
Thumb and any two fingers........................... 50 40
Index, long, and ring; index, long, and little; or 40 30
index, ring, and little fingers....................
Long, ring, and little fingers...................... 30 20Note: Also consider whether evaluation as amputation is
warranted.5219 Two digits of one hand, unfavorable ankylosis of:
Thumb and any finger................................ 40 30
Index and long; index and ring; or index and little 30 20
fingers............................................
Long and ring; long and little; or ring and little 20 20
fingers............................................Note: Also consider whether evaluation as amputation is
warranted.------------------------------------------------------------------------
II. Multiple Digits: Favorable Ankylosis------------------------------------------------------------------------5220 Five digits of one hand, favorable ankylosis of.... 50 405221 Four digits of one hand, favorable ankylosis of:
Thumb and any three fingers......................... 50 40
Index, long, ring, and little fingers............... 40 305222 Three digits of one hand, favorable ankylosis of:
Thumb and any two fingers........................... 40 30
Index, long, and ring; index, long, and little; or 30 20
index, ring, and little fingers....................
Long, ring and little fingers....................... 20 205223 Two digits of one hand, favorable ankylosis of:
Thumb and any finger................................ 30 20
Index and long; index and ring; or index and little 20 20
fingers............................................
Long and ring; long and little; or ring and little 10 10
fingers............................................------------------------------------------------------------------------
III. Ankylosis of Individual Digits------------------------------------------------------------------------5224 Thumb, ankylosis of:
Unfavorable......................................... 20 20
Favorable........................................... 10 10Note: Also consider whether evaluation as amputation is
warranted and whether an additional evaluation is
warranted for resulting limitation of motion of other
digits or interference with overall function of the
hand.5225 Index finger, ankylosis of:
Unfavorable or favorable............................ 10 10Note: Also consider whether evaluation as amputation is
warranted and whether an additional evaluation is
warranted for resulting limitation of motion of other
digits or interference with overall function of the
hand.5226 Long finger, ankylosis of:
Unfavorable or favorable............................ 10 10Note: Also consider whether evaluation as amputation is
warranted and whether an additional evaluation is
warranted for resulting limitation of motion of other
digits or interference with overall function of the
hand.5227 Ring or little finger, ankylosis of:
Unfavorable or favorable............................ 0 0Note: Also consider whether evaluation as amputation is
warranted and whether an additional evaluation is
warranted for resulting limitation of motion of other
digits or interference with overall function of the
hand.------------------------------------------------------------------------
IV. Limitation of Motion of Individual Digits------------------------------------------------------------------------5228 Thumb, limitation of motion:
With a gap of more than two inches (5.1 cm.) between 20 20
the thumb pad and the fingers, with the thumb
attempting to oppose the fingers...................
With a gap of one to two inches (2.5 to 5.1 cm.) 10 10
between the thumb pad and the fingers, with the
thumb attempting to oppose the fingers.............
With a gap of less than one inch (2.5 cm.) between 0 0
the thumb pad and the fingers, with the thumb
attempting to oppose the fingers...................5229 Index or long finger, limitation of motion:
With a gap of one inch (2.5 cm.) or more between the 10 10
fingertip and the proximal transverse crease of the
palm, with the finger flexed to the extent
possible, or; with extension limited by more than
30 degrees.........................................
With a gap of less than one inch (2.5 cm.) between 0 0
the fingertip and the proximal transverse crease of
the palm, with the finger flexed to the extent
possible, and; extension is limited by no more than
30 degrees.........................................5230 Ring or little finger, limitation of motion:
Any limitation of motion............................ 0 0------------------------------------------------------------------------
The Spine------------------------------------------------------------------------
Rating------------------------------------------------------------------------
General Rating Formula for Diseases and Injuries of the Spine
(For diagnostic codes 5235 to 5243 unless 5243 is evaluated
under the Formula for Rating Intervertebral Disc Syndrome Based
on Incapacitating Episodes):
With or without symptoms such as pain (whther or not it
radiates), stiffness, or aching in the area of the spine
affected by residuals of injury or disease
Unfavorable ankylosis of the entire spine............... 100
Unfavorable ankylosis of the entire thoracolumbar spine. 50
Unfavorable ankylosis of the entire cervical spine; or, 40
forward flexion of the thoracolumbar spine 30 degrees
or less; or, favorable ankylosis of the entire
thoracolumbar spine....................................
Forward flexion of the cervical spine 15 degrees or 30
less; or, favorable ankylosis of the entire cervical
spine..................................................
Forward flexion of the thoracolumbar spine greater than 20
30 degrees but not greater than 60 degrees; or, forward
flexion of the cervical spine greater than 15 degrees
but not greater than 30 degrees; or, the combined range
of motion of the thoracolumbar spine not greater than
120 degrees; or, the combined range of motion of the
cervical spine not greater than 170 degrees; or, muscle
spasm or guarding severe enough to result in an
abnormal gait or abnormal spinal contour such as
scoliosis, reversed lordosis, or abnormal kyphosis.....
Forward flexion of the thoracolumbar spine greater than 10
60 degrees but not greater than 85 degrees; or, forward
flexion of the cervical spine greater than 30 degrees
but not greater than 40 degrees; or, combined range of
motion of the thoracolumbar spine greater than 120
degrees but not greater than 235 degrees; or, combined
range of motion of the cervical spine greater than 170
degrees but not greater than 335 degrees; or, muscle
spasm, guarding, or localized tenderness not resulting
in abnormal gait or abnormal spinal contour; or,
vertebral body fracture with loss of 50 percent or more
of the height..........................................Note (1): Evaluate any associated objective neurologic
abnormalities, including, but not limited to, bowel or bladder
impairment, separately, under an appropriate diagnostic code.Note (2): (See also Plate V.) For VA compensation purposes,
normal forward flexion of the cervical spine is zero to 45
degrees, extension is zero to 45 degrees, left and right
lateral flexion are zero to 45 degrees, and left and right
lateral rotation are zero to 80 degrees. Normal forward flexion
of the thoracolumbar spine is zero to 90 degrees, extension is
zero to 30 degrees, left and right lateral flexion are zero to
30 degrees, and left and right lateral rotation are zero to 30
degrees. The combined range of motion refers to the sum of the
range of forward flexion, extension, left and right lateral
flexion, and left and right rotation. The normal combined range
of motion of the cervical spine is 340 degrees and of the
thoracolumbar spine is 240 degrees. The normal ranges of motion
for each component of spinal motion provided in this note are
the maximum that can be used for calculation of the combined
range of motion.Note (3): In exceptional cases, an examiner may state that
because of age, body habitus, neurologic disease, or other
factors not the result of disease or injury of the spine, the
range of motion of the spine in a particular individual should
be considered normal for that individual, even though it does
not conform to the normal range of motion stated in Note (2).
Provided that the examiner supplies an explanation, the
examiner's assessment that the range of motion is normal for
that individual will be accepted.Note (4): Round each range of motion measurement to the nearest
five degrees.Note (5): For VA compensation purposes, unfavorable ankylosis is
a condition in which the entire cervical spine, the entire
thoracolumbar spine, or the entire spine is fixed in flexion or
extension, and the ankylosis results in one or more of the
following: difficulty walking because of a limited line of
vision; restricted opening of the mouth and chewing; breathing
limited to diaphragmatic respiration; gastrointestinal symptoms
due to pressure of the costal margin on the abdomen; dyspnea or
dysphagia; atlantoaxial or cervical subluxation or dislocation;
or neurologic symptoms due to nerve root stretching. Fixation
of a spinal segment in neutral position (zero degrees) always
represents favorable ankylosis.Note (6): Separately evaluate disability of the thoracolumbar
and cervical spine segments, except when there is unfavorable
ankylosis of both segments, which will be rated as a single
disability.
5235 Vertebral fracture or dislocation
5236 Sacroiliac injury and weakness
5237 Lumbosacral or cervical strain
5238 Spinal stenosis
5239 Spondylolisthesis or segmental instability
5240 Ankylosing spondylitis
5241 Spinal fusion
5242 Degenerative arthritis of the spine (see also diagnostic
code 5003)
5243 Intervertebral disc syndromeEvaluate intervertebral disc syndrome (preoperatively or
postoperatively) either under the General Rating Formula for
Diseases and Injuries of the Spine or under the Formula for
Rating Intervertebral Disc Syndrome Based on Incapacitating
Episodes, whichever method results in the higher evaluation
when all disabilities are combined under Sec. 4.25.
Formula for Rating Intervertebral Disc Syndrome Based on
Incapacitating Episodes
With incapacitating episodes having a total duration of at least 60
6 weeks during the past 12 months..............................With incapacitating episodes having a total duration of at least 40
4 weeks but less than 6 weeks during the past 12 months........With incapacitating episodes having a total duration of at least 20
2 weeks but less than 4 weeks during the past 12 months........With incapacitating episodes having a total duration of at least 10
one week but less than 2 weeks during the past 12 months.......Note (1): For purposes of evaluations under diagnostic code
5243, an incapacitating episode is a period of acute signs and
symptoms due to intervertebral disc syndrome that requires bed
rest prescribed by a physician and treatment by a physician.Note (2): If intervertebral disc syndrome is present in more
than one spinal segment, provided that the effects in each
spinal segment are clearly distinct, evaluate each segment on
the basis of incapacitating episodes or under the General
Rating Formula for Diseases and Injuries of the Spine,
whichever method results in a higher evaluation for that
segment.------------------------------------------------------------------------ [GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
The Hip and Thigh------------------------------------------------------------------------
Rating------------------------------------------------------------------------5250 Hip, ankylosis of:
Unfavorable, extremely unfavorable ankylosis, the foot not \3\ 90
reaching ground, crutches necessitated.......................
Intermediate.................................................. 70
Favorable, in flexion at an angle between 20[deg] and 40[deg], 60
and slight adduction or abduction............................5251 Thigh, limitation of extension of:
Extension limited to 5[deg]................................... 105252 Thigh, limitation of flexion of:
Flexion limited to 10[deg].................................... 40
Flexion limited to 20[deg].................................... 30
Flexion limited to 30[deg].................................... 20
Flexion limited to 45[deg].................................... 105253 Thigh, impairment of:
Limitation of abduction of, motion lost beyond 10[deg]........ 20
Limitation of adduction of, cannot cross legs................. 10
Limitation of rotation of, cannot toe-out more than 15[deg], 10
affected leg.................................................5254 Hip, flail joint........................................... 805255 Femur, impairment of:
Fracture of shaft or anatomical neck of:
With nonunion, with loose motion (spiral or oblique 80
fracture)..................................................
With nonunion, without loose motion, weightbearing preserved 60
with aid of brace..........................................
Fracture of surgical neck of, with false joint................ 60
Malunion of:
With marked knee or hip disability.......................... 30
With moderate knee or hip disability........................ 20
With slight knee or hip disability.......................... 10------------------------------------------------------------------------\3\ Entitled to special monthly compensation.
The Knee and Leg------------------------------------------------------------------------
Rating------------------------------------------------------------------------5256 Knee, ankylosis of:
Extremely unfavorable, in flexion at an angle of 45[deg] or 60
more.........................................................
In flexion between 20[deg] and 45[deg]........................ 50
In flexion between 10[deg] and 20[deg]........................ 40
Favorable angle in full extension, or in slight flexion 30
between 0[deg] and 10[deg]...................................5257 Knee, other impairment of:
Recurrent subluxation or lateral instability:
Severe...................................................... 30
Moderate.................................................... 20
Slight...................................................... 105258 Cartilage, semilunar, dislocated, with frequent episodes of 20
``locking,'' pain, and effusion into the joint.................5259 Cartilage, semilunar, removal of, symptomatic.............. 105260 Leg, limitation of flexion of:
Flexion limited to 15[deg].................................... 30
Flexion limited to 30[deg].................................... 20
Flexion limited to 45[deg].................................... 10
Flexion limited to 60[deg].................................... 05261 Leg, limitation of extension of:
Extension limited to 45[deg].................................. 50
Extension limited to 30[deg].................................. 40
Extension limited to 20[deg].................................. 30
Extension limited to 15[deg].................................. 20
Extension limited to 10[deg].................................. 10
Extension limited to 5[deg]................................... 05262 Tibia and fibula, impairment of:
Nonunion of, with loose motion, requiring brace............... 40
Malunion of:
With marked knee or ankle disability........................ 30
With moderate knee or ankle disability...................... 20
With slight knee or ankle disability........................ 105263 Genu recurvatum (acquired, traumatic, with weakness and 10
insecurity in weight-bearing objectively demonstrated).........------------------------------------------------------------------------
The Ankle------------------------------------------------------------------------
Rating------------------------------------------------------------------------5270 Ankle, ankylosis of:
In plantar flexion at more than 40[deg], or in dorsiflexion at 40
more than 10[deg] or with abduction, adduction, inversion or
eversion deformity...........................................
In plantar flexion, between 30[deg] and 40[deg], or in 30
dorsiflexion, between 0[deg] and 10[deg].....................
In plantar flexion, less than 30[deg]......................... 205271 Ankle, limited motion of:
Marked........................................................ 20
Moderate...................................................... 105272 Subastragalar or tarsal joint, ankylosis of:
In poor weight-bearing position............................... 20
In good weight-bearing position............................... 105273 Os calcis or astragalus, malunion of:
Marked deformity.............................................. 20
Moderate deformity............................................ 105274 Astragalectomy............................................. 20------------------------------------------------------------------------
Shortening of the Lower Extremity------------------------------------------------------------------------
Rating------------------------------------------------------------------------5275 Bones, of the lower extremity, shortening of:
Over 4 inches (10.2 cms.)..................................... \3\ 60
3\1/2\ to 4 inches (8.9 cms. to 10.2 cms.).................... \3\ 50
3 to 3\1/2\ inches (7.6 cms. to 8.9 cms.)..................... 40
2\1/2\ to 3 inches (6.4 cms. to 7.6 cms.)..................... 30
2 to 2\1/2\ inches (5.1 cms. to 6.4 cms.)..................... 20
1\1/4\ to 2 inches (3.2 cms. to 5.1 cms.)..................... 10
Note: Measure both lower extremities from anterior superior
spine of the ilium to the internal malleolus of the tibia.
Not to be combined with other ratings for fracture or faulty
union in the same extremity.------------------------------------------------------------------------\3\ Also entitled to special monthly compensation.
The Foot------------------------------------------------------------------------
Rating------------------------------------------------------------------------5276 Flatfoot, acquired:
Pronounced; marked pronation, extreme tenderness of plantar
surfaces of the feet, marked inward displacement and severe
spasm of the tendo achillis on manipulation, not improved by
orthopedic shoes or appliances...............................
Bilateral..................................................... 50
Unilateral.................................................... 30
Severe; objective evidence of marked deformity (pronation,
abduction, etc.), pain on manipulation and use accentuated,
indication of swelling on use, characteristic callosities:
Bilateral................................................... 30
Unilateral.................................................. 20
Moderate; weight-bearing line over or medial to great toe, 10
inward bowing of the tendo achillis, pain on manipulation and
use of the feet, bilateral or unilateral.....................
Mild; symptoms relieved by built-up shoe or arch support...... 05277 Weak foot, bilateral:
A symptomatic condition secondary to many constitutional
conditions, characterized by atrophy of the musculature,
disturbed circulation, and weakness:
Rate the underlying condition, minimum rating............... 105278 Claw foot (pes cavus), acquired:
Marked contraction of plantar fascia with dropped forefoot,
all toes hammer toes, very painful callosities, marked varus
deformity:
Bilateral................................................... 50
Unilateral.................................................. 30
All toes tending to dorsiflexion, limitation of dorsiflexion
at ankle to right angle, shortened plantar fascia, and marked
tenderness under metatarsal heads:
Bilateral................................................... 30
Unilateral.................................................. 20
Great toe dorsiflexed, some limitation of dorsiflexion at
ankle, definite tenderness under metatarsal heads:
Bilateral................................................... 10
Unilateral.................................................. 10
Slight........................................................ 05279 Metatarsalgia, anterior (Morton's disease), unilateral, or 10
bilateral......................................................5280 Hallux valgus, unilateral:
Operated with resection of metatarsal head.................... 10
Severe, if equivalent to amputation of great toe.............. 105281 Hallux rigidus, unilateral, severe:
Rate as hallux valgus, severe.
Note: Not to be combined with claw foot ratings.5282 Hammer toe:
All toes, unilateral without claw foot........................ 10
Single toes................................................... 05283 Tarsal, or metatarsal bones, malunion of, or nonunion of:
Severe........................................................ 30
Moderately severe............................................. 20
Moderate...................................................... 10
Note: With actual loss of use of the foot, rate 40 percent.5284 Foot injuries, other:
Severe........................................................ 30
Moderately severe............................................. 20
Moderate...................................................... 10
Note: With actual loss of use of the foot, rate 40 percent.------------------------------------------------------------------------
The Skull------------------------------------------------------------------------
Rating------------------------------------------------------------------------5296 Skull, loss of part of, both inner and outer tables:
With brain hernia............................................. 80
Without brain hernia:
Area larger than size of a 50-cent piece or 1.140 in \2\ 50
(7.355 cm \2\).............................................
Area intermediate........................................... 30
Area smaller than the size of a 25-cent piece or 0.716 in 10
\2\ (4.619 cm \2\).........................................
Note: Rate separately for intracranial complications.------------------------------------------------------------------------
The Ribs------------------------------------------------------------------------
Rating------------------------------------------------------------------------5297 Ribs, removal of:
More than six................................................. 50
Five or six................................................... 40
Three or four................................................. 30
Two........................................................... 20
One or resection of two or more ribs without regeneration..... 10
Note (1): The rating for rib resection or removal is not to be
applied with ratings for purrulent pleurisy, lobectomy,
pneumonectomy or injuries of pleural cavity.
Note (2): However, rib resection will be considered as rib
removal in thoracoplasty performed for collapse therapy or to
accomplish obliteration of space and will be combined with
the rating for lung collapse, or with the rating for
lobectomy, pneumonectomy or the graduated ratings for
pulmonary tuberculosis.------------------------------------------------------------------------
The Coccyx------------------------------------------------------------------------
Rating------------------------------------------------------------------------5298 Coccyx, removal of:
Partial or complete, with painful residuals................... 10
Without painful residuals..................................... 0------------------------------------------------------------------------ (Authority: 38 U.S.C. 1155) [29 FR 6718, May 22, 1964, as amended at 34 FR 5062, Mar. 11, 1969; 40 FR 42536, Sept. 15, 1975; 41 FR 11294, Mar. 18, 1976; 43 FR 45350, Oct. 2, 1978; 51 FR 6411, Feb. 24, 1986; 61 FR 20439, May 7, 1996; 67 FR 48785, July 26, 2002; 67 FR 54349, Aug. 22, 2002; 68 FR 51456, Aug. 27, 2003; 69 FR 32450, June 10, 2004] Sec. 4.72 [Reserved]