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e-CFR data is current as of March 4, 2021

Title 38Chapter IPart 4Subpart B → §4.71a


Title 38: Pensions, Bonuses, and Veterans' Relief
PART 4—SCHEDULE FOR RATING DISABILITIES
Subpart B—Disability Ratings


§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 with multiple localization or with long history of intractability and debility, anemia, amyloid liver changes, or other continuous constitutional symptoms100
Frequent episodes, with constitutional symptoms60
With definite involucrum or sequestrum, with or without discharging sinus30
With discharging sinus or other evidence of active infection within the past 5 years20
Inactive, following repeated episodes, without evidence of active infection in past 5 years10
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:
Active100
Inactive: See §§4.88c and 4.89
5002   Multi-joint arthritis (except post-traumatic and gout), 2 or more joints, as an active process:
With constitutional manifestations associated with active joint involvement, totally incapacitating100
Less than criteria for 100% but with weight loss and anemia productive of severe impairment of health or severely incapacitating exacerbations occurring 4 or more times a year or a lesser number over prolonged periods60
Symptom combinations productive of definite impairment of health objectively supported by examination findings or incapacitating exacerbations occurring 3 or more times a year40
One or two exacerbations a year in a well-established diagnosis20
Note (1): Examples of conditions rated using this diagnostic code include, but are not limited to, rheumatoid arthritis, psoriatic arthritis, and spondyloarthropathies.
Note (2): For chronic residuals, rate under diagnostic code 5003.
Note (3): The ratings for the active process will not be combined with the residual ratings for limitation of motion, ankylosis, or diagnostic code 5003. Instead, assign the higher evaluation.
5003   Degenerative arthritis, other than post-traumatic:
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 or 2 or more minor joint groups, with occasional incapacitating exacerbations20
With X-ray evidence of involvement of 2 or more major joints or 2 or more minor joint groups10
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   Other specified forms of arthropathy (excluding gout).
Note (1): Other specified forms of arthropathy include, but are not limited to, Charcot neuropathic, hypertrophic, crystalline, and other autoimmune arthropathies.
Note (2): With the types of arthritis, diagnostic codes 5004 through 5009, rate the acute phase under diagnostic code 5002; rate any chronic residuals under diagnostic code 5003.
5010   Post-traumatic arthritis: Rate as limitation of motion, dislocation, or other specified instability under the affected joint. If there are 2 or more joints affected, each rating shall be combined in accordance with §4.25.
5011   Decompression illness: Rate manifestations under the appropriate diagnostic code within the affected body system, such as arthritis for musculoskeletal residuals; auditory system for vestibular residuals; respiratory system for pulmonary barotrauma residuals; and neurologic system for cerebrovascular accident residuals.
5012   Bones, neoplasm, malignant, primary or secondary100
Note: The 100 percent rating will be continued for 1 year following the cessation of surgical, X-ray, antineoplastic chemotherapy or other prescribed therapeutic procedure. If there has been no local recurrence or metastases, rate based on residuals.
5013   Osteoporosis, residuals of.
5014   Osteomalacia, residuals of.
5015   Bones, neoplasm, benign.
5016   Osteitis deformans.
5017   Gout.
5018   [Removed]
5019   Bursitis.
5020   [Removed]
5021   Myositis.
5022   [Removed]
5023   Heterotopic ossification.
5024   Tenosynovitis, tendinitis, tendinosis or tendinopathy.
Note to DCs 5013 through 5024: Evaluate the diseases under diagnostic codes 5013 through 5024 as degenerative arthritis, based on limitation of motion of affected parts.
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 therapy40
That are episodic, with exacerbations often precipitated by environmental or emotional stress or by overexertion, but that are present more than one-third of the time20
That require continuous medication for control10
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 and Resurfacing

   Rating
MajorMinor
Note (1): When an evaluation is assigned for joint resurfacing or the prosthetic replacement of a joint under diagnostic codes 5051-5056, an additional rating under §4.71a may not also be assigned for that joint, unless otherwise directed.
Note (2): Only evaluate a revision procedure in the same manner as the original procedure under diagnostic codes 5051-5056 if all the original components are replaced.
Note (3): The term “prosthetic replacement” in diagnostic codes 5051-5053 and 5055-5056 means a total replacement of the named joint. However, in DC 5054, “prosthetic replacement” means a total replacement of the head of the femur or of the acetabulum.
Note (4): The 100 percent rating for 1 year following implantation of prosthesis will commence after initial grant of the 1-month total rating assigned under §4.30 following hospital discharge.
Note (5): The 100 percent rating for 4 months following implantation of prosthesis or resurfacing under DCs 5054 and 5055 will commence after initial grant of the 1-month total rating assigned under §4.30 following hospital discharge.
Note (6): Special monthly compensation is assignable during the 100 percent rating period the earliest date permanent use of crutches is established.
5051   Shoulder replacement (prosthesis).
Prosthetic replacement of the shoulder joint:
For 1 year following implantation of prosthesis100100
With chronic residuals consisting of severe, painful motion or weakness in the affected extremity6050
With intermediate degrees of residual weakness, pain or limitation of motion, rate by analogy to diagnostic codes 5200 and 5203.
Minimum rating3020
5052   Elbow replacement (prosthesis).
Prosthetic replacement of the elbow joint:
For 1 year following implantation of prosthesis100100
With chronic residuals consisting of severe painful motion or weakness in the affected extremity5040
With intermediate degrees of residual weakness, pain or limitation of motion rate by analogy to diagnostic codes 5205 through 5208.
Minimum evaluation3020
5053   Wrist replacement (prosthesis).
Prosthetic replacement of wrist joint:
For 1 year following implantation of prosthesis100100
With chronic residuals consisting of severe, painful motion or weakness in the affected extremity4030
With intermediate degrees of residual weakness, pain or limitation of motion, rate by analogy to diagnostic code 5214.
Minimum rating2020
5054   Hip, resurfacing or replacement (prosthesis):
For 4 months following implantation of prosthesis or resurfacing100
Prosthetic replacement of the head of the femur or of the acetabulum:
Following implantation of prosthesis with painful motion or weakness such as to require the use of crutches190
Markedly severe residual weakness, pain or limitation of motion following implantation of prosthesis70
Moderately severe residuals of weakness, pain or limitation of motion50
Minimum evaluation, total replacement only30
Note: At the conclusion of the 100 percent evaluation period, evaluate resurfacing under diagnostic codes 5250 through 5255; there is no minimum evaluation for resurfacing.
5055   Knee, resurfacing or replacement (prosthesis):
For 4 months following implantation of prosthesis or resurfacing100
Prosthetic replacement of knee joint:
With chronic residuals consisting of severe painful motion or weakness in the affected extremity60
With intermediate degrees of residual weakness, pain or limitation of motion rate by analogy to diagnostic codes 5256, 5261, or 5262.
Minimum evaluation, total replacement only30
Note: At the conclusion of the 100 percent evaluation period, evaluate resurfacing under diagnostic codes 5256 through 5262; there is no minimum evaluation for resurfacing.
5056   Ankle replacement (prosthesis).
Prosthetic replacement of ankle joint:
For 1 year following implantation of prosthesis   100
With chronic residuals consisting of severe painful motion or weakness   40
With intermediate degrees of residual weakness, pain or limitation of motion rate by analogy to 5270 or 5271.
Minimum rating   20
combinations of disabilities
5104   Anatomical loss of one hand and loss of use of one foot   1100
5105   Anatomical loss of one foot and loss of use of one hand   1100
5106   Anatomical loss of both hands   1100
5107   Anatomical loss of both feet   1100
5108   Anatomical loss of one hand and one foot   1100
5109   Loss of use of both hands   1100
5110   Loss of use of both feet   1100
5111   Loss of use of one hand and one foot   1100

1Also entitled to special monthly compensation.

Table II—Ratings for Multiple Losses of Extremities With Dictator's Rating Code and 38 CFR Citation

Impairment of one extremityImpairment of other extremity
Anatomical loss or loss of use below elbowAnatomical loss or loss of use below kneeAnatomical loss or loss of use above elbow (preventing use of prosthesis)Anatomical loss or loss of use above knee (preventing use of prosthesis)Anatomical loss near shoulder (preventing use of prosthesis)Anatomical loss near hip (preventing use of prosthesis)
Anatomical loss or loss of use below elbowM Codes M-1 a, b, or c, 38 CFR 3.350 (c)(1)(i)L Codes L-1 d, e, f, or g, 38 CFR 3.350(b)M 12 Code M-5, 38 CFR 3.350 (f)(1)(x)L 12 Code L-2 c, 38 CFR 3.350 (f)(1)(vi)N Code N-3, 38 CFR 3.350 (f)(1)(xi)M Code M-3 c, 38 CFR 3.350 (f)(1)(viii)
Anatomical loss or loss of use below kneeL Codes L-1 a, b, or c, 38 CFR 3.350(b)L 12 Code L-2 b, 38 CFR 3.350 (f)(1)(iii)L 12 Code L-2 a, 38 CFR 3.350 (f)(1)(i)M Code M-3 b, 38 CFR 3.350 (f)(1)(iv)M Code M-3 a, 38 CFR 3.350 (f)(1)(ii)
Anatomical loss or loss of use above elbow (preventing use of prosthesis)N Code N-1, 38 CFR 3.350 (d)(1)M Code M-2 a, 38 CFR 3.350 (c)(1)(iii)N 12 Code N-4, 38 CFR 3.350 (f)(1)(ix)M 12 Code M-4 c, 38 CFR 3.350 (f)(1)(xi)
Anatomical loss or loss of use above knee (preventing use of prosthesis)M Code M-2 a, 38 CFR 3.350 (c)(1)(ii)M 12 Code M-4 b, 38 CFR 3.350 (f)(1)(vii)M 12 Code M-4 a, 38 CFR 3.350 (f)(1)(v)
Anatomical loss near shoulder (preventing use of prosthesis)O Code O-1, 38 CFR 3.350 (e)(1)(i)N Code N-2 b, 38 CFR 3.350 (d)(3)
Anatomical loss near hip (preventing use of prosthesis)N Code N-2 a, 38 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
MajorMinor
Arm, amputation of:
5120   Complete amputation, upper extremity:
Forequarter amputation (involving complete removal of the humerus along with any portion of the scapula, clavicle, and/or ribs)11001100
Disarticulation (involving complete removal of the humerus only)190190
5121   Above insertion of deltoid190180
5122   Below insertion of deltoid180170
Forearm, amputation of:
5123   Above insertion of pronator teres180170
5124   Below insertion of pronator teres170160
5125   Hand, loss of use of170160
multiple finger amputations
5126   Five digits of one hand, amputation of170160
Four digits of one hand, amputation of:
5127   Thumb, index, long and ring170160
5128   Thumb, index, long and little170160
5129   Thumb, index, ring and little170160
5130   Thumb, long, ring and little170160
5131   Index, long, ring and little6050
Three digits of one hand, amputation of:
5132   Thumb, index and long6050
5133   Thumb, index and ring6050
5134   Thumb, index and little6050
5135   Thumb, long and ring6050
5136   Thumb, long and little6050
5137   Thumb, ring and little6050
5138   Index, long and ring5040
5139   Index, long and little5040
5140   Index, ring and little5040
5141   Long, ring and little4030
Two digits of one hand, amputation of:
5142   Thumb and index5040
5143   Thumb and long5040
5144   Thumb and ring5040
5145   Thumb and little5040
5146   Index and long4030
5147   Index and ring4030
5148   Index and little4030
5149   Long and ring3020
5150   Long and little3020
5151   Ring and little3020
(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 appliance.
single finger amputations
5152   Thumb, amputation of:
With metacarpal resection4030
At metacarpophalangeal joint or through proximal phalanx3020
At distal joint or through distal phalanx2020
5153   Index finger, amputation of
With metacarpal resection (more than one-half the bone lost)3020
Without metacarpal resection, at proximal interphalangeal joint or proximal thereto2020
Through middle phalanx or at distal joint1010
5154   Long finger, amputation of:
With metacarpal resection (more than one-half the bone lost)2020
Without metacarpal resection, at proximal interphalangeal joint or proximal thereto1010
5155   Ring finger, amputation of:
With metacarpal resection (more than one-half the bone lost)2020
Without metacarpal resection, at proximal interphalangeal joint or proximal thereto1010
5156   Little finger, amputation of:
With metacarpal resection (more than one-half the bone lost)2020
Without metacarpal resection, at proximal interphalangeal joint or proximal thereto1010
Note: The single finger amputation ratings are the only applicable ratings for amputations of whole or part of single fingers.

1Entitled to special monthly compensation.

eCFR graphic ec04no91.004.gif

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Amputations: Lower Extremity

   Rating
Thigh, amputation of:
5160   Complete amputation, lower extremity:
Trans-pelvic amputation (involving complete removal of the femur and intrinsic pelvic musculature along with any portion of the pelvic bones)2100
Disarticulation (involving complete removal of the femur and intrinsic pelvic musculature only)290
Note: Separately evaluate residuals involving other body systems (e.g., bowel impairment, bladder impairment) under the appropriate diagnostic code.
5161   Upper third, one-third of the distance from perineum to knee joint measured from perineum280
5162   Middle or lower thirds260
Leg, amputation of:
5163   With defective stump, thigh amputation recommended260
5164   Amputation not improvable by prosthesis controlled by natural knee action260
5165   At a lower level, permitting prosthesis240
5166   Forefoot, amputation proximal to metatarsal bones (more than one-half of metatarsal loss)240
5167   Foot, loss of use of240
5170   Toes, all, amputation of, without metatarsal loss or transmetatarsal, amputation of, with up to half of metatarsal loss30
5171   Toe, great, amputation of:
With removal of metatarsal head30
Without metatarsal involvement10
5172   Toes, other than great, amputation of, with removal of metatarsal head:
One or two20
Without metatarsal involvement0
5173   Toes, three or four, amputation of, without metatarsal involvement:
Including great toe20
Not including great toe10

2Also entitled to special monthly compensation.

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The Shoulder and Arm

   Rating
MajorMinor
5200   Scapulohumeral articulation, ankylosis of:
Note: The scapula and humerus move as one piece.
Unfavorable, abduction limited to 25° from side5040
Intermediate between favorable and unfavorable4030
Favorable, abduction to 60°, can reach mouth and head3020
5201   Arm, limitation of motion of:
Flexion and/or abduction limited to 25° from side4030
Midway between side and shoulder level (flexion and/or abduction limited to 45°)3020
At shoulder level (flexion and/or abduction limited to 90°)2020
5202   Humerus, other impairment of:
Loss of head of (flail shoulder)8070
Nonunion of (false flail joint)6050
Fibrous union of5040
Recurrent dislocation of at scapulohumeral joint:
With frequent episodes and guarding of all arm movements3020
With infrequent episodes and guarding of movement only at shoulder level (flexion and/or abduction at 90°)2020
Malunion of:
Marked deformity3020
Moderate deformity2020
5203   Clavicle or scapula, impairment of:
Dislocation of2020
Nonunion of:
With loose movement2020
Without loose movement1010
Malunion of1010
Or rate on impairment of function of contiguous joint.

The Elbow and Forearm

   Rating
MajorMinor
5205   Elbow, ankylosis of:
Unfavorable, at an angle of less than 50° or with complete loss of supination or pronation6050
Intermediate, at an angle of more than 90°, or between 70° and 50°5040
Favorable, at an angle between 90° and 70°4030
5206   Forearm, limitation of flexion of:
Flexion limited to 45°5040
Flexion limited to 55°4030
Flexion limited to 70°3020
Flexion limited to 90°2020
Flexion limited to 100°1010
Flexion limited to 110°0   0
5207   Forearm, limitation of extension of:
Extension limited to 110°5040
Extension limited to 100°4030
Extension limited to 90°3020
Extension limited to 75°2020
Extension limited to 60°1010
Extension limited to 45°1010
5208   Forearm, flexion limited to 100° and extension to 45°2020
5209   Elbow, other impairment of Flail joint6050
Joint fracture, with marked cubitus varus or cubitus valgus deformity or with ununited fracture of head of radius2020
5210   Radius and ulna, nonunion of, with flail false joint5040
5211   Ulna, impairment of:
Nonunion in upper half, with false movement:
With loss of bone substance (1 inch (2.5 cms.) or more) and marked deformity4030
Without loss of bone substance or deformity3020
Nonunion in lower half2020
Malunion of, with bad alignment1010
5212   Radius, impairment of:
Nonunion in lower half, with false movement:
With loss of bone substance (1 inch (2.5 cms.) or more) and marked deformity4030
Without loss of bone substance or deformity3020
Nonunion in upper half2020
Malunion of, with bad alignment1010
5213   Supination and pronation, impairment of:
Loss of (bone fusion):
The hand fixed in supination or hyperpronation4030
The hand fixed in full pronation3020
The hand fixed near the middle of the arc or moderate pronation2020
Limitation of pronation:
Motion lost beyond middle of arc3020
Motion lost beyond last quarter of arc, the hand does not approach full pronation2020
Limitation of supination:
To 30° or less1010
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
MajorMinor
5214   Wrist, ankylosis of:
Unfavorable, in any degree of palmar flexion, or with ulnar or radial deviation5040
Any other position, except favorable4030
Favorable in 20° to 30° dorsiflexion3020
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°1010
Palmar flexion limited in line with forearm1010

Evaluation of Ankylosis or Limitation of Motion of Single or Multiple Digits of the Hand

   Rating
Major Minor
(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 of6050
Note: Also consider whether evaluation as amputation is warranted.
5217   Four digits of one hand, unfavorable ankylosis of:
Thumb and any three fingers6050
Index, long, ring, and little fingers5040
Note: Also consider whether evaluation as amputation is warranted.
5218   Three digits of one hand, unfavorable ankylosis of:
Thumb and any two fingers5040
Index, long, and ring; index, long, and little; or index, ring, and little fingers4030
Long, ring, and little fingers3020
Note: Also consider whether evaluation as amputation is warranted.
5219 Two digits of one hand, unfavorable ankylosis of:
Thumb and any finger4030
Index and long; index and ring; or index and little fingers3020
Long and ring; long and little; or ring and little fingers2020
Note: Also consider whether evaluation as amputation is warranted.
II. Multiple Digits: Favorable Ankylosis
5220   Five digits of one hand, favorable ankylosis of5040
5221   Four digits of one hand, favorable ankylosis of:
Thumb and any three fingers5040
Index, long, ring, and little fingers4030
5222 Three digits of one hand, favorable ankylosis of:
Thumb and any two fingers4030
Index, long, and ring; index, long, and little; or index, ring, and little fingers3020
Long, ring and little fingers2020
5223   Two digits of one hand, favorable ankylosis of:
Thumb and any finger3020
Index and long; index and ring; or index and little fingers2020
Long and ring; long and little; or ring and little fingers1010
III. Ankylosis of Individual Digits
5224   Thumb, ankylosis of:
Unfavorable2020
Favorable1010
Note: 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 favorable1010
Note: 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 favorable1010
Note: 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 favorable00
Note: 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 the thumb pad and the fingers, with the thumb attempting to oppose the fingers2020
With a gap of one to two inches (2.5 to 5.1 cm.) between the thumb pad and the fingers, with the thumb attempting to oppose the fingers1010
With a gap of less than one inch (2.5 cm.) between the thumb pad and the fingers, with the thumb attempting to oppose the fingers00
5229   Index or long finger, limitation of motion:
With a gap of one inch (2.5 cm.) or more between the 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 degrees1010
With a gap of less than one inch (2.5 cm.) between 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 degrees00
5230   Ring or little finger, limitation of motion:
Any limitation of motion00

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 spine100
Unfavorable ankylosis of the entire thoracolumbar spine50
Unfavorable ankylosis of the entire cervical spine; or, forward flexion of the thoracolumbar spine 30 degrees or less; or, favorable ankylosis of the entire thoracolumbar spine40
Forward flexion of the cervical spine 15 degrees or less; or, favorable ankylosis of the entire cervical spine30
Forward flexion of the thoracolumbar spine greater than 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 kyphosis20
Forward flexion of the thoracolumbar spine greater than 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 height10
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, degenerative disc disease other than intervertebral disc syndrome (also, see either DC 5003 or 5010)
5243   Intervertebral disc syndrome: Assign this diagnostic code only when there is disc herniation with compression and/or irritation of the adjacent nerve root; assign diagnostic code 5242 for all other disc diagnoses.
Evaluate 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 §4.25.
5244   Traumatic paralysis, complete:
Paraplegia: Rate under diagnostic code 5110.
Quadriplegia: Rate separately under diagnostic codes 5109 and 5110 and combine evaluations in accordance with §4.25.
Note: If traumatic paralysis does not cause loss of use of both hands or both feet, it is incomplete paralysis. Evaluate residuals of incomplete traumatic paralysis under the appropriate diagnostic code (e.g., §4.124a, Diseases of the Peripheral Nerves).
Formula for Rating Intervertebral Disc Syndrome Based on Incapacitating Episodes
With incapacitating episodes having a total duration of at least 6 weeks during the past 12 months60
With incapacitating episodes having a total duration of at least 4 weeks but less than 6 weeks during the past 12 months40
With incapacitating episodes having a total duration of at least 2 weeks but less than 4 weeks during the past 12 months20
With incapacitating episodes having a total duration of at least one week but less than 2 weeks during the past 12 months10
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.
eCFR graphic er27au03.003.gif

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The Hip and Thigh

   Rating
5250   Hip, ankylosis of:
Unfavorable, extremely unfavorable ankylosis, the foot not reaching ground, crutches necessitated390
Intermediate70
Favorable, in flexion at an angle between 20° and 40°, and slight adduction or abduction60
5251   Thigh, limitation of extension of:
Extension limited to 5°10
5252   Thigh, limitation of flexion of:
Flexion limited to 10°40
Flexion limited to 20°30
Flexion limited to 30°20
Flexion limited to 45°10
5253   Thigh, impairment of:
Limitation of abduction of, motion lost beyond 10°20
Limitation of adduction of, cannot cross legs10
Limitation of rotation of, cannot toe-out more than 15°, affected leg10
5254   Hip, flail joint80
5255   Femur, impairment of:
Fracture of shaft or anatomical neck of:
With nonunion, with loose motion (spiral or oblique fracture)80
With nonunion, without loose motion, weight bearing preserved with aid of brace60
Fracture of surgical neck of, with false joint60
Malunion of:
Evaluate under diagnostic codes 5256, 5257, 5260, or 5261 for the knee, or 5250-5254 for the hip, whichever results in the highest evaluation.

3Entitled to special monthly compensation.

The Knee and Leg

   Rating
5256   Knee, ankylosis of:
Extremely unfavorable, in flexion at an angle of 45° or more60
In flexion between 20° and 45°50
In flexion between 10° and 20°40
Favorable angle in full extension, or in slight flexion between 0° and 10°30
5257   Knee, other impairment of:
Recurrent subluxation or instability:
Unrepaired or failed repair of complete ligament tear causing persistent instability, and a medical provider prescribes both an assistive device (e.g., cane(s), crutch(es), walker) and bracing for ambulation30
One of the following:
(a) Sprain, incomplete ligament tear, or repaired complete ligament tear causing persistent instability, and a medical provider prescribes a brace and/or assistive device (e.g., cane(s), crutch(es), walker) for ambulation.
(b) Unrepaired or failed repair of complete ligament tear causing persistent instability, and a medical provider prescribes either an assistive device (e.g., cane(s), crutch(es), walker) or bracing for ambulation20
Sprain, incomplete ligament tear, or complete ligament tear (repaired, unrepaired, or failed repair) causing persistent instability, without a prescription from a medical provider for an assistive device (e.g., cane(s), crutch(es), walker) or bracing for ambulation10
Patellar instability:
A diagnosed condition involving the patellofemoral complex with recurrent instability after surgical repair that requires a prescription by a medical provider for a brace and either a cane or a walker30
A diagnosed condition involving the patellofemoral complex with recurrent instability after surgical repair that requires a prescription by a medical provider for one of the following: A brace, cane, or walker20
A diagnosed condition involving the patellofemoral complex with recurrent instability (with or without history of surgical repair) that does not require a prescription from a medical provider for a brace, cane, or walker10
Note (1): For patellar instability, the patellofemoral complex consists of the quadriceps tendon, the patella, and the patellar tendon.
Note (2): A surgical procedure that does not involve repair of one or more patellofemoral components that contribute to the underlying instability shall not qualify as surgical repair for patellar instability (including, but not limited to, arthroscopy to remove loose bodies and joint aspiration).
5258   Cartilage, semilunar, dislocated, with frequent episodes of “locking,” pain, and effusion into the joint20
5259   Cartilage, semilunar, removal of, symptomatic10
5260   Leg, limitation of flexion of:
Flexion limited to 15°30
Flexion limited to 30°20
Flexion limited to 45°10
Flexion limited to 60°0
5261   Leg, limitation of extension of:
Extension limited to 45°50
Extension limited to 30°40
Extension limited to 20°30
Extension limited to 15°20
Extension limited to 10°10
Extension limited to 5°0
5262   Tibia and fibula, impairment of:
Nonunion of, with loose motion, requiring brace40
Malunion of:
Evaluate under diagnostic codes 5256, 5257, 5260, or 5261 for the knee, or 5270 or 5271 for the ankle, whichever results in the highest evaluation.
Medial tibial stress syndrome (MTSS), or shin splints:
Requiring treatment for no less than 12 consecutive months, and unresponsive to surgery and either shoe orthotics or other conservative treatment, both lower extremities30
Requiring treatment for no less than 12 consecutive months, and unresponsive to surgery and either shoe orthotics or other conservative treatment, one lower extremity20
Requiring treatment for no less than 12 consecutive months, and unresponsive to either shoe orthotics or other conservative treatment, one or both lower extremities10
Treatment less than 12 consecutive months, one or both lower extremities0
5263   Genu recurvatum (acquired, traumatic, with weakness and insecurity in weight-bearing objectively demonstrated)10

The Ankle

   Rating
5270   Ankle, ankylosis of:
In plantar flexion at more than 40°, or in dorsiflexion at more than 10° or with abduction, adduction, inversion or eversion deformity40
In plantar flexion, between 30° and 40°, or in dorsiflexion, between 0° and 10°30
In plantar flexion, less than 30°20
5271   Ankle, limited motion of:
Marked (less than 5 degrees dorsiflexion or less than 10 degrees plantar flexion)20
Moderate (less than 15 degrees dorsiflexion or less than 30 degrees plantar flexion)10
5272   Subastragalar or tarsal joint, ankylosis of:
In poor weight-bearing position20
In good weight-bearing position10
5273   Os calcis or astragalus, malunion of:
Marked deformity20
Moderate deformity10
5274   Astragalectomy20

Shortening of the Lower Extremity

   Rating
5275   Bones, of the lower extremity, shortening of:
Over 4 inches (10.2 cms.)360
312 to 4 inches (8.9 cms. to 10.2 cms.)350
3 to 312 inches (7.6 cms. to 8.9 cms.)40
212 to 3 inches (6.4 cms. to 7.6 cms.)30
2 to 212 inches (5.1 cms. to 6.4 cms.)20
114 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.

3Also entitled to special monthly compensation.

The Foot

   Rating
5269   Plantar fasciitis:
No relief from both non-surgical and surgical treatment, bilateral30
No relief from both non-surgical and surgical treatment, unilateral20
Otherwise, unilateral or bilateral10
Note (1): With actual loss of use of the foot, rate 40 percent
Note (2): If a veteran has been recommended for surgical intervention, but is not a surgical candidate, evaluate under the 20 percent or 30 percent criteria, whichever is applicable
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
Bilateral50
Unilateral30
Severe; objective evidence of marked deformity (pronation, abduction, etc.), pain on manipulation and use accentuated, indication of swelling on use, characteristic callosities:
Bilateral30
Unilateral20
Moderate; weight-bearing line over or medial to great toe, inward bowing of the tendo achillis, pain on manipulation and use of the feet, bilateral or unilateral10
Mild; symptoms relieved by built-up shoe or arch support0
5277   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 rating10
5278   Claw foot (pes cavus), acquired:
Marked contraction of plantar fascia with dropped forefoot, all toes hammer toes, very painful callosities, marked varus deformity:
Bilateral50
Unilateral30
All toes tending to dorsiflexion, limitation of dorsiflexion at ankle to right angle, shortened plantar fascia, and marked tenderness under metatarsal heads:
Bilateral30
Unilateral20
Great toe dorsiflexed, some limitation of dorsiflexion at ankle, definite tenderness under metatarsal heads:
Bilateral10
Unilateral10
Slight0
5279   Metatarsalgia, anterior (Morton's disease), unilateral, or bilateral10
5280   Hallux valgus, unilateral:
Operated with resection of metatarsal head10
Severe, if equivalent to amputation of great toe10
5281   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 foot10
Single toes0
5283   Tarsal, or metatarsal bones, malunion of, or nonunion of:
Severe30
Moderately severe20
Moderate10
Note: With actual loss of use of the foot, rate 40 percent.
5284   Foot injuries, other:
Severe30
Moderately severe20
Moderate10
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 hernia80
Without brain hernia:
Area larger than size of a 50-cent piece or 1.140 in2 (7.355 cm2)50
Area intermediate30
Area smaller than the size of a 25-cent piece or 0.716 in2 (4.619 cm2)10
Note: Rate separately for intracranial complications.

The Ribs

   Rating
5297   Ribs, removal of:
More than six50
Five or six40
Three or four30
Two20
One or resection of two or more ribs without regeneration10
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 residuals10
Without painful residuals0

(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; 80 FR 42041, July 16, 2015; 85 FR 76460, Nov. 30, 2020, 85 FR 85523, Dec. 29, 2020, 86 FR 8142, Feb. 4, 2021]

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