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Hand and fingers

Hand and fingers (brief)

What it is

VA rates fingers mostly by measuring gaps with a ruler: how close your thumb gets to your fingers, and how close your fingertips get to the crease in your palm.

Normal movement (what VA counts as normal)

  • Knuckle (MCP) flexion, index to little finger0 to 90°
  • Middle finger joint (PIP) flexion0 to 100°
  • End finger joint (DIP) flexion0 to 70 or 80°

VA's code numbers for this: 5216-5227, 5228, 5229, 5230

What the examiner will do

  • The examiner measures gaps with a ruler and finger motion with a small goniometer.
  • They check grip and pinch strength, and repeat motions at least 3 times.
  • They ask about flare-ups and daily tasks.

The examiner fills out a form called a DBQ. You can read it ahead of time: Hand and Finger Conditions DBQ (updated 2024-09-27) (opens VA's site).

The rating levels, in plain words

VA rates most joints by how far they move. The less you can move, the higher the level.

Thumb gap

  • 0%

    Thumb pad gets within 1 inch of the fingers: 0%.

    Rule: 38 CFR 4.71a, DC 5228

  • 10%

    Gap of 1 to 2 inches between thumb pad and fingers when trying to touch: 10% either hand.

    Rule: 38 CFR 4.71a, DC 5228

  • 20%

    Gap of more than 2 inches: 20% either hand.

    Rule: 38 CFR 4.71a, DC 5228

Index or long finger

  • 10%

    Fingertip stays 1 inch or more from the palm crease when making a fist, OR finger cannot straighten by more than 30 degrees: 10% either hand.

    Rule: 38 CFR 4.71a, DC 5229

Ring or little finger

  • 0%

    Any limited motion of ring or little finger alone: 0%.

    Rule: 38 CFR 4.71a, DC 5230

Stuck (ankylosed) fingers

  • 10%

    Single thumb 10-20%; index or long finger 10%; several stuck fingers are rated together (up to 60% dominant / 50% other for all five, unfavorable). Also check whether rating as amputation is higher.

    Rule: 38 CFR 4.71a, DCs 5216-5227

Measure it at home

With a helper and a cheap tool. Your home numbers help you describe your bad days honestly at the exam.

The tool to get

  • A ruler or tape measure marked in inches.

  • A pen and the log sheet.

Step by step, with a helper

  1. 1. Thumb to fingers

    How to stand or lie
    Sit with the hand relaxed. Try to touch the thumb pad to each fingertip.
    Where the tool goes
    Measure the smallest gap between the thumb pad and the fingers, in inches.
    Who holds what
    Helper holds the ruler and reads the gap.

  2. 2. Fingertips to palm

    How to stand or lie
    Make a fist as tight as you can.
    Where the tool goes
    Measure from the tip of the index and long finger to the crease across your palm nearest the fingers (the 'proximal transverse crease').
    Who holds what
    Helper measures each finger.

Stop at the first real pain. Never force a joint to get a number. Stand close for balance during back and hip tests.

Your log: what to write each time

  1. Date
  2. Hand (R/L)
  3. Dominant?
  4. Thumb gap (inches)
  5. Index tip-to-crease (inches)
  6. Long tip-to-crease (inches)
  7. Fingers that won't straighten (degrees)
  8. Pain 0-10
  9. Notes

Tap Print this page to get a blank log sheet and your exam-day checklist on paper.

This is only to help you understand. The VA examiner measures and the VA decides.

Exam-day checklist

Tick each one off. Nothing you tick is saved or sent anywhere.

Tell the examiner

Flare-ups

A flare-up is a time when your joint gets much worse for a while. The examiner must ask about your flare-ups and estimate, in degrees, how much motion you lose during them, even if your exam is on a good day (Sharp v. Shulkin, 2017). They can only skip this if they explain why after getting your information. Be ready to say: how often (for example, 2 times a week), how long each lasts (for example, 1 to 2 days), what triggers it, and exactly what you cannot do (for example, 'I can't lift my arm to comb my hair'). If you measured at home on a flare-up day, show that number.

Repeated use

The examiner will have you do each motion at least 3 times and then measure again. Tell them if pain, weakness, tiredness, or poor control gets worse with each try. The form also asks about repeated use over time, like at the end of a workday. Pain alone does not raise a rating; pain that actually limits how far, how strong, or how long you can move does (Mitchell v. Shinseki, 2011; DeLuca v. Brown, 1995; 38 CFR 4.40 and 4.45).

Honest exam rules

  • Move each joint until pain starts. Say 'pain starts here' out loud. Stop when pain or stiffness stops you. Do not push through sharp pain to look tough. Do not stop before pain or stiffness really stops you, either. The examiner writes down both points.
  • Give your real, full effort on strength tests. The goal is an exam that shows how you truly are.
  • Describe a typical day AND your worst days. Bad days count, but say they are bad days and how often they happen.
  • Take your medicine the way you normally do. Do not skip it, and do not take extra just for the exam. Tell the examiner what you took and when, and how you are when it wears off. (Court decisions Jones v. Shinseki (2012) and Ingram v. Collins (2025) say VA should not lower a joint rating because medicine helps, when the rating rules do not mention medicine. VA tried to change this by rule in February 2026 and took the change back on February 27, 2026.)
  • Wear or bring any brace, cane, crutches, or walker you normally use. Bring the prescription or a record showing a provider ordered it.
  • Bring a one-page list: your diagnoses, surgeries, treatments tried, medicines, how often you have flare-ups, your home measurement log, and what you can no longer do at work and at home.
  • If you do not know or do not remember, say so. Do not guess.
  • Fraud warning: knowingly giving VA false information is a federal crime (18 U.S.C. 1001) and can cost you all VA benefits (38 U.S.C. 6103). Honest, complete reporting is all you need.

Common mistakes

  • Pushing through pain so the examiner only writes down your end point. Painful motion is a key factor, and the exam should record where pain starts.

    Where this comes from: 38 CFR 4.59; Burton v. Shinseki, 25 Vet. App. 1 (2011); Mitchell v. Shinseki, 25 Vet. App. 32 (2011)

  • Saying 'I'm fine' or only describing a good day. Flare-ups that are not described cannot be estimated.

    Where this comes from: Sharp v. Shulkin, 29 Vet. App. 26 (2017); DBQ flare-up section

  • An exam that skipped passive motion, weight-bearing testing, or the opposite joint. That exam may be inadequate; you or your representative can point this out.

    Where this comes from: Correia v. McDonald, 28 Vet. App. 158 (2016)

  • Rating each finger alone when several fingers are hurt. When two or more digits are limited, each is rated and combined, or the whole hand is rated by the level that best shows overall loss.

    Where this comes from: 38 CFR 4.71a, notes before DC 5216 (items 2 and 5)

Questions to ask together

A spouse, grown child or friend can read these out loud. Talk about each one before the exam, so nothing gets left out.

  1. Can you button a shirt?
  2. Can you pick up a coin from a flat table?
  3. Can you make a full fist?
  4. Can you hold a pen and write a full page?
  5. Can you grip a hammer or steering wheel firmly?

Sources

Checked against VA's rules on October 30, 2026.

Helping The Brave doesn't file or prepare claims. This guide is free education, not medical or legal advice. The VA examiner measures and VA decides your rating.