[Federal Register Volume 67, Number 144 (Friday, July 26, 2002)]
[Rules and Regulations]
[Pages 48784-48787]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 02-18965]


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DEPARTMENT OF VETERANS AFFAIRS

38 CFR Part 4

RIN 2900-AI44


Ankylosis and Limitation of Motion of Digits of the Hands

AGENCY: Department of Veterans Affairs.

ACTION: Final rule.

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SUMMARY: This document amends the Department of Veterans Affairs (VA) 
Schedule for Rating Disabilities by revising the evaluation criteria 
for ankylosis and limitation of motion of the fingers and thumb in 
order to assure that veterans diagnosed with these conditions receive 
consistent evaluations.

DATES: Effective Date: This amendment is effective August 26, 2002.

FOR FURTHER INFORMATION CONTACT: Caroll McBrine, M.D., Consultant, 
Regulations Staff (211A), Compensation and Pension Service, Veterans 
Benefits Administration, Department of Veterans Affairs, 810 Vermont 
Ave., NW, Washington DC, 20420, (202) 273-7210.

SUPPLEMENTARY INFORMATION: As part of its review of the Schedule for 
Rating Disabilities (38 CFR part 4), VA published a proposal to amend 
that portion of the Schedule pertaining to ankylosis and limitation of 
motion of the fingers and thumb. The proposed rule was published in the 
Federal Register on November 2, 2001 (66 FR 55614). Interested persons 
were invited to submit written comments on or before January 2, 2002. 
We received one comment, from the Disabled American Veterans.
    We proposed to change the name of the ``middle finger'' to ``long 
finger'' in the diagnostic codes pertaining to digit ankylosis and 
limitation of motion. The commenter suggested that we make the same 
change in diagnostic codes for finger amputations. In response, we have 
made that change. In addition, in current Plate III, one finger is 
labeled ``middle finger,'' and we will be revising that as part of the 
overall revision of the orthopedic system to ``long finger''. 
Similarly, the commenter suggested that

[[Page 48785]]

we change ``median transverse fold of palm'' to ``proximal transverse 
crease of palm'' in 38 CFR 4.71, as we proposed to do in Sec. 4.71a. We 
have also made that change.
    We proposed to evaluate an ankylosed digit as amputation when both 
joints are ankylosed, and either is in extension or ``full'' flexion. 
The commenter felt that the proposed ratings do not adequately provide 
for the disability that occurs when a finger ankylosed in flexion 
obstructs the other fingers and reduces the strength of the hand in 
gripping or grasping motions. The commenter expressed the belief that 
this disability is worse than an amputation and should receive a higher 
evaluation.
    Digits that inhibit the use of other fingers are sometimes 
amputated if they inhibit hand function. Since 38 CFR 4.68, 
``Amputation rule,'' however, prohibits an evaluation exceeding that 
which would be assigned if the finger were amputated, we have adopted 
another way of addressing this problem. In our judgment, if finger 
flexion deformity interferes with the function of other fingers or hand 
function overall, assessment of the other fingers or the hand overall 
should be taken into account in rating. This is both more appropriate 
than providing a higher evaluation for the ankylosed finger itself and 
consistent with the requirements of Sec. 4.68. Provisions #2 and #5 of 
this portion of the rating schedule would apply in this situation. 
However, to assure that raters address any additional disability due to 
ankylosis of a single digit, we have revised the notes following the 
diagnostic codes for ankylosis of individual digits, which currently 
direct raters to consider rating as amputation, to read ``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''. In our 
judgment, this will be sufficient to alert raters to the possibility of 
additional disability due to a single ankylosed digit.
    VA appreciates the comment submitted in response to the proposed 
rule. Based on the rationale stated in the proposed rule and in this 
document, the proposed rule is adopted with the changes noted.

Paperwork Reduction Act

    This document contains no provisions constituting a collection of 
information under the Paperwork Reduction Act (44 U.S.C. 3501-3520).

Regulatory Flexibility Act

    The Secretary hereby certifies that this regulatory amendment will 
not have a significant economic impact on a substantial number of small 
entities as they are defined in the Regulatory Flexibility Act (RFA), 5 
U.S.C. 601-612. The reason for this certification is that this 
amendment would not directly affect any small entities. Only VA 
beneficiaries could be directly affected. Therefore, pursuant to 5 
U.S.C. 605(b), this amendment is exempt from the initial and final 
regulatory flexibility analysis requirements of sections 603 and 604.

Executive Order 12866

    This regulatory amendment has been reviewed by the Office of 
Management and Budget under the provisions of Executive Order 12866, 
Regulatory Planning and Review, dated September 30, 1993.
    The Catalog of Federal Domestic Assistance program numbers are 
64.104 and 64.109.

List of Subjects in 38 CFR Part 4

    Disability benefits, Individuals with disabilities, Pensions, 
Veterans.

    Approved: May 16, 2002.
Anthony J. Principi,
Secretary of Veterans Affairs.

    For the reasons set out in the preamble, 38 CFR part 4, subpart B, 
is amended as set forth below:

PART 4--SCHEDULE FOR RATING DISABILITIES

Subpart B--Disability Ratings

    1. The authority citation for part 4 continues to read as follows:

    Authority: 38 U.S.C. 1155, unless otherwise noted.

    2. In Sec. 4.71, last sentence, remove ``median transverse fold of 
the palm'' and add, in its place, ``proximal transverse crease of 
palm''.

    3. In Sec. 4.71a under the tables MULTIPLE FINGER AMPUTATIONS and 
SINGLE FINGER AMPUTATIONS, remove ``middle'' every place it occurs and 
add in each place ``long''.

    4. Section 4.71a is amended by removing the tables ``MULTIPLE 
FINGERS: UNFAVORABLE ANKYLOSIS''; MULTIPLE FINGERS: FAVORABLE 
ANKYLOSIS''; and ANKYLOSIS OF INDIVIDUAL FINGERS'' and adding, in their 
place, the following table to read as follows:


Sec. 4.71a  Schedule of ratings--musculoskeletal system.

* * * * *

  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................

[[Page 48786]]

 
    (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                 60         50
 ankylosis of.....................................
Note: 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         40
Note: 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                40         30
     little; or index, ring, and little fingers...
    Long, ring, and little fingers................         30         20
Note: 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           30         20
     little fingers...............................
    Long and ring; long and little; or ring and            20         20
     little fingers...............................
Note: Also consider whether evaluation as
 amputation is warranted.
------------------------------------------------------------------------
                II. Multiple Digits: Favorable Ankylosis
------------------------------------------------------------------------
5220  Five digits of one hand, favorable ankylosis         50         40
 of...............................................
5221  Four digits of one hand, favorable ankylosis
 of:
    Thumb and any three fingers...................         50         40
    Index, long, ring, and little fingers.........         40         30
5222 Three digits of one hand, favorable ankylosis
 of:
    Thumb and any two fingers.....................         40         30
    Index, long, and ring; index, long, and                30         20
     little; or index, ring, and little fingers...
    Long, ring and little fingers.................         20         20
5223  Two digits of one hand, favorable ankylosis
 of:
    Thumb and any finger..........................         30         20
    Index and long; index and ring; or index and           20         20
     little fingers...............................
    Long and ring; long and little; or ring and            10         10
     little fingers...............................
------------------------------------------------------------------------
                   III. Ankylosis of Individual Digits
------------------------------------------------------------------------
5224  Thumb, ankylosis of:
    Unfavorable...................................         20         20
    Favorable.....................................         10         10
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 favorable......................         10         10
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 favorable......................         10         10
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 favorable......................          0          0

[[Page 48787]]

 
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.)           20         20
     between 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            10         10
     cm.) 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.)              0          0
     between 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               10         10
     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
     degrees......................................
    With a gap of less than one inch (2.5 cm.)              0          0
     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
     degrees......................................
5230  Ring or little finger, limitation of motion:
    Any limitation of motion......................          0          0
------------------------------------------------------------------------

* * * * *
(Authority: 38 U.S.C. 1155)
[FR Doc. 02-18965 Filed 7-25-02; 8:45 am]
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