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Dupuytren's Contracture

Thickening of tissue in the palm causing fingers to bend inward and not fully straighten. There is no diagnostic code for Dupuytren's contracture in 38 CFR 4.71a, so it is rated by analogy under 38 CFR 4.20 and the code is built up under 38 CFR 4.27 — here as 5299-5219, an unlisted musculoskeletal condition rated as ankylosis of the digits. Which code applies depends on HOW MANY fingers are contracted and WHICH ones: the schedule prices the thumb and index finger far higher than the ring and little fingers, which is significant because Dupuytren's typically starts in the ring and little fingers.

Code: 5299-5219
Criteria: 38 CFR 4.71a, DC 5216-5230 (rated by analogy under 38 CFR 4.20 and 4.27)
Exam length: ~20-30 minutes
Form: Hand and Finger DBQ

Rating steps

The percentages this diagnostic code can be rated at. Which one applies depends on the findings — no tool here can tell you in advance.

What happens at the appointment

The examiner will inspect your palms for thickened tissue (palmar fibromatosis), nodules, and cords running along the tendons toward the affected fingers.
Range of motion of each affected finger will be measured in degrees at the MCP, PIP, and DIP joints, with particular attention to extension deficit (inability to straighten the finger).
The examiner will measure the gap between your fingertip and the palm during attempted full extension, as well as the tabletop test (whether you can lay your hand flat on a table).
You will be asked about the rate of progression — how quickly the contracture has worsened — and whether any surgical intervention (fasciectomy, needle aponeurotomy, or collagenase injection) has been performed.
Functional assessment will include grip testing, ability to grasp objects of various sizes, and questions about how the contracture affects daily activities and work.

What the examiner is actually filling in

01Degree of flexion contracture at each joint (MCP, PIP, DIP) of each affected finger, measured in degrees of extension deficit.
02Whether the contracture results in favorable or unfavorable ankylosis of any finger — unfavorable ankylosis (finger flexed and in the way of hand function) rates significantly higher.
03Gap between fingertip and palm in centimeters during attempted full extension, and whether the hand can be laid flat (tabletop test).
04Impact on grip strength and fine motor function measured by dynamometer and functional testing.
05Progression rate of the disease and whether it has recurred after prior surgical intervention.

Rated under 38 CFR 4.71a, DC 5216-5230 (rated by analogy under 38 CFR 4.20 and 4.27). The examiner records findings on the DBQ; a rating specialist makes the decision.

A complete answer sounds like

Place your hand flat on the exam table to demonstrate the tabletop test — if your affected fingers cannot lay flat, the examiner can see and measure the contracture angle directly.
Show the examiner the palmar nodules and cords by pressing your fingertips together with fingers extended — the cords become more visible under tension.
If you cannot fully open your hand to grip large objects like a jar lid or basketball, demonstrate this during the exam rather than just describing it.
Report any numbness or tingling in the affected fingers — nerve compression can occur alongside Dupuytren's and may warrant separate neurological evaluation.
If the contracture has progressed despite treatment, emphasize the recurrent and progressive nature — this supports an ongoing disability rather than a resolved condition.

What costs veterans points

Not reporting the functional impact of even a mild contracture — a 30-degree flexion contracture of the ring finger significantly impairs grip and grasp function.
Failing to mention that you cannot lay your hand flat (positive tabletop test), which is a key clinical finding indicating significant contracture.
Not reporting progression — Dupuytren's is a progressive condition and documenting how quickly it is worsening supports the need for a current accurate rating.
Minimizing grip weakness caused by the inability to fully open and close the hand around objects of different sizes.
Not mentioning that surgical correction has a high recurrence rate, which means the condition will likely worsen again even after treatment.

The rating criteria, in plain language

Rating levels for Dupuytren's Contracture under 38 CFR 4.71a, DC 5216-5230 (rated by analogy under 38 CFR 4.20 and 4.27)
Rating	Rating criteria	What that means for you
0%	Ring or little finger, ankylosis of: Unfavorable or favorable. Major: 0 percent. Minor: 0 percent.	You have minimal contracture with slight thickening of the palmar fascia and no significant limitation of motion. There is also a real 0 percent rung to be aware of: DC 5227 rates ankylosis of the RING or LITTLE finger at 0 percent on either hand, and DC 5230 rates any limitation of motion of those two fingers at 0 percent. Because Dupuytren's usually begins in exactly those fingers, a single-finger case very often is noncompensable.
0%	What supports this level Diagnosis of Dupuytren's contracture Minimal palmar fascia thickening documented Which fingers are affected recorded Grip strength measured
10%	Long finger, ankylosis of: Unfavorable or favorable. Major: 10 percent. Minor: 10 percent.	The contracture has ankylosed the long (middle) finger, or the index finger. DC 5226 and DC 5225 each pay 10 percent on either hand — favorable and unfavorable ankylosis are rated the same. Favorable ankylosis of two of the lesser fingers together (long and ring, long and little, or ring and little) also pays 10 percent, under DC 5223.
10%	What supports this level Dupuytren's contracture of the long or index finger documented Position of the metacarpophalangeal and proximal interphalangeal joints recorded Gap between the fingertip and the proximal transverse crease of the palm measured Functional grip partially maintained
20%	Two digits of one hand, unfavorable ankylosis of: Long and ring; long and little; or ring and little fingers. Major: 20 percent. Minor: 20 percent.	The contracture has left two of the lesser fingers — long and ring, long and little, or ring and little — in unfavorable ankylosis. DC 5219 pays 20 percent on either hand for that combination. Under 38 CFR 4.71a, ankylosis counts as UNFAVORABLE when the metacarpophalangeal or proximal interphalangeal joint is ankylosed and there is a gap of more than two inches between the fingertip and the proximal transverse crease of the palm with the finger flexed as far as possible.
20%	What supports this level Two fingers with unfavorable ankylosis documented Gap of more than two inches from fingertip to palm crease measured Which joints are ankylosed recorded for each finger Documented impact on grip and grasp function
30%40% dominant side	Three digits of one hand, unfavorable ankylosis of: Index, long, and ring; index, long, and little; or index, ring, and little fingers. Major: 40 percent. Minor: 30 percent.	The contracture has left three of the lesser fingers in unfavorable ankylosis (DC 5218 rates long, ring and little at 30 percent on either hand), or has taken the index finger with two others. Where the index finger is involved, DC 5218 pays 40 percent on the dominant hand and 30 percent on the non-dominant hand. The criterion quoted below is the index-finger combination.
30%40% dominant side	What supports this level Unfavorable ankylosis of three fingers documented Which fingers are affected recorded Hand dominance confirmed in medical records Substantial loss of grip and grasp function Documented inability to hold or manipulate objects
50%60% dominant side	Five digits of one hand, unfavorable ankylosis of. Major: 60 percent. Minor: 50 percent.	The contracture has taken four or five digits. DC 5217 pays 50 percent major / 40 percent minor for unfavorable ankylosis of the index, long, ring and little fingers, and 60 / 50 where the thumb is one of four. DC 5216 pays 60 / 50 for all five digits — the ceiling of the digit ankylosis codes. At this point ask the VA to consider evaluation as an amputation, and loss of use of the hand under DC 5125, which pays 70 percent on the dominant hand.
50%60% dominant side	What supports this level Four or five digits with severe contracture Hand dominance confirmed in medical records Near-total loss of hand grip function Inability to perform fine motor tasks Loss of use of the hand evaluation requested

The middle column is our transcription of the criteria at 38 CFR 4.71a, DC 5216-5230 (rated by analogy under 38 CFR 4.20 and 4.27), condensed for reading. Read the section itself on eCFR before relying on the exact wording. The items under each level are the kinds of evidence that document it — not a VA checklist, and not a prediction of which level applies to you.

Mistakes we see most often

Not documenting WHICH fingers are affected. This matters more than severity. The schedule rates ankylosis of the ring or little finger at 0 percent, the long or index finger at 10 percent, and combinations that include the thumb or index finger far higher. An exam that says only "contracture of the hand" cannot be rated correctly.

Not having the gap measured. Favorable and unfavorable ankylosis are separated by a specific measurement — the gap between the fingertip and the proximal transverse crease of the palm, with the finger flexed as far as it will go. More than two inches is unfavorable; two inches or less is favorable. Ask the examiner to record it in inches or centimetres for each finger.

Not reporting functional limitations (grip strength, ability to grasp objects).

Missing the connection to hand trauma or vibration exposure during service.

Not filing separately for each hand if bilateral.

Before & after your exam

These apply to every C&P exam, whatever the condition.

Do not miss the appointment: Missing your C&P exam without a good reason can cost you. Under 38 CFR § 3.655, a missed exam can cause a claim for an increased rating or a reopened claim to be denied, and can cause an original claim to be decided on the evidence already in your file. If you cannot make it, call the VA or the exam company right away to reschedule — a documented good reason (illness, work conflict, no transportation, a family emergency) protects your claim.
Your examiner may be a contractor: Many C&P exams are performed by VA-contracted companies — QTC, Optum Serve (LHI), VES, or MSLA — not at a VA hospital. They will call, text, or mail you to schedule. Do not ignore an unknown number or letter while your claim is pending, and confirm the exam location and time before you go.
The examiner does not decide your claim: The examiner's job is to record findings on the Disability Benefits Questionnaire (DBQ). A rating specialist at the Regional Office makes the actual decision, using the exam together with your full record — service records, medical records, and lay statements. One appointment does not settle everything.
Get a copy of your exam report: After the exam you can request the report (often called the DBQ or C&P exam results) through VA.gov, the Blue Button tool, or your accredited representative. Reading it lets you catch errors while you still have time to respond.
If the exam was inadequate, you have options: If the examiner rushed you, evaluated the wrong condition, or the report is inaccurate, you can submit a statement and new evidence, and — after a decision — request a review (a Supplemental Claim or Higher-Level Review). A single bad exam is not the end of your claim.

View condition guide →View evidence checklist →

Folder readiness

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C&P Exam Preparation Guides

The VA orders this exam to verify your diagnosis and measure how severe it is right now. It can shape your rating and your monthly compensation — but it does not decide your claim. A rating specialist weighs it against your full record, and if the exam does not reflect your condition, you can say so and ask the VA to correct it.

Source forms
Coverage

Dupuytren's Contracture

Rating steps

What happens at the appointment

What the examiner is actually filling in

A complete answer sounds like

What costs veterans points

The rating criteria, in plain language

What supports this level

What supports this level

What supports this level

What supports this level

What supports this level

Mistakes we see most often

Before & after your exam

Dupuytren's Contracture

Rating steps

What happens at the appointment

What the examiner is actually filling in

A complete answer sounds like

What costs veterans points

The rating criteria, in plain language

What supports this level

What supports this level

What supports this level

What supports this level

What supports this level

Mistakes we see most often

Before & after your exam