4.71a—Schedule of ratings—musculoskeletal system.

Acute, Subacute, or Chronic Diseases

	Rating
5000Osteomyelitis, 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 symptoms	100
Frequent episodes, with constitutional symptoms	60
With definite involucrum or sequestrum, with or without discharging sinus	30
With discharging sinus or other evidence of active infection within the past 5 years	20
Inactive, following repeated episodes, without evidence of active infection in past 5 years	10
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.
Code of Federal Regulations 388
5001Bones and joints, tuberculosis of, active or inactive:
Active	100
Inactive: See §§ 4.88b and 4.89 .
5002Arthritis rheumatoid (atrophic) As an active process:
With constitutional manifestations associated with active joint involvement, totally incapacitating	100
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 periods	60
Symptom combinations productive of definite impairment of health objectively supported by examination findings or incapacitating exacerbations occurring 3 or more times a year	40
One or two exacerbations a year in a well-established diagnosis	20
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.
5003Arthritis, 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 or 2 or more minor joint groups, with occasional incapacitating exacerbations	20
With X-ray evidence of involvement of 2 or more major joints or 2 or more minor joint groups	10
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.
5004Arthritis, gonorrheal.
5005Arthritis, pneumococcic.
5006Arthritis, typhoid.
5007Arthritis, syphilitic.
5008Arthritis, streptococcic.
5009Arthritis, other types (specify).
With the types of arthritis, diagnostic codes 5004 through 5009, rate the disability as rheumatoid arthritis.
5010Arthritis, due to trauma, substantiated by X-ray findings: Rate as arthritis, degenerative.
5011Bones, caisson disease of: Rate as arthritis, cord involvement, or deafness, depending on the severity of disabling manifestations.
5012Bones, 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.
5013Osteoporosis, with joint manifestations.
5014Osteomalacia.
5015Bones, new growths of, benign.
5016Osteitis deformans.
5017Gout.
5018Hydrarthrosis, intermittent.
5019Bursitis.
5020Synovitis.
5021Myositis.
5022Periostitis.
5023Myositis ossificans.
5024Tenosynovitis.
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.
5025Fibromyalgia (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 environmental or emotional stress or by overexertion, but that are present more than one-third of the time	20
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.
Code of Federal Regulations 389

Prosthetic Implants

	Rating
	Major	Minor
5051Shoulder replacement (prosthesis).
Prosthetic replacement of the shoulder joint:
For 1 year following implantation of prosthesis	100	100
With chronic residuals consisting of severe, painful motion or weakness in the affected extremity	60	50
With intermediate degrees of residual weakness, pain or limitation of motion, rate by analogy to diagnostic codes 5200 and 5203.
Minimum rating	30	20
5052Elbow replacement (prosthesis).
Prosthetic replacement of the elbow joint:
For 1 year following implantation of prosthesis	100	100
With chronic residuals consisting of severe painful motion or weakness in the affected extremity	50	40
With intermediate degrees of residual weakness, pain or limitation of motion rate by analogy to diagnostic codes 5205 through 5208.
Minimum evaluation	30	20
5053Wrist replacement (prosthesis).
Prosthetic replacement of wrist joint:
For 1 year following implantation of prosthesis	100	100
With chronic residuals consisting of severe, painful motion or weakness in the affected extremity	40	30
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 § 4.30 following hospital discharge.
5054Hip 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 motion or weakness such as to require the use of crutches		1 90
Markedly severe residual weakness, pain or limitation of motion following implantation of prosthesis		70
Moderately severe residuals of weakness, pain or limitation of motion		50
Minimum rating		30
5055Knee replacement (prosthesis).
Prosthetic replacement of knee joint:
For 1 year following implantation of prosthesis		100
With chronic residuals consisting of severe painful motion or weakness in the affected extremity		60
With intermediate degrees of residual weakness, pain or limitation of motion rate by analogy to diagnostic codes 5256, 5261, or 5262.
Minimum rating		30
5056Ankle 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
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 § 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
5104Anatomical loss of one hand and loss of use of one foot		1 100
5105Anatomical loss of one foot and loss of use of one hand		1 100
5106Anatomical loss of both hands		1 100
5107Anatomical loss of both feet		1 100
5108Anatomical loss of one hand and one foot		1 100
5109Loss of use of both hands		1 100
5110Loss of use of both feet		1 100
5111Loss 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 one extremity	Impairment of other extremity
Impairment of one extremity	Anatomical loss or loss of use below elbow	Anatomical loss or loss of use below knee	Anatomical 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 elbow	M 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)	M1/2 Code M-5, 38 CFR 3.350 (f)(1)(x)	L1/2 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 knee		L Codes L-1 a, b, or c, 38 CFR 3.350(b)	L1/2 Code L-2 b, 38 CFR 3.350 (f)(1)(iii)	L1/2 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)	N1/2 Code N-4, 38 CFR 3.350 (f)(1)(ix)	M1/2 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)	M1/2 Code M-4 b, 38 CFR 3.350 (f)(1)(vii)	M1/2 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) .

Amputations: Upper Extremity

	Rating
	Major	Minor
Arm, amputation of:
5120Disarticulation	1 90	1 90
5121Above insertion of deltoid	1 90	1 80
5122Below insertion of deltoid	1 80	1 70
Forearm, amputation of:
5123Above insertion of pronator teres	1 80	1 70
5124Below insertion of pronator teres	1 70	1 60
5125Hand, loss of use of	1 70	1 60
multiple finger amputations
5126Five digits of one hand, amputation of	1 70	1 60
Four digits of one hand, amputation of:
5127Thumb, index, long and ring	1 70	1 60
5128Thumb, index, long and little	1 70	1 60
5129Thumb, index, ring and little	1 70	1 60
5130Thumb, long, ring and little	1 70	1 60
5131Index, long, ring and little	60	50
Three digits of one hand, amputation of:
5132Thumb, index and long	60	50
5133Thumb, index and ring	60	50
5134Thumb, index and little	60	50
5135Thumb, long and ring	60	50
5136Thumb, long and little	60	50
5137Thumb, ring and little	60	50
5138Index, long and ring	50	40
5139Index, long and little	50	40
5140Index, ring and little	50	40
5141Long, ring and little	40	30
Two digits of one hand, amputation of:
5142Thumb and index	50	40
5143Thumb and long	50	40
5144Thumb and ring	50	40
5145Thumb and little	50	40
5146Index and long	40	30
5147Index and ring	40	30
5148Index and little	40	30
5149Long and ring	30	20
5150Long and little	30	20
5151Ring 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.
Code of Federal Regulations 391
(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
5152Thumb, amputation of:
With metacarpal resection	40	30
At metacarpophalangeal joint or through proximal phalanx	30	20
At distal joint or through distal phalanx	20	20
5153Index finger, amputation of
With metacarpal resection (more than one-half the bone lost)	30	20
Without metacarpal resection, at proximal interphalangeal joint or proximal thereto	20	20
Through middle phalanx or at distal joint	10	10
5154Long finger, amputation of:
With metacarpal resection (more than one-half the bone lost)	20	20
Without metacarpal resection, at proximal interphalangeal joint or proximal thereto	10	10
5155Ring finger, amputation of:
With metacarpal resection (more than one-half the bone lost)	20	20
Without metacarpal resection, at proximal interphalangeal joint or proximal thereto	10	10
5156Little finger, amputation of:
With metacarpal resection (more than one-half the bone lost)	20	20
Without metacarpal resection, at proximal interphalangeal joint or proximal thereto	10	10
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.

Amputations: Lower Extremity

	Rating
Thigh, amputation of:
5160Disarticulation, with loss of extrinsic pelvic girdle muscles	2 90
5161Upper third, one-third of the distance from perineum to knee joint measured from perineum	2 80
5162Middle or lower thirds	2 60
Leg, amputation of:
5163With defective stump, thigh amputation recommended	2 60
5164Amputation not improvable by prosthesis controlled by natural knee action	2 60
5165At a lower level, permitting prosthesis	2 40
5166Forefoot, amputation proximal to metatarsal bones (more than one-half of metatarsal loss)	2 40
5167Foot, loss of use of	2 40
5170Toes, all, amputation of, without metatarsal loss	30
5171Toe, great, amputation of:
With removal of metatarsal head	30
Without metatarsal involvement	10
5172Toes, other than great, amputation of, with removal of metatarsal head:
One or two	20
Without metatarsal involvement	0
5173Toes, three or four, amputation of, without metatarsal involvement:
Including great toe	20
Not including great toe	10
2 Also entitled to special monthly compensation.

The Shoulder and Arm

	Rating
	Major	Minor
5200Scapulohumeral articulation, ankylosis of:
Note: The scapula and humerus move as one piece.
Unfavorable, abduction limited to 25° from side	50	40
Intermediate between favorable and unfavorable	40	30
Favorable, abduction to 60°, can reach mouth and head	30	20
5201Arm, limitation of motion of:
To 25° from side	40	30
Midway between side and shoulder level	30	20
At shoulder level	20	20
5202Humerus, 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 movements	30	20
With infrequent episodes, and guarding of movement only at shoulder level	20	20
Malunion of:
Marked deformity	30	20
Moderate deformity	20	20
5203Clavicle 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

Tips

	Rating
	Major	Minor
5205Elbow, ankylosis of:
Unfavorable, at an angle of less than 50° or with complete loss of supination or pronation	60	50
Intermediate, at an angle of more than 90°, or between 70° and 50°	50	40
Favorable, at an angle between 90° and 70°	40	30
5206Forearm, limitation of flexion of:
Flexion limited to 45°	50	40
Flexion limited to 55°	40	30
Flexion limited to 70°	30	20
Flexion limited to 90°	20	20
Flexion limited to 100°	10	10
Flexion limited to 110°	0	0
5207Forearm, limitation of extension of:
Extension limited to 110°	50	40
Extension limited to 100°	40	30
Extension limited to 90°	30	20
Extension limited to 75°	20	20
Extension limited to 60°	10	10
Extension limited to 45°	10	10
5208Forearm, flexion limited to 100° and extension to 45°	20	20
5209Elbow, other impairment of Flail joint	60	50
Joint fracture, with marked cubitus varus or cubitus valgus deformity or with ununited fracture of head of radius	20	20
5210Radius and ulna, nonunion of, with flail false joint	50	40
5211Ulna, impairment of:
Nonunion in upper half, with false movement:
With loss of bone substance (1 inch (2.5 cms.) or more) and marked deformity	40	30
Without loss of bone substance or deformity	30	20
Nonunion in lower half	20	20
Malunion of, with bad alignment	10	10
5212Radius, impairment of:
Nonunion in lower half, with false movement:
With loss of bone substance (1 inch (2.5 cms.) or more) and marked deformity	40	30
Without loss of bone substance or deformity	30	20
Nonunion in upper half	20	20
Malunion of, with bad alignment	10	10
5213Supination and pronation, impairment of:
Loss of (bone fusion):
The hand fixed in supination or hyperpronation

CFR

4.71a—Schedule of ratings—musculoskeletal system.

Code of Federal Regulations

Code of Federal Regulations