Source: https://www.federalregister.gov/documents/2002/07/26/02-18965/ankylosis-and-limitation-of-motion-of-digits-of-the-hands
Timestamp: 2017-11-23 07:32:53
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Federal Register :: Ankylosis and Limitation of Motion of Digits of the Hands
Ankylosis and Limitation of Motion of Digits of the Hands
A Rule by the Veterans Affairs Department on 07/26/2002
48784-48787 (4 pages)
2900-AI44
https://www.federalregister.gov/d/02-18965 https://www.federalregister.gov/d/02-18965
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.
Effective Date: This amendment is effective August 26, 2002.
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.
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 Start Printed Page 48785we change “median transverse fold of palm” to “proximal transverse crease of palm” in 38 CFR 4.71, as we proposed to do in § 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 § 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.
Approved: May 16, 2002.
2. In § 4.71, last sentence, remove “median transverse fold of the palm” and add, in its place, “proximal transverse crease of palm”.
3. In § 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:
§ 4.71a
Schedule of ratings—musculoskeletal system.
5216 Five digits of one hand, unfavorable ankylosis of 60 50
5217 Four digits of one hand, unfavorable ankylosis of:
5218 Three digits of one hand, unfavorable ankylosis of:
5220 Five digits of one hand, favorable ankylosis of 50 40
5221 Four digits of one hand, favorable ankylosis of:
5223 Two digits of one hand, favorable ankylosis of:
5224 Thumb, ankylosis of:
5225 Index finger, ankylosis of:
5226 Long finger, ankylosis of:
5227 Ring or little finger, ankylosis of:
Start Printed Page 48787
5228 Thumb, limitation of motion:
5229 Index or long finger, limitation of motion:
5230 Ring or little finger, limitation of motion:
[FR Doc. 02-18965 Filed 7-25-02; 8:45 am]