Fingers are the bones located at the end of the hand, and are referred to as digits, or phalanges. Amputation is the removal of a limb, appendage, or outgrowth of the body. In this case, the amputation refers to the amputation of three digits of one hand, including the thumb, index and long finger.

Amputations usually stem from disabilities of the musculoskeletal system due to damage from trauma, peripheral vascular disease, tumor, infection, or congenital anomaly.

Functional loss may manifest from absence of part, or all, of the necessary bones, joints and muscles, or associated structures. Prior to an amputation of three digits of one hand, manifestations may include: pain; tenderness; weakness; paleness; cyanosis; numbness; stiffness; decreased sensation; ulcers; deformities; swelling; or paralysis. After the amputation, there may be pain, blood loss, deformity, possible infection, and shock.

Examinations used to evaluate functional loss from an amputation, or the need for the procedure would most likely include: physical examinations focused on evaluation of the patient's musculoskeletal system for swelling, deformity, tenderness, range of motion and circulation; x-rays to visualize bone loss; laboratory tests to determine underlying cause and possible complications; and goniometers to measure joint movements and angles. Computed tomography (CT) scan, and magnetic resonance imaging (MRI) are not commonly used, but may assist in visualizing areas that cannot be seen by regular x-ray.

In case of traumatic amputation, surgery may be indicated. After healing of an amputation site, regardless of cause, a prosthesis is usually applied. Special care to the residual part is needed. Postoperatively, specific treatment of the stump is essential for a prosthesis to fit properly, and to assist the patient to regain mobility. To prevent contractures, range of motion exercises and proper alignment are encouraged.

• Phantom limb pain occurs in 70% of new amputees. Contractures can occur if conditioning exercises are not done. Finally, due to body image disturbances, patients may require emotional support and counseling.

• When deciding expressly claimed issues, decision makers must consider entitlement to any complications that are within the scope of the claim, including those identified by the rating criteria for that condition in 38 CFR Part 4. This could include but is not limited to, scars as the result of surgical intervention for a service-connected (SC) disability.

• The rating schedule for musculoskeletal was updated on February 7, 2021. Protection still does apply and should be considered with existing evaluations (38 CFR 3.951(a)).

• To properly rate disability, accurate and complete descriptions of the affected extremity in the medical records are essential. Descriptions of the affected extremity should include exact place of amputation or resection, length of stump, limitations of motion, pain, weakness, carriage, gait, and posture. An occupational therapy work-up is extremely beneficial, especially when amputation of the hands or fingers is involved.

• Do not use numerical designations for either the fingers or the joints of the fingers. Each digit, except the thumb, includes three phalanges:

  • the proximal phalanx (closest to the wrist)

  • the middle phalanx, and

  • the distal phalanx (closest to the tip of the finger).

•  If the location of the injury in the hand is unclear, obtain x-rays to clarify the exact point of injury. 

• Determining dominant handedness – See 38 CFR 4.69.

• A determination as to loss of use (LOU) of a hand is not restricted to organic loss; it includes functional LOU as well.

• The ratings for multiple finger amputations apply to amputations at the proximal interphalangeal joints or through proximal phalanges.

• Amputation through middle phalanges will be rated as prescribed for unfavorable ankylosis of the fingers.

• Amputations at distal joints, or through distal phalanges, other than negligible losses, will be rated as prescribed for favorable ankylosis of the fingers.

• 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.

• 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.

• 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 appliance. 38 CFR 4.71a [Schedule of ratings-musculoskeletal system]