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VA Rating Assistant

DC 5222 · 38 CFR 4.71a

Favorable Ankylosis - 3 Digits C&P Exam Prep

To document the nature, severity, and functional impact of ankylosis (abnormal stiffness or fusion) affecting three digits of one hand, to support an accurate disability rating under 38 CFR 4.71a, DC 5222.

Format:
Interview + Physical
Typical duration:
30-45 minutes
DBQ form:
Hand_and_Finger (Hand_and_Finger)
Examiner:
Physician or Physician Assistant

What the examiner evaluates

  • Which three digits are ankylosed (thumb, index, long, ring, or little)
  • Whether the ankylosis is favorable (joint fixed in neutral/functional position) or unfavorable (joint fixed in non-functional position)
  • Which joint(s) are ankylosed - MCP (metacarpophalangeal), PIP (proximal interphalangeal), CMC (carpometacarpal for thumb), or IP (interphalangeal for thumb)
  • Fingertip-to-palm gap measurement: distance from fingertip(s) to the proximal transverse crease of the palm with fingers flexed as much as possible
  • Thumb-to-finger opposition gap (if thumb is involved): distance from thumb pad to fingers with thumb attempting to oppose
  • Active and passive range of motion at all affected joints
  • Presence of angulation or rotation of bone at ankylosed joints
  • DeLuca factors: pain, fatigue, weakness, incoordination, and flare-ups on repetitive use
  • Dominant hand status
  • Hand grip strength of affected and unaffected hands
  • Functional loss in daily activities, work, and self-care
  • Presence of any assistive devices or bracing
  • Atrophy of muscles in the affected hand
  • Swelling, deformity, or instability of adjacent joints

The examiner will physically inspect and manipulate the affected hand. Bring the hand in its typical resting state - do not apply lotions or tape that might obscure findings. If you normally wear a brace or splint, bring it to show the examiner but remove it for measurement. The examiner will note your dominant hand, so be prepared to state which hand is dominant.

Measurements and tests

Fingertip-to-Palm Gap (GAP) Measurement

What it measures: The distance in centimeters between the fingertip and the proximal transverse crease of the palm when the affected finger is flexed as far as possible. This is the primary determinant of favorable versus unfavorable ankylosis under M21-1.

What to expect: The examiner will ask you to flex your ankylosed finger(s) as much as you can toward your palm. They will measure the gap between the fingertip and the proximal transverse crease of the palm using a ruler or measuring tape.

Critical thresholds

  • 2 inches (5.1 cm) or less Favorable ankylosis - supports rating under DC 5222 at applicable percentage for digit combination
  • More than 2 inches (5.1 cm) Unfavorable ankylosis - may trigger re-evaluation under DC 5223 (unfavorable ankylosis) at higher rating percentages
  • Both MCP and PIP joints of a single digit ankylosed Automatically unfavorable regardless of gap measurement, per M21-1 guidance

Tips

  • Flex the finger as far as it will go, even if it causes pain - the measurement must reflect your maximum effort
  • If pain during flexion limits your attempt, clearly tell the examiner how much pain you experience so it is documented
  • Do not artificially straighten your finger before measurement - let it rest in its ankylosed position
  • If you have flare-ups where the gap is greater or the finger is more rigid, describe this to the examiner so it is noted in the DBQ

Pain considerations: Pain during flexion attempts can limit the gap measurement. Tell the examiner precisely where the pain is, its severity (0-10 scale), and whether it worsens with repetitive attempts. Pain-limited motion should be documented as a DeLuca factor contributing to functional loss.

Thumb Opposition Gap (Thumb cases only)

What it measures: For ankylosis involving the thumb, the distance between the thumb pad and the fingers when the thumb attempts to oppose (pinch toward) the other fingers. Two inches or less is favorable; more than two inches is unfavorable.

What to expect: The examiner will ask you to bring your thumb as close to your fingers as possible. They measure the space between the thumb pad and the nearest fingertip or finger pad.

Critical thresholds

  • 2 inches (5.1 cm) or less Favorable ankylosis of the thumb - rated under DC 5222 (thumb and two fingers = 40% dominant / 30% non-dominant)
  • More than 2 inches (5.1 cm) Unfavorable ankylosis of the thumb - may be rated under DC 5223

Tips

  • Attempt the full opposition motion even if limited - the measured gap is critical
  • If both the CMC and IP joints of the thumb are ankylosed, this is automatically unfavorable regardless of gap
  • Describe how the inability to oppose your thumb impacts daily tasks such as gripping, pinching, turning keys, or buttoning clothing

Pain considerations: Thumb opposition pain during attempted movement should be clearly communicated to the examiner. Note whether the pain radiates, is localized to a specific joint, and how it limits functional pinch and grip.

Active Range of Motion (AROM) at Affected Joints

What it measures: The degrees of motion you can achieve independently (without assistance) at each ankylosed and adjacent joint (MCP, PIP, DIP, CMC, IP). For ankylosed joints, AROM will be 0 degrees or near 0 degrees of flexion and extension.

What to expect: The examiner will ask you to flex and extend each finger and thumb joint independently. They use a goniometer (small angle-measuring device) to record the degrees of motion. Ankylosed joints will show near-zero motion.

Critical thresholds

  • 0 degrees of motion at a joint Confirms ankylosis of that joint; position of fixation determines favorable vs. unfavorable classification
  • Fixation at neutral/anatomical position (0 degrees) Favorable ankylosis
  • Fixation in flexion, extension, rotation, or angulation Unfavorable ankylosis - higher rating tiers apply

Tips

  • Perform ROM in the order the examiner requests - do not anticipate or move joints before asked
  • If an adjacent (non-ankylosed) joint also has limited motion, make sure the examiner measures all affected joints
  • Request that repetitive use testing be performed if you experience increased stiffness or pain after repeated movement attempts

Pain considerations: Even if the ankylosed joint cannot move, nearby joints may have painful limited motion. Report pain at each joint tested and indicate whether pain is present at rest, with active motion, or with passive manipulation.

Passive Range of Motion (PROM) at Affected Joints

What it measures: Motion achieved when the examiner moves the joint for you, without your muscle effort. Per Correia requirements, passive ROM must be documented separately from active ROM.

What to expect: The examiner will gently move each ankylosed and adjacent finger/thumb joint through its range. For truly ankylosed joints, passive ROM will also be near zero.

Critical thresholds

  • Passive ROM greater than active ROM Indicates pain or muscle weakness - not true bony ankylosis at that joint; may require separate evaluation under different DCs
  • Passive ROM equals active ROM at near-zero Confirms true ankylosis; supports DC 5222 rating

Tips

  • Relax your hand completely during passive ROM testing - do not resist the examiner's movement
  • If passive motion causes pain, say so immediately and describe the pain
  • If passive ROM is greater than active ROM in adjacent non-ankylosed joints, clearly state that you experience pain limiting your active motion

Pain considerations: Pain during passive ROM of adjacent joints is important for DeLuca purposes. If the examiner moves a joint beyond what you can do actively and it causes pain, report the pain level and location clearly.

Hand Grip Strength

What it measures: The overall grip strength of the affected hand compared to the unaffected hand, measured in kilograms or pounds using a dynamometer. Grip strength is significantly reduced when multiple digits are ankylosed.

What to expect: You will squeeze a handheld grip device as hard as you can, typically three times per hand. The examiner records and compares results between hands.

Critical thresholds

  • Significant grip strength reduction vs. contralateral hand Supports functional loss documentation for DeLuca factors (weakness, lack of endurance)

Tips

  • Squeeze as hard as you can to accurately reflect your maximum capability
  • If grip causes pain, tell the examiner after each squeeze so pain-limited effort is documented
  • Note if your grip worsens after the first attempt due to fatigue or pain on repetitive use

Pain considerations: Pain with gripping is a key functional loss. Describe how grip limitations affect your work, home tasks, and recreational activities. Report if grip strength decreases with repeated attempts (fatigue/endurance factor).

Repetitive Use Testing (DeLuca Factor)

What it measures: Whether range of motion and function worsen after repetitive use of the hand/digits. Per DeLuca v. Brown, examiners must document whether symptoms worsen with repetitive use over time.

What to expect: The examiner may ask you to open and close your hand, flex and extend your fingers, or perform a functional task multiple times, then re-measure or re-assess.

Critical thresholds

  • Increased pain or stiffness after repetitive use Supports higher functional impairment rating; examiner must document DeLuca factors

Tips

  • If the examiner does not perform repetitive use testing, politely ask: 'Can you document how my symptoms change with repeated use of my hand?'
  • Describe your typical work or daily tasks that involve repetitive hand use and how those activities affect your symptoms
  • Report how long your hand needs to rest before you can perform tasks again

Pain considerations: Describe fatigue, pain, swelling, or weakness that develops with sustained or repeated hand activity. Provide specific time thresholds (e.g., 'After 10 minutes of gripping, my pain goes from 3/10 to 8/10 and I must rest for 20 minutes').

Rating criteria by percentage

40%

Favorable ankylosis of the thumb and any two fingers of one hand (dominant hand rate; 30% for non-dominant hand). This is the highest rating tier under DC 5222 and applies when the thumb plus two additional digits are ankylosed in favorable positions.

Key symptoms

  • Thumb ankylosed at CMC or IP joint in neutral/functional position with gap - 2 inches
  • Two additional fingers (index, long, ring, or little) ankylosed at MCP or PIP in functional position with gap - 2 inches
  • Severely impaired pinch and opposition function
  • Significant grip strength reduction
  • Inability to perform fine motor tasks (buttoning, writing, pinching small objects)

From 38 CFR: 38 CFR 4.71a DC 5222: 'Thumb and any two fingers - 40 (dominant) / 30 (non-dominant)'

30%

Favorable ankylosis of the index, long, and ring fingers; index, long, and little fingers; or index, ring, and little fingers of one hand (dominant hand rate; 20% for non-dominant). Also applies to thumb and two fingers in the non-dominant hand.

Key symptoms

  • Three non-thumb digits ankylosed in favorable position (index + long + ring, or index + long + little, or index + ring + little)
  • Gap of 2 inches or less at all affected fingertips
  • Significant reduction in ability to grip, pinch, and type
  • Inability to make a full fist
  • Difficulty with keyboard use, tool operation, or manual labor

From 38 CFR: 38 CFR 4.71a DC 5222: 'Index, long, and ring; index, long, and little; or index, ring, and little fingers - 30 (dominant) / 20 (non-dominant)'

20%

Favorable ankylosis of the long, ring, and little fingers of one hand (dominant or non-dominant; same rate for both). Also applies to index, long, ring, or index, ring, little combinations in the non-dominant hand.

Key symptoms

  • Long, ring, and little (small) finger ankylosed in functional position
  • Gap of 2 inches or less at all affected fingertips
  • Reduced grip strength - particularly power grip
  • Difficulty with gripping tools, handles, or cups
  • Some preserved pinch function if index finger is unaffected

From 38 CFR: 38 CFR 4.71a DC 5222: 'Long, ring and little fingers - 20 (dominant and non-dominant)'

Describing your symptoms accurately

Pain

How to describe it: Describe the exact location (which joint, which digit), character (sharp, aching, burning, throbbing), severity on a 0-10 scale, what makes it worse (gripping, cold weather, prolonged use), and what makes it better (rest, heat, medication). Describe your worst-day pain level, not your average day.

Example: On my worst days, the pain in my ankylosed index and long finger joints is an 8 out of 10. The pain starts as soon as I try to grip anything - like a coffee mug or steering wheel - and it radiates up into the palm of my hand. I can't hold anything heavier than a few ounces for more than a minute before I have to set it down. The pain wakes me up at night if I roll onto my hand.

Examiner listens for: Specific joint localization of pain, pain at rest versus with activity, pain-limited grip and pinch, pain with repetitive use, pain that limits duration of activities, pain affecting sleep.

Avoid: Saying 'it's not too bad' or 'I manage' when you have significant daily limitations. Do not minimize your worst days - the rating should reflect your most severe, not most typical, presentation per M21-1 guidance.

Functional Loss from Ankylosis

How to describe it: Describe specifically which tasks you cannot perform or can only partially perform because of the fused fingers. Be concrete: 'I cannot button my shirt with my right hand,' 'I cannot type more than 5 minutes,' 'I cannot open jars,' 'I cannot hold my grandchild.' Explain whether you use adaptive techniques or devices.

Example: On my worst days, I cannot grip anything with my right hand. I have to use my left hand to open doors, carry bags, and hold utensils. I've dropped items I was holding because my fused fingers don't allow me to adjust my grip. I've had to stop woodworking entirely because I can't safely hold tools.

Examiner listens for: Specific named activities that are limited or impossible, compensatory strategies the veteran uses, occupational impact, need for assistive devices, impact on activities of daily living (ADLs).

Avoid: Saying only 'it limits my hand use' without providing specific examples. The examiner needs concrete functional examples to document impairment accurately.

Flare-ups

How to describe it: Describe what triggers flare-ups (overuse, weather changes, lifting, gripping activities), how often they occur, how long they last, how severe they are, and what you must do to recover (rest, ice, medications, immobilization).

Example: I have flare-ups about twice a week, usually triggered by any repetitive hand use like typing, driving, or yard work. During a flare-up, the entire hand swells noticeably, pain goes to 9 out of 10, and I cannot use the hand at all for 24-48 hours. I have to take prescription anti-inflammatories and apply ice every 2 hours to get back to baseline.

Examiner listens for: Frequency and duration of flare-ups, triggers, severity during flare-up versus baseline, recovery time, treatment used during flare-ups, functional limitation during flare-up (DBQ field: PUBLICDBQMUSCHANDANDFINGER_270).

Avoid: Failing to mention flare-ups entirely, or saying 'it flares up sometimes' without giving frequency, severity, and impact. The examiner specifically looks for flare-up information in the DBQ.

Weakness and Fatigue

How to describe it: Describe loss of grip strength, inability to sustain grip, hand fatigue with activity, and how quickly the hand tires during tasks. Compare to your ability before the condition developed.

Example: I used to be able to grip 90 pounds with my right hand. Now I can barely hold 10 pounds before my hand gives out. After just 5 minutes of writing or typing, my hand becomes so fatigued and painful that I have to stop completely for at least 30 minutes. I've had to switch to voice-to-text software because I can no longer sustain hand use for work tasks.

Examiner listens for: Quantitative reduction in grip strength, time-limited functional endurance, fatigue with repetitive use, comparison to pre-injury or pre-service baseline (DBQ fields: PUBLICDBQMUSCHANDANDFINGER_1868_WEAKNESS, 1869_LACKOFENDURANCE).

Avoid: Saying 'my grip is weaker' without quantifying how weak or how quickly fatigue develops.

Incoordination and Fine Motor Impairment

How to describe it: Describe difficulty with precision tasks: picking up small objects, using a keyboard, writing, using tools, tying shoes, or handling money. Explain whether you drop items, have difficulty with pinch tasks, or have lost dexterity.

Example: I cannot pick up a coin or a pill from a flat surface because my fused fingers won't position for a precise pinch. I drop items regularly when trying to transfer them between hands. My handwriting is now illegible because I cannot hold a pen with proper grip. I've burned myself several times because I couldn't release a hot object quickly.

Examiner listens for: Loss of fine motor coordination, inability to perform precision pinch, dropping objects, inability to write or type, safety concerns from impaired grip-release ability (DBQ field: PUBLICDBQMUSCHANDANDFINGER_1870_INCOORDINATION).

Avoid: Attributing coordination problems only to age or other causes - the examiner needs to understand the direct link to the digit ankylosis.

Common mistakes to avoid

Not specifying which exact digits are ankylosed

Why: The rating percentage under DC 5222 depends entirely on which combination of three digits is involved. The digit combination determines whether the rating is 40%, 30%, or 20% (dominant) or 30%, 20%, or 20% (non-dominant).

Do this instead: Know and clearly state which specific three fingers are ankylosed (e.g., 'my thumb, index finger, and long finger of my right dominant hand are ankylosed'). Bring any prior imaging or surgical reports confirming the specific joints involved.

Impact: All tiers - wrong combination could mean 20% instead of 40%

Failing to report whether both MCP and PIP joints of any single digit are affected

Why: Per M21-1, if BOTH the MCP and PIP joints of the same digit are ankylosed, the condition automatically becomes unfavorable ankylosis - regardless of gap measurement - which means a higher rating under DC 5223 (unfavorable ankylosis) may apply instead of DC 5222.

Do this instead: Know your medical records. If two joints of a single digit are both fused, tell the examiner explicitly. Ask the examiner to document each specific ankylosed joint. This could mean the difference between a favorable and unfavorable classification.

Impact: May shift from DC 5222 to DC 5223 (higher ratings possible)

Not disclosing the dominant hand

Why: DC 5222 ratings are explicitly split by dominant versus non-dominant hand. A 40% rating applies to the dominant hand but only 30% for the same condition in the non-dominant hand. If the examiner does not know which hand is dominant, the DBQ may be completed incorrectly.

Do this instead: Proactively state your dominant hand at the start of the exam. The examiner will document this in the RG_Dominant_Hand field. If you are ambidextrous, explain that as well.

Impact: 40% vs. 30% (thumb + two fingers); 30% vs. 20% (other combinations)

Straightening fingers or relaxing the hand during gap measurement

Why: The gap measurement must reflect the maximum flexion you can achieve. If you passively let the finger straighten, the gap appears larger than it actually is when you try to flex, potentially misclassifying favorable ankylosis as unfavorable or misjudging the true position of fixation.

Do this instead: Allow the ankylosed joint to remain in its natural fixed position. When asked to flex toward your palm, attempt full flexion even if limited by ankylosis. The examiner measures from the fingertip in the maximally flexed position.

Impact: All tiers - directly determines favorable vs. unfavorable classification

Not mentioning flare-ups or reporting only average-day symptoms

Why: M21-1 and DeLuca require the examiner to capture the worst-day presentation. If you report only how the hand feels on a typical day, the DBQ will underrepresent true disability severity. Flare-up frequency, duration, and severity are specifically captured in the DBQ.

Do this instead: Describe your worst days specifically and separately from your average days. State: 'On my worst days, which occur approximately X times per month...' and provide specific functional limitations during those episodes.

Impact: All tiers - may also support increase to unfavorable classification during flare-ups

Ignoring adjacent non-ankylosed digit limitations

Why: Ankylosis of three digits often causes compensatory stress and limitation in adjacent digits. If the remaining two fingers also have limited motion or pain, they may be separately ratable under different diagnostic codes, increasing the overall combined rating.

Do this instead: Tell the examiner about any pain, stiffness, or limited motion in ALL five digits, not just the three that are ankylosed. Ensure the examiner documents ROM at all joints of all digits.

Impact: Potentially separate additional ratings for non-ankylosed digits

Failing to report whether angulation or rotation is present at ankylosed joints

Why: Per M21-1, if there is rotation or angulation of a bone at an ankylosed joint, the condition may be classified as unfavorable ankylosis even if the gap measurement would suggest favorable. Rotation or angulation triggers unfavorable classification and potentially higher ratings under DC 5223.

Do this instead: Review your X-rays or imaging before the exam. If any report or prior physician has noted angulation or rotation at a fused joint, bring that documentation and inform the examiner. The examiner will document angulation/rotation in the RG_5A_RIGHT_ANGULATION_YN or equivalent fields.

Impact: May shift from DC 5222 (favorable) to DC 5223 (unfavorable) at higher rates

Prep checklist

  • critical

    Identify the exact three digits and specific joints that are ankylosed

    Review your medical records, surgical reports, and imaging to confirm which three fingers are ankylosed and which joints (MCP, PIP, CMC, IP) are involved. Write down the finger names and joint names before the exam.

    before exam

  • critical

    Confirm and document your dominant hand

    The rating depends on whether the affected hand is dominant or non-dominant. If right-handed and the right hand is affected, note this. If ambidextrous or hand dominance changed due to injury, document that history.

    before exam

  • critical

    Gather all relevant medical records and imaging

    Collect X-rays, MRI reports, surgical operative reports, physical therapy notes, and any prior VA or private physician documentation of the ankylosis. Bring copies to the exam or ensure they are in your VA file.

    before exam

  • critical

    Review your worst-day symptoms and functional limitations

    Write out specific examples of tasks you cannot do or have difficulty doing due to the ankylosed digits. Include daily activities (dressing, cooking, driving), work tasks, and recreational activities. Focus on your worst-day presentation.

    before exam

  • critical

    Document your flare-up history

    Write down how often flare-ups occur, what triggers them, how severe they are (pain scale), how long they last, and what you must do to recover. The examiner will specifically ask about flare-ups per DBQ field 270.

    before exam

  • recommended

    Check if angulation or rotation has been documented at any ankylosed joint

    Review X-ray or imaging reports for any notation of angulation, rotation, malunion, or malalignment at the ankylosed joints. If present, this supports unfavorable classification and potentially higher ratings under DC 5223.

    before exam

  • recommended

    Note any assistive devices or adaptive equipment you use

    List any braces, splints, adaptive utensils, voice recognition software, or other accommodations you use due to the ankylosed digits. Bring devices to show the examiner.

    before exam

  • recommended

    Research whether you are eligible to record the exam

    Many states allow veterans to record their C&P exam. Check your state laws and VA facility policy. If recording is permitted, bring a small audio recorder or use your smartphone. Notify the examiner that you intend to record.

    before exam

  • critical

    Do not apply lotions, tape, or bandages to the hand before the exam

    Keep the hand in its natural state for accurate measurement and visual inspection. If you routinely wear a brace, bring it but remove it for ROM and gap measurement testing.

    day of

  • recommended

    Do not take pain medication that might mask symptoms before the exam

    Avoid taking more pain medication than usual before the exam. The examiner should see your hand as it typically functions. If you always take daily medications, continue your normal regimen and inform the examiner what you take.

    day of

  • recommended

    Arrive with your written symptom summary

    Bring a one-page written summary of: (1) which digits are ankylosed, (2) dominant hand, (3) specific functional limitations, (4) flare-up description, and (5) worst-day pain level. Give a copy to the examiner if they will accept it.

    day of

  • critical

    Note your current pain and function level on the exam day

    If the day of your exam is better or worse than usual, tell the examiner immediately. If it is a good day, explicitly state: 'Today is better than my typical day - on my worst days, which happen X times per month, my symptoms are [describe].'

    day of

  • critical

    State your dominant hand at the start of the exam

    Do not wait for the examiner to ask. Begin by stating: 'My dominant hand is my [right/left] hand, and the affected hand is my [right/left] hand.' This ensures the dominant hand field is correctly documented.

    during exam

  • critical

    Perform all ROM and gap tests to your maximum ability despite pain

    Attempt full flexion of ankylosed and adjacent joints even if painful. The gap measurement must reflect your best-effort flexion attempt. After each attempt, report your pain level so it is documented.

    during exam

  • critical

    Explicitly request repetitive use documentation if not offered

    If the examiner does not perform or mention repetitive use testing, ask: 'Can you document how my symptoms change with repetitive use of my hand over time?' This is required under DeLuca factors.

    during exam

  • critical

    Describe functional limitations with specific examples, not generalizations

    Instead of 'my hand doesn't work well,' say 'I cannot button my shirt, I cannot grip a cup, I dropped a knife last week and have stopped cooking.' Specific examples are more likely to be documented accurately.

    during exam

  • critical

    Report all symptoms - pain, weakness, fatigue, incoordination

    Volunteer information about all DeLuca factors even if not directly asked: pain, weakness, lack of endurance, incoordination, and flare-ups. These correspond to specific DBQ checkboxes the examiner must complete.

    during exam

  • recommended

    If adjacent non-ankylosed digits also have problems, report them

    Tell the examiner about pain or limitation in the remaining two (non-ankylosed) fingers as well. These may be separately ratable under other diagnostic codes.

    during exam

  • recommended

    Request a copy of the completed DBQ

    You are entitled to a copy of your DBQ. Request it in writing after the exam through your VSO, MyHealtheVet, or by submitting a records request. Review the document to ensure your symptoms were accurately captured.

    after exam

  • recommended

    Document your exam experience while memory is fresh

    Immediately after the exam, write down what was tested, what you reported, and any discrepancies between what you said and what seemed to be noted. This can support a future challenge if the DBQ is inaccurate.

    after exam

  • optional

    Submit a buddy statement or personal statement if the DBQ was inadequate

    If the examiner seemed rushed, did not perform all tests, or you felt your symptoms were not accurately captured, submit a personal statement (VA Form 21-4138) or nexus letter from a private physician to supplement the record.

    after exam

Your rights during a C&P exam

  • You have the right to have your C&P exam conducted by a qualified examiner (physician or physician assistant for musculoskeletal conditions).
  • You have the right to request a copy of the completed DBQ/C&P exam report after it is finalized.
  • In most states, you have the right to audio record your C&P examination - notify the examiner of your intent to record before the exam begins.
  • You have the right to have a VSO (Veteran Service Officer) representative present during your exam in some circumstances - check with your VSO in advance.
  • You have the right to submit a personal statement (VA Form 21-4138) or a statement from a buddy, family member, or employer describing your functional limitations to supplement the DBQ.
  • You have the right to challenge a C&P exam you believe was inadequate, incomplete, or inaccurate by requesting a new examination or submitting a private nexus or IMO letter from your own physician.
  • You have the right to be rated on your worst-day presentation per M21-1, not just how you appeared on the day of the exam.
  • You have the right to have DeLuca factors (pain on use, fatigue, weakness, incoordination, flare-ups, repetitive use effects) documented and considered in your rating.
  • You have the right to an exam that tests both active and passive range of motion separately, per Correia requirements for musculoskeletal conditions.
  • You have the right to have your dominant hand status documented and factored into the rating determination, as the rating under DC 5222 differs between dominant and non-dominant hand.

Related conditions

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This C&P exam preparation guide is for educational purposes only and does not constitute legal, medical, or claims advice. Always consult with a qualified Veterans Service Organization (VSO) representative or VA-accredited attorney for guidance specific to your claim. Never exaggerate, minimize, or fabricate symptoms during a C&P examination.