VA Disability Ratings for Wrist Conditions
VA offers compensation to veterans who experience wrist conditions as a result of their service. Find out more about common wrist conditions. and how VA rates them for disability compensation below.
Common Types of Wrist Conditions Among Veterans
Wrist injuries often result in wrist pain. Sprains and fractures, from falls or other physical activity, are a common cause of wrist pain. Wrist injuries often occur when a person falls because, as they are falling, they tend to reach out their hands to catch themselves. This can result in the person landing on their wrist wrong, causing a sprain, strain, or fracture. Wrist injuries can sometimes go unnoticed.
A scaphoid fracture occurs when one of the small bones in the wrist, nearer to the thumb, is fractured. The fracture here can often be so small that it is not detected on X-rays directly after the injury. Delaying treatment of a scaphoid fracture can often cause additional complications and issues later.
Ganglion cysts can also be a cause of wrist pain. These cysts occur on the wrist, closer to the backside typically, and can cause pain. The pain may worsen with movement.
Repetitive stress or movement can also cause other conditions that lead to wrist pain. Specifically, repetitive stress can cause osteoarthritis or rheumatoid arthritis. Osteoarthritis can occur in the wrist when the cartilage which protects the ends of the bones deteriorates. This typically happens over time.
People with prior wrist injuries, such as fractures and sprains, are more susceptible to developing osteoarthritis in the wrist. Rheumatoid arthritis occurs when a person’s immune system actually attacks their own tissues. Unlike osteoarthritis, rheumatoid arthritis commonly occurs in the wrist, often affecting both wrists.
Wrist tendonitis affects the tendons of the wrist. There are many tendons surrounding the wrist which, with wrist tendonitis, become inflamed and irritated. Tendons are cord-like structures that connect a muscle to a bone. There are two groups of tendons in the wrist: extensors and flexors. Extensors are in the back of the wrist, while the flexors are in the front. Tendonitis is most commonly caused by inflammation. When the proteins which form the tendon begin to degrade, the tendons become inflamed and tendonitis develops.
Symptoms of tendonitis include swelling, redness or warmth around the wrist, and a grinding sensation that may come with movement. Some cases of wrist tendonitis may require surgery to repair. Usually, ice, anti-inflammatory medication, and limiting mobility to the wrist are used to treat wrist tendonitis. Cortisone shots or hand therapy may be used as well.
VA rates wrist tendonitis on a percentage scale, with increasing percentages corresponding to the severity of the condition. Typically, tendonitis is awarded a 10% minimum rating. In some instances, veterans may be awarded a higher rating if the tendonitis is more severe.
Carpal tunnel is a condition that occurs when one of the major nerves in the hand, the median nerve, is compacted or pinched throughout the wrist. The condition can worsen noticeably over time.
Symptoms of carpal tunnel include numbness, tingling, weakness in the hand or arm, and pain. Treatment for carpal tunnel may involve wearing a wrist splint, avoiding certain activities, or surgery in some cases. Some risk factors may increase a person’s chance of developing carpal tunnel such as heredity, repetitive hand use, repetitive hand use involving certain hand positions, and certain health conditions like diabetes, arthritis, or thyroid gland imbalance.
VA rates carpal tunnel under 38 CFR § 4.124a, Schedule of Ratings – Neurological conditions and convulsive disorders, Diagnostic Code 8515. The rating criteria is as follows based on paralysis of the median nerve:
- 70/60% – complete paralysis; marked by the absence of flexion of the index finger and feeble flexion of the middle finger, inability to make a fist, index and middle fingers remain extended, inability to flex distal phalanx of the thumb, weakened flexion of, etc.
- 50/40% – incomplete paralysis; severe
- 30/20% – incomplete paralysis; moderate
- 10/10% – incomplete paralysis; mild
The higher rating percentage is applied when the carpal tunnel affects your dominant hand, whereas the lower percentage is applied when your non-dominant hand is affected.
De Quervain’s Tenosynovitis
De Quervain’s Tenosynovitis is a form of tendonitis that affects the tendons towards the thumb. This can make it painful to move or turn the wrist, grab things, or form a fist. Repetitive overuse of the wrist generally causes de Quervain’s tenosynovitis. When a person uses their wrist to grab things, the two tendons in the wrist and lower thumb glide through a sheath that connects to the base of the thumb. Overuse can irritate this sheath and cause inflammation.
Sometimes, a direct injury, like a fracture or sprain can cause de Quervain’s tenosynovitis. Rheumatoid arthritis may also cause de Quervain’s tenosynovitis. De Quervain’s tenosynovitis may cause pain near the thumb, swelling, difficulty moving the thumb or the wrist, difficulty grabbing or pinching things, or a sticking sensation in the thumb. Some risk factors, such as age, sex, pregnancy, or jobs with repetitive wrist motion, may increase a person’s chances of developing de Quervain’s tenosynovitis.
When issuing a rating for de Quervain’s Tenosynovitis, VA will consider if the impairment is mild or reaching total paralysis. If the condition is affecting the veteran’s dominant hand, it receives a higher rating.
Motion limitation is generally the determining factor for rating criteria. For hand conditions, such as de Quervain’s Tenosynovitis, the combined rating may not exceed 70% for the dominant hand and 60% for the non-dominant hand. In cases where the veteran is ambidextrous, the hand or arm which is affected by the condition is considered the dominant hand.
C&P Exams for Wrist Conditions
In order to assess the veteran’s condition, VA may request a Compensation and Pension exam (C&P) for the veteran’s wrist condition. Compensation and Pension exams allow VA to collect more information regarding the condition in order to establish if it is related to service. VA may also use this exam to help determine what disability rating the veteran receives if service connection is decided.
When requesting an exam, VA will usually call the veteran or send a letter. It is important to follow through with scheduling the exam and attending it, as VA may deny the veteran’s claim if they do not attend the exam.
The exam will be performed by a VA health care provider or a VA contracted health care provider. Before the exam, the examiner will review the veteran’s claims file, which contains the documentation submitted prior to the exam such as medical treatment records and other previously submitted evidence. The claims file usually also contains the veteran’s service records.
Following the examination, the examiner will issue an opinion that can be favorable or unfavorable. A favorable opinion will support that the veteran’s wrist condition was caused or worsened by service. An unfavorable opinion will not support service connection.
Veterans who receive an unfavorable opinion can obtain a second opinion to refute the VA examiner’s findings. A private physician or medical expert may be able to provide the second opinion.
TDIU for Wrist Conditions
Veterans with wrist conditions may be entitled to total disability based on individual unemployability, or TDIU. TDIU is a disability benefit that compensates veterans at the 100 percent level. It is available to those who may not regularly meet the criteria needed to reach the 100 percent rating.
To be eligible for this benefit, a veteran must show that they are unable to secure substantially gainful employment. Gainful employment refers to the ability to support oneself financially.
There are two pathways that lead to an award of TDIU. They are called schedular and extraschedular.
- 38 CFR § 4.16a (“Schedular”) – For this form of TDIU, the veteran must have:
- One condition rated at minimum 60 percent OR
two conditions that can be combined to reach 70 percent, where one condition is at minimum 40 percent
- 38 CFR § 4.16b (“Extraschedular”) – This form of TDIU is for veterans who may not be able to achieve the ratings necessary for schedular TDIU but are still unable to obtain substantially gainful employment on account of their conditions.
- In this instance, the veteran must prove that their condition is uniquely hinders their ability to obtain substantially gainful employment and therefore should not be rated on the standard disability rating criteria.
Was Your Claim for a Wrist Condition Denied?
If your VA disability claim for a wrist condition has been denied, the VA disability lawyers at Chisholm, Chisholm & Kilpatrick may be able to help. Contact our office at 800-544-9144 for a free initial consultation.
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