What is the De Quervain’s Tenosynovitis VA Rating?

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VA ratings for De Quervain’s tenosynovitis range from 10% to 70% with breaks at 20%, 30%, 40%, 50%, and 60%.

The rating factors include the severity of the limitation of range of motion, measured by degrees with a goniometer, and whether it affects your major (dominant) or minor wrist (non-dominant).

Your final VA rating for De Quervain’s tenosynovitis depends on the frequency (how often), severity (how bad), and duration (how long) of symptoms and how those symptoms negatively impact your work, life, and social functioning.

Summary of Main Points

• De Quervain’s tenosynovitis is most commonly rated under CFR Title 38, Part 4, the Schedule for Rating Disabilities, Diagnostic Code (DC) 5214, Wrist Ankylosis between 20% and 50% with breaks at 30% and 40%.

• If you have extremely unfavorable wrist ankylosis, De Quervain’s tenosynovitis is rated under DC 5125 for the loss of use of hands with ratings of either 60% (non-dominant wrist) or 70% (dominant wrist).

• If you have minor limitation of range of motion of the wrist, your De Quervain’s tenosynovitis is rated under DC 5215 at 10%, which is the minimum compensable rating for painful motion.

• Ratings depend on the level of range of motion impairment, whether the condition affects the major (dominant) or minor (non-dominant) wrist as well as painful motion.

What is De Quervain’s Tenosynovitis?

De Quervain’s tenosynovitis is a painful condition that affects the tendons on the thumb side of your wrist.

It occurs when the tendons around the base of the thumb become irritated or constricted, leading to inflammation.

The two tendons primarily involved are the abductor pollicis longus and the extensor pollicis brevis.

Veterans with De Quervain tenosynovitis likely feel wrist pain upon movement or when attempting to grasp objects or make a fist.

Symptoms of De Quervain’s Tenosynovitis in Veterans

Symptoms of De Quervain’s tenosynovitis in veterans vary depending on a variety of factors.

Here’s a list of common symptoms:

• Pain and tenderness along the thumb side of the wrist: Veterans may experience pain that worsens with thumb and wrist movement or when grasping objects.

• Swelling: Inflammation of the tendons can cause swelling around the base of the thumb, leading to discomfort and restricted movement.

• Difficulty gripping or pinching: Veterans with De Quervain’s tenosynovitis may find it challenging to perform tasks that involve gripping objects or pinching with their thumb and fingers.

• Stiffness and limited range of motion: The condition can result in stiffness of the thumb and wrist, making it difficult to move these joints freely.

• Weakness: Chronic inflammation and pain can weaken the affected thumb and wrist muscles, reducing grip strength and overall hand function.

What are the Risk Factors for Military Veterans?

Although the exact cause of De Quervain tenosynovitis is not known, activities that involve  repetitive use of the hand or wrist can make it worse.

Here’s a list of risk factors for military veterans:

• Repetitive hand and wrist movements: Military veterans, especially those in certain occupational specialties, may have been exposed to repetitive tasks that involve gripping, lifting, or manipulating objects, which can increase the risk of developing De Quervain’s tenosynovitis.

• Overuse injuries: Veterans may have engaged in physically demanding activities during their military service, including combat deployments, training exercises, or maintenance work, which can lead to overuse injuries of the tendons in the hand and wrist.

• Heavy lifting: Military duties often involve tasks that require lifting and carrying heavy equipment or gear, placing increased strain on the tendons in the hand and wrist and predisposing them to injury.

• Prolonged use of handheld equipment: Veterans who have operated handheld tools, weapons, or communication devices for extended periods may be at higher risk of developing De Quervain’s tenosynovitis due to the repetitive strain on the thumb and wrist.

• Poor ergonomic practices: Inadequate ergonomic conditions in military environments, such as poorly designed workstations or equipment, may contribute to the development of musculoskeletal disorders, including De Quervain’s tenosynovitis.

• Pre-existing conditions: Veterans with pre-existing conditions such as arthritis, diabetes, or obesity may be at increased risk of developing De Quervain’s tenosynovitis due to the compromised health of their tendons and joints.

• Age and gender: While De Quervain’s tenosynovitis can affect individuals of any age and gender, it is more common in women and individuals aged 30-50. Veterans within this demographic group may be at higher risk.

• Posture and body mechanics: Poor posture and improper body mechanics during military training or activities may contribute to the development of overuse injuries, including De Quervain’s tenosynovitis.

• Previous hand or wrist injuries: Veterans with a history of hand or wrist injuries, such as fractures or sprains, may be more susceptible to developing De Quervain’s tenosynovitis due to altered biomechanics or weakened structures.

• Occupational hazards: Exposure to environmental hazards or traumatic events during military service can lead to injuries or conditions that predispose veterans to musculoskeletal disorders like De Quervain’s tenosynovitis.

What is the De Quervain’s Tenosynovitis VA Rating?

The VA usually rates De Quervain’s tenosynovitis under CFR Title 38, Part 4, the Schedule for Rating Disabilities, DC 5214 wrist ankylosis with ratings ranging from 10% to 50% with breaks at 20%, 30%, and 40%.

However, if you have minor limitation of range of motion of the wrist, the condition is rated under DC 5215 at 10%, which is the minimum compensable rating.

If you have extremely unfavorable wrist ankylosis, the condition is rated under DC 5125 for the loss of use of hands with ratings of either 60% (non-dominant wrist) or 70% (dominant wrist).

Other factors that impact the rating include whether the condition affects your dominant (major) or non-dominant (minor) wrist as well as any painful motion.

Here’s a summary of each of the three DCs, how they’re applied, and the VA ratings for the major vs. minor wrist.

VA Ratings for De Quervain’s tenosynovitis	VA Rating % of Major vs. Minor
	Major Wrist (Dominant)	Minor Wrist (Non-Dominant)
DC 5214, Wrist Ankylosis:		
Unfavorable, in any degree of palmar flexion, or with ulnar or radial deviation	50%	40%
Any other position, except favorable	40%	30%
Favorable in 20° to 30° dorsiflexion	30%	20%
Note: Extremely unfavorable wrist ankylosis will be rated as loss of use of hands under diagnostic code 5125.		
DC 5215, Limitation of Motion of the Wrist
Dorsiflexion less than 15°	10%	10%
Palmar flexion limited in line with forearm	10%	10%
DC 5125, Loss of Use of the Hand		
Extremely unfavorable wrist ankylosis	70%	60%

Detailed Explanation of the VA Ratings for De Quervain’s Tenosynovitis

What is the Difference Between Major and Minor?

• Major Wrist (Dominant): This refers to the wrist of the hand that the veteran predominantly uses (right-handed individuals would have their right wrist considered “major”).

• Minor Wrist (Non-Dominant): Conversely, this refers to the wrist on the side that is not predominantly used.

DC 5214, Wrist Ankylosis:

Wrist ankylosis refers to the stiffening or immobility of the wrist due to fusion of the bones.

The VA ratings are based on the position and functionality of the wrist:

• Unfavorable, in any degree of palmar flexion, or with ulnar or radial deviation: This position significantly impacts wrist function. The VA rates this condition as 50% disabling for the dominant hand and 40% for the non-dominant hand.

• Any other position, except favorable: This includes positions that are not as debilitating as the unfavorable positions but still limit functionality, rated at 40% for the dominant hand and 30% for the non-dominant.

• Favorable in 20° to 30° dorsiflexion: A position considered to maintain some functionality, thus rated lower at 30% for the dominant hand and 20% for the non-dominant.

DC 5215, Limitation of Motion of the Wrist

This diagnostic code refers to restrictions in wrist movement:

• Dorsiflexion less than 15°: Refers to the inability to move the wrist upwards, rated at 10% for both hands. Major and minor are rated the same.

• Palmar flexion limited in line with forearm: Refers to the inability to bend the wrist downwards, also rated at 10%, regardless of major vs. minor.

DC 5125, Loss of Use of the Hand

This condition refers to situations where the functionality of the hand is severely compromised:

• Extremely unfavorable wrist ankylosis: This is considered when the wrist’s position significantly impairs hand use, rated at 70% for the dominant hand and 60% for the non-dominant.

What is the Painful Motion Principle for VA Wrist Ratings?

The Painful Motion Principle is outlined in 38 CFR § 4.59 – Painful Motion, which acknowledges that pain itself can be a cause for disability and can lead to compensation at the minimum compensable level of 10%.

For wrist conditions, even in cases where the range of motion might not significantly be limited according to measurements taken during a C&P exam, if the veteran experiences pain during motion, this pain can justify the minimum compensable rating for a particular condition.

If a veteran has a diagnosed wrist condition with reported pain during movement, the VA should grant the minimum rating for impairment, even if range of motion criteria aren’t met for a compensable rating.

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