38 CFR Part 4 — 38 CFR § 4.71a

Loss of use of both hands — VA Diagnostic Code 5109

Musculoskeletal

Diagnostic code

5109

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38 CFR § 4.71a lists Diagnostic Code 5109 as “Loss of use of both hands.” The row sits under a centered line that reads “combinations of disabilities,” inside the table captioned “Prosthetic Implants and Resurfacing.” The Major cell is blank. The Minor cell is superscript 1 and 100. Footnote 1 says “Also entitled to special monthly compensation.” Appendix B to Part 4 uses the same title, with a period.

Reviewed 2026-10-05. Text checked against the eCFR versioner full-text XML for 2026-10-01 on 2026-10-05. Title 38 was up to date as of 2026-10-01 and last amended on 2026-08-27. The § 4.71a source note prints 29 FR 6718, May 22, 1964, as amended at 34 FR 5062, Mar. 11, 1969; 40 FR 42536, Sept. 15, 1975; 41 FR 11294, Mar. 18, 1976; 43 FR 45350, Oct. 2, 1978; 51 FR 6411, Feb. 24, 1986; 61 FR 20439, May 7, 1996; 67 FR 48785, July 26, 2002; 67 FR 54349, Aug. 22, 2002; 68 FR 51456, Aug. 27, 2003; 69 FR 32450, June 10, 2004; 80 FR 42041, July 16, 2015; 85 FR 76460, Nov. 30, 2020, 85 FR 85523, Dec. 29, 2020, 86 FR 8142, Feb. 4, 2021. The source note uses a comma, not a semicolon, before 85 FR 85523 and before 86 FR 8142. The § 4.63 source note prints 29 FR 6718, May 22, 1964, as amended at 43 FR 45349, Oct. 2, 1978.

The rating criteria at each level

5109 Loss of use of both hands — combinations of disabilities

Rating %: 100

Criteria (verbatim). Loss of use of both hands

Rating %	Criteria (verbatim)
100	Loss of use of both hands

The table header splits Rating into Major and Minor. On the DC 5109 row the Major cell is blank. The number 100, with superscript 1, is in the Minor cell.

Footnote 1 reads: “Also entitled to special monthly compensation.” It does not name a level, it does not cite § 3.350, and it does not state a payment amount.

The same footnote and the same blank-Major, 100-Minor pattern are on DC 5104 through DC 5111. DC 5110 is “Loss of use of both feet.” DC 5111 is “Loss of use of one hand and one foot.” Those are different titles.

DC 5244, traumatic paralysis, complete, says “Quadriplegia: Rate separately under diagnostic codes 5109 and 5110 and combine evaluations in accordance with § 4.25.” It says “Paraplegia: Rate under diagnostic code 5110.” Its note says that if traumatic paralysis does not cause loss of use of both hands or both feet, it is incomplete paralysis, and to evaluate residuals of incomplete traumatic paralysis under the appropriate diagnostic code, for example § 4.124a, Diseases of the Peripheral Nerves. 38 CFR § 4.25 is the combined-ratings section that the quadriplegia sentence names.

38 CFR § 4.63 defines loss of use of a hand or a foot, for the purpose of special monthly compensation. It uses the singular “a hand.” The comparison for the hand is grasping, manipulation, and so on, against an amputation stump at the site of election below elbow or knee with use of a suitable prosthetic appliance. Paragraph (b) names the external popliteal nerve and the foot. It does not name the hand, and it does not assign the DC 5109 percentage. The DC 5109 title is both hands.

DC 5125 is loss of use of the hand, in the Amputations: Upper Extremity table, at 70 major and 60 minor. Its footnote says “Entitled to special monthly compensation.” It does not say “Also.” That is one hand. DC 5110 is loss of use of both feet, at 100 in the Minor cell, with the same “Also entitled” footnote. DC 5111 is loss of use of one hand and one foot. 38 CFR § 4.7 assigns the higher rating when the disability picture more nearly approximates the criteria required for that rating. Otherwise, the lower rating will be assigned. 38 CFR § 4.6 requires each element affecting the evidence to be studied so that decisions will be equitable and just. 38 CFR § 4.31 says that in every instance where the schedule does not provide a zero percent evaluation for a diagnostic code, a zero percent evaluation shall be assigned when the requirements for a compensable evaluation are not met. DC 5109 does not print a 0 percent line.

The next table caption is “Table II—Ratings for Multiple Losses of Extremities With Dictator's Rating Code and 38 CFR Citation.” That caption prints “Dictator's.” The table cites § 3.350. It does not print the number 5109. The footnote on DC 5109 does not cite § 3.350.

Source: 38 CFR § 4.71a, Diagnostic Code 5109, eCFR full-text XML for 2026-10-01.

What the words mean in your records

100 in the Minor cell

The Prosthetic Implants and Resurfacing table uses Major and Minor columns. After the centered “combinations of disabilities” line, DC 5109’s Major cell is empty and the Minor cell is 100 with superscript 1.

Also entitled

Footnote 1 says “Also entitled to special monthly compensation.” The one-hand footnote on DC 5125 says “Entitled to special monthly compensation,” without “Also,” and it sits on a different table.

Both hands, not one hand

DC 5109 says both hands. DC 5125 says loss of use of the hand, singular, at 70 major and 60 minor. Section 4.63 also speaks of a hand, singular, and it is the special-monthly-compensation definition.

Evidence that speaks to each level

100

What the rater needs to see. Loss of use of both hands, which is the DC 5109 title.

Where that usually lives. The examination of remaining function in each hand. Section 4.63 is the special-monthly-compensation definition for a hand. It is not the DC 5109 percentage.

Footnote 1

What the rater needs to see. The footnote says also entitled to special monthly compensation. It does not name a level.

Where that usually lives. The same decision. This page does not state a payment amount.

Level	What the rater needs to see	Where that usually lives
100	Loss of use of both hands, which is the DC 5109 title.	The examination of remaining function in each hand. Section 4.63 is the special-monthly-compensation definition for a hand. It is not the DC 5109 percentage.
Footnote 1	The footnote says also entitled to special monthly compensation. It does not name a level.	The same decision. This page does not state a payment amount.

VA’s public DBQ list, checked October 5, 2026, names “Amputations” under Musculoskeletal. The file is Amputations.

The exam form

DC 5109 prints 100 in the Minor cell, with footnote 1. This page does not say the form replaces that row.

Related codes and how they interact

Quadriplegia names this code and DC 5110.

DC 5244 says to rate quadriplegia separately under diagnostic codes 5109 and 5110 and combine under § 4.25. Paraplegia is rated under diagnostic code 5110.

Secondary conditions and presumptions

The 2026-10-01 text of 38 CFR § 3.309 does not contain “loss of use.” DC 5109 is a rating-schedule line, not a § 3.309 name.

A separate question, when a presumption does not decide it, is a medical question on the facts under 38 CFR § 3.310. Paragraph (a) covers disability proximately due to or the result of a service-connected disease or injury. Paragraph (b) covers increase in severity and requires a medical baseline.

Short answers

What is the VA rating for loss of use of both hands?

Under 38 CFR § 4.71a, Diagnostic Code 5109 is 100 percent in the Minor cell, with a footnote that says “Also entitled to special monthly compensation.” The Major cell is blank. Education only. VA decides on the evidence.

Does complete quadriplegia use this code?

DC 5244 says to rate quadriplegia separately under diagnostic codes 5109 and 5110 and combine evaluations in accordance with § 4.25. Paraplegia is rated under diagnostic code 5110.

FAQ

What number does DC 5109 print?

100, in the Minor cell, with superscript 1. The Major cell is blank. Footnote 1 says “Also entitled to special monthly compensation.” The footnote does not name a level or a dollar amount. Education only.

Is this the amputation-of-the-arm table?

No. The row is in the Prosthetic Implants and Resurfacing table, under the centered line “combinations of disabilities.” Loss of use of one hand is DC 5125, in the Amputations: Upper Extremity table, at 70 major and 60 minor.

What does § 4.63 say about a hand?

For special monthly compensation, loss of use of a hand exists when no effective function remains other than that which would be equally well served by an amputation stump at the site of election below elbow or knee with use of a suitable prosthetic appliance. The comparison named for the hand is grasping and manipulation. DC 5109’s title is both hands, and its percentage is the schedule line.

Next steps

Read the decision for DC 5109, which cell was used, and any special-monthly-compensation footnote.
The free worksheet is a place to write the code, the findings, and the records you already have. It does not file a claim or protect a filing date. An accredited representative is at find a VSO.
Other musculoskeletal codes are on the musculoskeletal diagnostic-code index. The category page is musculoskeletal conditions.

Education only. Not legal or medical advice. My Claim Packet is not a VA-accredited representative and does not file claims. VA decides every claim on its own evidence.

Other codes in this body system

Nearby catalog entries in Musculoskeletal, ordered by diagnostic code number. All Musculoskeletal codes

Also: DC code lookup (tools) lists the same index in a compact layout.

Source: 38 CFR Part 4, Diagnostic Code 5109 • va.gov

⚠️ Important Disclaimer

This page provides general educational information based on public VA regulations and VA.gov resources. It is not legal or medical advice, and My Claim Packet is not a VA-accredited representative. Any worksheets or draft documents produced by the tools must be reviewed for accuracy and are not filed with VA for you. Ratings and service connection are decided case-by-case from the individual record. Consult a VA-accredited VSO, claims agent, attorney, or qualified clinician for help with your situation, and verify current rules using the linked official source.