Anatomical Loss of Both Hands
Diagnostic Code 5106 • 38 CFR § 4.71a
The schedule assigns 100% when service connection and the DC 5106 criteria are established
Diagnostic Code
5106
DC 5106 schedular evaluation: 100%
The rating schedule also directs VA to consider special monthly compensation
How compensation works (2026 rates, effective Dec. 1, 2025):
- 100% basic rate, veteran alone:$3,938.58/month
- SMC-M basic rate, veteran alone:$5,408.55/month
SMC-M is the applicable basic compensation rate for anatomical loss or loss of use of both hands; it is not added to the 100% rate. Dependency and other qualifying SMC facts can change the payment.
Rating Breakdown
Schedular Rating (DC 5106)
Anatomical loss of both hands; DC 5109 separately addresses loss of use of both hands
100%
$3,938.58/mo base
SMC-M (38 U.S.C. § 1114(m))
Basic SMC level associated with anatomical loss or loss of use of both hands
$5,408.55
veteran-alone basic rate per month
DC 5106 and the separate loss-of-use code
Anatomical Loss
Physical amputation or removal of both hands at any level at or above the wrist joint
- • Through the wrist (disarticulation)
- • Above the wrist (forearm amputation)
- • At any higher level (elbow or above)
Loss of use of both hands — DC 5109
The hands remain anatomically present, but no effective function remains beyond what would be equally well served by amputation stumps with suitable prosthetic appliances.
VA evaluates remaining function, including:
- • Actual grasping and manipulation ability
- • Neurologic, orthopedic, and prosthetic findings
- • Whether a suitable prosthesis would serve equally well
- • Functional evidence from examinations and treatment records
Evidence VA may review for DC 5106
Surgical/Amputation Records
Operative reports documenting the amputation procedure, level of amputation, and reason for surgery. Include all post-operative care records.
Medical examination findings
VA may schedule a C&P examination or request an opinion. Existing surgical, rehabilitation, and prosthetic records can document the anatomy and functional effects.
Relevant visual or prosthetic records
Clinically relevant images, prosthetic evaluations, and device records may help explain the amputation level or remaining function. They are not a universal filing requirement.
Service Connection Evidence
The record still must establish the applicable service-connection path. Depending on the facts, that may include service records, medical records, or competent medical-link evidence; a separately purchased nexus letter is not automatically required.
Buddy Statements & Daily Impact
Lay statements from family/friends describing limitations, need for assistance with daily activities, and quality of life impact.
Special Monthly Compensation (SMC)
When both-hand anatomical loss is service connected and DC 5106 applies, the schedule also identifies special monthly compensation. Under 38 U.S.C. § 1114(m) and 38 CFR § 3.350(c), anatomical loss or loss of use of both hands corresponds to SMC-M.
Important payment distinction
- •SMC-M veteran-alone basic rate: $5,408.55/month for 2026.
- •Not an add-on: Levels L through O are basic SMC rates paid instead of the ordinary 100% basic rate.
- •Possible higher level: Separate qualifying disabilities or combinations may support an intermediate or higher rate under § 3.350, but VA cannot count the same disability twice.
Rating and SMC are related but distinct
Schedular evaluation
100%
DC 5106 lists 100% for anatomical loss of both hands once the disability is service connected and the diagnostic-code facts are established.
Basic SMC level
SMC-M
The 2026 veteran-alone SMC-M basic rate is $5,408.55 per month. Use VA's current table for the veteran's dependency status and any separately supported additions.
Rate note: Figures are effective Dec. 1, 2025. The correct payment depends on dependency status, effective date, and any separate qualifying SMC facts. Confirm the current amount on VA.gov rather than adding the ordinary 100% rate to SMC-M.
Key Definitions
🖐️ What is "Anatomical Loss"?
Physical absence of the body part due to amputation, surgical removal, or traumatic loss. The hand must be missing at or above the wrist joint level.
⚠️ What is "Loss of Use"?
Under 38 CFR § 4.63, loss of use exists when no effective function remains beyond what an amputation stump with a suitable prosthetic appliance would provide. VA evaluates the actual remaining ability to grasp and manipulate objects; severe limitation alone is not necessarily loss of use.
🏠 What is "Aid and Attendance"?
Regular need for another person's assistance with activities of daily living (ADLs) such as bathing, dressing, eating, using the restroom. Medical evidence and caregiver statements required.
How to File Your Claim
File VA Form 21-526EZ
File your initial claim for disability compensation. Clearly describe both hand loss/loss of use and when/how it occurred in service or as a result of service-connected condition.
Submit All Medical Evidence
Include surgical records, treatment history, prosthetic device prescriptions, and any functional capacity evaluations. Don't assume the VA has all your records.
Attend C&P Examination
VA may schedule an examination or request a medical opinion. Upload relevant records to the claim before the appointment and describe actual functional limitations and assistance needs accurately.
Verify that VA addresses SMC-M
VA says it will award SMC when a qualifying disability is established. A separate SMC application is generally not required for the bilateral-hand-loss level. If aid and attendance is separately raised, VA Form 21-2680 may be relevant; ask an accredited representative which evidence and form fit the actual facts.
Work with a VSO or Attorney
SMC combinations are complex. A VA-accredited VSO, claims agent, or attorney can review whether the decision applied DC 5106 and the correct SMC level without counting the same disability twice.
Conditions that may warrant separate medical review
Some veterans with bilateral hand loss also have distinct physical or mental-health conditions. A separate condition is not automatic: it needs its own diagnosis and evidence connecting it to service or to an established service-connected disability.
🦴 Shoulder Conditions
Overuse from compensatory movements with prosthetics
🦴 Elbow & Forearm Pain
Strain from prosthetic socket pressure and use
🧠 PTSD
Traumatic event causing hand loss or adjustment challenges
🧠 Depression/Anxiety
Mental health impact of severe disability
💊 Phantom Limb Pain
Neuropathic pain at amputation sites
🔥 Stump Scarring
Painful or unstable scars affecting prosthetic use
🦴 Back/Neck Pain
Postural changes and compensatory strain
💤 Sleep Disturbances
Pain, positioning issues, psychological impact
Educational starting point: Use the Secondary Condition Mapper to prepare questions for a qualified clinician or VA-accredited representative—not as a prediction of service connection.
What to expect after filing
VA confirms receipt, gathers or reviews evidence, may request an examination or medical opinion, and then issues a written decision addressing service connection, evaluation, effective date, and any SMC entitlement raised by the record. Processing and payment timing vary; this guide does not promise a decision or payment date. Track the claim on VA.gov and respond to evidence or examination requests.
Important Considerations
Effective Date Matters
Effective-date rules depend on the claim type and procedural history. Consider an intent to file while gathering evidence, and ask an accredited representative to review the applicable date rule.
Don't Forget SMC
Review the decision to confirm that VA addressed SMC-M, the level associated with anatomical loss or loss of use of both hands—not SMC-L and not an amount added to the 100% rate.
Document Distinct Conditions
Do not file a condition solely because it appears on a list. Document the diagnosis, symptoms, and medical evidence for any distinct condition you discuss with an accredited representative.
Get Professional Help
A VA-accredited VSO, claims agent, or attorney can review service connection, effective date, SMC-M, and any separately qualifying disability without promising a particular award.
Additional VA Benefits You May Qualify For
🦾 Prosthetic Devices & Maintenance
VA's Prosthetic and Sensory Aids Service provides clinically appropriate prosthetic and assistive devices for eligible veterans enrolled in VA health care. A VA clinician and PSAS determine medical need, available equipment, maintenance, and any program-specific eligibility.
🏠 Home & Vehicle Adaptations
Bilateral hand loss may satisfy disability criteria for adapted-housing or automobile-adaptive-equipment programs, but each program has separate service-connection, ownership, medical, and application rules. Check the current VA eligibility page before relying on a grant amount.
🎓 Vocational Rehabilitation
Veterans may apply for Chapter 31 Veteran Readiness and Employment services. VA determines eligibility and the rehabilitation plan based on the individual circumstances.
💻 Assistive Technology
VA health-care and rehabilitation teams may recommend communication devices, adaptive controls, or other assistive technology when clinically appropriate and program eligibility is met.
Related Tools & Resources
Frequently Asked Questions
Can I work with a 100% rating for bilateral hand loss?
Yes, you can work while receiving 100% disability compensation. However, if you have Total Disability based on Individual Unemployability (TDIU) as a separate benefit, there are income restrictions. The 100% schedular rating for DC 5106 has no work restrictions.
What if I have partial hand loss (fingers) rather than complete loss?
DC 5106 addresses anatomical loss of both hands. Finger-amputation criteria appear under DCs 5126 through 5156, with the applicable code depending on the digits and amputation level.
Does "loss of use" really equal anatomical loss for rating purposes?
VA applies the regulatory functional test: no effective function remains beyond what an amputation stump with a suitable prosthetic appliance would provide. The evidence must address actual grasping and manipulation function; the diagnosis label alone does not decide the question.
How long does retroactive compensation go back?
It depends on the claim type, filing history, date entitlement arose, and any applicable exception. Do not estimate back pay from the diagnosis alone; have an accredited representative review the record and effective-date rule.
Can SMC levels stack or combine?
Some separate disability combinations support an intermediate or higher SMC rate under § 3.350. Bilateral hand loss itself corresponds to SMC-M. The same hand disability cannot be counted again to manufacture a higher level, and aid-and-attendance rules require a fact-specific review.
Official Regulatory Source
Authorities checked Aug. 20, 2026:
- 38 CFR § 4.71a — DC 5106 and DC 5109 schedule entries
- 38 CFR § 4.63 — loss-of-use standard for a hand or foot
- 38 CFR § 3.350 — SMC-M and higher-level combinations
- VA.gov — current SMC rates and level descriptions
Regulatory text checked against the eCFR snapshot current through Aug. 18, 2026.
Standard Diagnostic Code Reference
For the standard diagnostic code format with regulatory citations and claim notes, see the DC 5106 reference page.
View DC 5106 Reference Page →⚠️ 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.