Anatomical Loss of Both Hands
Diagnostic Code 5106 • 38 CFR § 4.71a
One of the most severe service-connected disabilities with automatic 100% rating
Diagnostic Code
5106
100% Rating Guaranteed
Automatic 100% schedular rating + Eligible for SMC (Special Monthly Compensation)
Total Monthly Compensation (2026 rates, effective Dec 1, 2025):
- Base 100% Rating (no dependents):$3,938.58/month
- SMC-L (Loss of both hands):+$4,900.83/month
- Typical Total:$8,839.41/month
+ Additional amounts for dependents (spouse, children, parents)
Rating Breakdown
Schedular Rating (DC 5106)
Anatomical loss or loss of use of both hands at or above the wrist
100%
$3,938.58/mo base
SMC-L (38 USC § 1114(l))
Special compensation for catastrophic loss of both hands
+$4,900.83
per month
What Qualifies as "Anatomical Loss of Both Hands"?
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" Equivalent
Complete functional loss where both hands are physically present but completely non-functional
Medical evidence must demonstrate:
- • Zero functional grasp or grip strength bilaterally
- • Complete paralysis or contracture of both hands
- • Total inability to perform any hand functions
- • Severity equivalent to amputation
Evidence Requirements 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.
C&P Examination Report
VA compensation exam documenting bilateral hand loss or complete loss of use. For loss of use claims, exam must show zero functional capacity bilaterally.
Photographic/Video Evidence
Images showing prosthetic devices or the extent of loss. For "loss of use," video demonstrating complete inability to perform hand functions.
Service Connection Evidence
In-service injury documentation, medical records showing progressive deterioration, or nexus letter linking hand loss to service-connected condition.
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)
Anatomical loss of both hands automatically qualifies for SMC-L under 38 USC § 1114(l), adding approximately $4,900.83/month on top of your 100% rating.
Higher SMC Levels Available (2026 rates):
- •SMC-M: If you also need aid & attendance (A&A) → ~$5,408.55/mo
- •SMC-R.1: A&A required for catastrophic combined conditions → ~$9,826.88/mo
- •Additional SMC tiers: Multiple severe disabilities can qualify for higher levels (O, P, R.2, S, T)
Rating Scenarios & Compensation
Single Veteran, No Dependents
100% Rating
$3,938.58
SMC-L
+$4,900.83
TOTAL
$8,839.41/mo
Veteran with Spouse & 2 Children
100% Rating
$3,938.58
Dependents
+$437.81
SMC-L
+$4,900.83
TOTAL
$9,277.22/mo
Spouse (+$219.59) + 2 children (+$109.11 each @ 100% rating) = +$437.81
With Aid & Attendance Needs
100% Rating
$3,938.58
Dependents
+$437.81
SMC-M (w/ A&A)
+$5,408.55
TOTAL
$9,784.94/mo
Aid & Attendance elevates SMC-L to SMC-M level
Note: Rates shown are 2026 figures (effective Dec 1, 2025). Actual amounts may vary based on specific circumstances, effective dates, and additional disabilities. Some SMCs can combine for even higher levels. Source: va.gov/disability/compensation-rates.
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"?
The hand is physically present but has zero functional capacity. This is a very high bar to meet.
Not qualified: Reduced function, limited grip strength, pain with use, difficulty with fine motor tasks. These conditions rate under different DCs based on range of motion or functional limitation.
🏠 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
Bring all medical records to your exam. Be thorough in describing functional limitations and daily assistance needs. The examiner's report is crucial.
File for SMC Separately
Use VA Form 21-0847 to request SMC evaluation. Clearly state you are claiming SMC-L (or higher) due to bilateral hand loss. Include aid & attendance evidence if applicable.
Work with a VSO or Attorney
SMC claims are complex and can be worth $50,000+ per year. Professional representation ensures you receive all benefits you're entitled to, including proper SMC level determinations.
Common Secondary Conditions to Claim
Loss of both hands often leads to additional service-connected conditions. File separate claims for these:
🦴 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
Tip: Use our Secondary Condition Mapper tool to identify all potential secondary claims.
Typical Claim Timeline
File Initial Claim
Day 0-7: Submit VA Form 21-526EZ with all medical evidence
VA Acknowledges Claim
Week 1-2: Receive confirmation and claim number
C&P Examination Scheduled
Month 1-3: VA schedules your compensation exam
Attend C&P Exam
Bring all records, describe functional limitations thoroughly
Decision & Rating
Month 3-6: Receive decision letter with rating and effective date
First Payment
Within 15 days: Retroactive to effective date (often date of claim)
Timeline varies by case complexity and VA regional office workload. Some claims resolve faster, others may take longer.
Important Considerations
Effective Date Matters
Your effective date determines when back pay starts. File as early as possible - delays can cost tens of thousands in retroactive compensation.
Don't Forget SMC
Some VA raters may award the 100% rating but miss the SMC-L entitlement. Explicitly request SMC evaluation in your claim.
File All Secondary Conditions
Each secondary condition is a separate claim with separate effective date. File them all at once to maximize retroactive pay.
Get Professional Help
This is a catastrophic injury claim potentially worth $100K+ annually. Work with a VA-accredited attorney or experienced VSO who understands SMC.
Additional VA Benefits You May Qualify For
🦾 Prosthetic Devices & Maintenance
VA provides prosthetic hands/arms at no cost, including advanced myoelectric prosthetics, body-powered devices, and cosmetic prostheses. Replacements and repairs covered.
🏠 Home & Vehicle Adaptations
Specially Adapted Housing (SAH) and Special Housing Adaptation (SHA) grants, vehicle modifications, and adaptive equipment. Bilateral hand loss qualifies for the SAH grant — up to $126,526 for FY2026 (Oct 1, 2025–Sep 30, 2026).
🎓 Vocational Rehabilitation
Chapter 31 VR&E services for retraining, adaptive technology, and employment support at no cost.
💻 Assistive Technology
Voice-controlled devices, adaptive keyboards/mice, environmental control units, and other assistive tech through VA.
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?
Partial hand loss is rated under different diagnostic codes based on specific fingers/joints lost. DC 5106 only applies to complete bilateral hand loss. Individual finger losses have their own DC codes (5113-5127) with ratings from 0% to 60% per hand depending on which fingers and joints.
Does "loss of use" really equal anatomical loss for rating purposes?
Yes, but the bar is extremely high. "Loss of use" requires complete, permanent, and total loss of function - effectively zero ability to grasp, grip, or manipulate objects. Reduced function or severe limitation is not sufficient; it must be equivalent to amputation.
How long does retroactive compensation go back?
Generally, your effective date is the date the VA receives your claim or the date entitlement arose, whichever is later. If you file within one year of discharge, it can be backdated to discharge. This can result in $50,000+ in back pay for DC 5106 claims.
Can SMC levels stack or combine?
Yes! If you have multiple qualifying conditions, you may receive higher SMC levels (M, N, O, P, R, etc.). For example, loss of both hands plus aid & attendance needs qualifies for SMC-M. Additional severe disabilities can qualify you for even higher intermediate levels. This is why professional representation is critical.
Official Regulatory Source
The authoritative rating criteria for DC 5106 is found in:
38 CFR Part 4, Subpart B (eCFR) →Navigate to § 4.71a (Musculoskeletal System) and search for diagnostic code 5106.
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 only based on public VA regulations (38 CFR) and va.gov resources. It is not legal, medical, or claims assistance. Ratings and service connections are decided case-by-case by the VA based on the individual veteran’s evidence. We do not prepare claims, generate documents, or provide personalized advice. Always consult a VA-accredited Veterans Service Organization (VSO), attorney, or your physician for help with your specific situation. Verify the latest rules on va.gov.
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