Dupuytren's Contracture: Can I Get Disability Benefits?

Dupuytren's contracture is a condition that causes deformities of the hand, most often in the middle finger, ring finger, and pinky. Dupuytren's (also called palmar fibromatosis) causes the layer of tissue that lies under the skin of the palm to thicken and knot, which pulls the fingers inward and can prevent them from opening. The condition can occur in one or both hands.

Some symptoms of Dupuytren's contracture can be treated using enzyme injections with stretching or a procedure called "needling" that can help break apart the tissue. In more severe cases, surgery might be necessary, but recovery is difficult and can require long periods of physical therapy. None of these treatments, however, can cure the condition.

Causes of Dupuytren's Contracture

Doctors aren't sure what causes Dupuytren's contracture, but there appears to be a genetic component and external factors. This type of fibromatosis (fibrous overgrowths of connective tissue under the palm) is most common in men over 50, especially those of European descent. And men usually have more severe symptoms than women.

Risk factors for developing Dupuytren contracture might include behaviors like smoking or excessive alcohol use. Having certain other medical conditions appears to put you at greater risk, such as:

• diabetes
• epilepsy
• liver disease, and
• thyroid problems.

Although it's unclear if a previous hand injury can lead to Dupuytren's contracture, higher rates of the disease have been observed in people with prior hand trauma.

Symptoms of Dupuytren's Contracture

Whatever the cause, Dupuytren's tends to develop slowly. The first sign of the condition is often the appearance of one or more small, hard nodules under the skin of the palm, usually at the base of the ring finger and pinky. The nodules can develop into hard, scar-like bands that cross the palm and extend into the fingers.

As Dupuytren's progresses, symptoms can progress and include any of the following:

• hand pain
• pitted, dimpled, or puckered skin
• swelling around your finger joints
• fingers that curl or bend toward the palm
• inability to spread your fingers wide or place your palm flat on a surface, or
• weakness or inflexibility that makes holding or grasping objects difficult.

Dupuytren's contracture can affect both hands, though one is usually more affected than the other. Symptoms are often limited to the ring finger and pinky, but the middle and index fingers can be affected in severe cases. Dupuytren's generally doesn't affect the thumbs.

Can I Get Disability for Dupuytren's Contracture?

To be eligible for disability, you must meet several basic requirements first:

You can't be working a substantial amount. Social Security has a threshold called the substantial gainful activity (SGA) level, which is currently around $1,600 per month. If you earn more than the SGA level when you apply for benefits, Social Security won't consider you disabled. And your condition must be expected to prevent you from working at the SGA level for at least 12 consecutive months.

Next, you'll have to prove your condition not only prevents you from doing your old job but that it stops you from doing any other job in the United States. To decide if you can work at any job, Social Security must first determine your residual functional capacity (RFC). Your RFC is the type of work you can do on a regular and sustained basis.

Your RFC

Social Security will prepare a detailed RFC report that uses your medical records to assess how your condition affects your ability to do certain physical, work-related activities such as walking, sitting, pushing, and pulling. Social Security will give you an RFC for sedentary, light, medium, or heavy work based on your functioning in these areas.

Dupuytren's contracture doesn't affect your strength, but it can affect your ability to do jobs at any strength level. So Social Security will also assess your "non-exertional" limitations. Examples of non-exertional limitations include having difficulty with manipulative (hand and finger) requirements, such as reaching, handling, or grasping.

For Dupuytren's, your RFC should note the non-exertional limitations caused by your curled fingers and hand, which might include an inability to:

• grasp or turn objects
• pick up large and small objects
• put on gloves
• put your hand in tight spaces, or
• perform activities that require you to have full use of your fingers (like typing or using a cash register).

If you can no longer use your hands to perform certain hand-related tasks, like grasping a lever or picking up an object, it will be considered a severe, non-exertional impairment.

How Non-Exertional Impairments Can Help You Get Disability

If you had a job involving fine manipulation, like parts assembly or typing, Social Security might agree that your non-exertional limitations prevent you from doing your prior job. But the agency could bring up many examples of jobs that don't require fine digital manipulation of both hands. You would have to explain why you couldn't do those jobs.

Here are two examples of how Social Security might view the effect of non-exertional limitations on someone's ability to work.

For more information, see our article on how non-exertional limitations affect the disability decision.

Older Claimants More Likely to Get Disability for Dupuytren's

It can be much easier to win disability if you're older—even if Social Security decides you can still do a sedentary job. This advantage is due to Social Security's use of a series of tables called "the grids" when deciding an older person's disability claim. The grid rules don't allow Social Security to base a decision on whether there are a few types of jobs you could still do.

The grid rules take a number of medical and vocational factors into consideration, including your:

• age
• RFC strength level (sedentary, light, medium)
• education, and
• the skill level of your past work.

Based on these factors, the grids direct a finding of disabled or not disabled. You won't be able to rely on the grid rules to get disability if you have job skills that could transfer to other work, but the grid rules give an advantage to older workers with less education and fewer job skills. Here's an example of how the grids work.

For a detailed discussion of the grid rules, see our article on how the grids can be used to win your disability claim.

Dupuytren's Contracture in Combination With Other Impairments

Many people who suffer from Dupuytren's contracture also suffer from other contracture disorders elsewhere in their body, especially in their feet. Ledderhose disease (plantar fibromatosis) is sometimes referred to as "Dupuytren's of the foot" because it causes similar thickening of the connective tissue in the sole of the foot.

Although Ledderhose disease generally doesn't cause contractures, it does cause painful nodules to form on the bottom of your foot. Walking and wearing shoes can make the pain worse.

If you suffer from contractures in multiple locations, Social Security will consider the combined effect of these conditions on your ability to work. Here's an example.

Social Security will also consider the combined effect of other medical conditions, like heart disease or depression. For more information, see our article on how you can win your claim using a combination of impairments.

When to Contact an Attorney for Help

Depending on the severity of your condition, your age, and whether you have other impairments, you might be able to win a disability claim based on your Dupuytren's contracture on your own. But if Dupuytren's is your only disabling condition, the techniques and strategies needed to win on appeal can be complicated. Consider contacting an experienced disability attorney to discuss your case.

Can I Get VA Disability for Dupuytren's Contracture?

It's possible to get disability compensation from the Department of Veterans Affairs (VA) for Dupuytren's contracture. To qualify for VA benefits, your impairment must be service-connected.

The VA rates hand and finger impairments in the Schedule of Ratings for the musculoskeletal system. Your disability rating for Dupuytren's will depend on how much of your hand is affected by contracture and how severe your impairment is. (38 C.F.R. § 4.71a.)

If you've lost the use of one hand entirely due to Dupuytren's, the VA rating is based on diagnostic code 5125. If it's your dominant hand, the rating is 70%, and for your non-dominant hand, it's 60%. The VA rating for the loss of use of both hands (under diagnostic code 5109) is 100%.

If your Dupuytren's contracture affects one or more of your fingers, but you haven't completely lost the use of the affected hand, the VA ratings get a bit more complicated. The VA evaluates ankylosis (stiffening or immobility of a joint) using diagnostic codes 5216-5227 and limitation of motion of your fingers using diagnostic codes 5228-5230. The ratings are based on the following:

• the number of fingers involved
• which fingers are affected
• which joints on the affected finger(s) are involved, and
• how severe your condition is (how close your fingertips are to your palm when you try to flex them and how limited your movement is).

For example, if your ring and little fingers are curled due to Dupuytren's contracture, the VA rating is 10-20% (depending on severity). If the contracture affects your middle finger too, the rating is 20-30%, depending on severity and whether it's your dominant or non-dominant hand. If you also have limited motion in your middle or index finger, it's rated separately at 10% (for each affected finger).

To complicate things further, the VA can evaluate severe contracture as an amputation of the affected finger(s) using diagnostic codes 5126-5156. Depending on how many and which fingers are evaluated as amputations and which hand is affected, the disability rating ranges from 10% to 60%.

Learn more about how VA disability ratings work, including how the VA calculates multiple ratings.