Amputation is the removal of a limb, appendage, or outgrowth of the body. In this case, the amputation in the forearm occurs below the insertion of the pronator teres muscle (view Forearm amputation).

Amputations usually stem from disabilities of the musculoskeletal system due to damage from trauma, peripheral vascular disease, tumor, infection, or congenital anomaly.

Functional loss may manifest from absence of part, or all, of the necessary bones, joints and muscles, or associated structures. Amputation below the insertion of the pronator teres results in fewer limitations of motion because of the intact pronator teres muscle. At this level, supination and pronation of the forearm as well as flexion and extension of the wrist (depending on level of amputation) are preserved and can improve the patient's overall function. Furthermore, the long lever arm increases the ease and power with which prosthesis can be used. However, prosthetic fitting is more difficult and requires a skilled prosthetist.

Examinations used to evaluate functional loss from an amputation, or the need for the procedure would most likely include: physical examinations focused on evaluation of the patient's musculoskeletal system for swelling, deformity, tenderness, range of motion and circulation; x-rays to visualize bone loss; laboratory tests to determine underlying cause and possible complications; and goniometers to measure joint movements and angles. Computed tomography (CT) scan and magnetic resonance imaging (MRI) are not commonly used, but may assist in visualizing areas that cannot be seen by regular x-ray.

In case of traumatic amputation, surgery may be indicated. After healing of an amputation site, regardless of cause, prosthesis is usually applied. Special care to the residual part is needed. Postoperatively, specific treatment of the stump is essential for prosthesis to fit properly, and to assist the patient to regain mobility. To prevent contractures, range of motion exercises and proper alignment are encouraged.

• Phantom limb pain occurs in 50% to 70% of new amputees. Contractures can occur if conditioning exercises are not done. Finally, due to body image disturbances, patients may require emotional support and counseling.

• When deciding expressly claimed issues, decision makers must consider entitlement to any complications that are within the scope of the claim, including those identified by the rating criteria for that condition in 38 CFR Part 4. This could include but is not limited to, scars as the result of surgical intervention for a service-connected (SC) disability.

• The rating schedule for musculoskeletal was updated on February 7, 2021. Protection still does apply and should be considered with existing evaluations (38 CFR 3.951(a)).

• (5120-5130) Entitled to special monthly compensation under loss of use 38 CFR 3.350 (2)(i). Consider entitlement to SMC under 38 CFR 3.350 as an issue in every case where there is a severe degree of disability involving the loss or loss of use of an extremity or sensory organ or any other functional loss providing entitlement to SMC.

• To properly rate disability, accurate and complete descriptions of the affected extremity in the medical records are essential. Descriptions of the affected extremity should include exact place of amputation or resection, length of stump, limitations of motion, pain, weakness, carriage, gait, and posture. An occupational therapy work-up is extremely beneficial, especially when amputation of the hands or fingers is involved.

• Consider entitlement to specially adapted housing (SAH), special home adaptation (SHA), and/or automobile or other conveyances and adaptive equipment, if otherwise in order. See 38 CFR 3.808 – Automobile or other conveyances and adaptive equipment; 38 CFR 3.809 – Specially adapted housing; 38 CFR 3.809a – Special home adaptation grants.

• 38 CFR 4.30 provides for a temporary 100-percent evaluation without regard to other provisions of the rating schedule if treatment of a service-connected (SC) disability resulted in surgery necessitating at least one month convalescence surgery with severe postoperative residuals, or immobilization of at least one major joint by cast without surgery, including procedures performed at an outpatient clinic.

• Compensation is payable under 38 U.S.C. 1160 for disabilities involving certain paired organs or extremities, one service-connected (SC) and the other non-service-connected (NSC), provided the NSC disability is not the result of the Veteran’s own willful misconduct.

• A determination as to loss of use (LOU) of a hand is not restricted to organic loss; it includes functional LOU as well.

• Where an NSC cause necessitates amputation of an extremity resulting in elimination of an SC disability distal to the site of the amputation, do not sever SC for or reduce the evaluation of the SC disability.

• Loss of use of the hand will be held to exist when no effective function remains other than that which would be equally well served by an amputation stump with a suitable prosthetic appliance. 38 CFR 4.71a [Schedule of ratings-musculoskeletal system]