The term anatomical refers to anatomy or structure. In this case, the term refers to the anatomy or structure of the hands and feet. In accordance with the Code of Federal Regulations (38 CFR 4.63) related to the loss of use of hand or foot, disabilities are defined as: Loss of use of a hand or a foot, for the purpose of special monthly compensation, will be held to exist 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 determination will be made on the basis of the actual remaining function of the hand or foot, whether the acts of grasping, manipulation, etc., in the case of the hand, or of balance and propulsion, etc., in the case of the foot, could be accomplished equally well by an amputation stump with prosthesis.

Disability is primarily an inability due to damage or infection in parts of the musculoskeletal system. In regards to amputation, congenital or developmental factors should also be considered.

The signs and symptoms associated with "functional loss may be due to absence of part, or all, of the necessary bones, joints and muscles, or associated structures, or to deformity, adhesions, defective innervation, or other pathology, or it may be due to pain, as supported by adequate pathology and evidenced by the visible behavior of the claimant undertaking the motion". (38 CFR 4.40). Weakness may be viewed as important as limitation of motion. In addition, a part that has not been used may show evidence of disuse, either through atrophy, altered skin, or absence of the normal skin thickness on the flexor areas (callosity).

Complete physical examination and psychiatric examination, including history and work, are indicated. "The duration of the initial, and any subsequent, period of total incapacity, especially periods reflecting delayed union, inflammation, swelling, drainage, or operative (surgical) intervention, should be given close attention". (38 CFR 4.41)

Treatment modalities may vary depending on the underlying cause, extent of the anatomical loss, i.e., combinations of hand and foot, both hands, both feet etc., and loss of functionality. In the case of traumatic amputations, after healing of the wound, prosthesis is usually applied. However, if the loss of functionality is due to a condition, e.g., fibromyalgia, there is no specific treatment. Any treatment in this case would be directed towards patient education and reassurance.

• In the case of amputation, special care to the site of the removed limb or part is needed. This requires extensive rehabilitation and patient education. Contractures can occur if conditioning exercises are not done. In addition, correct limb bandaging is necessary to assist with limb shrinkage for a proper fit of the prosthesis. 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 scope of the claim, including those identified by the rating criteria for that condition in 38 CFR Part 4. This could include, but not limited to, scars as the result of surgical intervention for an 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)).

• May be entitled to special monthly compensation where the veteran has a single service-connected disability rated as 100% with additional service-connected disability or disabilities independently ratable at 60% or more, which are separate and distinct from the 100% service-connected disability and involves different anatomical segments or bodily systems. See  38 CFR 3.350(i)(1) – Special Monthly Compensation (SMC).

• To ensure an accurate judgment as to anatomical loss or loss of use to properly rate a disability it is necessary that examinations be clear, complete, and precise in measurements and describing area/amount of anatomical loss, and/or functionality of hand/foot.

• Ischemic heart disease or other cardiovascular disease developing in a veteran who has a service-connected amputation of one lower extremity at or above the knee or service-connected amputations of both lower extremities at or above the ankles, shall be held to be the proximate result of the service-connected amputation or amputations. See 38 CFR 3.310(c) – Disabilities that are proximately due to, or aggravated by, service-connected disease or injury.

• 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.

• 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.

• Consider entitlement to Dependents’ Educational Assistance (DEA) under 38 U.S.C. Chapter 35, if otherwise in order.

• Entitled to special monthly compensation under 38 CFR 3.350. Also, consider entitlement to SMC 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. If SMC is not granted, the reason must be indicated.

• Need for aid attendance or permanently bedridden qualifies for subpar. L. Code L-1 h, i (38 CFR 3.350(b)). Paraplegia with loss of use of both lower extremities and loss of anal and bladder sphincter control qualifies for subpar. O. Code O-2 (38 CFR 3.350(e)(2)). Where there are additional disabilities rated 50% or 100%, or anatomical or loss of use of a third extremity see 38 CFR 3.350(f)(3), (4) or (5).

• For more information, see Table II of the "Ratings for Multiple Losses of Extremities with Dictator's Rating Code and 38 CFR Citation".