Amputation refers to removing a limb, appendage, or outgrowth of the body.

Amputations of the middle or lower third of the leg occur as a result of poor circulation leading to gangrene; cancer; trauma; or bone infection.

Amputation of the lower leg will result in loss of mobility. Postoperatively, infection, pain, blood loss, and shock are possible.

Examinations to evaluate the need for an amputation 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; and laboratory tests to determine the underlying cause and possible complications. Computed tomography (CT) scan, and magnetic resonance imaging (MRI) are not commonly used, but may assist in visualizing areas that cannot be seen on regular x-ray.

Amputation is the treatment for the listed etiologies. Postoperatively, specific treatment of the stump is essential for the prosthesis to fit properly, and to assist the patient to regain mobility.

• There will be a need for rehabilitation, physical therapy and fitting for a prosthesis. There is an impact on body image and lifestyle from losing a limb that may require counseling. Phantom limb pain is a burning, painful sensation in the amputated part. Noninvasive treatments such as increased prosthetic limb usage, physical therapy modalities, intermittent compression, and transcutaneous electrical nerve stimulation (TENS) often will decrease symptoms. Another cause of residual limb pain is a condition that is similar to reflex sympathetic dystrophy (causalgia), when the patient has had an amputation following a crush injury. Other lesser causes include temporary loss of blood supply, entrapped nerves, disk herniation, proximal arthritis, or visceral etiologies. Phantom limb pain occurs in 70% of new amputees. Other complications of amputation include swelling, joint contracture, wound failure, skin problems, or poor-fitting prosthesis requiring frequent modifications.

• 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 is not limited to, scars as the result of surgical intervention for a service-connected (SC) disability.    

• To properly rate this disability, accurate and complete descriptions of the affected extremity are necessary. 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.

• 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. 

• 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 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 or foot 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.

• With service incurred lower extremity amputation or shortening, a disabling arthritis, developing in the same extremity, or in both lower extremities, with indications of earlier, or more severe, arthritis in the injured extremity, including also arthritis of the lumbosacral joints and lumbar spine, if associated with the leg amputation or shortening, will be considered as service incurred, provided, however, that arthritis affecting joints not directly subject to strain as a result of the service incurred amputation will not be granted service connection. See 38 CFR 4.58 – Arthritis due to strain.

• Ischemic heart disease or other cardiovascular disease, including hypertension 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. 

• Also entitled to special monthly compensation. (AMPUTATIONS: LOWER EXTREMITY)