Amputation is defined as the removal of a limb or a part of a limb. Amputations may be related to removal by surgery, or may result from trauma. In this circumstance, the amputation is located at a lower level of a lower extremity, permitting prosthesis.

Amputations can result from conditions including: accidental loss of limb due to trauma; poor circulation resulting in gangrene; cancer; or bone infection.

Amputations of the lower leg will result in loss of mobility and necessitate the need for a prosthesis. Stumps that provide for an effective prosthesis fitting have received appropriate stump care and preparation.

Diagnostic examinations to evaluate stump readiness for a prosthesis may include: x-rays; stage of wound healing; inspection of the limb for possible contractures; and the development of proper shaping (molding) of the stump.

The focus of treatment is to prepare the stump for a prosthesis. This preparation includes: daily cleansing and thoroughly drying of the stump; massage of the scar; avoidance of exposure of the stump to excessive perspiration; performance of prescribed exercises; prevention of contractures and abduction; and lying prone for several hours a day. Several times a day, resistance maneuvers may be done by first pushing the stump against a pillow which is soft, then progressing to a firm pillow, and finally using a hard surface.

• In the aftermath of an amputation, there is an impact on body image, lifestyle, and mobility. Phantom limb pain occurs in 70% of new amputees, and it may require treatment. Counseling, rehabilitation, artificial limb-fitting, and learning to walk again are aspects to be considered in assisting a patient's return to normal activity.

• 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)