The foot is the last structural portion of the lower extremity. Loss of use of the foot will affect mobility.

Loss of use of the foot may be caused by: trauma; vascular diseases; systemic diseases; impaired circulation; frostbite; infection; surgery; congenital anomalies; and neurologic or muscular conditions.

Signs and symptoms in the foot may include: pain; tenderness; weakness; paleness; cyanosis; numbness; stiffness; decreased sensation; ulcers; deformities; swelling; foot drop; paralysis; and decreased pulses.

Examinations that may be used to diagnose the many etiologic conditions include: physical and neuromuscular examinations; laboratory studies related to the specific underlying causes; x-rays; magnetic resonance imaging (MRI); computed tomography (CT) scan; electromyography (EMG); angiography; Doppler studies; arthroscopy; and bone scan.

Treatment will depend on the etiology. There may be a need for assistive devices such as walkers, splints, crutches, canes or wheelchairs. Physical therapy and rehabilitation may be needed to improve mobility.

• Some diseases may result in an amputation, e.g., chronic-treatment resistant osteomyelitis. Loss of use of a body part and disability may result in a self-concept disturbance and require 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 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.

• Also entitled to special monthly compensation.

• Plate IV – AMPUTATIONS: LOWER EXTREMITY