100%
Highest listed pathwayThis level covers every DC 5104-5111 combination-of-disabilities finding, forequarter amputation (DC 5120) on either extremity, and trans-pelvic amputation (DC 5160).
What separates the next level: Disarticulation at either the shoulder (DC 5120) or the hip (DC 5160) is a genuinely distinct, less extensive finding rated at 90 percent, never the same 100 percent tier.
Review CFR criteria, examples, and evidence
- Official CFR language
- DC 5104-5111 each list 100 percent for their own combination of disabilities. DC 5120 lists forequarter amputation (complete removal of the humerus along with any portion of the scapula, clavicle, or ribs) at 100 percent for both Major and Minor extremities. DC 5160 lists trans-pelvic amputation (involving complete removal of the femur and intrinsic pelvic musculature along with any portion of the pelvic bones) at 100 percent.
- Qualification explanation
- These are genuinely distinct findings across 3 diagnostic code families -- a combination-of-disabilities finding, forequarter amputation, and trans-pelvic amputation are not interchangeable, and the record needs to identify which specific finding applies.
- Examples
- Anatomical loss of both hands is documented (DC 5106).; Forequarter amputation is documented, with removal of a portion of the scapula, clavicle, or ribs along with the humerus.; Trans-pelvic amputation is documented, with removal of a portion of the pelvic bones along with the femur and intrinsic pelvic musculature.
- Medical evidence
- Amputation Rule / Residuals of Amputation DBQ; Operative reports identifying the exact amputation level; Records confirming anatomical loss or loss of use across paired limbs
- Functional impact examples
- Complete loss of limb function at the highest documented severity level in this schedule.
- Common misconceptions
- Forequarter amputation and disarticulation of the shoulder are distinct findings (100 percent vs. 90 percent), not the same finding under different names.; Trans-pelvic amputation and hip disarticulation are distinct findings (100 percent vs. 90 percent), per the corrected wording confirmed across this hub and the Hip guide.
- Related topics
- combinations-of-disabilities; dominant-nondominant; lower-extremity-amputation-levels
- Source context
- 38 CFR 4.68; 5104-5111, 5120, 5160; Current DC 5104-5173 educational pathway.
90%
Next: 100%This level covers disarticulation at the shoulder (DC 5120), amputation above the insertion of the deltoid on the major extremity (DC 5121), and disarticulation at the hip (DC 5160).
What separates the next level: The identical DC 5121 finding on the minor extremity is 80 percent instead -- confirming the Major/Minor axis is genuinely load-bearing for DC 5120-5125.
Review CFR criteria, examples, and evidence
- Official CFR language
- DC 5120 lists disarticulation (complete removal of the humerus only) at 90 percent for both Major and Minor extremities. DC 5121 lists amputation above the insertion of the deltoid at 90 percent for the Major extremity. DC 5160 lists disarticulation (involving complete removal of the femur and intrinsic pelvic musculature only) at 90 percent.
- Qualification explanation
- These are distinct findings across 3 diagnostic codes; the same 90 percent value does not mean the underlying findings are interchangeable.
- Examples
- Disarticulation at the shoulder is documented.; Amputation above the insertion of the deltoid is documented on the dominant arm.; Disarticulation at the hip is documented.
- Medical evidence
- Amputation Rule / Residuals of Amputation DBQ; Operative reports identifying the exact amputation level
- Functional impact examples
- Severe loss of limb function just short of the highest documented tier.
- Common misconceptions
- Disarticulation is a genuinely distinct, less extensive finding from forequarter amputation or trans-pelvic amputation -- never the same tier.
- Related topics
- dominant-nondominant; lower-extremity-amputation-levels
- Source context
- 38 CFR 4.68; 5120, 5121, 5160; Current DC 5104-5173 educational pathway.
80%
Next: 90%This level covers amputation above the insertion of the deltoid on the minor extremity (DC 5121), amputation below the insertion of the deltoid and above the insertion of the pronator teres on the major extremity (DC 5122/5123), and upper third of thigh amputation (DC 5161).
What separates the next level: The identical DC 5122/5123 findings on the minor extremity drop to 70 percent instead.
Review CFR criteria, examples, and evidence
- Official CFR language
- DC 5121 lists 80 percent for the Minor extremity. DC 5122 and DC 5123 each list 80 percent for the Major extremity. DC 5161 lists amputation of the upper third of the thigh, one-third of the distance from the perineum to the knee joint measured from the perineum, at 80 percent.
- Qualification explanation
- 4 distinct routes across 3 diagnostic codes share this value; the record needs to identify the specific amputation level and, for the upper-extremity routes, the extremity's dominance.
- Examples
- Amputation above the insertion of the deltoid on the non-dominant arm.; Amputation below the insertion of the deltoid on the dominant arm.; Amputation above the insertion of the pronator teres on the dominant arm.; Amputation at the upper third of the thigh, measured from the perineum.
- Medical evidence
- Amputation Rule / Residuals of Amputation DBQ; Operative reports identifying the exact amputation level and measurement from the perineum for thigh-level findings
- Functional impact examples
- Substantial loss of upper-arm or upper-thigh function and reliance on a prosthesis.
- Common misconceptions
- Amputation level in the thigh is measured from the perineum, not simply described as 'above the knee.'
- Related topics
- dominant-nondominant; lower-extremity-amputation-levels
- Source context
- 38 CFR 4.68; 5121, 5122, 5123, 5161; Current DC 5104-5173 educational pathway.
70%
Next: 80%This level covers amputation below the insertion of the deltoid and above the insertion of the pronator teres on the minor extremity, and amputation below the insertion of the pronator teres and hand loss of use on the major extremity (DC 5122-5125).
What separates the next level: The identical DC 5124/5125 findings on the minor extremity drop to 60 percent instead.
Review CFR criteria, examples, and evidence
- Official CFR language
- DC 5122 and DC 5123 each list 70 percent for the Minor extremity. DC 5124 and DC 5125 each list 70 percent for the Major extremity.
- Qualification explanation
- 4 distinct routes share this value across DC 5122-5125; identifying the specific amputation level and extremity dominance is required.
- Examples
- Amputation below the insertion of the deltoid on the non-dominant arm.; Amputation above the insertion of the pronator teres on the non-dominant arm.; Amputation below the insertion of the pronator teres on the dominant arm.; Loss of use of the dominant hand.
- Medical evidence
- Amputation Rule / Residuals of Amputation DBQ; Functional testing supporting a loss-of-use determination for DC 5125; Operative reports for amputation-level findings
- Functional impact examples
- Substantial forearm-level loss of function, or complete functional loss of the hand equivalent to amputation.
- Common misconceptions
- Loss of use under DC 5125 requires a functional-equivalence determination under 38 CFR 4.63, not simply severe pain or weakness.
- Related topics
- dominant-nondominant; section-4-63-loss-of-use-standard
- Source context
- 38 CFR 4.63/4.68; 5122, 5123, 5124, 5125; Current DC 5104-5173 educational pathway.
60%
Next: 70%This level covers amputation below the insertion of the pronator teres and hand loss of use on the minor extremity (DC 5124/5125), middle or lower thirds of thigh amputation (DC 5162), a defective stump recommended for reamputation (DC 5163), and amputation not improvable by a natural-knee-action prosthesis (DC 5164).
What separates the next level: The identical DC 5124/5125 findings on the major extremity are 70 percent instead. A lower-level amputation that does permit a prosthesis (DC 5165) drops to 40 percent instead.
Review CFR criteria, examples, and evidence
- Official CFR language
- DC 5124 and DC 5125 each list 60 percent for the Minor extremity. DC 5162 lists amputation of the middle or lower thirds of the thigh at 60 percent. DC 5163 lists a defective stump where thigh amputation is recommended at 60 percent. DC 5164 lists amputation not improvable by prosthesis controlled by natural knee action at 60 percent.
- Qualification explanation
- 4 distinct routes across 4 diagnostic codes share this value; DC 5163 and DC 5164 are easy to overlook 'orphan-zone' findings between the more commonly cited thigh-level and prosthesis-fitting findings.
- Examples
- Amputation below the insertion of the pronator teres on the non-dominant arm.; Loss of use of the non-dominant hand.; Amputation at the middle or lower third of the thigh.; A stump is documented as defective, with reamputation recommended.; The amputation is documented as not improvable by a prosthesis using natural knee action.
- Medical evidence
- Amputation Rule / Residuals of Amputation DBQ; Prosthetic-fitting records; Surgical notes describing stump condition
- Functional impact examples
- Meaningful loss of forearm or thigh-level function, or documented prosthetic-fitting difficulty.
- Common misconceptions
- DC 5163 (defective stump) and DC 5164 (not improvable by prosthesis) are genuinely distinct findings from the thigh-measurement-based levels (DC 5161/5162), not simply restatements of them.
- Related topics
- dominant-nondominant; lower-extremity-amputation-levels
- Source context
- 38 CFR 4.68; 5124, 5125, 5162, 5163, 5164; Current DC 5104-5173 educational pathway.
40%
Next: 60%This level covers a lower-level amputation permitting a prosthesis (DC 5165), forefoot amputation with more than one-half metatarsal loss (DC 5166), and loss of use of the foot (DC 5167).
What separates the next level: Higher lower-extremity findings (DC 5160-5164) all require more extensive amputation levels than a lower-level, prosthesis-compatible amputation.
Review CFR criteria, examples, and evidence
- Official CFR language
- DC 5165 lists amputation at a lower level, permitting prosthesis, at 40 percent. DC 5166 lists forefoot amputation proximal to the metatarsal bones, with more than one-half metatarsal loss, at 40 percent. DC 5167 lists loss of use of the foot at 40 percent.
- Qualification explanation
- 3 distinct findings share this value; DC 5165 and DC 5166 both concern lower-leg/foot-level amputation but are measured differently, and DC 5167's loss-of-use finding requires the 38 CFR 4.63 functional-equivalence standard.
- Examples
- A lower-level leg amputation is documented that permits a standard prosthesis.; Forefoot amputation with more than half of the metatarsal bones lost.; Loss of use of the foot is documented under the 38 CFR 4.63 functional-equivalence standard.
- Medical evidence
- Amputation Rule / Residuals of Amputation DBQ; Prosthetic-fitting records; Functional testing supporting a loss-of-use determination
- Functional impact examples
- Meaningful loss of lower-leg or foot function while still compatible with prosthetic use, or complete functional loss of the foot.
- Common misconceptions
- Loss of use of the foot (DC 5167) is not automatic just because a foot injury is severe -- it requires 38 CFR 4.63's functional-equivalence standard.
- Related topics
- lower-extremity-amputation-levels; section-4-63-loss-of-use-standard
- Source context
- 38 CFR 4.63/4.68; 5165, 5166, 5167; Current DC 5104-5173 educational pathway.
30%
Next: 40%This level covers DC 5170's two disjunctive routes (all toes amputated without metatarsal loss, or a transmetatarsal amputation with up to half of the metatarsal bones lost) and great toe amputation with removal of the metatarsal head (DC 5171).
What separates the next level: Great toe amputation without metatarsal involvement (still DC 5171) drops to 10 percent instead.
Review CFR criteria, examples, and evidence
- Official CFR language
- DC 5170 lists 'toes, all, amputation of, without metatarsal loss' at 30 percent, and, separately, 'transmetatarsal, amputation of, with up to half of metatarsal loss' also at 30 percent. DC 5171 lists great toe amputation with removal of the metatarsal head at 30 percent.
- Qualification explanation
- DC 5170's two routes are genuinely equally valid, disjunctive qualifying findings resolving to the SAME 30 percent tier -- neither is a lesser or backup finding. DC 5171's route is a distinct diagnostic code from DC 5170 and requires great-toe involvement specifically.
- Examples
- All toes are amputated with no metatarsal bone lost.; A transmetatarsal amputation is documented with up to half of the metatarsal bones lost.; The great toe is amputated with the metatarsal head removed.
- Medical evidence
- Foot amputation DBQ or operative report; Imaging confirming metatarsal involvement
- Functional impact examples
- Significant loss of push-off and balance function.
- Common misconceptions
- DC 5170's transmetatarsal route is not a lesser finding than its all-toes route -- both are separate, equally valid paths to the identical 30 percent tier.
- Related topics
- toe-amputation-patterns
- Source context
- 38 CFR 4.68; 5170, 5171; Current DC 5104-5173 educational pathway.
20%
Next: 30%This level covers one or two toes other than the great toe, amputated with removal of the metatarsal head (DC 5172), and three or four toes, including the great toe (DC 5173).
What separates the next level: The same toe count without metatarsal-head removal (DC 5172) drops to 0 percent instead; the same 3-or-4-toe count without great-toe involvement (DC 5173) drops to 10 percent instead.
Review CFR criteria, examples, and evidence
- Official CFR language
- DC 5172 lists amputation of one or two toes, other than the great toe, with removal of the metatarsal head, at 20 percent. DC 5173 lists amputation of three or four toes, including the great toe, at 20 percent.
- Qualification explanation
- 2 distinct routes across 2 diagnostic codes share this value; the record needs to identify the number of toes involved, whether the great toe is included, and metatarsal-head involvement.
- Examples
- One or two toes, other than the great toe, are amputated with the metatarsal head removed.; Three or four toes, including the great toe, are amputated.
- Medical evidence
- Foot amputation DBQ or operative report; Imaging confirming metatarsal head involvement and toe count
- Functional impact examples
- Reduced forefoot support and altered gait.
- Common misconceptions
- Great-toe inclusion changes which diagnostic code and tier applies within DC 5173 -- it is not interchangeable with a non-great-toe finding.
- Related topics
- toe-amputation-patterns
- Source context
- 38 CFR 4.68; 5172, 5173; Current DC 5104-5173 educational pathway.
10%
Next: 20%This level covers great toe amputation without metatarsal involvement (DC 5171) and three or four toes amputated, not including the great toe (DC 5173).
What separates the next level: Great toe amputation WITH metatarsal head removal (DC 5171) rises to 30 percent instead; 3-or-4-toe amputation INCLUDING the great toe (DC 5173) rises to 20 percent instead.
Review CFR criteria, examples, and evidence
- Official CFR language
- DC 5171 lists great toe amputation without metatarsal involvement at 10 percent. DC 5173 lists amputation of three or four toes, not including the great toe, at 10 percent.
- Qualification explanation
- 2 distinct routes across 2 diagnostic codes share this value.
- Examples
- The great toe is amputated without metatarsal involvement.; Three or four toes, not including the great toe, are amputated.
- Medical evidence
- Foot amputation DBQ or operative report; Imaging confirming metatarsal status and toe count
- Functional impact examples
- Footwear fit and gait changes may still be real even when the record only supports a 10 percent pathway.
- Common misconceptions
- Metatarsal involvement is a distinct surgical finding from toe-only amputation, not assumed from severity alone.
- Related topics
- toe-amputation-patterns
- Source context
- 38 CFR 4.68; 5171, 5173; Current DC 5104-5173 educational pathway.
0%
Next: 20%This level covers one or two toes, other than the great toe, amputated without metatarsal involvement.
What separates the next level: The same toe count WITH metatarsal head removal rises to 20 percent instead.
Review CFR criteria, examples, and evidence
- Official CFR language
- DC 5172 lists amputation of one or two toes, other than the great toe, without metatarsal involvement, at 0 percent -- a genuine stated outcome, not missing evidence.
- Qualification explanation
- The record needs to confirm the toe count and confirm no metatarsal bone was involved; this is the one toe-amputation route rated at 0 percent.
- Examples
- One toe, other than the great toe, is amputated without metatarsal involvement.; Two toes, other than the great toe, are amputated without metatarsal involvement.
- Medical evidence
- Foot amputation DBQ or operative report
- Functional impact examples
- Balance or footwear-fit changes may still be real even when the record only supports a 0 percent pathway.
- Common misconceptions
- 0 percent does not mean the amputation is unimportant -- it means this specific route does not reach a compensable percentage under DC 5172.
- Related topics
- toe-amputation-patterns
- Source context
- 38 CFR 4.68; 5172; Current DC 5104-5173 educational pathway.