Leg, amputation of, at a lower level, permitting prosthesis — VA Diagnostic Code 5165

38 CFR § 4.68 says the combined rating for disabilities of an extremity shall not exceed the rating for the amputation at the elective level, were amputation to be performed. For example, the combined evaluations for disabilities below the knee shall not exceed the 40 percent evaluation, diagnostic code 5165. This 40 percent rating may be further combined with evaluation for disabilities above the knee but not to exceed the above the knee amputation elective level. Painful neuroma of a stump after amputation shall be assigned the evaluation for the elective site of reamputation.

DC 5164 is the row above, at 60, also with footnote 2. Its schedule text is “Amputation not improvable by prosthesis controlled by natural knee action.” Appendix B shortens that row to “Not improvable by prosthesis controlled by natural knee action.” It does not shorten DC 5165. DC 5166 is forefoot amputation proximal to the metatarsal bones, more than one-half of metatarsal loss, at 40. DC 5167 is loss of use of the foot, at 40. Both carry footnote 2.

38 CFR § 4.63 says 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. Section 4.63 does not name DC 5165. The DC 5165 row is an amputation level, not the loss-of-use sentence.

38 CFR § 3.350(a) says special monthly compensation under 38 U.S.C. 1114(k) is payable for each anatomical loss or loss of use of one hand, one foot, and the other losses that sentence lists. Section 3.350(b) names both feet, and one hand and one foot, under 38 U.S.C. 1114(l). The DC 5165 footnote does not cite either paragraph. This page does not state a payment amount. 38 CFR § 4.7 assigns the higher rating when the disability picture more nearly approximates the criteria required for that rating. Otherwise, the lower rating will be assigned. 38 CFR § 4.6 requires each element affecting the evidence to be studied so that decisions will be equitable and just.

The code prints no 0 percent line. 38 CFR § 4.31 says that in every instance where the schedule does not provide a zero percent evaluation for a diagnostic code, a zero percent evaluation shall be assigned when the requirements for a compensable evaluation are not met. The 2026-10-01 text of 38 CFR § 3.309 does not contain “prosthesis.” A separate question, when a presumption does not decide it, is a medical question on the facts under 38 CFR § 3.310. Paragraph (a) covers disability proximately due to or the result of a service-connected disease or injury. Paragraph (b) covers increase in severity and requires a medical baseline.

Source: 38 CFR § 4.71a and 38 CFR § 4.68, Diagnostic Code 5165, eCFR full-text XML for 2026-10-01.