Claim Raven explanation
What this means
The combined rating for disabilities of an extremity cannot exceed the rating for amputation at the applicable level. This is a limit on combining evaluations for that part of the limb.
The correct level matters because injuries above and below a joint may involve different limits. The rule also addresses a painful neuroma at an amputation stump, so the complete location and residual findings should be reviewed.
How this helps your claim
This helps explain why adding another evaluation does not always increase the combined rating for a limb. Check which disabilities and anatomical level VA included in the calculation.
What to check in your records
Use your decision, examination reports, and relevant records to check the following points.
- Identify every rating for the affected extremity and its location.
- Find the amputation level or equivalent level used in the calculation.
- Compare the combined evaluation with the applicable amputation rating.
Identify the applicable level before checking the cap
The amputation rule depends on the level of the extremity involved. A group of below-the-knee disabilities raises a different anatomical comparison from an injury extending higher in the limb. List the location of each evaluated disability before comparing the combined value with a limit.
Keep the combination rule separate from the underlying severity findings. A cap can affect the combined evaluation even when the individual findings are accurately recorded. The rule's particular treatment of stump residuals should also be checked where relevant rather than reduced to a single universal limb percentage.
Does the cap mean VA found the individual conditions less severe?
Not necessarily. It is a limit on the combined rating for the specified extremity circumstances. The individual medical findings and the combined-payment limit answer different questions. Read the rating calculation and anatomical basis before assuming the cap represents a new medical conclusion.
Official regulatory text
38 CFR § 4.68
eCFR snapshot: September 3, 2026. Layout and spacing are adapted for reading. The full section and its tables are included below.
§ 4.68 Amputation rule.
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.
Related references
- 38 CFR § 4.1: What a VA disability rating measures
- 38 CFR § 3.159: VA duty to assist: records and examinations
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