Anatomical loss of one hand and loss of use of one foot
38 CFR § 4.71a — Musculoskeletal system
Special combination rating in § 4.71a—confirm exact definitions of anatomical loss and loss of use in the regulation.
Diagnostic code
5104
DC 5104 addresses a specific combination: anatomical loss of one hand together with loss of use of one foot. The schedule assigns a high evaluation for this pattern; the words “anatomical loss” and “loss of use” have regulatory meanings that may not match everyday speech.
Special Monthly Compensation (SMC) and other benefits may interact with severe extremity loss—this page is only an orientation. Always review your decision and Part 4 definitions with a VA-accredited representative.
Official VA rating criteria — anatomical loss / loss of use (DCs 5104–5105)
These codes address combined anatomical loss scenarios. Ratings follow the amputation and loss-of-use tables in § 4.71a with special combination rules—read the DC notes.
| Rating | VA criteria (themes) | Key evidence at this level |
|---|---|---|
| Varies | Percentage is derived from the amputation table and loss-of-use rules for the paired extremities described in DC 5104/5105. | Amputation level documentation, prosthetics, occupational therapy, independence assessments. |
| Also see | Bilateral factor, special monthly compensation, and aids for daily living may apply—rules interact with combined ratings. | VA code sheet; accredited representative review for SMC and bilateral calculations. |
Source: 38 CFR § 4.71a — DCs 5104–5105 and amputation subpart.
Service connection — common paths
Direct service connection
Direct connection when anatomical loss or loss of use is due to in-service injury or disease.
Secondary service connection
When loss of use is secondary to another SC condition (e.g. diabetes, PAD) with medical evidence.
Secondary conditions sometimes pursued with Anatomical loss of one hand and loss of use of one foot
After anatomical loss or loss of use ratings, veterans may pursue additional conditions related to prosthetics, overuse of remaining limbs, chronic pain, and mental health.
Altered biomechanics may be argued when medically documented.
Adjustment to limb loss or loss of use.
“Strong” / “Moderate” / “Developing” reflect how often these theories appear in educational materials—not a prediction of approval. Use accredited help for your specific file.
Already service-connected for something else?
Anatomical loss ratings often follow service-connected trauma, vascular disease, or other SC disabilities that led to amputation or loss of use.
Nexus from SC event to amputation or loss of use.
Last verified against 38 CFR (eCFR Part 4):
Rating criteria (38 CFR Part 4)
Diagnostic code 5104 — Anatomical loss of one hand and loss of use of one foot — is listed under 38 CFR § 4.71a in 38 CFR Part 4. The paragraphs below summarize how this code is used; the official schedule text controls exact percentages, formulas, and notes.
Schedule summary (educational, not a substitute for the regulation): Use 38 CFR § 4.71a and locate DC 5104 for the full rating table and notes.
Exact rating criteria: Open Part 4 in the eCFR (link under “Official source” below). Locate your diagnostic code number (5104) in the correct body-system subpart, or use Find in Page (Ctrl+F / ⌘F) for “5104”. Copy the verbatim rating table, including any parenthetical notes, exceptions, and cross-references, for the version of Part 4 that applies to your effective date.
Effective dates & which schedule version applies
Which diagnostic code, percentage, and effective date apply depends on the facts of your claim and the version of the rating schedule in force for the period being decided. Generally, VA applies the schedule in effect at the specified time under 38 U.S.C. § 5110 and implementing rules, subject to exceptions (e.g., protected ratings, liberalizing law changes—see regulation and VA manual policy as applicable).
For older claims, the **current** eCFR may not match the text that applied years ago. If your decision references a prior percentage or code, compare against the Part 4 text **as of** your claim’s relevant dates; historical Federal Register / CFR snapshots may be needed for precise comparison.
The “Last verified” date on this page is when we last checked this educational summary against the electronic CFR—not the date of any VA policy or your personal claim decision.
Notes for your claim
Evidence: Show that your diagnosis and severity match the factors the schedule names for DC 5104 (e.g., measurements, frequency, treatment, functional loss), with medical and lay evidence as appropriate.
C&P exams: Results should reflect the schedule’s requirements (correct joints measured, correct formulas). If the exam omits required findings, consider submitting records or requesting clarification.
If you disagree with the DC, percentage, or effective date, review the Part 4 text for your period and consider a supplemental claim or appeal with a VA-accredited representative.
This site does not provide legal advice.
Official source
38 CFR Part 4 (eCFR) — locate diagnostic code 5104 in the subpart for your body system (use Find in Page if needed).
Discuss how your evidence fits DC 5104 with a VA-accredited representative. Quick search: DC code lookup.
⚠️ Important Disclaimer
This page provides general educational information only based on public VA regulations (38 CFR) and va.gov resources. It is not legal, medical, or claims assistance. Ratings and service connections are decided case-by-case by the VA based on the individual veteran’s evidence. We do not prepare claims, generate documents, or provide personalized advice. Always consult a VA-accredited Veterans Service Organization (VSO), attorney, or your physician for help with your specific situation. Verify the latest rules on va.gov.