d. Determining Exercise considerable care when requesting examinations in connection with the Extent of claims involving SMC under . Examinations in Claims A prior examination clearly established LOU of both lower Example: Involving SMC extremities at a level preventing natural knee action. Do not request a Under 38 complete medical examination if the only issue in question is the extent of U.S.C. 1114(l) involvement of one or both of the upper extremities. Instead, request an Through (n) examination with a notation that the examination be restricted to the degree of functional impairment of the upper extremities. A determination as to LOU of a hand or foot is not restricted to organic loss; e. Considering Amputation or it includes functional LOU as well. LOU of Extremities The relevant inquiry concerning entitlement to SMC is not whether amputation is warranted. Instead, question whether the effective function remaining is other than that which would be equally well served by an amputation with the use of a suitable prosthetic appliance. For more information on determining entitlement to SMC based Reference: on LOU that is equivalent to amputation, see 11 Vet.App. 369, 374 (1998). , Entitlement to SMC must be reflected in the section of the f. Showing Coded Conclusion Entitlement to rating decision by SMC in Rating Decisions noting entitlement to SMC and statutory awards immediately following citation of the combined evaluation of all SC disabilities (if more than one exists) listing any anatomical loss as the first entitlement in order of preference over all LOUs, and citing separately each additional specific disability if entitlement under is shown for more than one anatomical loss, or LOU. For more information on References: the rating decision codesheet in SMC decisions, see M21-1, Part III, Subpart iv, 6.D.5.a, and two-signature requirements for SMC ratings, see M21-1, Part III, Subpart iv, 6.D.7.c.
d. Determining the Extent of Examinations in Claims Involving SMC Under 38 U.S.C. 1114(l) Through (n) Exercise considerable care when requesting examinations in connection with claims involving SMC under . Example: A prior examination clearly established LOU of both lower extremities at a level preventing natural knee action. Do not request a complete medical examination if the only issue in question is the extent of involvement of one or both of the upper extremities. Instead, request an examination with a notation that the examination be restricted to the degree of functional impairment of the upper extremities. e. Considering Amputation or LOU of Extremities A determination as to LOU of a hand or foot is not restricted to organic loss; it includes functional LOU as well. The relevant inquiry concerning entitlement to SMC is not whether amputation is warranted. Instead, question whether the effective function remaining is other than that which would be equally well served by an amputation with the use of a suitable prosthetic appliance. Reference: For more information on determining entitlement to SMC based on LOU that is equivalent to amputation, see , 11 Vet.App. 369, 374 (1998). f. Showing Entitlement to SMC in Rating Decisions Entitlement to SMC must be reflected in the Coded Conclusion section of the rating decision by noting entitlement to SMC and statutory awards immediately following citation of the combined evaluation of all SC disabilities (if more than one exists) listing any anatomical loss as the first entitlement in order of preference over all LOUs, and citing separately each additional specific disability if entitlement under is shown for more than one anatomical loss, or LOU. References: For more information on the rating decision codesheet in SMC decisions, see M21-1, Part III, Subpart iv, 6.D.5.a, and two-signature requirements for SMC ratings, see M21-1, Part III, Subpart iv, 6.D.7.c.