The Arteries and Veins

Topics:

High Blood Pressure
Aneurysms
Arteriovenous Fistula
Blood Flow Restrictions and Blocks
Severe Allergic Swelling
Residual Symptoms from Vein and Artery Conditions
Overexposure to the Cold
Cancer of the Blood Vessels
Other Artery and Vein Conditions
DBQs for Artery and Vein Conditions
Principles that Apply

Reminder: The VA will give a Military Disability Rating for each service-connected condition a service member has, but the DoD will only rate service-connected conditions that make a service member Unfit for Duty.

The Cardiovascular System is divided into two pages: The Arteries and Veins, and The Heart.

 


High Blood Pressure

Code 7101: Hypertension and isolated systolic hypertension are forms of high blood pressure that are caused by hypertensive vascular disease. “Blood pressure” refers to the pressure exerted by the blood flowing through the veins. During each cycle (1 heart beat to the next), the highest pressure is called the systolic pressure, and the lowest pressure is called the diastolic pressure. Hypertension refers to both the diastolic and systolic pressure, and systolic hypertension refers to only the systolic pressure. When looking at a blood pressure reading, the systolic hypertension is the number on top, and the diastolic is the number on bottom.

To qualify for a high blood pressure rating, the condition must be clearly documented by the physician. Blood pressure readings must be taken two or more times a day on at least three different days in order for the condition to be officially diagnosed. A rating under this code cannot be combined with a rating for the underlying condition that caused the high blood pressure. Only the code that allows for the highest rating can be used for the condition. A rating for high blood pressure can, however, be used in addition to ratings for hypertensive heart disease and other heart diseases.

The ratings: If the average diastolic pressure is 130 or more, then it is rated 60%. If the average diastolic pressure is 120 to 129, then it is rated 40%. If the average diastolic pressure is 110 to 119, or the average systolic pressure is 200 or more, then it is rated 20%. If the average diastolic pressure is 100 to 109, or the average systolic pressure is 160 to 199, then it is rated 10%. If the average diastolic pressure was 100 or more before fully controlled by medication and continuous medication is required to keep the blood pressure under control, then the minimum rating is 10%.

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Aneurysms

An aneurysm occurs when an artery swells to 1.5 or more times its normal size. It is usually a sign of weakness in the tissues of the artery.

Code 7110: If an aneurysm in the aortic artery is corrected by surgery, then it is rated 100% from the day of admittance to the hospital. This rating continues for the first 6 months after discharge from the hospital. The condition is then reevaluated and rated accordingly. If the condition is active and causes symptoms such as pain or hemorrhaging, or if it is 5 centimeters or larger in diameter, then it is rated 100%. If the condition is serious enough that you cannot perform moderately strenuous activities (lifting weights or running), then it is rated 60%. If the condition does not qualify for these ratings, then it is rated based on the existing symptoms in the affected organ (e.g. if it caused erratic heart beats, then it would be rated as arrhythmia).

Code 7111: If an aneurysm in any large artery (except the aortic artery) is surgically corrected, then it is rated 100% from the date of admission to the hospital. This rating continues for the first 6 months after discharge from the hospital. The condition is then reevaluated and rated accordingly. A 100% rating is given if there is pain in the limbs (claudication) and tears in the skin of the limbs from lack of oxygen or if there is pain in the limbs and the ankle brachial index is 0.4 or less.

A 60% rating is given if you cannot walk further than 25 yards without limping because of pain and one or more of the following: there is coldness in the limb that does not respond to warming methods, there are one or more tears in the skin of the limb, or the ankle brachial index is 0.5 or less.

A 40% rating is given if you have limping because of pain when walking between 25 and 100 yards and one or more of the following: there are 1.) changes to the hair, skin, or nails of the affected limb, or 2.) the ankle brachial index is 0.7 or less.

A 20% rating is given if you have limping because of pain when walking more than 100 yards and one or more of the following: the pulse in the limb is diminished, or the ankle brachial index is 0.9 or less.

Note: These ratings are for a single limb only. If more than one limb has an aneurysm, then rate each separately.

Code 7112: An aneurysm in any small artery rates 0% if there are no symptoms. If there are symptoms, then the body part or system affected is rated. So if there is an aneurysm in a small artery of the leg that causes pain and a limited range of motion, then it would be rated on that limitation of motion.

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Arteriovenous Fistula

Code 7113: A traumatic arteriovenous fistula is an abnormal passageway between an artery and a vein. They are most often caused by penetrating wounds that affected nearby arteries or veins, thus causing the body to create a false passageway to continue blood flow. They can cause the heart to have to work harder to provide the necessary blood to all regions of the body, thus leading to various heart conditions. It can also cause loss of blood flow to the limbs resulting in pain, infection, swelling, skin changes, or amputation.

If the condition causes heart failure, then it is rated 100%. If the heart has not failed, but is enlarged with a rapid pulse and a wide pulse pressure, then it is rated 60%. If the heart is not affected, but in an arm there is swelling, stasis dermatitis, and either tears in the skin or a cellulitis infection, then it is rated 40%. If a leg has swelling, stasis dermatitis, and either tears in the skin or a cellulitis infection, it is rated 50%. If there is only swelling or stasis dermatitis in a leg, then it is rated 30%. If the swelling or stasis dermatitis is in an arm, it is rated 20%.

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Blood Flow Restrictions and Blocks

Code 7114 and 7115 are rated on the same system.

Code 7114: Arteriosclerosis obliterans (a.k.a. peripheral vascular disease) is the thickening and hardening of the tissues of an artery that causes the artery to narrow and develop blood clots. This condition most often affects the aorta artery in the abdomen and the small or medium arteries in the legs.

Code 7115: Thrombo-angiitis obliterans (or “Buerger’s Disease”) is a disease where the blood vessels of the hands or feet become blocked due to the build up of plaque. It is mostly associated with the use of tobacco products. It causes pain and swelling in the hands and feet and could result in necessary amputation.

The ratings:

A 100% rating is given if there is pain in the limbs and tears in the skin of the limbs from lack of oxygen or if there is pain in the limbs and the ankle brachial index is 0.4 or less.

A 60% rating is given if you cannot walk further than 25 yards without limping because of leg pain (claudication) and one or more of the following: there is coldness in the limb that does not respond to warming methods, there are one or more tears in the skin of the limb, or the ankle brachial index is 0.5 or less.

A 40% rating is given if there is limping because of leg pain when walking between 25 and 100 yards and one or more of the following: there are 1.) changes to the hair, skin, or nails of the affected limb, or 2.) the ankle brachial index is 0.7 or less.

A 20% rating is given if there is limping because of leg pain when walking more than 100 yards and one or more of the following: the pulse in the limb is diminished, or the ankle brachial index is 0.9 or less.

Note: The above ratings are for a single limb only. If more than one limb is affected, then rate each separately.

Other conditions:

Code 7117: Raynaud’s Syndrome is a condition that causes periods of severely restricted blood flow to areas of the body, most commonly the fingers and toes. Depending on how long these periods last, the damage to the affected areas could lead to amputation. “Characteristic attacks” include color changes to the affected areas, sometimes with pain and paralysis that could last minutes or hours. Regardless of how many areas are affected, only one rating is given for this condition as a whole.

A 100% rating is given if there is a history of characteristic attacks and tears in the skin on two or more affected areas and autoamputation of one or more fingers or toes. A 60% rating is given if there is a history of characteristic attacks and tears in the skin on two or more affected areas. A 40% rating is given if characteristic attacks occur at least daily. A 20% rating is given if characteristic attacks occur four to six times a week, and a 10% rating is given if characteristic attacks occur one to three times a week.

Code 7119: Erythromelalgia is a disorder that causes the blood vessels in the legs or hands to be periodically blocked, often on and off daily. This can cause swelling, redness, and pain. A “characteristic attack” consists of burning pain in the hands or feet with redness and heat. The symptoms normally occur equally in both hands or both feet at the same time. Regardless of how many areas are affected, only one rating is given for this condition as a whole.

A 100% rating is given if characteristic attacks occur more than once a day, lasting an average of more than 2 hours each. They respond poorly to treatment and restrict most daily activities. A rating of 60% is given if characteristic attacks occur more than once a day, lasting an average of more than 2 hours each. They respond poorly to treatment, but do not restrict most daily activities. A rating of 30% is given if characteristic attacks occur at least daily, but respond to treatment. A rating of 10% is given if characteristic attacks do not occur daily, but do occur at least 3 times a week and respond to treatment.

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Severe Allergic Swelling

Code 7118: Angioneurotic edema (a.k.a. angioedema or anaphylaxis) is a rapid allergic reaction that causes severe swelling just below the skin. The swelling most often occurs in the face and can cause the throat to swell and close up, although it can occur elsewhere. If there are attacks with swelling of the throat occurring 3 or more times a year, or if there are attacks that do not affect the throat lasting 1 or more days and occurring more than 8 times a year, then it is rated 40%. If there are attacks with swelling of the throat occurring 1 or 2 times a year, or if there are attacks that do not affect the throat lasting 1 or more days and occurring 5 to 8 times a year, it is rated 20%. If there are attacks that do not affect the throat lasting 1 or more days and occurring 2 to 4 times a year, it is rated 10%.

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Residual Symptoms from Vein and Artery Conditions

Code 7120 and 7121 are rated on the same system.

Code 7120: Varicose veins are veins that swell and have trouble moving blood in the right direction. They occasionally are painful.

Code 7121: Post-phlebitic syndrome can be caused by numerous different vein conditions. Basically, this is the catch-all term to describe any lasting symptoms of vein conditions. These symptoms can include pain, swelling, itching, tingling, skin discoloration, and open skin wounds. Circulatory disturbances are rated under this code.

The ratings:

Note: These ratings are for a single arm or leg at a time. If multiple extremities are involved, each receives its own rating.

A 100% rating is given if there is severe swelling to the extent that the limb is stiff like a board and there is constant pain at rest. A 60% rating is given if there is persistent swelling or a hardened bump under the skin, skin discoloration or itchy rashes, and an open skin wound that won’t heal. A 40% rating is given if there is persistent swelling and skin discoloration or itchy rashes whether or not there is an open wound. A 20% rating is given if there is persistent swelling that cannot be relieved by elevating the affected part whether or not skin discoloration or rashes are present. A 10% rating is given if there is occasional swelling or aching after prolonged use but the symptoms are relieved by rest, elevation or compression. A 0% rating is given if the veins can be felt or seen but are not symptomatic.

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Overexposure to the Cold

Code 7122: Frostbite and other conditions caused by overexposure to the cold can cause permanent damage to the arteries, nerves, and veins and are rated on the persistent symptoms of the condition.

A 30% rating is given if there is joint pain, numbness or sensitivity to the cold in the area affected and two or more of the following: discoloration of the skin, abnormal nail growth, tissue loss, decreased ability to feel, hyperhidrosis, or other abnormalities proven by x-ray.

A 20% rating is given if there is joint pain, numbness or sensitivity to the cold in the area affected and one of the following: discoloration of the skin, abnormal nail growth, tissue loss, decreased ability to feel, hyperhidrosis, or other abnormalities proven by x-ray.

A 10% rating is given if there is only pain, numbness or sensitivity to the cold in the affected area.

These ratings are for individual parts affected. So if a foot and a hand are both affected, then they each receive a separate rating. This does not include individual toes or fingers—if one or more fingers or toes are affected, then it is just rated once on the hand or foot.

Any other conditions resulting from overexposure to the cold not listed under this code are to be rated separately, including amputations, carcinomas and neuropathies.

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Cancer of the Blood Vessels

Sarcoma is a kind of cancer that is made up of diseased cells of the body parts it affects. So soft tissue sarcoma of the blood vessels is made up of diseased blood vessel cells. Any kind of cells in the body (bone, fat, etc) can create sarcoma cells, but sarcoma is very rare.

Code 7123: Sarcoma of the blood vessels is rated 100% while active. This rating will continue for the first 6 months following treatment. After that time, the condition will be reevaluated and rated based on its continuing symptoms.

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Other Artery and Vein Conditions

Some conditions relating directly to the arteries of the heart are discussed on The Heart page.

All other artery or vein conditions will be rated analogously (see the Analogous and Equivalent Codes page) with the above ratings. The bottom line rule is to rate any condition under the code that BEST describes it, even if it is not exact.

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DBQs for Artery and Vein Conditions

Here are the Disability Benefits Questionnaires (DBQs) used for artery and vein conditions: Hypertension DBQ and Artery and Vein Conditions (other) DBQ.

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Principles that Apply

Pyramiding: A single condition can only be rated once! However, if another condition exists that is additional to the artery or vein condition (not simply caused by it), then it can also be rated.

Probative Value: If two exams record the condition differently, the exam with the most thorough data and performed by the most qualified person in that specialty will be the exam the rating is based on.

A Tie Goes to the Veteran: If there are two equally strong exams with conflicting information, or if the condition can be equally rated under two different codes, then the one that gives the highest rating will be assigned. Every conflict should be resolved in favor of the higher rating.

Accurate Measurements: It is essential that the necessary information to rate your condition is recorded by the physician in your exam. With the information on this page, you should know what needs to be measured and recorded. Make sure this happens correctly to ensure that you receive a proper rating.

Hospital or Convalescent Ratings: Some conditions require periods of hospitalization or constant medical care (at-home nurse, etc.). Any condition that requires this is rated 100% during this intensive treatment. Once it ends, then the 100% rating will continue for a certain period. This period is 3 months unless another length (6 months, 1 year, etc.) is directly specified in the condition ratings. Some patients may need more time to recover than others, so the physician or Rating Authorities can lengthen this time period if they see fit.

The Bilateral Factor: If an artery or vein condition affects both upper or both lower limbs, then they are both separately rated and then combined with an addition 10% for the bilateral factor.

Please see the VASRD Principles page for further guidance.

For other heart, artery and vein conditions not discussed on this page, see The Heart page. for conditions of the blood, see The Blood page.

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