VA Disability Rating for Arteriovenous Fistula (DC 7113)
Diagnostic Code 7113 · 38 CFR §4.104
What Is It?
An arteriovenous (AV) fistula is an abnormal connection between an artery and a vein that allows blood to bypass the capillaries and flow directly from the artery to the vein. Traumatic AV fistulas commonly occur from penetrating injuries such as gunshot wounds, shrapnel, or stab wounds — making them particularly relevant for veterans. Congenital AV fistulas may also be service-aggravated. Large or symptomatic AV fistulas can cause high-output heart failure, swelling, pain, and impaired blood flow to the affected area. DC 7113 is built in two halves. The top two evaluations turn on the heart: 100 percent with high-output heart failure, 60 percent without heart failure but with an enlarged heart, wide pulse pressure and tachycardia. Below that, where there is no cardiac involvement at all, the code splits by limb — the same findings are worth more in a lower extremity than in an upper one. Chronic edema, stasis dermatitis and either ulceration or cellulitis is 50 percent in a lower extremity and 40 percent in an upper one; chronic edema or stasis dermatitis alone is 30 percent in a lower extremity and 20 percent in an upper one. The code prints no 0 percent row, so where none of the criteria are met 38 CFR 4.31 assigns 0.
Rating Criteria
| Rating | Criteria |
|---|---|
| 100% | With high-output heart failure. |
| 60% | Without heart failure but with enlarged heart, wide pulse pressure, and tachycardia. |
| 50% | Without cardiac involvement but with chronic edema, stasis dermatitis, and either ulceration or cellulitis — lower extremity. |
| 40% | Without cardiac involvement but with chronic edema, stasis dermatitis, and either ulceration or cellulitis — upper extremity. |
| 30% | Without cardiac involvement but with chronic edema or stasis dermatitis — lower extremity. |
| 20% | Without cardiac involvement but with chronic edema or stasis dermatitis — upper extremity. |
Evidence Needed
- Imaging confirming the AV fistula — duplex ultrasound, CT angiography, or conventional angiography
- Records of the original injury that caused the fistula (for traumatic cases)
- Echocardiogram to assess cardiac output and whether heart failure is developing
- Documentation of symptoms — swelling, pain, warmth, bruit, skin changes
- Vascular surgery records if repair was attempted
- Which limb is affected, stated plainly — the two lowest evaluations are worth ten percentage points more in a lower extremity than in an upper one
- Documentation of chronic edema, stasis dermatitis, and any ulceration or cellulitis — these are the findings the 50, 40, 30 and 20 percent rows are built on
C&P Exam Tips
- Bring records of the original injury that caused the AV fistula if it was traumatic
- Make sure the examiner listens for and documents any bruit at the fistula site
- Describe all symptoms including swelling, pain and skin changes, and make sure the examiner records which limb — the code rates a lower extremity higher than an upper one on the same findings
- If the fistula affects your heart, bring echocardiogram results showing cardiac output
- Report any complications like bleeding, thrombosis, or progressive enlargement
How to File
File on VA Form 21-526EZ. For traumatic AV fistulas, include records of the in-service injury and current vascular imaging. For cases causing cardiac effects, include echocardiogram results. A nexus letter connecting the fistula to the service injury is important.
Common Mistakes
Not connecting the fistula to the original combat or service injury Clearly document the mechanism of injury and how it created the abnormal artery-vein connection. Overlooking cardiac effects Large AV fistulas put extra strain on the heart. Get an echocardiogram: high-output heart failure is the 100 percent row, and an enlarged heart with wide pulse pressure and tachycardia is the 60 percent row. Not documenting the bruit and physical findings Ask your doctor to document the bruit, thrill, swelling, and any skin changes at each visit.
Frequently Asked Questions
Can a traumatic AV fistula from a combat injury be service-connected?
Yes, and these are among the strongest claims. If you sustained a penetrating injury in service and now have an AV fistula at that site, the connection is usually straightforward.
What if the fistula was surgically repaired?
You are evaluated on what remains after repair. DC 7113 prints no 0 percent row of its own, so where a successful repair leaves none of the listed findings, 38 CFR 4.31 supplies the 0 percent evaluation. Any remaining chronic edema, stasis dermatitis, ulceration or cellulitis is still compensable, and so is any cardiac involvement.
Can an AV fistula created for dialysis be rated?
A surgically created dialysis fistula itself is not a disability, but the underlying kidney disease that requires dialysis would be rated under the kidney diagnostic codes.