Peripheral Artery Disease — VA Disability Rating Criteria (DC 7114)

Diagnostic Code 7114 · 38 CFR §4.104

What Is It?

Peripheral artery disease is a circulatory condition where narrowed arteries reduce blood flow to your limbs, most commonly the legs. Symptoms include cramping leg pain on walking that eases with rest, pain at rest as the disease progresses, slow-healing wounds, and in severe cases tissue death requiring amputation. Veterans may develop it as a result of diabetes, hypertension, smoking during service, or exposure to herbicide agents like Agent Orange. What matters for the rating is narrower than the symptom picture: DC 7114 is scored entirely on objective circulation testing. Four measurements can carry it — ankle/brachial index, ankle pressure, toe pressure, and transcutaneous oxygen tension — and each of the four evaluations lists a band for all four. Meeting at least one of the four in a band is enough for that evaluation. Note (1) to the code sets the normal values: an ankle/brachial index of 0.80 or greater, an ankle pressure of 100 mm Hg or greater, a toe pressure of 60 mm Hg or greater, and a transcutaneous oxygen tension of 60 mm Hg or greater, all determined by objective testing. Note (2) says which test governs: where ankle pressure, toe pressure and transcutaneous oxygen tension are not of record, evaluate on the ankle/brachial index, unless the examiner states another test is needed because the index does not sufficiently reflect the severity; in all other cases evaluate on the test that provides the highest impairment value. Note (3) reaches beyond the disease itself — evaluate residuals of aortic and large arterial bypass surgery or arterial graft as peripheral arterial disease, which is where a repaired aneurysm under DC 7110 or DC 7111 ends up. Note (4) makes each evaluation a single extremity: where more than one is affected, each is evaluated separately and combined under 38 CFR 4.25, with the bilateral factor at 38 CFR 4.26 where it applies. The code prints no 0 percent row, so where none of the bands is met 38 CFR 4.31 assigns 0.

Rating Criteria

Evidence Needed

An ankle/brachial index test — a comparison of the systolic blood pressure at the ankle with the simultaneous brachial artery systolic pressure — is the primary rating evidence, and the number itself is what the evaluation is read off. Ankle pressure, toe pressure and transcutaneous oxygen tension are the three alternatives, and any one of them meeting a band is enough for that evaluation, so ask for whichever of them your specialist thinks reflects your severity best. Additional testing may include Doppler ultrasound, CT angiography, or MR angiography to visualize the blockages. Treatment records showing medications (blood thinners, statins, antiplatelet drugs), procedures (angioplasty, stenting, bypass grafting), and wound care for circulation-related ulcers document severity. If PAD is secondary to diabetes or hypertension, include a nexus opinion. If claiming under Agent Orange presumptive, provide qualifying service evidence.

C&P Exam Tips

The exam will include a physical examination of your lower extremities and, in most cases, ankle/brachial index testing. The single most important thing is that the measurement is actually taken and recorded as a number — the four evaluations are bands of numbers, and an exam that describes your symptoms without measuring anything gives the rater nothing to read them against. If ankle pressure, toe pressure or transcutaneous oxygen tension has been measured, bring those results too: the code lets whichever test gives the highest impairment value carry the evaluation once more than one is of record. Each affected limb is evaluated separately, so ask that both legs be measured. Describe rest pain, non-healing wounds and any skin changes as well — they are what prompt a specialist to order the further testing the higher bands usually rest on.

How to File

File on VA Form 21-526EZ. If PAD is secondary to service-connected diabetes or hypertension, identify the primary condition and include a nexus opinion. For Agent Orange presumptive claims, provide evidence of qualifying service. Submit ABI test results, vascular imaging, treatment records, and documentation of any procedures or wound care.

Common Mistakes

The most common mistake is not getting an ankle/brachial index test before filing. The code is scored on objective testing and nothing else, so without a measured number there is no band to place you in. The second is arguing the claim on walking distance. Walking distance decided these evaluations before the 2021 revision of 38 CFR 4.104 and it decides none of them now — the schedule no longer prints a distance anywhere. Describe the symptoms so the specialist orders the right test, then let the number carry the rating. Veterans also sometimes do not claim PAD secondary to already service-connected diabetes or hypertension, both of which are well-established causes of vascular disease.

Frequently Asked Questions

What ankle/brachial index do I need for each rating?

An index of 0.67 to 0.79 is 20 percent, 0.54 to 0.66 is 40 percent, 0.40 to 0.53 is 60 percent, and 0.39 or less is 100 percent. Note (1) to the code puts normal at 0.80 or greater. Ankle pressure, toe pressure and transcutaneous oxygen tension have their own bands at each level, and meeting any one of the four is enough.

I had bypass surgery or an arterial graft. What am I rated under?

Note (3) to DC 7114 says to evaluate residuals of aortic and large arterial bypass surgery or arterial graft as peripheral arterial disease. So once the temporary total under DC 7110 or DC 7111 ends and the mandatory examination is done, the repaired artery is rated on this code — on ankle/brachial index, ankle pressure, toe pressure or transcutaneous oxygen tension, the same as the disease itself.

Can I get separate ratings for PAD in each leg?

Yes. If both legs are affected by PAD, each leg is rated separately. The bilateral factor (an additional percentage added for conditions affecting both limbs) may also apply, increasing your combined rating.