100% (DC 7114, ceiling tier)
Highest listed pathwayAnkle/brachial index (ABI) of 0.39 or less; ankle pressure under 50 mm Hg; toe pressure under 30 mm Hg; or TcPO2 under 30 mm Hg.
What separates the next level: 60 percent applies when the measurement falls in the next band up instead (ABI 0.40-0.53, etc.).
Review CFR criteria, examples, and evidence
- Official CFR language
- Ankle/brachial index (ABI) of 0.39 or less, ankle pressure of less than 50 mm Hg, toe pressure of less than 30 mm Hg, or transcutaneous oxygen tension (TcPO2) of less than 30 mm Hg -- 100.
- Qualification explanation
- Reached when any one of the four objective measurements meets this most-severe threshold.
- Examples
- Vascular studies document an ABI of 0.32 in the affected leg.
- Medical evidence
- Artery and Vein Conditions DBQ; Vascular studies (ABI, segmental pressures, TcPO2)
- Functional impact examples
- Most severe documented arterial insufficiency reachable under DC 7114.
- Common misconceptions
- Confirmed via two independent primary sources (verbatim): DC 7114 Note (2) states, 'If AP, TP, and Tc PO2 testing are not of record, evaluate based on ABI unless the examiner states that an AP, TP, or Tc PO2 test is needed in a particular case because ABI does not sufficiently reflect the severity of the veteran's peripheral arterial disease. In all other cases, evaluate based on the test that provides the highest impairment value.' This is an ABI-first default with an examiner-stated exception -- not a simple 'always use whichever test scores highest' rule.
- Related topics
- highest-evaluation-gap
- Source context
- 38 CFR 4.104; 7114; Current DC 7114 educational pathway. No pending rulemaking found touching this range (RSCH-040).
60% (DC 7114)
Next: 100%ABI of 0.40-0.53; ankle pressure of 50-65 mm Hg; toe pressure of 30-39 mm Hg; or TcPO2 of 30-39 mm Hg.
What separates the next level: 100 percent applies at the more severe band; 40 percent applies at the next band down.
Review CFR criteria, examples, and evidence
- Official CFR language
- Ankle/brachial index of 0.40 to 0.53, ankle pressure of 50 to 65 mm Hg, toe pressure of 30 to 39 mm Hg, or transcutaneous oxygen tension of 30 to 39 mm Hg -- 60.
- Qualification explanation
- Reached when any one of the four objective measurements falls within this band.
- Examples
- Vascular studies document a toe pressure of 35 mm Hg.
- Medical evidence
- Artery and Vein Conditions DBQ; Vascular studies
- Functional impact examples
- Significant documented arterial insufficiency, one band below DC 7114's ceiling.
- Related topics
- rating-criteria
- Source context
- 38 CFR 4.104; 7114; Current DC 7114 educational pathway.
40% (DC 7114)
Next: 60%ABI of 0.54-0.66; ankle pressure of 66-83 mm Hg; toe pressure of 40-49 mm Hg; or TcPO2 of 40-49 mm Hg.
What separates the next level: 60 percent applies at the more severe band; 20 percent applies at the next band down.
Review CFR criteria, examples, and evidence
- Official CFR language
- Ankle/brachial index of 0.54 to 0.66, ankle pressure of 66 to 83 mm Hg, toe pressure of 40 to 49 mm Hg, or transcutaneous oxygen tension of 40 to 49 mm Hg -- 40.
- Qualification explanation
- Reached when any one of the four objective measurements falls within this band.
- Examples
- Vascular studies document an ankle pressure of 74 mm Hg.
- Medical evidence
- Artery and Vein Conditions DBQ; Vascular studies
- Functional impact examples
- Moderate documented arterial insufficiency.
- Related topics
- rating-criteria
- Source context
- 38 CFR 4.104; 7114; Current DC 7114 educational pathway.
20% (DC 7114, floor -- no explicit 0 percent row)
Next: 40%ABI of 0.67-0.79; ankle pressure of 84-99 mm Hg; toe pressure of 50-59 mm Hg; or TcPO2 of 50-59 mm Hg.
What separates the next level: 40 percent applies at the next band up.
Review CFR criteria, examples, and evidence
- Official CFR language
- Ankle/brachial index of 0.67 to 0.79, ankle pressure of 84 to 99 mm Hg, toe pressure of 50 to 59 mm Hg, or transcutaneous oxygen tension of 50 to 59 mm Hg -- 20.
- Qualification explanation
- Reached when any one of the four objective measurements falls within this band -- DC 7114's lowest reachable tier.
- Examples
- Vascular studies document an ABI of 0.72.
- Medical evidence
- Artery and Vein Conditions DBQ; Vascular studies
- Functional impact examples
- Mildest documented arterial insufficiency reaching a DC 7114 rating.
- Common misconceptions
- Confirmed via two independent primary sources: DC 7114 has NO explicit 0 percent row -- measurements less severe than this band simply do not reach a DC 7114 rating at all, they are not rated at 0 percent under this code.
- Related topics
- rating-criteria
- Source context
- 38 CFR 4.104; 7114; Current DC 7114 educational pathway.
100% (DC 7111, aneurysm's single tier)
Highest listed pathwayThe aneurysm is symptomatic, or the veteran is within six months of hospital discharge following surgical correction.
What separates the next level: Outside this window, an asymptomatic aneurysm with no surgery scheduled has no named DC 7111 tier at all -- see the disclosed gap below. A surgically corrected aneurysm more than six months post-discharge is re-evaluated as peripheral arterial disease under DC 7114.
Review CFR criteria, examples, and evidence
- Official CFR language
- If symptomatic; or, for the period beginning on the date a physician recommends surgical correction and continuing for six months following discharge from inpatient hospital admission for surgical correction -- 100.
- Qualification explanation
- DC 7111 (aneurysm, any large artery) has only this single stated rating tier.
- Examples
- A physician has recommended surgical correction of an abdominal aortic aneurysm, and the veteran is three months past hospital discharge from that surgery.
- Medical evidence
- Artery and Vein Conditions DBQ; Surgical and hospital discharge records establishing the surgical-correction timeline
- Functional impact examples
- Documented symptomatic aneurysm, or a documented active surgical-recovery window.
- Common misconceptions
- DC 7111 is not a graduated ladder -- it states one 100 percent tier only, unlike DC 7114/7115's multi-tier structure.
- Related topics
- 7111-asymptomatic-gap
- Source context
- 38 CFR 4.104; 7111; Current DC 7111 educational pathway.
No tier named (DC 7111, asymptomatic gap -- disclosed, not computed)
Highest listed pathwayAn aneurysm that is asymptomatic and not within the surgical-correction window has no rating tier stated in DC 7111's own text.
What separates the next level: If the aneurysm becomes symptomatic, or surgical correction is recommended, the 100 percent tier applies for that period.
Review CFR criteria, examples, and evidence
- Official CFR language
- DC 7111's text states only the single 100 percent tier above; it names no separate tier for an asymptomatic aneurysm outside that window.
- Qualification explanation
- This is a genuine gap in the published schedule for this specific circumstance, not a RatingScope limitation -- disclosed here rather than silently defaulted to 0 percent or any other value.
- Examples
- An aneurysm is documented as asymptomatic, with no surgery scheduled or performed.
- Medical evidence
- Artery and Vein Conditions DBQ; Records documenting symptom status and any surgical planning
- Functional impact examples
- No documented symptoms and no planned surgical correction -- a circumstance DC 7111's own text simply does not address.
- Common misconceptions
- This is NOT the same as a 0 percent rating -- DC 7111 simply does not address this circumstance in its own text. RatingScope does not compute or guess a percentage here.
- Related topics
- 7111-asymptomatic-gap
- Source context
- 38 CFR 4.104; 7111; Current DC 7111 educational pathway -- disclosed gap, not a pending-rulemaking item.
100% (DC 7115, upper extremity ceiling)
Highest listed pathwayDeep ischemic ulcers and necrosis of the fingers, with persistent coldness, trophic changes with activity-related pain, and diminished pulses.
What separates the next level: 60 percent applies with the same coldness/trophic/pulse findings, but without ischemic ulcers or necrosis.
Review CFR criteria, examples, and evidence
- Official CFR language
- Deep ischemic ulcers and necrosis of the fingers with persistent coldness of the extremity, trophic changes with pains in the hand during physical activity, and diminished upper extremity pulses -- 100.
- Qualification explanation
- Reached when all of these upper-extremity findings are documented together.
- Examples
- Records document finger tip necrosis, persistent coldness of the hand, and diminished radial pulses.
- Medical evidence
- Artery and Vein Conditions DBQ; Vascular studies of the affected arm/hand
- Functional impact examples
- Most severe documented upper-extremity Buerger's disease findings reachable under DC 7115.
- Common misconceptions
- DC 7115's upper-extremity ladder is structurally INDEPENDENT of DC 7114 -- both happen to have four tiers at 100/60/40/20 percent, but the underlying findings are entirely different (measurement thresholds for DC 7114, clinical findings for DC 7115).
- Related topics
- function-reuse
- Source context
- 38 CFR 4.104; 7115; Current DC 7115 educational pathway.
60% (DC 7115, upper extremity)
Next: 100%Persistent coldness of the extremity, trophic changes with activity-related pain in the hands, and diminished upper extremity pulses -- without ischemic ulcers or necrosis.
What separates the next level: 100 percent applies when ischemic ulcers and necrosis of the fingers are also documented; 40 percent applies when trophic changes present as numbness/paresthesia at the fingertips instead of activity-related pain.
Review CFR criteria, examples, and evidence
- Official CFR language
- Persistent coldness of the extremity, trophic changes with pains in the hands during physical activity, and diminished upper extremity pulses -- 60.
- Qualification explanation
- Reached when coldness, activity-related trophic pain, and diminished pulses are documented together, without the ischemic ulcers or necrosis required for the 100 percent tier.
- Examples
- Records document persistent coldness of the hand, trophic changes with pain during physical activity, and diminished radial pulses, without ulcers or necrosis.
- Medical evidence
- Artery and Vein Conditions DBQ; Vascular studies of the affected arm/hand
- Functional impact examples
- Significant documented upper-extremity Buerger's disease findings, one tier below DC 7115's ceiling.
- Related topics
- function-reuse
- Source context
- 38 CFR 4.104; 7115; Current DC 7115 educational pathway.
40% (DC 7115, upper extremity)
Next: 60%Trophic changes with numbness and paresthesia at the fingertips, and diminished upper extremity pulses.
What separates the next level: 60 percent applies when trophic changes present instead as activity-related pain together with persistent coldness; 20 percent applies when only diminished pulses are documented, without trophic changes.
Review CFR criteria, examples, and evidence
- Official CFR language
- Trophic changes with numbness and paresthesia at the tips of the fingers, and diminished upper extremity pulses -- 40.
- Qualification explanation
- Reached when trophic changes present as numbness and paresthesia at the fingertips, together with diminished pulses.
- Examples
- Records document trophic changes with numbness and paresthesia at the fingertips, and diminished radial pulses.
- Medical evidence
- Artery and Vein Conditions DBQ; Vascular studies of the affected arm/hand
- Functional impact examples
- Moderate documented upper-extremity Buerger's disease findings.
- Related topics
- function-reuse
- Source context
- 38 CFR 4.104; 7115; Current DC 7115 educational pathway.
20% (DC 7115, upper extremity floor -- no explicit 0 percent row)
Next: 40%Diminished upper extremity pulses, without the other findings required for the higher tiers.
What separates the next level: 40 percent applies once trophic changes with numbness/paresthesia at the fingertips are also documented.
Review CFR criteria, examples, and evidence
- Official CFR language
- Diminished upper extremity pulses -- 20.
- Qualification explanation
- DC 7115's lowest reachable upper-extremity tier.
- Examples
- Records document diminished radial pulses with no other associated findings.
- Medical evidence
- Artery and Vein Conditions DBQ; Vascular studies
- Functional impact examples
- Mildest documented upper-extremity Buerger's disease finding reaching a DC 7115 rating.
- Common misconceptions
- Confirmed via two independent primary sources: DC 7115 has NO explicit 0 percent row -- findings milder than this simply do not reach a DC 7115 rating.
- Related topics
- rating-criteria
- Source context
- 38 CFR 4.104; 7115; Current DC 7115 educational pathway.