Varicose Veins and Post-Phlebitic Syndrome VA Rating: DC 7120 & DC 7121

In 38 CFR 4.104, Diagnostic Code 7120 for varicose veins contains no independent percentage rating criteria. Instead, the schedule provides a direct instruction: rate varicose veins under DC 7121 (post-phlebitic syndrome of any etiology). Whether venous insufficiency originates from primary congenital valvular failure, superficial vein varicosities, or chronic residuals of deep vein thrombosis (DVT), the identical 6-tier disability ladder governs the rating.

DC 7121 establishes six distinct rating levels: 100% for massive board-like edema with constant severe pain at rest; 60% for persistent edema or subcutaneous induration, stasis pigmentation or eczema, and persistent ulceration; 40% for persistent edema and stasis pigmentation or eczema, with either intermittent ulceration or no ulceration; 20% for persistent edema incompletely relieved by elevation of extremity; 10% for intermittent edema of extremity, or aching and fatigue in leg relieved by elevation or compression hosiery; and 0% for asymptomatic visible or palpable varicose veins.

Deep vein thrombosis (DVT) is an acute medical event that frequently results in permanent damage to delicate venous valves, producing post-thrombotic syndrome. In VA adjudication, chronic post-DVT complications are not rated under an acute blood clot code, but under DC 7121 based on observable clinical findings of chronic swelling, stasis dermatitis, skin induration, and ulceration.

Venous disease reflects impaired blood return from the extremities toward the heart, characterized by fluid pooling, dependent edema, hyperpigmentation, and skin breakdown that responds favorably to leg elevation. By contrast, peripheral arterial disease is an issue of impaired blood flow away from the heart. Objective arterial testing such as the ankle-brachial index (ABI) is never applied to venous ratings, and venous stasis symptoms cannot be substituted for arterial pressure measurements.

Under DC 7121 Note (2), post-phlebitic syndrome is evaluated separately for each affected lower extremity. When both the right and left lower extremities are service-connected, the separate evaluations are combined under 38 CFR 4.25, and the 10% bilateral factor adjustment under 38 CFR 4.26 is applied. The official examination form is the VA Artery and Vein Conditions Disability Benefits Questionnaire.