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Aortic aneurysm is rated under 38 CFR § 4.104, Diagnostic Code 7110, covering ascending, thoracic, and abdominal aneurysms. The code has two evaluations and nothing in between: 100 percent or 0 percent.
The detail that decides how much money is on the table is the start date. DC 7110 was rewritten effective November 14, 2021, and the current note ties the 100 percent to the date a physician recommends surgical correction. Several of the pages ranking for this condition still say the 100 percent runs from the date of hospital admission. For a veteran who waits three months between the surgeon's recommendation and an operating room date, that is three months of total compensation.
TL;DR
- DC 7110 assigns 100 percent if the aneurysm is five centimeters or larger in diameter, is symptomatic, or requires surgery.
- Otherwise it assigns 0 percent. That is an assigned evaluation, not a denial.
- When surgery is required, the 100 percent begins on the date a physician recommends surgical correction.
- A mandatory VA examination follows six months after hospital discharge.
- Any reduction from that examination is subject to 38 CFR § 3.105(e).
- Post-surgical cardiovascular residuals are evaluated under the General Rating Formula for cardiovascular disease.
- Non-cardiovascular residuals of surgical correction are rated by the organ systems affected.
- Aneurysms of other arteries are DC 7111 (large artery) or DC 7112 (small artery), not DC 7110.
The Two Evaluations
The current DC 7110 entry reads:
Evaluate at 100 percent if the aneurysm is any one of the following: Five centimeters or larger in diameter; symptomatic (e.g., precludes exertion); or requires surgery ... 100
Otherwise ... 0
Any one of the three triggers is enough. You do not need all three, and the criteria are joined by "or" in the regulation itself.
Five centimeters or larger in diameter. This is a measurement off imaging. Serial CT or ultrasound reports carry the diameter, and the number in the radiologist's impression is the number that matters.
Symptomatic. The regulation gives one example, "precludes exertion," but the example is illustrative rather than exhaustive. Deep abdominal or low back pain, chest pain with a thoracic aneurysm, early satiety from mass effect, and hoarseness from nerve compression are all symptoms attributable to the aneurysm.
Requires surgery. This is the trigger most often misapplied.
The 0 Percent Is Not a Denial
A veteran with a service-connected aortic aneurysm measuring under five centimeters, asymptomatic and not requiring surgery, holds a 0 percent rating. This produces a rating decision that pays nothing and reads, to most people, like a loss.
It is not. A 0 percent evaluation preserves the finding of service connection. That finding is what lets you file for an increase the moment the aneurysm reaches five centimeters, becomes symptomatic, or is referred for repair, without having to re-establish the connection to service. It also preserves your effective date for that underlying service connection.
Aneurysms grow. A 0 percent under DC 7110 is a rating that is expected to change, and keeping the annual surveillance imaging in the VA record is what makes the increase straightforward when it does.
When the 100 Percent Starts and Stops
The note attached to DC 7110 is the operative text:
When surgery is required, a 100-percent evaluation begins on the date a physician recommends surgical correction with a mandatory VA examination six months following hospital discharge. Evaluate post-surgical residuals under the General Rating Formula. Any change in evaluation based upon that or any subsequent examination shall be subject to the provisions of § 3.105(e) of this chapter.
Read the start date carefully. It is the date a physician recommends surgical correction. It is not the date of admission, and it is not the date of the operation. Before the November 14, 2021 rewrite, the rule did run from hospital admission, which is why older Board decisions and several current guide pages describe it that way. If your claim spans that period, the effective date analysis is worth checking against the version of the regulation in force at the time.
Preserve the clinic note in which the surgeon or cardiologist recommends repair. That single document sets the start date.
The end is a mandatory VA examination six months after discharge from the hospital admission for surgery. Whatever evaluation comes out of that examination is a new rating decision. If it lowers your percentage, § 3.105(e) requires VA to propose the reduction, notify you, and give you an opportunity to submit evidence and request a hearing before it takes effect. A reduction that skipped that procedure is worth challenging on that basis alone.
Rating Residuals After Repair
The regulation names two distinct residual routes, and most guides mention only the first.
Cardiovascular residuals are evaluated under the General Rating Formula for cardiovascular disease, which is driven by metabolic equivalents (METs) capacity, ejection fraction, and cardiac findings such as congestive heart failure. This is the route for reduced exercise tolerance and cardiac dysfunction after repair.
Non-cardiovascular residuals get their own sentence in DC 7110: "Evaluate non-cardiovascular residuals of surgical correction according to organ systems affected." Open repair of an abdominal aortic aneurysm is major abdominal surgery. Renal impairment, bowel dysfunction, nerve injury, and the surgical scar itself are organ-system findings rated under their own codes, not folded into a cardiac METs figure.
The surgical scar is worth claiming explicitly. Board decisions on aortic aneurysm repair regularly address scar ratings as a separate issue.
Service Connection
Direct. An aneurysm diagnosed during service, or attributable to documented in-service chest or abdominal trauma, supports direct service connection under 38 CFR § 3.303. This needs a current imaging study confirming the aneurysm, the in-service event in the record, and a medical opinion linking them.
Secondary to hypertension. Sustained hypertension contributes to aneurysm formation and growth. Where hypertension is already service connected, 38 CFR § 3.310(a) supports secondary causation with a medical opinion that addresses the connection specifically. Under § 3.310(b), poorly controlled service-connected hypertension that accelerated an aneurysm's growth supports an aggravation theory. VA's claims manual, M21-1 V.ii.2.D (changed May 1, 2026 to follow Spicer v. McDonough), asks whether the increase would not have happened, or the aneurysm would be less severe, but for the service-connected hypertension, including when it got in the way of treatment. VA no longer considers natural progress in these claims, even though the text of § 3.310(b) still mentions it, and the worsening does not have to be permanent. VA still needs a baseline before the aggravation to measure against and rates the difference between the baseline and the current severity; an increase too small to change the rating level is granted at 0 percent.
Ask the physician to address competing causes directly. Age, smoking history, and connective tissue disorders are the alternatives an examiner will reach for, and an opinion that does not engage with them is easy to discount.
Note one procedural point: the § 4.104 notes require VA to evaluate hypertension separately from hypertensive heart disease and other heart disease. Your hypertension rating and your aneurysm rating are separate evaluations.
Common Failure Modes
- Using the date of hospital admission rather than the date the physician recommended surgery.
- Reading a 0 percent evaluation as a denial and not filing for an increase when the aneurysm grows.
- Missing the mandatory six-month post-discharge examination.
- Accepting a reduction that did not follow § 3.105(e).
- Rating only cardiovascular residuals and omitting the organ-system route.
- Never claiming the surgical scar.
- Applying DC 7110 to an aneurysm of another artery. Large arteries are DC 7111, small arteries are DC 7112.
- Submitting a hypertension nexus opinion that does not address age and smoking as competing causes.
Bottom Line
DC 7110 is a simple code with one expensive detail. Two evaluations exist, 100 percent and 0 percent, and the triggers are measurable: five centimeters, symptomatic, or requiring surgery. The 100 percent starts on the date a physician recommends repair, which is usually earlier than veterans and sometimes earlier than raters assume. After the mandatory six-month examination, build the residual record on both tracks the regulation names, cardiovascular and organ-system, and do not leave the scar unclaimed.
Related Conditions and Tools
Compare hypertension, heart disease, peripheral vascular disease, and scars. Review DC 7101 for the hypertension code that anchors the secondary lane, and organize imaging reports and surgical records with the Statement Builder and the Evidence Checklists.
Legal sources: 38 CFR § 4.104, § 3.105, § 3.303, and § 3.310, checked against the eCFR snapshot for August 14, 2026. Secondary aggravation guidance from M21-1 V.ii.2.D (change date May 1, 2026), checked September 24, 2026.