Peripheral Vascular Disease VA Rating

Peripheral vascular disease is rated under 38 CFR § 4.104, diagnostic code 7114, which the schedule now titles peripheral arterial disease. Since November 14, 2021, the rating turns on objective test numbers, not on how far you can walk. The main one is the ankle/brachial index, the ABI, which is the ratio of blood pressure at the ankle to blood pressure at the arm. The code also accepts ankle pressure, toe pressure, and transcutaneous oxygen tension (TcPO2), a measure of oxygen reaching the skin of the foot. Get a valid test result for each affected leg into the record and the rating tends to follow the regulation. Leave it out and the rating tends to default low or the case gets sent back.

The structural feature that separates DC 7114 from most cardiovascular codes is that each affected extremity is rated separately. If the left leg rates at 40 percent and the right leg rates at 20 percent, those are two ratings that combine, not one. A decision that assigns a single rating for both legs leaves the second leg's rating, and the bilateral factor that would follow, out of the calculation.

This page walks through the DC 7114 rating tiers and what each one requires, why the ABI and the other pressure tests set the rating, the C&P exam that determines whether the case is decided or remanded, the related code DC 7115 for Buerger's disease, peripheral vascular disease secondary to diabetes or hypertension under 38 CFR § 3.310, and why VA denies peripheral vascular disease claims.

TL;DR

• Peripheral vascular disease (peripheral arterial disease, titled arteriosclerosis obliterans in the schedule before November 14, 2021) is rated under 38 CFR § 4.104, DC 7114. Each affected extremity is rated separately.
• The rating engine is objective testing: the ankle/brachial index (ABI), ankle pressure, toe pressure, or transcutaneous oxygen tension (TcPO2). Walking distance, coldness, and skin or nail changes are no longer rating criteria.
• 100% requires at least one of: an ABI of 0.39 or less, ankle pressure below 50 mm Hg, toe pressure below 30 mm Hg, or TcPO2 below 30 mm Hg.
• 60% requires at least one of: an ABI of 0.40 to 0.53, ankle pressure of 50 to 65 mm Hg, toe pressure of 30 to 39 mm Hg, or TcPO2 of 30 to 39 mm Hg.
• 40% requires at least one of: an ABI of 0.54 to 0.66, ankle pressure of 66 to 83 mm Hg, toe pressure of 40 to 49 mm Hg, or TcPO2 of 40 to 49 mm Hg.
• 20% requires at least one of: an ABI of 0.67 to 0.79, ankle pressure of 84 to 99 mm Hg, toe pressure of 50 to 59 mm Hg, or TcPO2 of 50 to 59 mm Hg. DC 7114 lists no level below 20 percent.
• Diabetes and hypertension, both major medical risk factors for PAD, are common anchors for a secondary claim. Tobacco is a risk factor too, but disability from tobacco use during service cannot be service connected for claims received after June 9, 1998.
• Peripheral vascular disease is not on the Agent Orange list, and VA's definition of ischemic heart disease for that list expressly leaves it out.
• DC 7115 covers thromboangiitis obliterans (Buerger's disease). Leg involvement is rated under DC 7114; arm involvement has its own criteria built on pulses, coldness, trophic changes, pain with hand use, and ulcers.
• A ruling is one issue the Board decided in one decision; one decision often rules on several issues. Across 2,855 decided Board rulings on peripheral vascular disease from 2021 to 2026, 19.9% were granted, 27.4% denied and 52.6% remanded. Remand is the most common outcome, 7.3 points above the Board-wide remand share of 45.3%. Secondary claims outnumbered direct ones and were granted more often; the Board section below shows both.

Peripheral vascular disease VA rating criteria (DC 7114)

The peripheral arterial disease code is built as a ladder, and since the 2021 revision every rung is defined by objective test results. Here is what each tier requires under 38 CFR § 4.104.

At least one of the following: Ankle/brachial index less than or equal to 0.39; ankle pressure less than 50 mm Hg; toe pressure less than 30 mm Hg; or transcutaneous oxygen tension less than 30 mm Hg, 100%

At least one of the following: Ankle/brachial index of 0.40-0.53; ankle pressure of 50-65 mm Hg; toe pressure of 30-39 mm Hg; or transcutaneous oxygen tension of 30-39 mm Hg, 60%

At least one of the following: Ankle/brachial index of 0.54-0.66; ankle pressure of 66-83 mm Hg; toe pressure of 40-49 mm Hg; or transcutaneous oxygen tension of 40-49 mm Hg, 40%

At least one of the following: Ankle/brachial index of 0.67-0.79; ankle pressure of 84-99 mm Hg; toe pressure of 50-59 mm Hg; or transcutaneous oxygen tension of 50-59 mm Hg, 20%

A few things about how this ladder actually behaves.

Every tier is disjunctive: any single qualifying test result carries the tier, and when more than one test is in the record, VA rates on the one that shows the greatest impairment. The first part comes from the "at least one of the following" wording; the second comes from Note (2) to the code. If ankle pressure, toe pressure, and TcPO2 testing are not of record, VA rates on the ABI, unless the examiner states that one of those tests is needed because the ABI does not sufficiently reflect the severity of the disease. Note (1) adds that every measurement must be determined by objective testing.

Note (1) also defines normal for this code: an ABI of 0.80 or higher, an ankle pressure of 100 mm Hg or higher, and a toe pressure or TcPO2 of 60 mm Hg or higher. The 20 percent tier starts just below normal. By ABI alone, 0.67 to 0.79 supports 20 percent, 0.54 to 0.66 supports 40 percent, 0.40 to 0.53 supports 60 percent, and 0.39 or less supports 100 percent. Because Note (2) makes the ABI the default measurement, a C&P exam that omits it, without substituting another qualifying test, leaves the rater without a number to place the leg on the ladder.

Note (3) rates residuals of aortic and large arterial bypass surgery or an arterial graft as peripheral arterial disease. Note (4) makes each extremity its own rating: if more than one extremity is affected, each is evaluated separately and combined under § 4.25, using the bilateral factor under § 4.26 when it applies. The real-world combined rating for a veteran with bilateral PAD can therefore be substantially higher than any single leg's number. Two legs at 40 percent each do not equal 80 percent. They combine under 38 CFR § 4.25, and because both legs are involved, the bilateral factor under 38 CFR § 4.26 adds 10 percent of the combined value before further combinations. That is a meaningful adjustment that single-leg decisions never reach.

Ankle/brachial index (ABI) and the other tests that set the rating

If there is one thing to take from this page, it is that DC 7114 is decided by objective test results, and at least one of them has to be in the file for each affected leg.

The ankle/brachial index is measured with a blood pressure cuff and a Doppler probe, comparing systolic pressure at the ankle to systolic pressure at the arm. It is inexpensive, repeatable, and objective, and under Note (2) it is the default measurement when the other tests are not of record. An exam without an ABI, and without one of the alternative tests, is missing the number the code runs on.

Ankle pressure, toe pressure, and TcPO2 are the alternatives, and they matter most when the ABI understates the disease. In proposing the current criteria, VA noted that the former criteria did not account for veterans with non-compressible arteries, who can have a normal or elevated ABI that would have been noncompensable. When the examiner finds that the ABI does not sufficiently reflect severity, Note (2) allows rating on those other tests, and once they are of record VA uses whichever test shows the greatest impairment.

Walking distance no longer places a leg on the ladder. Before November 14, 2021, DC 7114 (then titled arteriosclerosis obliterans) combined ABI cutoffs with clinical findings: claudication distance on a level grade at two miles per hour, persistent coldness, trophic skin and nail changes, diminished pulses, rest pain, and ischemic ulcers. The current code dropped those findings from the leg criteria, and VA described claudication as an inconsistent measure of disability. Claudication, coldness, and skin changes still help establish the diagnosis and describe daily impact, but they do not set the percentage. Older records and Board decisions that discuss walking distance reflect the former criteria.

The gap between a usable exam and an unusable one is narrow. A Doppler ABI for each affected leg, plus a toe pressure or TcPO2 when the ABI may not reflect the disease, gives the rater everything DC 7114 needs. An exam that records none of them leaves the rater with a vascular diagnosis and no way to place it on the ladder, and that is precisely the kind of record that gets sent back rather than decided.

The peripheral vascular disease C&P exam

The artery and vein conditions DBQ drives the PAD exam. For DC 7114 specifically, the components that decide the rating are these.

• The ankle/brachial index for each affected extremity, measured by Doppler, not estimated.
• Ankle pressure, toe pressure, or TcPO2 for each affected extremity when the examiner finds that the ABI does not sufficiently reflect the severity of the disease, with the examiner's statement explaining why.
• A separate result for each leg, since each extremity is rated on its own.
• Residuals of any aortic or large arterial bypass surgery or arterial graft, which Note (3) rates as peripheral arterial disease.
• History and findings such as claudication, rest pain, ulcers, pulses, and skin changes, which support the diagnosis and describe functional impact but no longer set the percentage.

When all of these are in the report, the rater can place each leg on the DC 7114 ladder without guessing. When the exam omits the ABI and every alternative test, the case loses its objective anchor.

The Board data fits this. Remand is the most common outcome on peripheral vascular disease, at 52.6 percent of decided rulings, and the most common reason for a remand is an inadequate VA exam or opinion. The read records the Board's reason, not which measurement was missing, but an exam with no test result for each leg is exactly the kind of record that gets sent back. The Board section below shows the remand reasons and what happened after a remand.

Buerger's disease (DC 7115)

A related code worth knowing is DC 7115, thromboangiitis obliterans, commonly called Buerger's disease. It is a non-atherosclerotic inflammatory disease that most often affects the small and medium arteries, veins and nerves of the arms and legs. A history of smoking is the major criterion for the diagnosis, and it causes ischemia in the hands and feet much like other peripheral arterial disease.

Since November 14, 2021, DC 7115 splits by limb. Lower-extremity involvement is rated under DC 7114, on the same ABI, ankle pressure, toe pressure, and TcPO2 tiers. Upper-extremity involvement has its own ladder under 38 CFR § 4.104.

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%

Persistent coldness of the extremity, trophic changes with pains in the hands during physical activity, and diminished upper extremity pulses, 60%

Trophic changes with numbness and paresthesia at the tips of the fingers, and diminished upper extremity pulses, 40%

Diminished upper extremity pulses, 20%

Note (2) to DC 7115 says trophic changes include skin changes such as thinning, atrophy, fissuring, ulceration, scarring, and absence of hair, as well as nail changes such as clubbing and deformities. As with DC 7114, each extremity is evaluated separately and combined, using the bilateral factor when it applies.

The practical point is that for the legs, DC 7114 and DC 7115 use the same test numbers, so the distinction between them is a diagnostic one rather than a rating-mechanics one. For the arms, Buerger's disease is still rated on clinical findings, so pulses, coldness, trophic changes, pain with hand use, and ulcers need to be documented for each affected arm. If the clinical picture is small-vessel inflammatory disease in a tobacco user, DC 7115 may be the better-fitting code.

Peripheral vascular disease secondary to diabetes or hypertension

Peripheral arterial disease is often claimed as a downstream condition rather than a standalone one. In the Board's 2021 to 2026 service connection rulings on it, secondary claims outnumbered direct ones and were granted more often; the Board section below shows both. Under 38 CFR § 3.310, secondary service connection can be granted for a condition caused by a service-connected disability, or aggravated by it, meaning it would be less severe but for the service-connected disability. The anchors and issues that come up most are these.

Diabetes mellitus to PAD. Diabetes is one of the strongest medical risk factors for peripheral artery disease. A 2026 review found that smoking, diabetes, hypertension and high cholesterol account for roughly three quarters of cases, with smoking and diabetes the most common associations. A veteran service-connected for diabetes, including type 2 diabetes connected on an Agent Orange presumptive basis, who later develops claudication and a low ABI has a well-supported secondary theory. The nexus opinion should connect the diabetic vascular pathology to the arterial disease in the legs, not just note that both conditions exist.

Hypertension to PAD. Hypertension is another established risk factor. When hypertension is the service-connected anchor, the opinion has to explain how it contributed to the arterial disease in the legs and deal with the other risk factors in the record, such as smoking. Since the PACT Act, hypertension is on the statutory Agent Orange list in 38 USC § 1116, so for a veteran with covered herbicide service the hypertension itself may be presumptive.

Ischemic heart disease. Ischemic heart disease is on the Agent Orange list, but Note 2 to 38 CFR § 3.309(e) says that term does not include peripheral manifestations of arteriosclerosis such as peripheral vascular disease. A presumptive grant for heart disease does not carry PAD with it. PAD needs its own direct or secondary theory.

Tobacco. Tobacco use is a major risk factor for PAD and especially for Buerger's disease under DC 7115. For claims received after June 9, 1998, 38 CFR § 3.300 bars service connection on the basis that a disease came from tobacco use during service. That bar does not stop a claim that rests on another basis, such as a presumption or a service-connected condition like diabetes.

The standard for any of these nexus opinions is the same. The opinion has to identify the mechanism, address the time course, rule out the obvious alternative causes, and address aggravation as well as causation; an opinion that says only "not caused by" is inadequate (El-Amin v. Shinseki, 26 Vet. App. 136 (2013)). "Veteran has diabetes and also has PAD" is not a nexus. "The veteran's long-standing diabetic microvascular and macrovascular disease accelerated the atherosclerotic occlusion documented in the lower extremities, consistent with the reduced ABI and claudication onset" is the kind of articulated reasoning that carries a secondary claim.

A veteran service-connected for diabetes who then establishes bilateral PAD as a secondary, with each leg rated separately under DC 7114 and the bilateral factor applied, can build a combined rating well beyond what the diabetes rating alone produces.

Why VA denies peripheral vascular disease claims

Peripheral vascular disease claims do worse at the Board than the average claim. Across 2,855 decided Board rulings on peripheral vascular disease from 2021 to 2026, 19.9% were granted, 27.4% denied and 52.6% remanded. That grant rate is 4.8 points below the Board-wide 24.7 percent, and more than half of the decided rulings went back for more work.

When the Board denies peripheral vascular disease service connection, the most common reason is no link between the disease and service, followed by no in-service event or exposure. Less often, the record did not show a current diagnosis. The patterns repeat.

No link to service. The arterial disease appears years after discharge, and no medical opinion explains how service, or a service-connected condition, caused or worsened it.

A presumption that does not cover it. Peripheral vascular disease is not on the Agent Orange list, and VA's definition of ischemic heart disease for that list leaves it out. Claims argued under a presumption were granted least often of the three theories; the Board section below shows direct, secondary and presumptive results. The chronic disease presumption can still apply: arteriosclerosis is on the list in § 3.309(a), so arterial disease that reached a compensable level within one year after qualifying service can be presumed.

No objective diagnosis. Leg pain or cramping is recorded, but no ABI or other vascular test confirms arterial disease.

Secondary nexus left implicit. For PAD claimed as secondary to diabetes or hypertension, the file often shows both conditions but no medical opinion explicitly connecting them. The adjudicator is not obligated to infer the link. A nexus opinion that articulates the mechanism and addresses aggravation is what moves a secondary claim from plausible to granted.

Evidence gaps that hold down the rating

A few patterns I see across BVA decisions involving peripheral vascular disease concern the rating rather than service connection.

No ABI or alternative test in the record. This is the central gap. Under Note (2), the ABI is the default measurement, and without it or an ankle pressure, toe pressure, or TcPO2 result, the rater has no number to place the leg on any tier.

An ABI that may not reflect the disease. Non-compressible arteries can produce a normal or elevated ABI that understates the disease. If the examiner does not address that and no toe pressure or TcPO2 is taken, the leg can be rated on a number that understates it. Note (2) lets the examiner state that another test is needed.

Each leg not evaluated separately. DC 7114 rates each affected extremity on its own. When the exam treats PAD as a single bilateral entity and the decision assigns one rating, the second leg's rating, and the bilateral factor that would follow, never enter the calculation.

Records built on the former criteria. Walking distance, coldness, pulses, and skin or nail changes were leg rating criteria before November 14, 2021. They no longer set a leg's percentage under DC 7114. A claim or exam built around them, without a current test result, leaves the leg unplaced on the current ladder. For Buerger's disease in the arms, those clinical findings still matter under DC 7115.

When the Board sends a peripheral vascular disease claim back, the most common reason is an inadequate VA exam or opinion, followed by records VA still had to get. Appeals for a higher rating did better than service connection appeals. The Board section below shows the denial and remand reasons, what happened after a remand, results by what the appeal asked for, and what the Board did with medical opinions. Under the current code, the record that holds up is one with a documented ABI, or another qualifying test, for each affected leg, plus, where relevant, an articulated secondary nexus.

Questions veterans ask about peripheral vascular disease

What is the VA rating for peripheral vascular disease?

VA rates peripheral vascular disease of the legs under DC 7114, peripheral arterial disease, at 20, 40, 60 or 100 percent for each affected leg. Each level needs one qualifying test result: an ankle/brachial index, ankle pressure, toe pressure or transcutaneous oxygen reading. For example, an ABI of 0.67 to 0.79 supports 20 percent and an ABI of 0.39 or less supports 100 percent.

Does VA rate each leg separately for peripheral arterial disease?

Yes. Note (4) to DC 7114 says each affected extremity is evaluated separately and the ratings are combined under 38 CFR § 4.25. When both legs are rated, the bilateral factor in § 4.26 adds 10 percent of their combined value before it is combined with your other ratings.

Does walking distance still count for a peripheral vascular disease rating?

No. Since November 14, 2021, DC 7114 sets the percentage only on objective test results such as the ABI. VA dropped claudication distance from the criteria, calling claudication an inconsistent measure of disability. Claudication still helps show the diagnosis and how the disease affects your day.

Is peripheral vascular disease presumptive for Agent Orange?

No. Peripheral vascular disease is not on the herbicide list in 38 CFR § 3.309(e), and Note 2 to that section says ischemic heart disease does not include peripheral manifestations of arteriosclerosis such as peripheral vascular disease. It can still be service connected secondary to a condition that is presumptive, such as type 2 diabetes. Separately, arteriosclerosis is on the chronic disease list in § 3.309(a), which covers arterial disease that reached a compensable level within one year after service.

Can peripheral artery disease be secondary to diabetes?

Yes. Under 38 CFR § 3.310, PAD can be service connected if service-connected diabetes caused it or aggravated it, meaning the PAD would be less severe but for the diabetes. Having both conditions is not enough. A medical opinion has to explain the link and address aggravation as well as causation.

Is peripheral vascular disease the same as peripheral arterial disease for VA?

VA rates arterial disease of the legs under DC 7114, which the schedule titles peripheral arterial disease. Vein problems are rated under other codes, such as varicose veins under DC 7120 and post-phlebitic syndrome under DC 7121. Buerger's disease has its own code, DC 7115, though leg involvement under it is rated with the DC 7114 tests.

Bottom Line

Peripheral vascular disease ratings under DC 7114 are not really about the diagnosis. They are about objective test numbers: the ankle/brachial index, or ankle pressure, toe pressure, or TcPO2 when those are of record. Walking distance, coldness, and skin changes no longer set the percentage for a leg. Get a valid result into the record for each affected leg and the rating tends to track the regulation. Leave it out and the case defaults low or gets remanded, which is consistent with the Board data, where more than half of decided rulings were remanded and only 19.9 percent were granted. Each leg is rated separately, the bilateral factor applies when both are involved, and the most common route into the condition is a secondary claim, often from service-connected diabetes or hypertension. Same vascular disease, different paper trail, different outcome.

Related Conditions

Peripheral vascular disease most often connects to diabetes and hypertension, common secondary anchors. The secondary conditions to diabetes and secondary conditions to hypertension pages list the other conditions veterans claim from each. It overlaps in clinical picture and rating venue with varicose veins, another lower-extremity vascular condition rated under § 4.104, and with broader heart disease where shared atherosclerotic pathology and tobacco exposure run through the same record. Veterans pursuing PAD as a secondary should review the secondary conditions tool before assuming a single-leg rating tells the whole story.

Methodology and Limitations

• Data source: Rating criteria quoted from 38 CFR § 4.104, DC 7114 (peripheral arterial disease) and DC 7115 (thromboangiitis obliterans / Buerger's disease), in the version effective November 14, 2021, checked against the eCFR text dated September 20, 2026 and again on October 6, 2026. VA's reasons for dropping claudication distance and adding ankle pressure, toe pressure, and TcPO2 are from its 2019 proposed rule for the cardiovascular system (84 FR 37594); the final rule is 86 FR 54089, effective November 14, 2021. Combined ratings math from § 4.25 and the bilateral factor from § 4.26. Secondary service connection from § 3.310, with secondary aggravation under Allen v. Brown, 7 Vet. App. 439 (1995), and El-Amin v. Shinseki, 26 Vet. App. 136 (2013). Presumptions from §§ 3.307 and 3.309(a) and (e) and 38 USC § 1116; the tobacco rule from § 3.300. Medical background from Yukselen and Mukherjee, "Epidemiology of Peripheral Artery Disease, Risk Factors, and Trends," International Journal of Angiology (2026); Cacione et al., "Pharmacological treatment for Buerger's disease," Cochrane Database of Systematic Reviews (2020); and Fazeli et al., "Diagnostic criteria for Buerger's disease," International Angiology (2023), read as PubMed abstracts.
• Sample size: Board figures in this post come from Claim Raven's read of every Board decision from 2021 to 2026 that it holds: 511,036 decisions containing 1,378,030 rulings. Of 3,085 Board rulings on peripheral vascular disease, 2,855 were decided (granted, denied or remanded); the rest were dismissed, withdrawn or closed another way. Across 2,855 decided Board rulings on peripheral vascular disease from 2021 to 2026, 19.9% were granted, 27.4% denied and 52.6% remanded, against a Board-wide grant rate of 24.7% on decided rulings. Claim theory, denial and remand reasons, post-remand outcomes, appeal types and medical-opinion tiers appear in the Board section below, computed from the same data. The data captures the outcome of each ruling rather than a per-extremity or per-tier breakdown.
• Classification approach: Diagnostic code definitions drawn from the regulatory text. Secondary analysis follows § 3.310 and the medical relationship between diabetes, hypertension, tobacco exposure, and arterial disease. Compensation logic uses the VA combined ratings table and the bilateral factor.
• Limitations:
• The ABI, ankle pressure, toe pressure, and TcPO2 cutoffs are quoted from DC 7114, but their application depends on whether the exam actually recorded those measurements. Many records do not.
• Some Board decisions in the data may address periods before November 14, 2021, when the former DC 7114 criteria (claudication distance, coldness, trophic changes, pulses, rest pain, and ulcers) applied, so some outcomes may reflect the former criteria.
• Worked descriptions of combined ratings are illustrative; exact combined values depend on the specific ratings and the § 4.25 table.
• The distinction between DC 7114 and DC 7115 is diagnostic. A clinician's characterization of the underlying disease decides which code fits.
• Secondary service connection for PAD depends on a competent, articulated nexus opinion. The existence of a service-connected anchor like diabetes does not by itself establish the link.
• Selection bias: BVA-level patterns reflect cases that appealed. Most peripheral vascular disease claims resolve at the RO level and are not in any BVA dataset.
• These observations reflect patterns from the regulatory text and BVA decisions. They are not predictions of individual outcomes.