Varicose Veins

Varicose veins get rated under a single diagnostic code, 38 CFR § 4.104, DC 7120. There's no seven-code stacking puzzle here like there is with the knee. The rating turns on one distinction, and almost everything in the file should be aimed at that distinction. Is the edema persistent or intermittent? That single word decides whether you sit at 10 percent or jump to 20 and up.

The criteria read like a ladder of skin and swelling findings. At the bottom is asymptomatic varicosity that you can see or feel but that does nothing functionally. One rung up is intermittent edema, or aching and fatigue after prolonged standing or walking, relieved by elevation or compression hosiery. That's the 10 percent world. The jump to 20 percent is the word "persistent": edema that does not fully resolve when you elevate the leg. From there the ladder climbs through stasis pigmentation, eczema, and ulceration, ending at massive board-like edema with constant pain at rest at 100 percent.

The other thing to understand up front is that each leg is its own claim. DC 7120 rates a single extremity, so a veteran with bilateral varicose veins gets two separate ratings, and when both legs are service-connected the bilateral factor under 38 CFR § 4.26 adds 10 percent to the combined value. This page walks through the DC 7120 tiers, the persistent-versus-intermittent lever, what a C&P examiner has to actually look at and photograph, the secondary chains into chronic venous insufficiency, stasis dermatitis, and post-DVT residuals, and the evidence gaps I see across the BVA dataset.

TL;DR

• Varicose veins are rated under 38 CFR § 4.104, DC 7120, on a single ladder from 0 to 100 percent, with each leg rated separately.
• The decisive lever is persistent versus intermittent edema. Intermittent edema relieved by elevation or compression caps at 10 percent. Persistent edema that elevation does not fully relieve starts at 20 percent.
• Higher tiers add skin findings: stasis pigmentation or eczema at 20 to 40 percent, persistent ulceration at 40 to 60 percent, and massive board-like edema with constant pain at rest at 100 percent.
• The bilateral factor under 38 CFR § 4.26 adds 10 percent to the combined value when both legs are service-connected.
• Document elevation use, compression hosiery use, standing and walking tolerance, and skin changes. Photographs of pigmentation, eczema, and ulcers carry real weight.
• Secondary chains under 38 CFR § 3.310 run to chronic venous insufficiency, stasis dermatitis, and residuals of deep vein thrombosis (DVT, rated under DC 7121).
• In Claim Raven's analysis of 525 BVA varicose veins cases, 43.4% were remanded, 14.3% granted, and 27.4% denied. Among the 410 cases with a C&P adequacy determination, 59.8% had the exam flagged as inadequate.
• The remand-heavy pattern tracks the evidence problem: these claims fail less on whether varicose veins exist than on whether the exam pinned down the persistent-versus-intermittent question and the skin findings.

DC 7120 and What Each Tier Pays

The varicose vein criteria under 38 CFR § 4.104 are a single graduated scale. Here is the regulatory ladder, rated for the involvement of a single extremity:

Massive board-like edema with constant pain at rest, 100% Persistent edema or subcutaneous induration, stasis pigmentation or eczema, and persistent ulceration, 60% Persistent edema and stasis pigmentation or eczema, with or without intermittent ulceration, 40% Persistent edema, incompletely relieved by elevation of the extremity, with or without beginning stasis pigmentation or eczema, 20% Intermittent edema of the extremity or aching and fatigue in the leg after prolonged standing or walking, with symptoms relieved by elevation of the extremity or compression hosiery, 10% Asymptomatic palpable or visible varicose veins, 0%

A few things to read carefully here. The note under DC 7120 directs that these evaluations are for involvement of a single extremity. If more than one extremity is involved, each is evaluated separately and combined under the combined ratings table, with the bilateral factor applied where it fits.

The 0 percent tier is the visible-but-quiet picture: you can see the rope-like veins or palpate them, but they aren't producing edema, aching, or skin change. A lot of veterans assume cosmetic varicosity is worth something. By the regulation, asymptomatic varicose veins are service-connectable but noncompensable.

The 10 percent tier is the first paying rung. It captures either intermittent edema or the aching-and-fatigue presentation after prolonged standing or walking, with the key qualifier that the symptoms are relieved by elevation or by compression hosiery. The fact that you wear compression stockings and they help is, by the text of the regulation, consistent with the 10 percent tier rather than a higher one.

The 20 percent tier is where the rating mechanics get serious, and it is covered in its own section below because it is the most common pivot point in these claims.

The Persistent-Versus-Intermittent Lever

The single biggest swing in a varicose vein rating, and where I see most of the disputes in the BVA dataset, is the line between the 10 percent tier and the 20 percent tier. The regulation draws that line with one word: persistent.

At 10 percent, the edema is intermittent. It comes and goes, and crucially it is relieved by elevation or compression. You put your leg up, the swelling goes down. You wear the stockings, the aching is manageable.

At 20 percent, the edema is persistent and "incompletely relieved by elevation of the extremity." The swelling is there most of the time, and putting the leg up does not make it fully resolve. The 20 percent tier also picks up the early skin changes ("with or without beginning stasis pigmentation or eczema"), but the load-bearing element is the persistence of the edema.

This matters because the typical C&P exam captures one day and one snapshot. An examiner who measures a leg in the morning, sees mild swelling, and notes "edema present, relieved with elevation" has effectively written a 10 percent exam, whether or not the veteran's actual lived pattern is persistent. If the swelling is there at the end of every workday, does not go away overnight, and only partially responds to elevation, that is a 20 percent picture, and the record has to say so.

The evidence that pushes a claim from intermittent to persistent is rarely the single exam. It is the longitudinal record: treatment notes describing chronic swelling across multiple visits, the veteran's own log of daily edema, photographs taken at different times of day, and a clear statement of how the leg responds to elevation. When the file shows swelling that persists despite elevation, the 20 percent tier is on the table. When the file shows swelling that resolves with elevation, it is not.

I want to be precise about a limit in the data here. The Claim Raven dataset codes the overall outcome of a BVA case, not the specific DC 7120 tier assigned. So I can describe this lever qualitatively from the regulation and from how the Board writes its remands, but I cannot read a "10 percent versus 20 percent" split directly out of the numbers.

Climbing the Ladder: Stasis Pigmentation, Eczema, and Ulceration

Above 20 percent, the rating is driven by skin findings layered on top of persistent edema.

Stasis pigmentation and eczema (40 percent). The 40 percent tier requires persistent edema and stasis pigmentation or eczema, with or without intermittent ulceration. Stasis pigmentation is the brownish discoloration around the lower leg and ankle that develops when chronic venous pressure pushes red blood cells into the tissue and they break down. Stasis eczema (also called stasis dermatitis) is the scaly, itchy, sometimes weeping skin change over the same area. These are objective, photographable findings. The presence of either one, on top of persistent edema, is what separates the 40 percent picture from the 20 percent picture.

Persistent ulceration (60 percent). The jump to 60 percent requires the full set: persistent edema or subcutaneous induration, stasis pigmentation or eczema, and persistent ulceration. Venous stasis ulcers are open wounds, typically around the medial ankle, that recur or fail to heal. The distinction between the 40 and 60 percent tiers is the word "intermittent" versus "persistent" applied to the ulceration. Intermittent ulceration sits within the 40 percent criteria; persistent ulceration, combined with the other findings, is the 60 percent picture.

Massive board-like edema with constant pain at rest (100 percent). The top of the ladder is reserved for severe, fixed swelling so dense the tissue feels board-like, with pain that is present even at rest. This is a small fraction of cases and is generally well-documented when it occurs.

The practical point across all of these higher tiers is that they are won or lost on documentation of skin change. Pigmentation and ulceration are visible. A treatment record that describes "hyperpigmentation of the bilateral lower extremities" or "recurrent venous stasis ulcer, medial left ankle, ongoing wound care" is doing more rating work than any number of subjective complaints. Photographs over time are some of the strongest evidence a veteran can put in the file because they let a rater or Board member see the persistence and severity directly.

The Bilateral Factor Under 38 CFR § 4.26

Because DC 7120 rates a single extremity, varicose veins are a textbook application of the bilateral factor when both legs are involved. The regulation:

"When a partial disability results from disease or injury of both arms, or of both legs, or of paired skeletal muscles, the ratings for the disabilities of the right and left sides will be combined as usual, and ten percent of this value will be added (i.e., not combined) before proceeding with further combinations."

The mechanics: rate each leg separately under DC 7120, combine the two leg ratings using the regular combined ratings table under 38 CFR § 4.25, then add 10 percent of that combined value arithmetically before the result combines with the rest of the veteran's ratings.

Example. A veteran with 20 percent in each leg. Combining 20 and 20 on the table: 20 + (80 × 0.20) = 36. Add 10 percent of 36, which is 3.6, for a bilateral-adjusted value of 39.6. That number then enters the overall combined rating with everything else before final rounding.

A couple of points that get missed. The 10 percent addition runs on the combined value, not on each leg, and it is a one-time add for the whole bilateral set. It also applies whenever both legs are service-connected at compensable levels, even if the two ratings are different, such as 10 percent on one leg and 40 percent on the other. The factor matters most near rounding thresholds, where a few points can be the difference between an 80 and a 90 percent combined rating.

C&P Exam Mechanics: What the Examiner Has to Look At

The varicose vein C&P exam follows the DBQ for artery and vein conditions. Unlike a knee exam, there is no goniometer and no range-of-motion math. The findings the examiner is supposed to capture map almost one-to-one onto the DC 7120 ladder:

• Presence, location, and extent of visible or palpable varicose veins, in each leg
• Edema, whether it is present, and critically whether it is intermittent or persistent
• Whether elevation relieves the edema, and whether that relief is complete or incomplete
• Use of compression hosiery and its effect
• Stasis pigmentation, described and located
• Eczema or stasis dermatitis
• Ulceration, including whether it is intermittent or persistent and whether it is currently active or healed
• Subcutaneous induration and any board-like edema
• Pain, including whether pain is present at rest
• Tolerance for prolonged standing and walking, and functional impact

The exam is the rating engine. When the report addresses each of these, the rater has the facts to place the leg on the correct rung. When the report is sparse, the rater defaults downward. The most consequential omission I see is an exam that records edema without resolving the persistent-versus-intermittent question, or that records skin discoloration without calling it stasis pigmentation. Each missing element is a potential opening for a tier that did not get assigned the first time.

Two examiner habits in particular produce inadequate exams. First, examining the leg without the veteran having been on their feet, so the swelling is at its minimum and the persistent pattern never shows. Second, failing to photograph or precisely describe the skin findings, leaving a rater to guess whether brown discoloration is stasis pigmentation or something incidental.

Secondary Chains: What Venous Disease Connects To

Under 38 CFR § 3.310, secondary service connection can be granted for a condition caused by a service-connected condition or aggravated by one (Allen v. Brown). Varicose veins sit at the front of a venous-disease chain.

Chronic venous insufficiency. Varicose veins and chronic venous insufficiency are part of the same underlying venous hypertension process, and the line between "varicose veins" and "chronic venous insufficiency" can blur in the medical record. Where the insufficiency is the broader documented diagnosis, the rating still flows through the same DC 7120 criteria, because the criteria themselves describe the downstream venous findings (edema, stasis pigmentation, ulceration).

Stasis dermatitis. The eczema/dermatitis over the lower leg is both a criterion inside DC 7120 and, in some records, a separately documented skin condition. Where it is rated as part of the varicose vein picture under DC 7120, it should not also be separately rated as a skin disease under the dermatology codes, because that would rate the same impairment twice under the pyramiding rule, 38 CFR § 4.14. The relationship to eczema claims is worth understanding for exactly this reason.

Deep vein thrombosis residuals (DC 7121). A history of DVT is the most important chain to flag. Post-thrombotic syndrome, the chronic venous damage that follows a clot, is rated under DC 7121 (post-phlebitic syndrome), which carries criteria parallel to DC 7120. A veteran with both a varicose vein history and a documented DVT may have residuals rated under DC 7121. Pyramiding rules mean the same edema and skin findings cannot be rated twice, so the question becomes which code captures the impairment, not whether to apply both to the same findings.

The standard for a nexus opinion on any of these chains is the same one that governs every secondary claim. The opinion has to identify the mechanism, address the time course, and rule out other causes. A bare "venous insufficiency is secondary to varicose veins" without rationale is not probative. A factually accurate, fully articulated opinion based on sound reasoning carries the case.

Common Evidence Gaps in Varicose Veins Claims

A few patterns I've noticed across BVA decisions involving varicose veins.

The exam never resolves persistent versus intermittent. This is the recurring problem. The examiner notes edema, but the report does not state whether the swelling persists or whether elevation fully relieves it. Without that finding, the rater has no basis to go above 10 percent, even when the longitudinal record suggests a persistent pattern. The Board sends these back to ask the examiner the question directly.

No photographs of skin change. Stasis pigmentation, eczema, and ulceration are visible, and they drive the 40 and 60 percent tiers. When the file describes "discoloration" in vague terms and contains no photographs, the higher tiers become hard to support. Dated photographs across time are some of the most underused evidence in these claims.

No documentation of compression and elevation use. The regulation builds elevation and compression hosiery directly into the criteria. A record that does not document what the veteran does to manage the swelling, and how the leg responds, leaves the persistent-versus-intermittent question unanswered. A simple log of daily compression use and the leg's response to elevation does real work.

Each leg not separately developed. Because DC 7120 rates a single extremity, a record that treats "bilateral varicose veins" as one undifferentiated problem can produce a single rating where two were warranted, and can leave the bilateral factor on the table. The exam should describe each leg on its own terms.

DVT history not connected. A documented clot history that never gets tied to current venous findings can leave a DC 7121 post-thrombotic residual unrated, or leave a nexus argument undeveloped.

I don't know exactly what percentage of varicose vein claims have one or more of these gaps. What I can say from Claim Raven's analysis of 525 BVA varicose veins cases is that, among the 410 cases with a C&P adequacy determination, 59.8% had the examination flagged as inadequate, and remands ran at 43.4%, the largest share of any outcome in this subset (granted ran 14.3% and denied 27.4%). That pattern is consistent with the evidence-gap dynamics in this post: the Board is sending varicose vein cases back for more development more often than it is granting or denying them outright, and the most common reason is an exam that did not pin down the edema and skin findings the rating turns on.

What to Push For

The varicose vein claim is conceptually simple and practically slippery. The rating lives almost entirely in two questions: is the edema persistent or intermittent, and what skin findings are present. Aim the entire evidentiary effort at those two questions.

For the edema question, the goal is to show the swelling at its real-world worst and to show that elevation does not fully relieve it. That means a treatment record across multiple visits, the veteran's own log of daily swelling, and photographs taken at the end of a day on the feet rather than first thing in the morning. An evidence checklist for venous claims should separate the edema lane from the skin-findings lane.

For the skin findings, dated photographs of pigmentation, eczema, and any ulceration are the strongest proof. Combine them with treatment notes that name the findings precisely, "stasis pigmentation," "venous stasis ulcer," "stasis dermatitis," rather than generic "discoloration."

Before the exam, use C&P exam prep for the artery and vein DBQ and track daily swelling, compression use, and standing tolerance. Ask the examiner to address persistence of edema, completeness of relief with elevation, and each skin finding by name. If both legs are involved, confirm each leg is examined and described separately, and check the secondary conditions tool for the venous insufficiency and post-DVT chains.

Bottom Line

Varicose vein ratings at the VA aren't a stacking puzzle. They are a single ladder under DC 7120, and almost the entire dispute lives on one rung: whether your edema is persistent or intermittent. Intermittent edema relieved by elevation or compression caps at 10 percent. Persistent edema that elevation does not fully relieve starts at 20 percent, and the higher tiers are built on documented skin change, stasis pigmentation, eczema, and ulceration. Each leg is rated on its own, and the bilateral factor adds 10 percent to the combined value when both legs are service-connected. The cases that succeed at the Board tend to have a longitudinal record and photographs that show the persistence of the swelling and the reality of the skin findings, rather than a single morning exam that catches the leg at its best. Same condition, different paper trail, different outcome.

Related Conditions

Varicose vein claims commonly connect to peripheral vascular disease and heart disease because they share the cardiovascular rating section of § 4.104 and the same proof issues around edema and circulation. The stasis dermatitis that drives the higher DC 7120 tiers overlaps with eczema claims, and the pyramiding question of whether a skin finding is rated inside the venous code or separately. Veterans with both legs involved should review the secondary conditions tool and bilateral-factor math before assuming a single leg rating tells the whole story.

Methodology and Limitations

• Data source: Rating criteria quoted from 38 CFR § 4.104, DC 7120, with the related post-phlebitic syndrome code DC 7121. Bilateral factor from § 4.26. Pyramiding from § 4.14. Combined ratings math from § 4.25. Secondary service connection from § 3.310. Case law on secondary aggravation from Allen v. Brown.
• Sample size: Patterns in this post are drawn from Claim Raven's analysis of 101,518 condition records drawn from the analyzed subset of Claim Raven's 501,000+ Board-decision library, including 525 varicose veins cases. Within that subset, outcomes ran 43.4% remanded, 14.3% granted, and 27.4% denied. Of the 410 cases that included a C&P adequacy determination, 59.8% had the examination flagged as inadequate. The dataset captures overall case outcome rather than the specific DC 7120 tier assigned.
• Classification approach: Diagnostic code definitions drawn from the regulatory text. Tier analysis follows the persistent-versus-intermittent and skin-finding structure of DC 7120. Compensation math uses the VA combined ratings table and 2026 rate tables.
• Limitations:
• Compensation figures are based on 2026 VA disability rates. They adjust annually with COLA.
• The dataset codes overall outcome, not the per-tier (10 percent versus 20 percent versus higher) breakdown, so tier-level analysis here is qualitative and drawn from the regulation and the language of Board decisions.
• Worked examples use approximate rating values to illustrate the bilateral-factor math.
• The line between "varicose veins" under DC 7120 and "chronic venous insufficiency" or "post-phlebitic syndrome" under DC 7121 can blur in the medical record, and rating practice varies on which code captures a given set of findings.
• Selection bias: BVA-level patterns reflect cases that appealed. Most varicose vein claims resolve at the RO level and aren't in any BVA dataset.
• These observations reflect patterns from the regulatory text, case law, and BVA decisions. They are not predictions of individual outcomes.