Peripheral Artery Disease (PAD)

Peripheral artery disease is exactly what it sounds like: your arteries in the extremities are narrowed or blocked, reducing blood flow to your legs, feet, arms, or hands. For veterans, PAD often develops years after service, sometimes decades later, and the connection to service is real but requires documentation to establish.

1. What This Condition Is

PAD occurs when plaque builds up inside the arteries supplying your arms, legs, and feet, reducing circulation to those extremities. The most common symptom is claudication: cramping or aching pain in the legs that comes on during walking or activity and goes away with rest. As the disease progresses, symptoms can include persistent coldness of the extremity, skin color changes, hair loss on the foot or leg, and in severe cases, non-healing ulcers or gangrene.

For veterans, PAD can develop as a direct result of tobacco use, which is heavily prevalent in the military, and can be secondary to service-connected conditions like hypertension or diabetes. Veterans with Agent Orange exposure and a diagnosis of ischemic heart disease may find that PAD develops concurrently as part of the same systemic vascular disease process.

2. VA Rating Criteria

PAD is rated under 38 CFR Part 4, Section 4.104, Schedule of Ratings for the Cardiovascular System.

Diagnostic Code 7114 covers Peripheral Arterial Disease of the lower extremities. The rating schedule was updated effective November 14, 2021. The updated criteria are based on objective vascular testing: Ankle-Brachial Index (ABI), ankle pressure, toe pressure, and transcutaneous oxygen tension (TcPO2).

Note on testing: If multiple test types are in the record, the VA is required to use the test that provides the highest benefit to the veteran. If ABI cannot reliably reflect disease severity (which can happen in diabetics or veterans with arterial calcification), the examiner may order ankle pressure, toe pressure, or TcPO2 testing instead. This is important. If your C&P exam only used ABI and your vascular specialist believes ABI underestimates your disease severity, push for toe pressure or TcPO2 testing.

Upper extremities are rated under DC 7115 (Arteriosclerosis obliterans, upper extremities) using similar functional criteria.

Amputations resulting from PAD are rated under the amputation diagnostic codes rather than DC 7114.

Bilateral factor (38 CFR 4.26): If both lower extremities are service-connected with PAD, the bilateral factor applies, adding a 10% adjustment before the final combined rating is calculated.

3. What to Expect at Your C&P Exam

The examiner will conduct or review vascular testing, most commonly an ABI study. The ABI compares blood pressure measured at your ankle to blood pressure at your arm. A normal ABI is 1.0 to 1.4. Below 0.9 indicates some degree of PAD.

The examiner will ask about claudication: how far can you walk before pain starts, on flat ground at a normal pace? Do you have pain at rest? Do you have any skin changes, wounds, or ulcers on your feet or legs? Do your feet feel cold? Are there any color changes?

They will also examine pulses in your feet (dorsalis pedis and posterior tibial), check for hair loss and skin changes, and look for any trophic changes. These physical findings support higher ratings.

Be prepared to describe your worst days, not your average days. If you can walk two blocks on a good day but barely make it to the mailbox on a bad day, both matter.

Bring your vascular surgery or vascular medicine records, including any Doppler ultrasound studies, ABI reports, or arterial duplex imaging. If you have had any procedures (angioplasty, stent placement, bypass surgery), bring those operative records.

DBQ Form: VA Form 21-0960A-2, Artery and Vein Conditions (Vascular Diseases Including Varicose Veins).

4. Evidence You Need to Win

For direct service connection:

1. A current diagnosis of PAD confirmed by a vascular physician or primary care provider with objective testing.
2. An in-service event or chronic exposure that contributed to PAD development. This most commonly includes a documented smoking history during service (tobacco use is a primary PAD risk factor), frostbite or cold injury that damaged arterial walls (see Cold Injury Residuals), or records of claudication complaints during service.
3. A medical nexus linking current PAD to service. The nexus letter should discuss the established relationship between smoking and PAD, or between the specific service exposure and arterial disease.

For secondary service connection:

PAD is commonly secondary to service-connected hypertension (DC 7101) or diabetes mellitus (DC 7913). A nexus letter from your vascular physician or internal medicine provider stating that the PAD is at least as likely as not caused or aggravated by the service-connected condition is required. This is a strong pathway for many veterans who did not develop PAD until years after service.

Supporting evidence:

• Private vascular medicine records with ABI studies, duplex ultrasound, or CTA.
• A personal statement describing your functional limitations: walking distance, daily activities affected, need for assistance.
• Buddy statements from family or fellow veterans who can describe observed changes in your mobility (VA Form 21-10210).

5. Secondary Conditions to Consider

Lower extremity neuropathy. Reduced blood flow causes nerve damage over time, resulting in numbness, tingling, and burning pain in the feet and legs. Peripheral neuropathy can be separately rated under DC 8520 (sciatic nerve) or other neural diagnostic codes depending on distribution.

Non-healing wounds and ulcers. Chronic lower extremity ulcers that require ongoing wound care are a direct consequence of arterial insufficiency. These can support an increased rating and a Total Disability based on Individual Unemployability (TDIU) argument when combined with other limitations.

Depression and anxiety. Chronic pain conditions, loss of mobility, and reduced independence reliably produce secondary mental health effects. Depression and anxiety secondary to PAD are compensable under 38 CFR 3.310.

Erectile dysfunction. Arterial disease affects blood flow systemically, and the internal pudendal artery is frequently affected in men with PAD. ED secondary to vascular disease is ratable under DC 7522 and also qualifies for Special Monthly Compensation under 38 CFR 3.350(a).

Ischemic heart disease. PAD and coronary artery disease share the same systemic risk factors and often occur together. If a veteran has Agent Orange exposure and ischemic heart disease is a presumptive, PAD may flow naturally from that same disease process.

Amputation. In advanced, uncontrolled PAD, limb loss becomes a risk. If amputation occurs, the claim migrates to amputation diagnostic codes with significantly higher ratings.

6. Common Mistakes That Kill Claims

Relying solely on ABI when ABI is unreliable. In veterans with diabetes or arterial calcification, ABI can produce falsely elevated readings that understate disease severity. If your vascular doctor has noted that ABI is unreliable for you, document that clearly and request toe pressure or TcPO2 testing at the C&P exam. Failing to do this can result in a rating that does not reflect your actual impairment.

Not claiming secondary service connection when there is a path. Many veterans with PAD also have service-connected hypertension or diabetes. The secondary connection is well-supported medically and regularly succeeds when properly documented with a nexus letter. Do not skip this step.

Describing only good days at the C&P exam. PAD symptoms are effort-dependent and variable. Veterans who focus only on what they can do on good days frequently receive ratings that do not reflect their actual functional limitation. Walk through your worst days, your average days, and the impact on work and household function.

Missing the bilateral factor. If both legs are affected, both extremities should be separately rated and combined with the bilateral factor. Claiming only one side is a common and costly oversight.

Not pursuing secondary mental health conditions. Chronic pain, loss of mobility, and fear of amputation take a real psychological toll. Secondary depression or anxiety claims are legitimate and frequently granted when properly connected to the physical condition.

7. FWD Assist Resources

For veterans pursuing TDIU because PAD has taken you off the job, the FWD Assist TDIU guide covers both the schedular pathway under 38 CFR 4.16(a) and the extraschedular referral process under 38 CFR 4.16(b). If hypertension or diabetes is your primary service-connected condition and PAD is secondary, the secondary conditions guide walks through the evidence required to establish that connection. For veterans dealing with the mental health fallout of chronic vascular disease, the PTSD and mental health guide covers secondary mental health claims. If PAD is related to cold injury or frostbite from service, the Cold Injury Residuals condition page on this site connects both conditions.

8. Get Help Without a Claim Shark

You do not need to pay anyone upfront to file a VA disability claim. Accredited VSOs including the DAV, VFW, American Legion, and AMVETS provide free representation from initial claim through appeal. County veterans service officers provide free local assistance in most states. If your claim reaches the Board of Veterans' Appeals, VA-accredited agents and attorneys can charge a fee, but only after an initial decision has been made and only up to 20% of any past-due benefits awarded. Charging upfront fees to assist with a VA claim is a federal crime under 38 U.S.C. 5905. Always verify any representative's accreditation at va.gov/ogc/accreditation.asp before you sign a power of attorney.