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VA Rating Assistant

DC 7110 · 38 CFR 4.104

Aortic Aneurysm C&P Exam Prep

To document the current severity, size, location, symptomatology, and cardiac involvement of an aortic aneurysm for disability rating purposes under 38 CFR 4.104, Diagnostic Code 7110.

Format:
Interview + Physical
Typical duration:
30-45 minutes
DBQ form:
Artery_and_Vein (Artery_and_Vein)
Examiner:
Vascular Surgeon, Cardiologist, or Internal Medicine

What the examiner evaluates

  • Location of the aneurysm (ascending, thoracic, abdominal aorta)
  • Aneurysm size in centimeters (diameter)
  • Symptomatic versus asymptomatic status
  • Whether the aneurysm is operable or inoperable
  • Presence and extent of cardiac involvement (enlarged heart, high-output heart failure, tachycardia, wide pulse pressure)
  • Peripheral vascular manifestations including diminished pulses, persistent coldness, trophic changes, numbness, and deep ischemic ulcers
  • History of surgical or endovascular repair (open surgery, EVAR, TEVAR) and post-operative residuals
  • Associated peripheral arterial disease
  • Functional impact on daily activities and occupational duties

Examination typically occurs in a clinic setting. The examiner will review service records, private treatment records, and imaging studies (CT angiography, ultrasound, MRI) prior to or during the exam. Bring all relevant imaging reports. If the exam is conducted via telehealth, note that a physical exam may be limited; ask how the examination is being conducted.

Measurements and tests

Aortic Diameter Measurement (CT Angiography / Ultrasound)

What it measures: Maximum outer-to-outer diameter of the aneurysm in centimeters, the primary determinant of rating level under DC 7110.

What to expect: The examiner will review existing imaging (CT scan, MRI, or ultrasound) rather than performing new imaging at the exam. Bring printed reports or a disc of your most recent and most severe studies. The examiner documents the measured diameter and location (ascending, thoracic, abdominal).

Critical thresholds

  • Less than 5.0 cm, asymptomatic 0% - non-compensable (diagnose only, no rating under DC 7110 unless symptomatic)
  • Symptomatic, any size, not operable Evaluated based on extent of cardiac involvement and peripheral signs
  • 5.0 cm or greater diameter (any large or aortic artery) Potentially 100% if inoperable with symptomatic or cardiac involvement
  • Post-surgical repair with residuals Rated on residuals; cardiac involvement drives percentage

Tips

  • Bring ALL imaging reports, not just the most recent - the examiner needs to see the documented size over time.
  • If your aneurysm has grown since the last measurement, bring evidence of that growth trend.
  • Ask your treating vascular surgeon to write a letter stating the current size, symptom status, and operability opinion.
  • If you have been told the aneurysm is 'too risky to repair' or 'inoperable,' make sure that clinical opinion is documented in your records.

Pain considerations: Report any back pain, abdominal pain, chest pain, or pulsating sensations as these indicate symptomatic status and affect the rating outcome.

Ankle-Brachial Index (ABI)

What it measures: Ratio of ankle systolic blood pressure to brachial (arm) systolic pressure; used to evaluate peripheral arterial disease that may accompany aortic disease.

What to expect: A blood pressure cuff is placed at the ankle and arm; Doppler ultrasound detects pulse. Normal is 1.0-1.4. Values below 0.9 indicate peripheral arterial disease. Values below 0.4 indicate severe ischemia.

Critical thresholds

  • 0.91-1.40 (Normal) No PAD; does not independently support higher rating
  • 0.71-0.90 (Mild PAD) Supports symptomatic vascular disease claim
  • 0.41-0.70 (Moderate PAD) Supports significant peripheral arterial involvement
  • 0.00-0.40 (Severe PAD / Critical Ischemia) Supports finding of deep ischemic ulcers and severe functional impairment

Tips

  • Do not exercise before the exam - test at rest.
  • Tell the examiner if you have calcified vessels (common in older veterans and diabetics), which can falsely elevate ABI.
  • Ask for a toe-pressure measurement (TBI) if ABI is artificially elevated due to vessel calcification.

Pain considerations: Claudication pain during walking is consistent with low ABI values and supports peripheral arterial disease secondary to aortic pathology.

Transcutaneous Oxygen Tension (TcPO2)

What it measures: Measures tissue oxygenation at the skin surface of the foot; used to assess severity of peripheral ischemia and wound healing potential.

What to expect: Small sensor electrodes are placed on the skin of the foot and heated to measure oxygen diffusion. Normal values are above 50 mmHg. Values below 30 mmHg indicate critical ischemia.

Critical thresholds

  • Above 50 mmHg Adequate perfusion; less supportive of severe ischemia
  • 30-50 mmHg Impaired perfusion; supports moderate ischemic changes
  • Below 30 mmHg Critical ischemia; supports deep ischemic ulcer and severe rating levels

Tips

  • This test is performed if ABI cannot be completed or is non-diagnostic.
  • Keep feet warm before the exam as cold can falsely lower values.
  • Any active wounds or ulcers should be documented with photographs and clinical notes.

Pain considerations: Persistent rest pain at night combined with low TcPO2 values strongly supports the 'constant pain at rest' criterion for higher ratings.

Rating criteria by percentage

100%

Aortic aneurysm (ascending, thoracic, or abdominal) that is symptomatic and inoperable, OR any large artery aneurysm with cardiac involvement including high-output heart failure, enlarged heart, tachycardia, or wide pulse pressure. Post-surgical cases rated on residuals of surgery.

Key symptoms

  • Persistent, severe back or abdominal pain unrelieved by rest or medication
  • Pulsatile abdominal mass with discomfort
  • Aneurysm deemed inoperable by vascular surgeon
  • High-output heart failure attributable to the aneurysm
  • Cardiac enlargement on imaging
  • Tachycardia at rest
  • Wide pulse pressure
  • Deep ischemic ulcers in extremities from distal embolization
  • Inability to work or perform activities of daily living

From 38 CFR: DC 7110 assigns 100% for aortic aneurysm (ascending, thoracic, or abdominal) that is symptomatic and inoperable. Also rated at 100% when cardiac manifestations are present (enlarged heart, high-output failure, tachycardia, wide pulse pressure). Note: post-surgical cases are rated on residual disability under applicable DCs.

50%

Aneurysm of any large artery (not aortic) that is symptomatic or requires surgical treatment; or post-surgical aortic aneurysm residuals with moderate cardiac or peripheral manifestations. Evaluated based on persistent symptoms such as pain, reduced perfusion, and functional limitations.

Key symptoms

  • Symptomatic peripheral artery aneurysm with claudication or rest pain
  • Moderate persistent edema
  • Persistent subcutaneous induration
  • Beginning stasis pigmentation or eczema
  • Residual symptoms following aneurysm repair
  • Intermittent deep ischemic symptoms
  • Moderate functional limitation of affected extremity

From 38 CFR: DC 7110 for aneurysm of any large artery that is symptomatic; rated by analogy or on residuals under applicable DCs for post-surgical cases. Cardiac manifestations at moderate level (tachycardia without heart failure) support this level.

20%

Small artery aneurysm that is symptomatic; or post-surgical aneurysm with mild residuals including mild edema, beginning pigmentation changes, aching after prolonged standing or walking. Mild but persistent symptoms that limit some activities.

Key symptoms

  • Aching in affected extremity after prolonged standing or walking
  • Fatigue in extremity after prolonged activity
  • Mild edema relieved by elevation
  • Beginning stasis pigmentation
  • Beginning eczema
  • Symptoms partially relieved by compression hosiery or elevation
  • Mild persistent coldness of extremity

From 38 CFR: DC 7110 for aneurysm of a small artery that is symptomatic. Post-surgical residuals with mild symptoms rated under applicable venous/arterial DCs. Varicose vein analog criteria may be applied to post-phlebitic or post-surgical venous residuals.

0%

Asymptomatic aortic or large artery aneurysm that is under observation, less than 5.0 cm, not causing cardiac manifestations, and not requiring surgical intervention. Diagnosis is confirmed but no ratable disability is present at this time.

Key symptoms

  • Incidentally discovered aneurysm on imaging
  • No pain, no cardiac symptoms
  • Stable size on serial imaging
  • No functional limitation
  • Currently managed with watchful waiting

From 38 CFR: A diagnosed but asymptomatic aneurysm under surveillance is non-compensable under DC 7110 but should still be service-connected to protect future rating increases as the condition progresses.

Describing your symptoms accurately

Pain - Back, Abdominal, or Chest

How to describe it: Describe the exact location (mid-back, lower back, epigastric, chest), character (dull, aching, tearing, pressure), intensity on your worst days (1-10 scale), frequency (constant vs. intermittent), and what triggers or worsens it (physical activity, coughing, straining). State specifically whether you experience pain at rest, not just with activity.

Example: On my worst days, I have a deep, constant tearing pain in my mid-back that radiates into my abdomen and rates 8 out of 10. It wakes me from sleep and is not relieved by lying still or taking ibuprofen. I cannot sit comfortably for more than 20 minutes.

Examiner listens for: The examiner is specifically determining whether the aneurysm is symptomatic versus asymptomatic. Symptomatic status is required for a compensable rating. Pain at rest is the key differentiator from activity-only pain.

Avoid: Do not say 'it's manageable' or 'I just deal with it.' If you have pain, describe it fully. Many veterans downplay pain because they have adapted - but the examiner must document what you actually experience on your worst days.

Cardiac Symptoms - Palpitations, Shortness of Breath, Fatigue

How to describe it: Describe heart racing (tachycardia), shortness of breath with minimal exertion or at rest, leg swelling, and inability to lie flat. Quantify what activities trigger these symptoms. State whether these symptoms began or worsened after aneurysm diagnosis.

Example: On bad days, I feel my heart racing even when I am sitting still. Walking to my mailbox leaves me short of breath and exhausted. I sleep with two pillows because I can't breathe lying flat. My cardiologist has noted my heart is enlarged on the last echo.

Examiner listens for: DBQ fields for enlarged heart, tachycardia, wide pulse pressure, and high-output heart failure directly drive the 100% rating level. The examiner must document whether cardiac involvement is present and its severity.

Avoid: Do not attribute cardiac symptoms solely to age or other conditions if they are connected to your aneurysm. Bring cardiology records documenting any echocardiograms, Holter monitor results, or echocardiographic evidence of cardiac enlargement.

Extremity Symptoms - Coldness, Numbness, Weakness, Pain

How to describe it: Describe persistent coldness in hands or feet that is present even in warm environments, numbness or tingling in fingers or toes, weakness in legs, and how far you can walk before leg pain forces you to stop (claudication distance). Note whether these symptoms are present at rest.

Example: My left foot is always cold, even in summer. I have constant numbness in my toes that makes it difficult to know if I am stepping on something. I can only walk about half a block before the pain in my calf forces me to stop and rest for several minutes.

Examiner listens for: Diminished pulses, persistent coldness, trophic changes (skin changes, hair loss on legs, thickened nails), numbness, deep ischemic ulcers, and necrosis are all specifically listed in DBQ fields and drive both the diagnosis and severity of peripheral involvement.

Avoid: Do not omit mentioning any wounds, ulcers, or skin changes on your lower extremities. Even small, slow-healing sores are clinically significant findings under DC 7110.

Functional Limitations - Work, Activity, Sleep

How to describe it: Be specific about what you cannot do or can only do with significant difficulty. Describe limitations at your worst, not your average day. Include how the condition affects sleep, ability to stand, walk, lift, drive, and perform job duties.

Example: On my worst days, I cannot stand for more than 10 minutes without severe back pain. I have had to stop working as a warehouse supervisor because I cannot lift, bend, or stand for extended periods. I wake up at night with pain and take prescribed medication that leaves me drowsy during the day.

Examiner listens for: The functional impact section of the DBQ (field _550_) requires the examiner to describe how the condition limits employment and daily activities. This narrative directly influences the rater's assessment of the overall disability picture and may support TDIU if combined disability is sufficient.

Avoid: Do not say 'I just take it easy' without explaining what that means. Taking it easy because you are in pain and fear rupture is a significant limitation. Describe specifically what activities you have given up or modified.

Post-Surgical Residuals (for veterans who have had repair)

How to describe it: Describe all symptoms that persist after surgical or endovascular repair: incisional pain, back pain, abdominal discomfort, erectile dysfunction (for abdominal repairs), bowel changes, graft-related symptoms, and any re-intervention history. Note the date of surgery and what symptoms existed before versus after.

Example: Even though I had the stent graft placed three years ago, I still have constant lower back pain that rates 6 out of 10 most days and 9 out of 10 on bad days. I also have swelling in both legs that has not resolved, and I cannot walk more than two blocks without stopping. My follow-up CTs show an endoleak that my doctor says needs to be watched.

Examiner listens for: Post-surgical cases are rated on residuals. The examiner will document surgery type (open vs. EVAR/TEVAR), date, complications, endoleak status, and persistent symptoms. All residual cardiac and peripheral symptoms still apply and still drive the rating.

Avoid: Do not assume that having surgery means you are 'cured.' If symptoms persist, they are ratable. Bring operative reports, post-op follow-up notes, and most recent surveillance imaging reports.

Common mistakes to avoid

Telling the examiner the aneurysm is asymptomatic when you do have symptoms

Why: A non-compensable (0%) rating results from asymptomatic status. Veterans sometimes say 'it doesn't really bother me' out of modesty or because they have normalized chronic discomfort.

Do this instead: Accurately describe all symptoms including back discomfort, abdominal awareness, fear-based activity restriction, and any periodic pain. If you avoid strenuous activity due to medical advice about rupture risk, that restriction is functionally significant.

Impact: 0% vs. 20-100%

Failing to bring imaging reports documenting aneurysm size

Why: The examiner may only have access to what VA has on file. If your private cardiologist or vascular surgeon has the most current CT scan showing the largest documented size, it will not be considered unless you provide it.

Do this instead: Print or bring a disc of every CT angiogram, ultrasound, and MRI related to the aneurysm. Highlight the measured diameter in each report. Organize them chronologically to show any growth trend.

Impact: All rating levels - size documentation is central to DC 7110

Not reporting cardiac symptoms that began after aneurysm diagnosis

Why: Tachycardia, enlarged heart, wide pulse pressure, and high-output heart failure are separate DBQ checkboxes that drive the 100% rating. If the veteran does not mention these symptoms or they are not in the exam record, the examiner may not ask about them.

Do this instead: Review your cardiology records for any mention of heart enlargement, arrhythmia, or heart failure. Bring echocardiogram results. Proactively tell the examiner about any cardiac diagnoses made after the aneurysm was identified.

Impact: Below 100% vs. 100%

Assuming surgery resolved the service-connected disability

Why: Veterans who had aneurysm repair sometimes believe they no longer have a ratable condition. Post-surgical residuals - including chronic pain, peripheral vascular changes, endoleak, graft complications, and cardiac sequelae - are all fully ratable.

Do this instead: Document all persistent post-surgical symptoms in detail. Obtain a letter from your vascular surgeon or cardiologist listing current residuals. Request post-operative imaging reports showing any endoleak, graft migration, or continued aneurysm sac enlargement.

Impact: 0% (improper closure) vs. 20-100%

Describing only average symptoms rather than worst-day symptoms

Why: M21-1 and VA adjudication guidance direct raters to consider the range of disability including worst-day presentations. Reporting only average days results in underrating.

Do this instead: Prepare specific worst-day examples before the exam. Write them down. When asked how you are doing, say 'On my worst days, which happen [frequency], I experience...' and describe the full severity.

Impact: All rating levels

Not mentioning operability status or surgeon's opinion about surgical risk

Why: The DBQ specifically asks whether the aneurysm is operable or inoperable. If the veteran's surgeon has recommended against surgery due to age, comorbidities, or anatomical factors, that opinion is critical to the 100% rating determination.

Do this instead: Obtain a written letter from your vascular surgeon stating that the aneurysm is symptomatic and that surgical repair is not recommended or carries prohibitive risk. Bring this to the exam and ensure the examiner documents it.

Impact: Below 100% vs. 100%

Failing to report peripheral symptoms (cold feet, numbness, claudication, ulcers) as related to the aortic aneurysm

Why: Distal embolization, reduced perfusion, and peripheral arterial disease are direct complications of aortic aneurysm. Veterans may report these to their primary care doctor without connecting them to the aneurysm, leading to separate undocumented claims.

Do this instead: At the C&P exam, specifically tell the examiner about any extremity symptoms and state 'My vascular surgeon told me these are related to my aortic aneurysm.' Bring records where treating physicians have linked these conditions.

Impact: Affects overall rating and secondary condition claims

Prep checklist

  • critical

    Gather all imaging reports for the aneurysm

    Collect every CT scan, CT angiogram, MRI, and abdominal or chest ultrasound that documents the aneurysm. Note the measured size (diameter in cm) in each report and organize chronologically. If the most recent imaging was done by a private provider, request a copy immediately.

    before exam

  • critical

    Obtain a nexus letter or clinical opinion from your treating vascular surgeon

    Ask your vascular surgeon or cardiologist to write a letter stating (1) the diagnosis, (2) current size and location, (3) whether the condition is symptomatic, (4) whether surgical repair is recommended or contraindicated, and (5) any cardiac or peripheral manifestations. This letter is one of the most powerful pieces of evidence you can bring.

    before exam

  • critical

    Write down your worst-day symptom narrative

    Before the exam, write a detailed description of your symptoms on your worst days. Include pain location, intensity (0-10), frequency, duration, what makes it worse, what makes it better, and how it limits your daily activities and work. Practice stating this clearly and concisely.

    before exam

  • critical

    Compile all treatment records including surgical reports

    Gather operative reports (if you had open repair, EVAR, or TEVAR), post-operative follow-up notes, cardiology records showing echocardiograms or stress tests, and any records documenting cardiac enlargement, heart failure, or arrhythmia. Also include records of peripheral symptoms.

    before exam

  • recommended

    Document all medications taken for this condition

    List every medication prescribed for the aneurysm and related conditions: antihypertensives (beta-blockers, ARBs), anticoagulants, antiplatelet agents, diuretics for heart failure, and pain medications. Bring your actual medication bottles or a current medication list. The type and dose of medications indicate symptom severity.

    before exam

  • recommended

    Prepare a list of all activity restrictions given by your doctor

    If your vascular surgeon or cardiologist has told you to avoid heavy lifting, strenuous exercise, or certain activities due to rupture risk, write this down and bring any written instructions. These restrictions reflect the functional impact of the condition.

    before exam

  • recommended

    Identify and document secondary conditions

    Consider whether peripheral arterial disease, hypertension, heart failure, post-phlebitic syndrome, or other vascular conditions are related to or caused by the aortic aneurysm. These may be filed as secondary service-connected conditions. Discuss with a VSO or accredited claims agent.

    before exam

  • recommended

    Review your right to record the examination

    Under 38 CFR 1.527(b) and most state laws, veterans have the right to record their C&P examination. Check your state's consent laws (one-party vs. two-party consent). Notify the examiner at the start of the exam that you intend to record. Use your smartphone or a small recording device.

    before exam

  • critical

    Arrive in your true condition - do not dress up your health

    Do not take extra pain medication, wear special compression garments for the first time, or otherwise prepare in a way that masks your true condition. The examiner needs to see and hear how you actually function. If you use a cane, walker, or brace regularly, bring it and use it.

    day of

  • critical

    Bring all documents in an organized folder

    Bring imaging reports (chronological order), surgeon's letter, treatment records summary, medication list, and your written symptom narrative. Offer the documents to the examiner at the start of the exam. Even if they already have the records, having physical copies demonstrates thoroughness.

    day of

  • optional

    Bring a buddy or family member as a witness

    A spouse, family member, or friend who observes your condition daily can attend the exam as a witness and provide a lay statement about functional limitations they observe. Their presence also helps ensure the exam is conducted thoroughly.

    day of

  • critical

    Report worst-day symptoms, not average-day symptoms

    When the examiner asks how you are doing, lead with your worst days. Use the phrase: 'On my worst days, which happen approximately [X times per week/month], I experience...' Describe the full range of your disability, not just what you are experiencing at that exact moment.

    during exam

  • critical

    Proactively report cardiac symptoms

    Tell the examiner about any heart palpitations, rapid heartbeat, shortness of breath, leg swelling, or inability to lie flat. State if any cardiologist has mentioned enlarged heart or heart failure. These findings trigger higher-level rating checkboxes on the DBQ.

    during exam

  • critical

    Report all peripheral vascular symptoms

    Mention persistent coldness of feet or hands, numbness and tingling, leg pain while walking (claudication), rest pain at night, skin changes on lower legs (discoloration, hair loss, thin skin), and any wounds or sores that heal slowly. All of these are specifically assessed on the DBQ.

    during exam

  • recommended

    Confirm the examiner reviews all evidence you brought

    At the start of the exam, confirm the examiner has reviewed your claims file. Hand over any additional documents. Ask, 'Will you be reviewing the imaging reports I brought?' Ensuring the examiner considers all evidence is your right.

    during exam

  • critical

    Do not minimize symptoms when asked 'how are you doing today?'

    A social 'I'm fine' response at the start of an exam can be documented by the examiner. Redirect immediately: 'I appreciate you asking, but I need to tell you that I'm actually having significant difficulties with this condition.' Then describe your symptoms.

    during exam

  • critical

    Request a copy of the completed DBQ

    You are entitled to receive a copy of the completed DBQ (VA Form 21-0960A-2) after the examination. Request this from the examiner or the VA facility. Review it carefully to ensure your reported symptoms are accurately documented.

    after exam

  • recommended

    File a buddy statement (lay evidence)

    Have family members, caregivers, or coworkers submit written buddy statements (VA Form 21-10210) describing the functional limitations they observe due to your aortic aneurysm. These statements are independent evidence that can support higher ratings.

    after exam

  • recommended

    Submit a personal statement if the exam was inadequate

    If the examiner did not ask about key symptoms, cut the exam short, or appeared dismissive, submit a written statement to the VA rating authority identifying specific inadequacies. You can request a supplemental examination if the DBQ is inadequate.

    after exam

  • critical

    Review the rating decision carefully when it arrives

    When you receive the rating decision, compare the stated criteria to the DC 7110 criteria you prepared with. Verify that all symptoms were considered and that the rating reflects your worst-day functional level. If undertreated, consult a VSO or accredited attorney about appeal options.

    after exam

Your rights during a C&P exam

  • You have the right to record your C&P examination in most states. Check your state's recording consent law (one-party vs. two-party consent) and notify the examiner at the start of the exam.
  • You have the right to submit your own medical evidence, including private physician opinions and imaging reports, before or at the time of the C&P examination. This evidence must be considered by the examiner.
  • You have the right to request a copy of the completed DBQ (Disability Benefits Questionnaire) after the examination is conducted.
  • You have the right to request a new or supplemental C&P examination if the original examination is found to be inadequate, incomplete, or not in support of the claim (38 CFR 3.159(c)(4)).
  • You have the right to have a representative (VSO, accredited attorney, or claims agent) assist you with your claim and accompany you to the examination.
  • You have the right to bring a family member or witness to the examination.
  • You have the right to disagree with the rating decision and request a Higher-Level Review, Supplemental Claim, or Board of Veterans' Appeals hearing within one year of the decision.
  • You have the right to a benefit of the doubt - when evidence is in approximate balance, VA must resolve it in your favor (38 U.S.C. 5107(b)).
  • You are not required to prove your disability beyond a reasonable doubt. A nexus letter from a treating physician stating that a condition 'is at least as likely as not' caused or aggravated by service is sufficient.
  • You have the right to request that VA obtain any outstanding federal records, including service treatment records, that are relevant to your claim (38 CFR 3.159(c)).

Related conditions

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This C&P exam preparation guide is for educational purposes only and does not constitute legal, medical, or claims advice. Always consult with a qualified Veterans Service Organization (VSO) representative or VA-accredited attorney for guidance specific to your claim. Never exaggerate, minimize, or fabricate symptoms during a C&P examination.