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VA Rating Assistant

DC 7114 · 38 CFR 4.104

Peripheral Artery Disease (Arteriosclerosis Obliterans) C&P Exam Prep

To evaluate the nature, severity, and functional impact of Peripheral Artery Disease (PAD), also known as Arteriosclerosis Obliterans, for VA disability rating purposes under Diagnostic Code 7114. The examiner will document objective findings, vascular testing results, symptoms, and how the condition limits daily activities and work.

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

  • Presence and severity of intermittent claudication (leg pain with walking or exertion)
  • Constant pain at rest indicating critical limb ischemia
  • Ankle-Brachial Index (ABI) measurements for both lower extremities
  • Toe pressure and transcutaneous oxygen tension (TcPO2) values
  • Presence of trophic changes (hair loss, skin discoloration, nail thickening, skin atrophy)
  • Persistent coldness of affected extremities
  • Presence and severity of deep ischemic ulcers or gangrene
  • Diminished or absent peripheral pulses
  • Numbness, paresthesia, or weakness in affected extremities
  • Deep aching or burning pain character and distribution
  • Presence of necrosis or prior amputation
  • History of surgical interventions (bypass grafting, angioplasty, stenting, endarterectomy)
  • Functional limitations including walking distance and ability to perform work or daily activities
  • Use of assistive devices (cane, walker, wheelchair, crutches)
  • Current medications and treatment compliance
  • History of prior vascular procedures and outcomes

The exam will include both an interview portion and a physical examination. You will likely be asked to walk or perform some mild exertion so the examiner can assess claudication. Wear comfortable, loose-fitting clothing that allows easy access to your legs and feet. Do not apply heavy lotions or bandages to your legs before the exam. Bring all assistive devices you use regularly. The examiner may perform Doppler ultrasound or request recent vascular lab results.

Measurements and tests

Ankle-Brachial Index (ABI)

What it measures: The ratio of ankle systolic blood pressure to brachial (arm) systolic blood pressure. A normal ABI is 1.0-1.4. Values below 0.9 indicate PAD; values below 0.4 indicate severe, limb-threatening ischemia.

What to expect: A technician or examiner will use a hand-held Doppler device and blood pressure cuffs placed at the ankle and arm. Both sides will be measured. The exam takes approximately 10-15 minutes. You will lie flat on an exam table. The test is non-invasive and not painful, though cuff inflation may be momentarily uncomfortable.

Critical thresholds

  • 0.9-1.0 Borderline/mild PAD - may support a lower rating if symptoms are minimal
  • 0.7-0.89 Mild-to-moderate PAD - claudication typically present; relevant to 20% rating
  • 0.5-0.69 Moderate PAD - significant claudication; supports 40% rating range
  • 0.4-0.49 Moderately severe PAD - rest pain often present; supports 60% rating
  • < 0.4 Severe/critical limb ischemia - rest pain, ulceration, or gangrene risk; supports 100% rating

Tips

  • Ensure you have not smoked or consumed caffeine for at least 2 hours before the exam, as both can affect peripheral vascular tone and artificially alter ABI values.
  • If you have calcified vessels (common in diabetics), your ABI may be falsely elevated (above 1.4); mention this to the examiner and request toe-pressure testing as an alternative.
  • Report any symptoms that occur during the test, including cramping or pain.
  • Ask the examiner to document the specific numeric ABI values for both extremities - not just 'reduced' or 'normal.'

Pain considerations: If positioning for the test causes pain or worsens your symptoms, inform the examiner immediately. Document any claudication or leg pain that occurs during or after the test.

Toe Pressure (TP) and Toe-Brachial Index (TBI)

What it measures: Systolic pressure at the great toe using a specialized small cuff. Normal toe pressure is above 50 mmHg. Values below 30 mmHg indicate critical ischemia. Particularly useful when ABI is unreliable due to calcified vessels.

What to expect: A small blood pressure cuff is placed around the great toe. A photoplethysmography (PPG) sensor detects blood flow. The test is non-invasive. Toe pressures below 30 mmHg are associated with poor wound healing and risk of amputation.

Critical thresholds

  • > 50 mmHg Adequate perfusion - less likely to support severe rating on this measurement alone
  • 30-50 mmHg Borderline ischemia - supports moderate-to-severe symptoms
  • < 30 mmHg Critical limb ischemia - strongly supports 60-100% rating range

Tips

  • Request toe pressure testing if you have diabetes, end-stage renal disease, or known arterial calcification.
  • Ensure feet are warm before testing - cold-induced vasoconstriction can falsely lower readings.
  • Document bilateral toe pressures separately on the DBQ.

Pain considerations: Report any toe or foot pain present at rest before, during, or after testing. Rest pain is a critical symptom for higher rating levels.

Transcutaneous Oxygen Tension (TcPO2)

What it measures: The partial pressure of oxygen diffusing through the skin, reflecting local tissue perfusion. Normal TcPO2 at the foot is above 40 mmHg. Values below 20-30 mmHg indicate critical ischemia and high amputation risk.

What to expect: Electrodes are placed on the dorsum of the foot. The electrodes heat the skin slightly (to 44-C) to increase local blood flow before measuring oxygen levels. The test takes 20-30 minutes and is non-invasive.

Critical thresholds

  • > 40 mmHg Adequate tissue perfusion
  • 20-40 mmHg Impaired perfusion - moderate ischemia
  • < 20 mmHg Critical ischemia - high risk of tissue loss; supports highest rating levels

Tips

  • This test is particularly valuable if you have non-healing wounds or ulcers.
  • Ensure the examiner documents both left and right foot TcPO2 values.
  • Smoking reduces TcPO2; confirm any recent smoking history is documented for context.

Pain considerations: Electrode warming is typically well-tolerated. Report any increase in foot pain during the procedure.

Claudication Distance Assessment (Walking Test)

What it measures: The distance or time a veteran can walk before onset of claudication pain (initial claudication distance) and the maximum walking distance before being forced to stop (absolute claudication distance). This directly correlates to rating criteria.

What to expect: The examiner may ask you to walk in a hallway or on a treadmill and report when pain begins and when you must stop. Alternatively, they may ask detailed verbal questions about your walking capacity on a typical bad day.

Critical thresholds

  • No claudication on flat surfaces Consistent with 0-10% range if other findings minimal
  • Claudication on flat surfaces after prolonged walking Consistent with 20% rating
  • Claudication on flat surfaces after less than 25 minutes walking OR limited to 1 city block Consistent with 40% rating
  • Claudication after less than 50 meters OR rest pain present Consistent with 60-100% rating

Tips

  • Report your WORST DAY walking capacity, not your best or average day.
  • Specify the exact distance or time before pain begins AND the distance you are forced to stop.
  • Describe the character of the pain - cramping, burning, aching - and the specific muscle groups affected (calf, thigh, buttock).
  • Note how long you must rest before pain resolves enough to walk again.
  • Describe how claudication has changed over the past 6-12 months.

Pain considerations: Pain with walking is the hallmark of PAD claudication. Be specific: 'After walking approximately one city block (about 500 feet) on flat ground, I develop severe cramping and burning pain in both calves that forces me to stop and rest for 5-10 minutes before I can continue.'

Rating criteria by percentage

0%

Diagnosis established but asymptomatic, or symptoms so minimal they do not meet any higher rating criteria. No objective evidence of claudication, rest pain, trophic changes, or abnormal vascular studies.

Key symptoms

  • Confirmed PAD diagnosis by history or imaging
  • No claudication symptoms at normal activity levels
  • ABI may be mildly reduced but no functional limitation
  • No trophic changes, ulcers, or rest pain

From 38 CFR: Service connection established but condition causes no current disability or functional impairment detectable on examination.

20%

Claudication on prolonged walking (flat ground) with diminished or absent peripheral pulses and consistent objective findings. Symptoms relieved by elevation or rest.

Key symptoms

  • Intermittent claudication after prolonged walking on flat surfaces
  • Diminished peripheral pulses (dorsalis pedis, posterior tibial)
  • Mild trophic changes (hair loss on lower legs, dry skin)
  • ABI in the 0.7-0.89 range
  • Symptoms relieved by rest or elevation
  • Aching or fatigue in leg after prolonged standing

From 38 CFR: Claudication on walking more than one city block (approximately 500 feet) on a flat surface; diminished pulses; objective evidence of arterial insufficiency.

40%

Claudication on walking less than 25 minutes on flat ground (approximately one city block), or marked limitation of walking. Objective vascular findings including diminished pulses, trophic changes, and ABI in the 0.5-0.69 range.

Key symptoms

  • Claudication within approximately one city block or less on flat ground
  • Persistent coldness of the affected extremity
  • Trophic changes including nail changes, skin atrophy, or pigmentation
  • Diminished or absent pulses on exam
  • ABI in the 0.5-0.69 range
  • Significant limitation of occupational and daily activities
  • Numbness or paresthesia in the affected extremity

From 38 CFR: Claudication limiting walking to approximately one city block on flat surfaces; marked objective vascular insufficiency with trophic changes and persistent coldness.

60%

Claudication on walking less than 50 meters (approximately half a city block), OR constant pain at rest, OR intermittent ischemic ulceration. Severe objective vascular findings with ABI typically below 0.5.

Key symptoms

  • Claudication within 50 meters on flat ground OR at rest
  • Constant pain at rest (especially nocturnal rest pain relieved by dependency)
  • Intermittent ischemic ulceration
  • Deep aching or burning pain at rest requiring narcotic or strong analgesics
  • ABI below 0.5
  • Severe trophic changes
  • Dependent rubor (redness when leg dependent, pallor on elevation)
  • Critical inability to work or perform most daily activities without pain

From 38 CFR: Claudication severely limiting walking ability; constant pain at rest; intermittent ulceration; objective evidence of critical limb ischemia.

100%

Persistent ulceration or gangrene resistant to treatment, OR rest pain that is constant and unrelenting, OR deep ischemic ulcers not responding to treatment. Often accompanied by a history of prior amputation(s) or imminent limb loss. ABI typically below 0.4 or TcPO2 below 20 mmHg.

Key symptoms

  • Persistent, non-healing ischemic ulceration
  • Gangrene of toes or foot
  • Necrosis of digits or soft tissue
  • Unrelenting rest pain requiring continuous narcotic analgesia or equivalent
  • Prior amputation of digits, foot, or limb due to ischemia
  • Bed- or chair-bound due to pain and ischemia
  • ABI below 0.4 or non-compressible with critical TcPO2 below 20 mmHg
  • Inability to ambulate without significant pain even at rest

From 38 CFR: Persistent ulceration or gangrene; rest pain constant and uncontrolled; evidence of critical limb ischemia with tissue loss; prior amputation due to ischemia.

Describing your symptoms accurately

Claudication (Exertional Leg Pain)

How to describe it: Accurately describe the exact distance or time before pain begins, the type of pain (cramping, burning, aching, heaviness), the specific muscle groups affected (calf is most common; thigh or buttock if aortoiliac disease), which legs are affected, and how long you must rest before you can walk again. Always report your worst day, not your best day.

Example: On my worst days, I cannot walk more than about 50 feet from my front door to my mailbox before severe cramping and burning pain forces me to stop and grip something for support. I have to stand still for at least 10 minutes before the pain eases enough for me to take a few more steps. Going to the grocery store is impossible without a cart to lean on, and even then I can only manage one or two aisles before I must sit down. At its worst, even slow walking on flat ground causes pain within 30 seconds.

Examiner listens for: Specific distances, specific time intervals, affected extremities, pain character, rest requirement, and consistency with vascular anatomy. The examiner is mapping your symptoms to the rating table thresholds.

Avoid: Do not say 'I walk okay but just get tired.' Do not describe only your best days when you pushed through the pain. Do not underreport rest pain by saying 'it's just a little uncomfortable at night' - if you have pain at rest, say so clearly and describe its character and frequency.

Rest Pain

How to describe it: Rest pain in PAD is typically a burning or aching pain in the forefoot or toes that occurs at night in bed, often relieved by dangling the leg over the side of the bed (dependency). Describe when it occurs, how long it lasts, what you do to relieve it, whether it wakes you from sleep, and what pain medications you require.

Example: The burning pain in my foot wakes me up almost every night, sometimes multiple times. It feels like my toes are on fire. I have to hang my foot off the side of the bed or get up and walk a few steps - the weight of the blood flowing down gives brief relief. On my worst nights, the pain is a constant 8 out of 10 and I cannot sleep at all. I take [medication] but it only takes the edge off.

Examiner listens for: Nocturnal occurrence, relief with dependency (limb dangling), need for analgesics including prescription pain medications, sleep disturbance, and functional impact on activities of daily living.

Avoid: Do not minimize rest pain as 'just nighttime discomfort.' Rest pain is a critical marker for the 60%+ rating levels. Do not forget to mention sleep disruption caused by pain.

Trophic Changes and Skin Findings

How to describe it: Trophic changes are visible objective findings the examiner will look for, but you should proactively describe what you have noticed at home, including hair loss on the lower legs, shiny or thin skin, nail changes (thickened or slow-growing), skin color changes (pallor, cyanosis, or redness), and temperature differences between your feet and calves.

Example: I've noticed over the past two years that the hair on my lower legs and feet has almost completely stopped growing. The skin on my feet looks shiny and feels papery-thin. My toenails grow extremely slowly and are thick. When I hold both feet next to each other, the affected foot always feels noticeably colder. After I sit with my legs down, my foot turns a dusky reddish-purple color.

Examiner listens for: Duration of changes, bilateral versus unilateral distribution, specific changes present (hair loss, nail changes, skin atrophy, color changes), and correlation with objective vascular exam findings.

Avoid: Do not assume the examiner will notice all trophic changes on their own - point them out and describe when they started and how they have progressed.

Ulceration and Wound History

How to describe it: If you have had or currently have ischemic ulcers, describe their location (toes, heel, lower leg), size, depth, healing timeline, treatment required, recurrence history, and whether they required hospitalization or surgery. Ischemic ulcers are typically located at pressure points or distal areas and are painful, unlike venous ulcers.

Example: I developed an ulcer on my right great toe about eight months ago. It started as a small dark spot and opened into a wound about the size of a dime. It has not healed despite weekly wound care visits, use of a wound vac for six weeks, and two courses of antibiotics. My vascular surgeon said it may require amputation if it does not improve. The pain from the ulcer is constant and severe, a 7 out of 10 even with prescription pain medication.

Examiner listens for: Location, size, depth, duration, treatment history, response to treatment, recurrence, and whether the wound qualifies as 'persistent' (not healing after standard treatment) which supports the 100% rating level.

Avoid: Do not describe an ischemic ulcer as just 'a sore' or 'a cut.' Specify it was diagnosed by your vascular surgeon or wound care provider as an ischemic or arterial ulcer. Describe resistance to treatment accurately.

Functional Impact and Daily Activity Limitations

How to describe it: Describe specifically how PAD affects your ability to perform work duties, household chores, shopping, self-care, recreational activities, and social activities. Include how it affects your employment. Connect symptoms to specific functional limitations.

Example: On my worst days, I cannot stand in the kitchen long enough to cook a meal. I cannot walk the length of a parking lot without stopping for pain. I lost my job as a warehouse worker because I could not stand or walk for more than a few minutes at a time. I use a cane to help redistribute my weight and reduce pain when walking. My wife does all the grocery shopping because I cannot tolerate the walking. I sleep in a recliner chair most nights because lying flat makes the foot pain worse.

Examiner listens for: Specific limitations, assistive device use, employment impact, activities of daily living affected, and whether the functional impact is consistent with the objective vascular findings documented on the DBQ.

Avoid: Do not say 'I manage okay' or 'I just take it slow.' Describe what you CANNOT do, not just what you can tolerate with difficulty. The DBQ has a specific field for functional impact - ensure your examiner captures it accurately.

Persistent Coldness and Numbness

How to describe it: Persistent coldness of the affected extremity is an objective finding that also has a subjective component. Describe whether the coldness is constant or intermittent, which extremity, how far up the leg it extends, and whether it is accompanied by numbness, tingling, or paresthesia. These symptoms reflect inadequate peripheral perfusion.

Example: My right foot and lower leg are cold virtually all the time, even in warm weather. I wear socks to bed year-round and often use a heating pad, though my vascular doctor warned me to be careful with heat due to poor circulation. The bottom of my foot has areas that feel numb - I cannot always tell if I'm stepping on something sharp. The numbness extends up to about mid-calf.

Examiner listens for: Constant versus intermittent coldness, laterality, extent, whether numbness is present and its distribution, and safety concerns related to impaired sensation (risk of undetected injuries).

Avoid: Do not omit numbness or loss of sensation - these are important for both rating and safety documentation. Impaired sensation creates risk of undetected ischemic injury that can progress to ulceration.

Common mistakes to avoid

Describing average or best-day walking capacity instead of worst-day capacity

Why: Rating criteria are based on the worst-day functional capacity as directed by M21-1. Veterans often minimize their condition by describing a day when they pushed through the pain. The examiner documents what you report, and if you report a higher functional capacity, you will be rated accordingly.

Do this instead: When asked how far you can walk, explicitly say: 'On my worst days, which happen [frequency], I can only walk [distance] before severe pain forces me to stop.' Then separately describe typical days. Use the phrase 'worst day' proactively.

Impact: All levels - especially the difference between 20% and 40%, and 40% and 60%

Failing to report rest pain

Why: Rest pain (pain in the foot or toes at rest, especially at night) is the threshold symptom separating moderate PAD from critical limb ischemia. Failing to report it means the examiner cannot document it, and you will be rated at a lower level than your condition warrants.

Do this instead: Proactively tell the examiner: 'I also have pain when I am not walking - at night, my foot burns and aches even in bed.' Describe nocturnal rest pain, dependency relief, analgesic requirements, and sleep disruption.

Impact: 60% - rest pain is explicitly listed in the criteria for this level

Not bringing documentation of vascular studies or recent labs

Why: The DBQ requires objective ABI values, toe pressures, and TcPO2 readings. If the examiner cannot obtain these at the time of the C&P exam, they may rely on older or missing data, potentially resulting in an inaccurate rating.

Do this instead: Bring copies of all recent vascular lab reports including ABI studies, duplex ultrasound reports, angiography results, and TcPO2 measurements. If no recent studies exist, ask your treating vascular surgeon for updated testing before your C&P exam.

Impact: All levels - objective data is required for accurate rating

Minimizing the impact on employment and daily activities

Why: The DBQ has a specific section on functional impact. VA raters and the VASRD consider functional impairment when evaluating cardiovascular conditions. Veterans who say 'I'm doing okay' or 'I manage' allow the examiner to record minimal functional impact, which does not support higher ratings.

Do this instead: Explicitly describe what you cannot do: job duties you can no longer perform, household tasks you require assistance with, activities you have given up, and how your condition has changed your daily routine. Be specific and use concrete examples.

Impact: All levels - functional impact fields affect the overall picture presented to raters

Failing to disclose use of assistive devices

Why: Use of a cane, walker, or wheelchair due to PAD is documented on the DBQ and reflects functional severity. If you use assistive devices but do not mention them, the examiner may not document them, underrepresenting your disability.

Do this instead: Bring all assistive devices you use to the exam. Tell the examiner: 'I use a [cane/walker] when walking because of the pain and instability from my PAD.' Explain how frequently you use the device and for what activities.

Impact: 40-100% - reflects significant functional limitation

Not describing bilateral involvement when both legs are affected

Why: The DBQ documents each extremity separately. If both legs have PAD but you only describe the worse side, the examiner may not adequately document bilateral disease, which can affect both the rating and the documentation of total disability impact.

Do this instead: Describe symptoms in both extremities separately. Note which is worse and which is less affected. Use specific anatomical locations: 'My right calf claudicates after 100 feet; my left calf claudicates after 200 feet.'

Impact: All levels - bilateral disease is rated separately under DC 7114 for each extremity

Not disclosing surgical or procedural history

Why: The DBQ specifically asks about prior vascular surgeries (bypass grafting, angioplasty, stenting, endarterectomy). Post-surgical results - whether improved, unchanged, or worsened - are critical to the rating picture. Examiners need to know if you have had procedures and whether they helped.

Do this instead: Prepare a written timeline of all vascular procedures including dates, facility, type of procedure, and outcome. Bring surgical records if available. Describe residual symptoms following any procedure.

Impact: All levels - procedure history informs rating continuity and current severity

Confusing PAD symptoms with other leg conditions during the exam

Why: PAD claudication has specific characteristics (cramping with walking, relief with rest, no pain at rest in early stages) that differentiate it from spinal stenosis (neurogenic claudication), venous disease, or musculoskeletal pain. Using imprecise language can confuse the examiner's assessment.

Do this instead: Describe your PAD symptoms using vascular-specific language: location (calf, thigh, buttock), onset with walking, relief with rest, progression over time, and objective findings (coldness, color changes, hair loss). If you have multiple leg conditions, describe each separately.

Impact: All levels - accurate symptom characterization is essential for correct diagnostic coding

Prep checklist

  • critical

    Gather all vascular lab reports and imaging studies

    Collect reports for all ankle-brachial index studies, arterial duplex ultrasound, CT angiography, MR angiography, conventional angiography, toe pressure studies, and TcPO2 measurements. Organize chronologically with the most recent first. These objective measurements directly correspond to rating thresholds.

    before exam

  • critical

    Obtain and bring all surgical and procedural records

    Collect operative reports, discharge summaries, and follow-up notes for any vascular procedures including peripheral angioplasty, stenting, bypass grafting, endarterectomy, or wound debridement. Note dates, facilities, and outcomes for each procedure.

    before exam

  • critical

    Write a detailed symptom narrative before the exam

    Write down your worst-day symptoms in advance so you do not forget important details under exam pressure. Include: worst walking distance, rest pain frequency and character, sleep disturbance, trophic changes you have noticed, cold extremity symptoms, numbness or tingling, and how symptoms have changed over time. Practice describing these aloud.

    before exam

  • critical

    Document all current medications related to PAD

    List all medications including antiplatelet agents (aspirin, clopidogrel), peripheral vasodilators (cilostazol, pentoxifylline), statins, antihypertensives, and any analgesics (including OTC medications) you take for PAD-related pain. Bring your medication bottles or a printed medication list.

    before exam

  • recommended

    Document employment impact and work restrictions

    Write down any jobs you have lost, job duties you can no longer perform, accommodations your employer has made, and any disability paperwork from employers or state disability programs related to PAD. If you have been told by a doctor to avoid standing or prolonged walking, bring that documentation.

    before exam

  • critical

    Request updated vascular studies from treating provider if outdated

    If your most recent ABI or vascular lab results are more than 12 months old, contact your vascular surgeon or primary care provider to request updated testing before your C&P exam. Current objective data is essential for accurate rating. The examiner cannot document what has not been measured.

    before exam

  • recommended

    Identify and list all affected extremities and symptom laterality

    Note specifically which extremities are affected (right lower, left lower, right upper, left upper), which is dominant (for upper extremity disease), and any asymmetry in symptoms between sides. DC 7114 can apply to each extremity separately - bilateral disease is important to document.

    before exam

  • optional

    Review your right to record the examination

    In most states, veterans have the right to record their C&P examination with a single-party consent recording. Research your state's consent laws before the exam. If allowed, bring a smartphone or small digital recorder and notify the examiner at the beginning of the appointment.

    before exam

  • critical

    Wear comfortable, loose clothing that provides easy access to legs and feet

    Wear shorts or loose-fitting pants that can be easily rolled up above the knee. Wear easy-to-remove footwear - you will need to have your feet and lower legs examined and likely have blood pressure cuffs placed at the ankles. Do not apply compression stockings, bandages, or heavy lotions to your legs on exam day.

    day of

  • critical

    Do not smoke or consume caffeine for at least 2-4 hours before the exam

    Both nicotine and caffeine cause peripheral vasoconstriction that can artificially alter ABI and vascular flow measurements. Avoid smoking, caffeine-containing beverages, and decongestants (which also cause vasoconstriction) before the exam to ensure the most accurate vascular testing.

    day of

  • critical

    Bring all assistive devices you use

    Bring your cane, walker, orthotics, or any other assistive devices to the exam. Use them as you normally would. The examiner will note their use on the DBQ. Do not leave them at home because you think you can 'make it' through the exam without them - this creates a false impression of your actual functional capacity.

    day of

  • recommended

    Arrive early and note any symptoms experienced getting to the exam

    Notice how far you walked from your car or transportation to the exam room and whether you experienced any claudication or pain. Mention this to the examiner: 'Walking from the parking lot to this room - about 200 feet - caused cramping in my calf that took 5 minutes to resolve.' This is real-time objective evidence of your functional limitation.

    day of

  • critical

    Do not take unusually high doses of pain medication before the exam

    Take your medications as prescribed on a normal schedule. Do not take extra medication to reduce pain before the exam in hopes of appearing more functional - this can mask the true severity of your condition. Do not skip medication either, as severe undertreated pain can also interfere with accurate examination.

    day of

  • critical

    Report symptoms using worst-day language explicitly

    When asked about your symptoms, preface descriptions with 'On my worst days...' and then also describe typical days. The M21-1 adjudication manual directs that ratings be based on worst-day severity. This is not exaggeration - it is accurate and complete reporting of the full range of your condition.

    during exam

  • critical

    Proactively disclose rest pain if you have it

    If you have pain in your foot or toes at rest - especially at night - tell the examiner even if not directly asked. Use specific language: 'I have constant burning pain in my [right/left] foot at night that wakes me from sleep. I hang my foot off the bed for relief. This happens [frequency].' Rest pain is the critical threshold for the 60% rating.

    during exam

  • recommended

    Ask the examiner to document specific numeric ABI and vascular test values

    If vascular testing is performed during the exam, ask the examiner to confirm they are recording the specific numeric values (e.g., ABI of 0.58 right, 0.62 left) rather than just 'reduced' or 'abnormal.' Specific values correspond directly to rating thresholds and are more defensible in appeals.

    during exam

  • critical

    Describe functional impact on specific daily activities and employment

    When the examiner asks about functional impact, be specific: 'I cannot stand at the kitchen counter for more than 3 minutes without pain.' 'I had to leave my job as a mail carrier because I cannot walk the route.' 'I cannot walk through a grocery store without stopping 4-5 times.' Connect each limitation to PAD symptoms specifically.

    during exam

  • recommended

    Correct the examiner immediately if you believe a finding is inaccurate

    If the examiner states something that does not match your experience - for example, 'you have good pulses bilaterally' when you know your pulses have been documented as absent - politely clarify: 'My vascular surgeon has documented absent pedal pulses; I have this report here if you would like to review it.' You are entitled to an accurate examination.

    during exam

  • recommended

    Report all symptoms that affect upper extremities if applicable

    If PAD affects your arms or hands (less common but possible), separately describe upper extremity symptoms including numbness, coldness, pain with hand or arm use, and any upper extremity pulse changes. The DBQ has separate sections for upper extremity involvement.

    during exam

  • critical

    Write detailed notes about the exam immediately afterward

    As soon as you leave the exam, write down what questions were asked, what the examiner examined, what tests were performed, what values were obtained, and whether you believe any significant symptoms were not discussed or documented. These notes are valuable if you need to request a supplemental exam or file a notice of disagreement.

    after exam

  • critical

    Request a copy of the completed DBQ

    You have the right to obtain a copy of the completed DBQ through a FOIA/Privacy Act request to the VA regional office or through your VA health records. Review the DBQ for accuracy. If significant findings are missing, inaccurate, or the examiner marked the condition without properly documenting all symptoms, you can submit a request for a new examination or supplemental statement.

    after exam

  • recommended

    Submit a personal statement (buddy statement or VA Form 21-4138) if the exam was inadequate

    If the examiner did not address all your symptoms, rushed through the exam, or documented inaccurate findings, submit a personal statement describing what was omitted and how your condition actually affects you. You can also submit buddy statements from family members or caregivers who observe your limitations daily.

    after exam

  • optional

    Track any worsening of symptoms after the exam for potential future claims

    Keep a symptom diary documenting claudication distances, rest pain episodes, new ulcerations, temperature changes, and functional limitations. This contemporaneous record is valuable for future rating increases or requests for re-evaluation.

    after exam

Your rights during a C&P exam

  • You have the right to a thorough, accurate, and unbiased Compensation and Pension examination. The examiner must review all available evidence, including your service treatment records, VA medical records, and private medical records submitted to the VA.
  • You have the right to record the C&P examination in most states. Check your state's single-party consent laws before the exam. If recording is permitted, inform the examiner at the start of the appointment.
  • You have the right to request a new examination if the original exam was inadequate, the examiner was not qualified in vascular medicine, or significant symptoms were not addressed. File a Notice of Disagreement or request a supplemental claim with additional evidence.
  • You have the right to submit a personal statement (VA Form 21-4138) describing your symptoms in your own words. This statement becomes part of your claims file and must be considered by the rater.
  • You have the right to submit private medical opinions from your own treating vascular surgeon, cardiologist, or internist. A nexus letter or detailed medical opinion from your treating provider carries significant evidentiary weight.
  • You have the right to obtain a copy of your completed DBQ through a FOIA/Privacy Act request. Review it for accuracy and completeness. If findings are inaccurate or incomplete, document the discrepancies in a statement to the VA.
  • You have the right to bring a VSO (Veterans Service Organization) representative, accredited claims agent, or VA-accredited attorney to your appointment. Some facilities allow a support person to accompany you.
  • Under the PACT Act and related legislation, veterans may have expanded eligibility for service connection for PAD related to toxic exposures (burn pits, Agent Orange, contaminated water). Discuss potential toxic exposure connections with your VSO or accredited representative.
  • You have the right to a rating decision based on the benefit of the doubt. Under 38 CFR 3.102, when there is an approximate balance of positive and negative evidence, VA must resolve the question in your favor.
  • You have the right to appeal any rating decision. Options include filing a supplemental claim with new evidence, requesting a Higher-Level Review, or filing a Board of Veterans' Appeals appeal. Each option has specific timeframes - consult an accredited representative.
  • You have the right to total disability based on individual unemployability (TDIU) if PAD prevents you from maintaining substantially gainful employment, even if the scheduler rating does not reach 100%. This requires VA Form 21-8940.
  • You have the right to request that both lower extremities be rated separately under DC 7114 if both are affected. Bilateral cardiovascular disability may be rated separately, potentially resulting in a combined higher disability rating.
  • You have the right to Special Monthly Compensation (SMC) if your PAD has resulted in the loss of use of a hand, foot, or creative organ, or if you require the aid and attendance of another person due to the severity of your disability.

Related conditions

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This guide covers what to expect for any veteran with this condition. If you have already uploaded your medical records, sign in to generate a packet that maps your specific symptoms to the DBQ fields your examiner will fill out.

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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.