An aneurysm is an abnormal, localized expansion of a blood vessel, usually an artery, due to a birth defect or weakness in the wall of the vessel.

The causes of the condition include: trauma, fungal infections, congenital defect, syphilis or arteriosclerosis or both. The majority of peripheral artery aneurysms involve the popliteal artery.

The location of the artery will determine the exact signs and symptoms. Generally, the manifestations are due to pressure on adjacent structures, thrombosis, emboli in the periphery, and neuropathy. Intermittent claudication and ischemic limb pain (see Diagnostic Code: 7114 Arteriosclerosis obliterans) may occur. Bruits (turbulent blood flow) are usually heard over the aneurysm. Many people are symptomatic at the time of diagnosis.

The usual test is an ultrasound to define the diameter of the aneurysm. Arteriography will be done prior to surgical intervention. Tests related to arterial circulation are as follows: use of a Doppler device to listen to blood flow while using a leg to measure blood pressure, and treadmill testing to check the ankle-brachial artery pressures. A ratio of ankle and brachial pressures over 1.0 is normal, under 1.0 signifies occlusive disease, and a ratio under 0.5 is consistent with severe ischemia.

If the aneurysm is asymptomatic and exceeds 2 cm. in diameter, or if the aneurysm is less than 2 cm. but is symptomatic, then a repair and graft is recommended.

Two-thirds of those having femoral aneurysms, and one-third having popliteal conditions, may have aortoiliac aneurysms.

• May be entitled to special monthly compensation where the Veteran has a single service-connected disability rated as 100% with additional service-connected disability or disabilities independently ratable at 60% or more, which are separate and distinct from the 100% service-connected disability and involves different anatomical segments or bodily systems. See  38 CFR 3.350(i)(1) – Special Monthly Compensation (SMC).

• This disease, (condition), only in its active form , has a 3 year presumptive period and shall be granted service connection although not otherwise established as incurred in or aggravated by service if manifested to a compensable degree within the applicable time limits under 38 CFR 3.307 following service in a period of war or following peacetime service on or after January 1, 1947, provided the rebuttable presumption provisions of 38 CFR 3.307 are also satisfied. [38 CFR 3.309 [Disease subject to presumptive service connection], 38 CFR 3.309 (a). [chronic disease].

Notes

• Six months following discharge from inpatient hospitalization for surgery, determine the appropriate disability rating by mandatory VA examination. Any change in evaluation based upon that or any subsequent examination shall be subject to the provisions of 38 CFR 3.105(e) of this chapter.

• Following surgery: Evaluate under DC 7114 (peripheral arterial disease).

• The ankle/brachial index (ABI) is the ratio of the systolic blood pressure at the ankle divided by the simultaneous brachial artery systolic blood pressure. For the purposes of this diagnostic code, normal ABI will be greater than or equal to 0.80. The ankle pressure (AP) is the systolic blood pressure measured at the ankle. Normal AP is greater than or equal to 100 mm Hg. The toe pressure (TP) is the systolic blood pressure measured at the great toe. Normal TP is greater than or equal to 60 mm Hg. Transcutaneous oxygen tension (T_cPO₂) is measured at the first intercostal space on the foot. Normal T_cPO₂ is greater than or equal to 60 mm Hg. All measurements must be determined by objective testing.

• If AP, TP, and T_cPO₂ testing are not of record, evaluate based on ABI unless the examiner states that an AP, TP, or T_cPO₂ test is needed in a particular case because ABI does not sufficiently reflect the severity of the veteran's peripheral arterial disease. In all other cases, evaluate based on the test that provides the highest impairment value.

• Evaluate residuals of aortic and large arterial bypass surgery or arterial graft as peripheral arterial disease.

• These evaluations involve a single extremity. If more than one extremity is affected, evaluate each extremity separately and combine (under 38 CFR 4.25), using the bilateral factor (38 CFR 4.26), if applicable.

• The rating criteria for cardiovascular conditions underwent full-scale revision effective on November 14, 2021 and January 12, 1999.  A regulatory change was effective August 13, 1998, updated criteria for cold injury residuals under 38 CFR 4.104, DC 7122.  The changes are not considered liberalizing and should not be used as the basis for reduction unless the disability has actually improved.