7115 - Thromboangiitis obliterans (Buerger's disease)
DBQ: Link to Index of DBQ/Exams by Disability for DC 7115
Acronym: TAO
Definition
Thromboangiitis obliterans (Buerger's disease) condition is defined as a vascular disorder that is chronic, inflammatory and occlusive, and involves small and medium arteries and veins of the extremities.
Etiology
The cause is unknown, but it does not occur in nonsmokers. Thus cigarette smoking is implicated as an etiological factor. The condition may be related to a hypersensitivity, a toxic vessel inflammation (angiitis), or an autoimmune disorder. When people stop smoking, the disease does not progress and it does not disappear.
Signs & Symptoms
This disease is seen in heavy-smoking, young males. Symptoms are related to occluded blood vessels and thrombosis. The clot can stop the blood supply to an organ or a part. Decreased circulation starts at distal points in the smallest vessels and progresses proximally; gangrene finally sets in at the distal portion. Complaints of cold extremities, numbness, cyanosis of the extremity, absent pulses in the feet or wrist and ischemic ulcers and gangrene appear in one or more digits or in the feet.
Tests
Similar to arteriosclerosis obliterans, an arterial blood pressure may be taken with a Doppler device to listen to blood flow. Treadmill testing is done to check the ankle-brachial systolic pressure ratio. Ankle and brachial artery pressure ratios over 1.0 is normal, under 1.0 indicates occlusive disease, and under 0.5 suggests severe ischemia. Occlusions may be visualized with arteriography, but the final diagnosis is made from a biopsy of a lesion.
Treatment
Preservation of blood supply is essential, and this includes elimination of smoking and protection of the extremities from the cold and vasoconstrictive drugs. Heel pads and foam rubber booties are protective measures to be used. Sleeping with the head of the bed raised 6 to 8 inches will aid arterial flow. Aspirin and calcium channel blockers may help to relieve vasospasm. Arterial insufficiency may be helped by a dorsal or lumbar sympathectomy, but only after a nerve block has been done to see if cutting will have a favorable response.
Residuals
The likelihood of amputation is ever present in this disease. If amputation should occur, then rehabilitation and counseling will be needed.
Special Considerations
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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).
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This disease 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 38 CFR 3.309 . [Disease subject to presumptive service connection], 38 CFR 3.309 (a) [chronic disease].
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The ankle/brachial index is the ratio of the systolic blood pressure at the ankle (determined by Doppler study) divided by the simultaneous brachial artery systolic blood pressure. The normal index is 1.0 or greater.
Notes
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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.
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Trophic changes include, but are not limited to, skin changes (thinning, atrophy, fissuring, ulceration, scarring, absence of hair) as well as nail changes (clubbing, deformities).
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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.