Arteriosclerosis obliterans is a disease of arterial vessels in the extremities involving the intima and the media linings being stenosed (narrowed) or occluded (closed). The atherosclerotic deposits (plaques) are segmental, multiple, and result in decreased blood circulation.

This condition is seen between the ages of 50 and 70 and, more commonly in males. Causes are considered to be related to an increase in cholesterol (hypercholesterolemia) and lipids (hyperlipidemia) in the blood. Other factors include: hypertension, diabetes mellitus, and cigarette smoking. Familial predisposition, stress, obesity, and sedentary lifestyle are additional factors in the development of arteriosclerosis.

Symptoms may include intermittent claudication. When blood flow becomes severely restricted, there is leg pain at rest. Bruits (turbulent blood flow sounds) are audible over the obstruction. Other symptoms of vessel narrowing include: absent pulses; dry shiny skin; loss of hair on the legs; muscle atrophy; thick nails; cool, pale or bluish skin; and leg ulcers or gangrene.

Arterial blood pressure is taken with a cuff on the affected leg, and a Doppler device is used to listen to blood flow. Blood pressure in the legs is lower than arm pressure with vessel stenosis. 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 is suggests severe ischemia. Angiography confirms the obstruction and is usually done prior to surgery or angioplasty or both. Magnetic resonance imaging (MRI) has proven accurate and helpful.

Medical treatment includes: some form of regular exercise, a healthy diet that is low in saturated fat and salt, abstention from smoking, meticulous foot care, and elevation of the feet at night to reduce rest pain. In addition, medication for high cholesterol levels or diabetes mellitus or both, and possible use of aspirin to reduce risks of emboli are also used. Several operative procedures (bypass graft or endarterectomy) are possible, depending on the patient's general medical condition and the extent of the peripheral vascular disease. There are also some non-operative procedures such as percutaneous transluminal angioplasty (PTA), or balloon angioplasty that are simple, less costly and carry a lower risk.

Arteriosclerosis obliterans progresses more rapidly in the presence of diabetes mellitus, and the prognosis is less satisfactory. Complications of diabetes mellitus and atherosclerosis may lead to amputation of the affected limb. Atherosclerosis is a generalized disease, and eventual death from stroke or heart disease is probable.

• 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 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

• 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.