Erythromelalgia is a condition that is characterized by attacks of intermittent, burning and throbbing pain in the feet and, less commonly, in the hands.

The primary cause of erythromelalgia is unknown. However, there is a secondary disease that may occur in patients having disorders, e.g., myeloproliferative conditions, hypertension, multiple sclerosis, diabetes mellitus, and gout.

The patient may have mild symptoms for years, or become totally disabled from severe symptoms. The feet or hands are hot, red, and have a burning pain.

Skin temperature related to patient complaints aids in the diagnosis of primary disease. Frequent blood counts should be done because erythromelalgia may start years before the onset of myeloproliferative disorders.

Rest, elevation, and cold applications to the extremity may prevent or stop an attack. Medications used include: aspirin, up to four times a day, and some vasoconstrictors. Avoidance of vasodilatation is helpful. In secondary disease, the underlying disorder should be treated.

There are no trophic changes in the shape or size of the feet, toes, hands or fingers from this disease.

• 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).

Note

• For purposes of this section, a characteristic attack of erythromelalgia consists of burning pain in the hands, feet, or both, usually bilateral and symmetrical, with increased skin temperature and redness, occurring at warm ambient temperatures. These evaluations are for the disease as a whole, regardless of the number of extremities involved.

• 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.