Phlebitis is defined as an inflammation of a vein. Post-phlebitis syndrome occurs after the acute stage is over, and the condition becomes chronic. Phlebitis is almost always associated with thrombosis. Long-term venous thrombosis is termed chronic venous insufficiency, and it is to be considered in post-phlebitic syndrome.

Many contributing factors cause venous thrombosis. The factors include: stasis of venous blood after surgery, postpartum states, and injury to the vein from catheters and irritating substances. Additional causes include: prolonged bed rest from chronic illness, oral contraceptives, hypercoagulability connected with malignancies, blood dyscrasias, and immobilization of legs in a dependent position, (e.g. plane travel). Most thrombi begin in the deep calf veins.

Edema of the leg or legs is present. If the femoral or iliac veins are involved, there will be measurable, marked edema. Skin discoloration, stasis dermatitis, and skin ulcers are common complications of venous stasis. Symptoms of leg aches and fullness occur with standing. Pulmonary embolism is a serious concern in deep venous thrombosis. Complaints of chest pain, inability to breathe normally and rapid heart rate should be investigated immediately.

The test used in detecting thrombi is duplex ultrasonography for femoral, iliac or popliteal veins. Plethysmography is also helpful in diagnosing thrombotic obstruction. A venogram is utilized in doubtful cases. A lung scan or pulmonary arteriogram will be used for diagnosis of pulmonary embolism.

Edema is to be controlled by elevation of the legs intermittently during the day, and all night. Pillows under the mattress should maintain the legs above heart level. Compression stockings are to be worn when legs are not elevated, and long periods of standing are to be avoided. Stasis dermatitis (depending on the current status) may be treated with compresses, antifungal or hydrocortisone cream or both, and antibiotics if infection is present. Stasis ulcers may need skin grafting, but, at first, the use of an Unna boot from the ankle to mid-calf is applied. Bony prominences, tendons, and the ulcer are carefully padded. This treatment compresses the veins, reduces swelling, and is changed every 1 to 2 weeks depending on the amount of ulcer drainage. Once the ulcer is healed, elastic stockings are used to prevent recurrence.

This is a chronic, recurrent problem requiring strict adherence to treatment measures for life, e.g., long-term anticoagulation therapy.

• 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).

Notes

• These evaluations are for involvement of a single extremity. If more than one extremity is involved, 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.