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Federal Register / Vol. 86, No. 187 / Thursday, September 30, 2021 / Rules and Regulations DISEASES OF THE HEARTContinued Unless otherwise directed, use this general rating formula to evaluate diseases of the heart.

Rating
LOTTER on DSK11XQN23PROD with RULES1

Note: When surgery is required, a 100-percent evaluation begins on the date a physician recommends surgical correction with a mandatory VA examination six months following hospital discharge. Evaluate post-surgical residuals under the General Rating Formula. Any change in evaluation based upon that or any subsequent examination shall be subject to the provisions of 3.105e of this chapter.
7111 Aneurysm, any large artery:
If symptomatic; or, for the period beginning on the date a physician recommends surgical correction and continuing for six months following discharge from inpatient hospital admission for surgical correction
Following surgery: Evaluate under DC 7114 peripheral arterial disease.
Note: 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 3.105e of this chapter.

100

7113 Arteriovenous fistula, traumatic:
With high-output heart failure
Without heart failure but with enlarged heart, wide pulse pressure, and tachycardia
Without cardiac involvement but with chronic edema, stasis dermatitis, and either ulceration or cellulitis:
Lower extremity
Upper extremity
Without cardiac involvement but with chronic edema or stasis dermatitis:
Lower extremity
Upper extremity
7114 Peripheral arterial disease:
At least one of the following: Ankle/brachial index less than or equal to 0.39; ankle pressure less than 50 mm Hg; toe pressure less than 30 mm Hg; or transcutaneous oxygen tension less than 30 mm Hg
At least one of the following: Ankle/brachial index of 0.400.53; ankle pressure of 5065 mm Hg; toe pressure of 3039
mm Hg; or transcutaneous oxygen tension of 3039 mm Hg
At least one of the following: Ankle/brachial index of 0.540.66; ankle pressure of 6683 mm Hg; toe pressure of 4049
mm Hg; or transcutaneous oxygen tension of 4049 mm Hg
At least one of the following: Ankle/brachial index of 0.670.79; ankle pressure of 8499 mm Hg; toe pressure of 5059
mm Hg; or transcutaneous oxygen tension of 5059 mm Hg
Note 1: 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 TcPO2 is measured at the first intercostal space on the foot. Normal TcPO2 is greater than or equal to 60 mm Hg. All measurements must be determined by objective testing.
Note 2: Select the highest impairment value of ABI, AP, TP, or TcPO2 for evaluation.
Note 3: Evaluate residuals of aortic and large arterial bypass surgery or arterial graft as peripheral arterial disease.
Note 4: These evaluations involve a single extremity. If more than one extremity is affected, evaluate each extremity separately and combine under 4.25, using the bilateral factor 4.26, if applicable.
7115 Thrombo-angiitis obliterans Buergers Disease:
Lower extremity: Rate under DC 7114.
Upper extremity:
Deep ischemic ulcers and necrosis of the fingers with persistent coldness of the extremity, trophic changes with pains in the hand during physical activity, and diminished upper extremity pulses
Persistent coldness of the extremity, trophic changes with pains in the hands during physical activity, and diminished upper extremity pulses
Trophic changes with numbness and paresthesia at the tips of the fingers, and diminished upper extremity pulses
Diminished upper extremity pulses
Note 1: These evaluations involve a single extremity. If more than one extremity is affected, evaluate each extremity separately and combine under 4.25, using the bilateral factor 4.26, if applicable.
Note 2: 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.
7117 Raynauds syndrome also known as secondary Raynauds phenomenon or secondary Raynauds:
With two or more digital ulcers plus auto-amputation of one or more digits and history of characteristic attacks
With two or more digital ulcers and history of characteristic attacks
Characteristic attacks occurring at least daily
Characteristic attacks occurring four to six times a week
Characteristic attacks occurring one to three times a week
Note 1: For purposes of this section, characteristic attacks consist of sequential color changes of the digits of one or more extremities lasting minutes to hours, sometimes with pain and paresthesias, and precipitated by exposure to cold or by emotional upsets. These evaluations are for Raynauds syndrome as a whole, regardless of the number of extremities involved or whether the nose and ears are involved.
Note 2: This section is for evaluating Raynauds syndrome secondary Raynauds phenomenon or secondary Raynauds. For evaluation of Raynauds disease primary Raynauds, see DC 7124.

7120 Varicose veins:
Evaluate under diagnostic code 7121.

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