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C&P Exam Prep: Varicose Veins
DBQ Overview
Interview + Physical- Form Name
- Artery_and_Vein
- Form Code
- Artery_and_Vein
- Page Count
- 10
- Examiner Type
- Vascular Surgeon, Cardiologist, or Internal Medicine
- Estimated Duration
- 30-45 minutes
- Exam Format
- Interview + Physical
What to Expect During Your Exam
Exam Overview
To document the current severity of varicose veins under Diagnostic Code 7120, including the presence and degree of symptoms such as edema, pain, aching, fatigue, skin changes, and ulceration, in order to assign an accurate disability rating.
What the examiner evaluates:
- Presence and extent of visible or palpable varicose veins in affected extremities
- Whether veins are asymptomatic or symptomatic
- Degree and type of edema (intermittent, persistent, or persistent incompletely relieved by elevation)
- Massive board-like edema
- Skin changes: beginning stasis pigmentation, beginning eczema, persistent stasis pigmentation, persistent eczema, persistent subcutaneous induration
- Ulceration: intermittent vs. persistent
- Symptoms including aching, fatigue, and pain in legs after prolonged standing or walking
- Relief of symptoms by elevation of extremity or compression hosiery
- Whether surgery has been performed and the type and date
- Functional impact on activities of daily living and work
- History of prior treatment including compression hosiery, surgery, sclerotherapy, ablation, or other interventions
- Presence of complications such as cellulitis, chronic edema, stasis dermatitis, or deep venous insufficiency
- Use of assistive devices
The physical examination will likely involve the examiner visually inspecting and palpating the affected legs while you are standing (weight-bearing) and possibly lying down. Skin changes, edema measurement, and ulcer assessment will be performed. Bring any compression stockings or braces you use, but do not wear them to the exam so the examiner can observe your veins and swelling in their natural state.
Typical duration: 30-45 minutes
Visual and Palpable Assessment of Varicose Veins
Presence, location, and extent of dilated, tortuous superficial veins in the lower extremities, assessed while standing and supine.
What to expect:
The examiner will ask you to stand so veins become more visible and palpable. They will note which extremities are affected (right lower, left lower, bilateral) and describe the distribution of visible veins.
Key thresholds:
- Asymptomatic palpable or visible varicose veins — 0% - noncompensable unless symptomatic
- Symptomatic with edema, pain, aching, or fatigue — Directs rating toward 10%-100% based on associated findings
Tips:
- Stand for the examination so veins are most prominent and visible.
- Do not wear compression stockings to the exam so veins and swelling are visible in their natural state.
- Point out all affected areas including both legs if bilateral.
- Note any areas of skin discoloration, thickening, or open sores.
Pain considerations: Describe any tenderness or pain when the examiner palpates the varicose veins or surrounding tissue.
Edema Assessment
Presence, severity, and response-to-elevation status of lower extremity swelling related to venous insufficiency.
What to expect:
The examiner will press on your ankles and lower legs to assess pitting edema. They will ask whether swelling is present every day, whether it goes away completely when you elevate your legs, and whether compression helps.
Key thresholds:
- Intermittent edema (comes and goes) — Associated with lower rating levels (10%)
- Persistent edema relieved by elevation — Associated with moderate rating levels (20%)
- Persistent edema incompletely relieved by elevation — Associated with higher rating levels (30%-40%)
- Massive board-like edema — Associated with highest rating levels (60%-100%)
Tips:
- Report whether your swelling is present every day or only after prolonged standing.
- Accurately describe whether elevating your legs fully resolves the swelling or only partially reduces it.
- Report how long you must elevate your legs and whether swelling returns when you stand again.
- Note if edema is present in the morning before you get out of bed - this indicates severity.
Pain considerations: Report any heaviness, tightness, or pain associated with edema. Describe pain on a 0-10 scale and whether it limits your ability to stand, walk, or work.
Skin Changes Assessment
Presence and severity of stasis pigmentation, eczema, and subcutaneous induration (hardening of tissue) caused by chronic venous hypertension.
What to expect:
The examiner will visually inspect the lower legs and ankles for discoloration (brownish staining), dry or scaly skin, weeping or inflamed skin (eczema), and hardened areas of skin or subcutaneous tissue. They will classify findings as 'beginning' or 'persistent/chronic.'
Key thresholds:
- Beginning stasis pigmentation or eczema — Associated with moderate rating levels (10%-20%)
- Persistent stasis pigmentation or eczema — Associated with higher rating levels (30%-40%)
- Persistent subcutaneous induration — Associated with higher rating levels (30%-40%)
Tips:
- Do not apply lotions, creams, or cover-up to affected areas before the exam so the examiner can see the true extent of skin changes.
- Point out all areas of skin discoloration, even if they have been present for a long time.
- Bring photographs taken on a bad day if skin changes fluctuate.
- Describe any itching, burning, or weeping associated with skin changes.
Pain considerations: Report any pain, burning, or itching from stasis dermatitis or eczema and how these symptoms affect your sleep, ability to wear shoes, and daily activities.
Ulceration Assessment
Presence, frequency, and persistence of venous stasis ulcers, typically located on the medial lower leg or ankle.
What to expect:
The examiner will look for any open sores, healed ulcer scars, or active ulcerations. They will assess size, depth, location, and whether ulcers are intermittent (heal and recur) or persistent (do not heal).
Key thresholds:
- Intermittent ulceration — Associated with higher rating levels (40%-60%)
- Persistent ulceration — Associated with highest rating levels (60%-100%)
Tips:
- Bring photographs of any ulcers that have been present, especially if they are currently healed at the time of the exam.
- Report all past episodes of ulceration with approximate dates and duration.
- Describe any current wound care, dressings, or treatment for ulcers.
- Report any hospitalizations or specialist visits related to venous ulcers.
Pain considerations: Describe pain associated with ulcers including constant pain at rest, pain with ambulation, and pain that disrupts sleep. Report whether you require narcotic or prescription pain medication for ulcer-related pain.
Functional Impact Assessment
How varicose veins and their complications limit occupational functioning, activities of daily living, mobility, and quality of life.
What to expect:
The examiner will ask about your ability to stand, walk, sit, perform physical activity, and work. They will ask about limitations during employment and effects on recreational or daily activities.
Key thresholds:
- No functional limitation beyond mild discomfort — 0%-10%
- Limits prolonged standing or walking — 10%-20%
- Requires elevation of legs, restricts occupation — 20%-40%
- Precludes standing employment, requires frequent leg elevation or wound care — 40%-100%
Tips:
- Be specific about how many minutes you can stand or walk before symptoms require you to sit or elevate your legs.
- Report how many times per day you must elevate your legs and for how long.
- Describe any job accommodations made or jobs lost due to this condition.
- Report any activity limitations including inability to perform household chores, yard work, exercise, or recreational activities.
Pain considerations: Report pain, fatigue, aching, and heaviness that occur with specific activities and how these symptoms limit duration and frequency of activity.
Rating Criteria Breakdown
| Rating % | Criteria | Key Symptoms |
|---|---|---|
| 40% | Varicose veins with persistent ulceration or massive board-like edema. Open sores that do not heal despite treatment, or severe non-pitting edema that is hard and board-like in quality. |
CFR: Diagnostic Code 7120: Ulcers that remain open despite appropriate treatment, or massively swollen legs with a hard, board-like quality indicating severe chronic venous insufficiency with fibrotic changes. |
| 30% | Varicose veins with persistent edema incompletely relieved by elevation, or with intermittent ulceration. Edema that persists even after prolonged leg elevation, or recurring open sores that heal but recur. |
CFR: Diagnostic Code 7120: Swelling that does not fully resolve overnight or with elevation, requiring ongoing wound care for recurring ulcers, inability to perform prolonged standing or walking activities. |
| 20% | Varicose veins with persistent edema, or with more advanced skin changes. Persistent edema that is relieved by elevation, persistent stasis pigmentation or eczema, or persistent subcutaneous induration. |
CFR: Diagnostic Code 7120: Persistent edema that resolves with leg elevation, established chronic skin changes including stasis pigmentation or eczema that are not transient, and palpable subcutaneous thickening or induration. |
| 10% | Symptomatic varicose veins with moderate symptoms. May include aching in the leg after prolonged standing or walking, fatigue in the leg after prolonged standing or walking, symptoms relieved by elevation of the extremity or compression hosiery, and/or beginning stasis pigmentation or eczema. |
CFR: Diagnostic Code 7120: Symptomatic - aching and fatigue after prolonged activity, beginning skin changes, or intermittent edema. Symptoms are present but manageable with conservative measures. |
| 0% | Asymptomatic varicose veins. Veins are visible or palpable but the veteran has no pain, swelling, skin changes, or other symptoms attributable to the varicose veins. |
CFR: Diagnostic Code 7120: Asymptomatic - rated as noncompensable (0%). The veins exist but do not cause measurable disability. |
40% Varicose veins with persistent ulceration or massive board-l ...
Varicose veins with persistent ulceration or massive board-like edema. Open sores that do not heal despite treatment, or severe non-pitting edema that is hard and board-like in quality.
Key Symptoms
- Persistent non-healing ulceration
- Massive board-like edema
- Severe functional limitation
- Unable to perform any prolonged standing or walking
- Requires daily wound care
- Chronic infections or cellulitis
CFR: Diagnostic Code 7120: Ulcers that remain open despite appropriate treatment, or massively swollen legs with a hard, board-like quality indicating severe chronic venous insufficiency with fibrotic changes.
30% Varicose veins with persistent edema incompletely relieved b ...
Varicose veins with persistent edema incompletely relieved by elevation, or with intermittent ulceration. Edema that persists even after prolonged leg elevation, or recurring open sores that heal but recur.
Key Symptoms
- Persistent edema incompletely relieved by elevation
- Intermittent ulceration
- Chronic non-resolving skin changes
- Significant limitation of activity and function
- Requires frequent leg elevation throughout the day
CFR: Diagnostic Code 7120: Swelling that does not fully resolve overnight or with elevation, requiring ongoing wound care for recurring ulcers, inability to perform prolonged standing or walking activities.
20% Varicose veins with persistent edema, or with more advanced ...
Varicose veins with persistent edema, or with more advanced skin changes. Persistent edema that is relieved by elevation, persistent stasis pigmentation or eczema, or persistent subcutaneous induration.
Key Symptoms
- Persistent edema relieved by elevation
- Persistent stasis pigmentation
- Persistent eczema
- Persistent subcutaneous induration
- Constant pain at rest
- Symptoms not fully controlled by compression or elevation
CFR: Diagnostic Code 7120: Persistent edema that resolves with leg elevation, established chronic skin changes including stasis pigmentation or eczema that are not transient, and palpable subcutaneous thickening or induration.
10% Symptomatic varicose veins with moderate symptoms. May inclu ...
Symptomatic varicose veins with moderate symptoms. May include aching in the leg after prolonged standing or walking, fatigue in the leg after prolonged standing or walking, symptoms relieved by elevation of the extremity or compression hosiery, and/or beginning stasis pigmentation or eczema.
Key Symptoms
- Aching in leg after prolonged standing
- Aching in leg after prolonged walking
- Fatigue in leg after prolonged standing
- Fatigue in leg after prolonged walking
- Symptoms relieved by elevation of extremity
- Symptoms relieved by compression hosiery
- Beginning stasis pigmentation
- Beginning eczema
- Intermittent edema of extremity
CFR: Diagnostic Code 7120: Symptomatic - aching and fatigue after prolonged activity, beginning skin changes, or intermittent edema. Symptoms are present but manageable with conservative measures.
0% Asymptomatic varicose veins. Veins are visible or palpable b ...
Asymptomatic varicose veins. Veins are visible or palpable but the veteran has no pain, swelling, skin changes, or other symptoms attributable to the varicose veins.
Key Symptoms
- Palpable varicose veins without symptoms
- Visible varicose veins without associated complaints
- No edema
- No skin changes
- No pain or functional limitation
CFR: Diagnostic Code 7120: Asymptomatic - rated as noncompensable (0%). The veins exist but do not cause measurable disability.
How to Describe Your Symptoms
Pain and Aching
How to describe:
Describe the type of pain (aching, throbbing, burning, heaviness), its location (specific leg or both legs, ankle, calf, thigh), what triggers it (standing, walking, end of day), how long it takes to develop, and what relieves it. Use a 0-10 numeric scale. Describe your worst days accurately.
Worst-day example:
“On my worst days, I have a constant deep aching and throbbing pain in both calves that starts within 10-15 minutes of standing. By the end of a workday, the pain reaches a 7/10 and I cannot tolerate standing at all. I must lie down with my legs elevated for 45 minutes before the pain drops to a 3/10, and even then it does not fully resolve.”
What the examiner listens for:
Specific triggers (standing vs. walking), onset timing, severity, duration, relieving factors, impact on work and sleep, and whether symptoms are constant or intermittent.
Understatements to avoid:
Saying 'my legs just get a little sore sometimes' instead of accurately describing the timing, severity, and functional impact of pain on your daily life.
Fatigue and Heaviness in Legs
How to describe:
Describe the sensation of leg fatigue or heaviness, how quickly it comes on with activity, how it limits your ability to stand or walk continuously, and how it affects your work and daily activities.
Worst-day example:
“After standing for about 20 minutes my legs feel like lead. They are so heavy and fatigued that I have to sit down or I cannot continue. This happens every day at work, and by midday I am barely functional because of the fatigue in my legs.”
What the examiner listens for:
Duration of standing or walking before fatigue develops, whether fatigue is daily, how it limits employment or household tasks, and whether elevation or rest resolves it completely.
Understatements to avoid:
Minimizing leg fatigue as normal tiredness rather than accurately describing how it is different from fatigue in the rest of your body and how it specifically limits your functional capacity.
Swelling (Edema)
How to describe:
Describe when swelling occurs (morning vs. evening, after standing vs. constant), which leg or legs are affected, how severe the swelling is (does your sock leave a mark, does your shoe not fit), and critically - whether elevating your legs fully resolves the swelling or only partially reduces it.
Worst-day example:
“My left leg is swollen every single morning when I wake up, even before I get out of bed. Elevating my leg for two hours only partially reduces the swelling - there is always some puffiness remaining. By the end of the day, my shoe will not fit on my left foot and there is a deep indentation from my sock that does not go away for hours.”
What the examiner listens for:
Whether edema is intermittent or persistent, whether it is fully relieved by elevation or only partially, whether it is present at rest, and the severity. These distinctions directly drive the rating level.
Understatements to avoid:
Saying 'my legs swell a little when I stand a lot' without clarifying that swelling is persistent, present every day, and not fully resolved by leg elevation overnight.
Skin Changes (Stasis Pigmentation, Eczema, Induration)
How to describe:
Describe the location and extent of skin discoloration (brownish-reddish staining), any dry, scaly, or weeping skin, itching, and any hardened or thickened areas of skin on the lower legs. Clarify how long these changes have been present.
Worst-day example:
“I have a large brownish stain covering most of my inner right ankle and lower calf that has been there for over two years. On bad days the skin becomes red, scaly, and itchy to the point where I scratch it until it bleeds, especially at night. There are hardened areas of skin around my ankle that feel like thick leather - they have been there for at least a year.”
What the examiner listens for:
Whether skin changes are new ('beginning') or established and long-standing ('persistent'), whether eczema is active or resolved, and presence of subcutaneous induration indicating chronic venous disease.
Understatements to avoid:
Failing to mention skin changes because they do not currently look their worst, or not describing how long they have been present and how they affect comfort, sleep, and ability to wear normal footwear.
Ulceration
How to describe:
Describe any current or past open sores on your lower legs or ankles. Report how often they occur, how long they take to heal, whether they recur after healing, any current wound care regimen, and whether any have been resistant to healing.
Worst-day example:
“I have had a sore on my inner left ankle that opened three months ago and has not healed despite weekly wound care visits, compression dressings, and a course of antibiotics for an infection. I cannot wear normal shoes and cannot work because the wound requires daily dressing changes that take 30 minutes.”
What the examiner listens for:
Whether ulceration is intermittent (heals and returns) or persistent (does not heal), the frequency and duration of episodes, treatment required, and impact on function. This is one of the most significant rating-determining findings.
Understatements to avoid:
Not mentioning past ulcers that have healed, or downplaying the impact of wound care on daily functioning and employment.
Functional Impact on Work and Daily Life
How to describe:
Be specific about how varicose veins limit your ability to perform your job, household tasks, exercise, sleep, and recreational activities. Quantify limitations in time (e.g., 'I can stand for 15 minutes before I must sit') and frequency (e.g., 'I must elevate my legs 4 times per day for 30 minutes each time').
Worst-day example:
“On my worst days I cannot stand for more than 10 minutes without severe aching and swelling. I have had to stop working in jobs that require standing. At home, I cannot cook a full meal, do laundry, or attend my children's sporting events because of the pain and swelling. I elevate my legs 5 to 6 times a day.”
What the examiner listens for:
Specific, quantifiable limitations, changes in employment, need for accommodations, impact on activities of daily living, and whether symptoms are consistent or fluctuating.
Understatements to avoid:
Saying 'I manage okay' or 'I get by' instead of accurately reporting the specific accommodations, limitations, and sacrifices you make every day because of this condition.
Common Mistakes to Avoid
Wearing compression stockings to the exam
Compression stockings reduce visible swelling and vein prominence, causing the examiner to underestimate the severity of your condition at baseline.
Instead: Remove compression stockings several hours before the exam so the examiner can observe your veins, edema, and skin changes in their natural state. Bring the stockings to show the examiner you use them and describe how they help.
Impact: 10%-40%
Only describing symptoms at their best or average, not at their worst
VA rating is intended to capture the full picture of disability including bad days. Understating severity can result in a rating that does not reflect true functional impairment. M21-1 guidance supports rating based on the full range of symptoms.
Instead: Describe your worst-day symptoms accurately and specifically, including the most severe edema you experience, the worst pain levels, and the most limiting episodes of skin changes or ulceration.
Impact: 10%-60%
Failing to distinguish whether edema is fully or only partially relieved by elevation
This distinction is a critical rating-level determinant under DC 7120. 'Persistent edema relieved by elevation' and 'persistent edema incompletely relieved by elevation' are different rating levels.
Instead: Specifically report whether elevating your legs overnight fully resolves your swelling or whether swelling remains present in the morning before you stand up. Be precise about the degree of resolution.
Impact: 20%-30%
Not reporting prior or healed ulcers
Intermittent ulceration (ulcers that heal and recur) is a significant finding under DC 7120 even when no ulcer is present at the time of exam. Failing to report this history results in an inaccurate lower rating.
Instead: Report all episodes of ulceration with dates, duration, treatment, and recurrence pattern. Bring photographs of past ulcers and medical records documenting wound care visits.
Impact: 30%-60%
Not reporting bilateral involvement
Each affected extremity is evaluated separately under the DBQ. If both legs are affected, both should be documented, potentially resulting in bilateral ratings.
Instead: Report symptoms in each leg separately to the examiner and point out findings in both extremities during the physical examination.
Impact: Any level
Minimizing functional limitations because 'other people have it worse'
Comparative statements have no bearing on VA ratings, which are based on your specific symptoms and limitations. Minimizing your disability leads to an inaccurate and lower rating.
Instead: Focus on your own symptoms, your specific limitations, and how they affect your life. Use specific numbers and timeframes to describe what you can and cannot do.
Impact: Any level
Not mentioning treatment history including surgery, sclerotherapy, or ablation
The DBQ specifically asks about treatment history. Prior surgery or procedures are relevant to nexus, severity assessment, and whether residuals persist despite treatment.
Instead: Be prepared to describe all treatments including the type of procedure, approximate date, which leg was treated, and whether it provided relief or whether symptoms persisted or recurred after treatment.
Impact: Any level
Prep Checklist
Before Your Exam
Day Of
During the Exam
After the Exam
Your Rights During a C&P Exam
- You have the right to request a copy of the completed DBQ through your VA records.
- You have the right to record your C&P examination in most states. Check your state's consent laws prior to the exam and notify the examiner before recording begins.
- You have the right to submit additional evidence (photographs, buddy statements, treatment records) after the exam to supplement the record.
- You have the right to a supplemental claim or appeal if you believe the C&P examiner's report is inadequate, inaccurate, or does not reflect the true severity of your condition.
- You have the right to request a new examination if the initial examination was inadequate - for example, if the examiner did not conduct a physical examination, did not review your records, or provided a clearly unsupported opinion.
- You have the right to have a VSO (Veterans Service Organization) representative, attorney, or claims agent assist you in preparing for and following up after the examination.
- You have the right to know the rating criteria that apply to your condition before the exam. VA ratings for varicose veins are governed by DC 7120 under 38 CFR 4.104.
- You have the right to submit a personal written statement (VA Form 21-4138) describing your symptoms and functional limitations at any time during the claims process.
- If your condition has worsened since your last rating, you have the right to file for an increased rating at any time with evidence of worsening symptoms.
- You are never required to exaggerate or fabricate symptoms. Report your condition accurately and completely - including your worst days - and trust that truthful, specific, and thorough communication of your actual symptoms is your most effective advocacy tool.
Related Conditions
- Post-Phlebitic Syndrome Post phlebitic syndrome (also rated under the vascular DBQ) can be a sequela of deep vein thrombosis and may coexist with or be confused with varicose veins. Both conditions cause edema, skin changes, and ulceration but have different etiologies. If present together, they may be rated separately.
- Stasis Dermatitis Stasis dermatitis is a skin complication directly caused by venous hypertension from varicose veins. It may be rated as a separate condition under the skin DBQ (DC 7800 series) if it is severe and distinct from the varicose vein rating, or it may be included within the varicose vein rating as one of the documented findings.
- Deep Vein Thrombosis (DVT) DVT can be a cause of secondary varicose veins and post phlebitic syndrome. If service connected DVT has caused or aggravated varicose veins, service connection for the varicose veins may be established on a secondary basis. DVT is rated separately under DC 7121.
- Peripheral Artery Disease (PAD) PAD involves arterial insufficiency and is rated under DC 7114 7115. It is a distinct condition from venous varicose veins but is evaluated on the same cardiovascular DBQ. Both may affect the lower extremities and should be evaluated and rated separately.
- Cellulitis Cellulitis is a bacterial skin infection that can occur as a complication of chronic venous insufficiency, varicose veins, and venous ulcers. Recurrent cellulitis related to varicose vein disease may be claimed as a secondary condition or noted as an aggravating complication in the varicose vein DBQ.
- Chronic Venous Insufficiency Chronic venous insufficiency is the underlying physiologic process driving symptomatic varicose veins. It encompasses edema, skin changes, and ulceration and is closely related to DC 7120 findings. Documenting the diagnosis of chronic venous insufficiency by a vascular specialist strengthens the severity narrative for varicose vein ratings.
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This C&P exam preparation guide is for educational purposes only and does not constitute legal, medical, or claims advice. Always consult with a qualified Veterans Service Organization (VSO) representative or VA-accredited attorney for guidance specific to your claim. Never exaggerate, minimize, or fabricate symptoms during a C&P examination.