Peripheral Arterial Disease Secondary to Type 2 Diabetes Claim Guide
Peripheral Arterial Disease (VA diagnostic code 7114) is sometimes claimed as secondary to service-connected Type 2 Diabetes (code 7913) under 38 CFR 3.310. We analyzed published Board of Veterans' Appeals decisions on that pairing; here is what they show. It is an encyclopedic reference, not a forecast.
The Numbers, from 1.9M Appeals
We analyzed the Board's published decisions and found peripheral arterial disease (DC 7114) claimed as secondary to type 2 diabetes (DC 7913) is a real, mid-sized claim pool that loses more often than it wins once it reaches a merits decision.
How those 611 issues came out
Symptoms Recorded in Granted Peripheral vascular disease Decisions
We analyzed 1,831 granted Board decisions involving peripheral vascular disease for symptoms named in sentences about the condition (rating-criteria recitations excluded). Descriptive of the published record, what the Board wrote down, not a checklist of what to report.
Detected by phrase-reading the decision text with condition-specific vocabularies. Source: Board of Veterans' Appeals decisions, RateMyVSO analysis.
ICD-10 Diagnosis Codes for Peripheral Arterial Disease
The ICD-10 diagnosis codes most commonly used for DC 7114, Peripheral Arterial Disease (the kind on your medical records, decision letter, or C&P exam report). VA rates the disability and its residuals, not the diagnosis itself, so coding can vary.
What a secondary claim on this pairing needs
Under 38 CFR 3.310 a secondary claim turns on three elements:
- A current diagnosis: a medical diagnosis of peripheral arterial disease (the secondary).
- A service-connected primary: Type 2 Diabetes, already service-connected (the primary). A 0% primary still counts.
- A medical nexus: a medical opinion linking the peripheral arterial disease to the type 2 diabetes, showing the primary caused or aggravated it.
See the Secondary Claim guide for the caused-versus-aggravated split, and the Nexus Letter guide for what makes the medical opinion strong.
Why peripheral arterial disease is claimed secondary to type 2 diabetes
Whether that medical link exists in any one case is a medical question decided on that case's own evidence (the nexus).
Caused By vs Aggravated By: What the Board Found
The outcome split above counts whole issues. This section goes one layer deeper. Under 38 CFR § 3.310 a secondary claim can be won two ways: the type 2 diabetes caused the peripheral arterial disease (§ 3.310(a)), or it aggravated an existing peripheral arterial disease (§ 3.310(b)). Every grant rests on one or the other, so the numbers below divide up the granted claims only.
Direct causation is the route that carries most grants here: 84% of them found the type 2 diabetes caused the peripheral arterial disease, the rest found aggravation. A practical consequence for the nexus opinion: it should address both routes, because a medical opinion that only argues causation leaves the aggravation theory, a separate legal basis, on the table. See the caused-vs-aggravated guide for how the two theories differ.
On the other side: in 50 denied claims the Board looked at this pairing and found no link, meaning it decided the type 2 diabetes neither caused nor worsened the peripheral arterial disease. That is a separate group from the grants above, counted here so the picture is not one-sided.
We analyzed published Board decisions on this pairing to build this split. The grant split covers granted claims only; denied, remanded, and dismissed claims are not in it. Descriptive of the published record, not a prediction.
What VA Looks For: Tests, Records, and Diagnostic Codes
The record VA actually reviews centers on a small set of documents. We analyzed published Board decisions on these claims and ranked the records that appeared most often:
- A medical nexus opinion: the one record VA weighs most on a secondary claim, a doctor's statement linking your peripheral arterial disease to your service-connected type 2 diabetes and naming the mechanism.
- Varicose veins or stasis findings
- Claudication documented
- Compression stockings documented
- Doppler study or ankle-brachial index documented
- Diminished pulses or trophic changes on exam
The diagnostic code involved: DC 7114 (Peripheral Arterial Disease). The rating levels for this code are in the rating section below.
Records ranked by how often published Board decisions cited them. The exam that captures most of this is covered in the C&P Exam section below. Source: Board of Veterans' Appeals decisions, RateMyVSO analysis.
The Evidence That Wins Peripheral Arterial Disease Secondary Claims
What veterans who win this pairing actually put in the file, and why each piece moves the claim.
- Ankle-brachial index (ABI) test: This is the main test VA uses to rate PAD, and it also proves you have the disease. Ask your doctor for ankle and toe pressures, both legs. The number VA sees maps straight to a rating percentage, so get it on record.
- Vascular ultrasound or angiogram: This imaging shows exactly where an artery is narrowed or blocked. It backs up the ABI number with a picture VA cannot argue with. If you had a stent, angioplasty, or bypass, get those procedure notes too.
- Full diabetes treatment history: Pull your records showing when diabetes was diagnosed, your blood sugar (HbA1c) numbers over time, and your medications. You need to show diabetes was there long enough, and poorly controlled enough, to have caused the artery damage.
- How PAD actually happens from diabetes: High blood sugar over years damages the inner lining of your arteries and speeds up plaque buildup (atherosclerosis). That plaque narrows the arteries in your legs and cuts off blood flow, causing leg pain when you walk and, in bad cases, tissue damage. This is a different problem than diabetic nerve damage, so don't let the two get mixed up in your file.
- A nexus letter that names the mechanism and rules out other causes: Get a doctor, ideally a vascular surgeon or cardiologist, to write that it is "at least as likely as not" your diabetes caused your PAD. The letter should explain the artery-damage mechanism in your case, use your actual test numbers and dates, and address smoking or family history head-on rather than ignoring them. A letter that just says "diabetes is a risk factor" without connecting it to you will get denied.
- Say aggravation too, not just cause: If your PAD could have started some other way but got worse once your diabetes took hold, your nexus letter should say that explicitly. VA has two separate paths, direct cause and aggravation, and covering only one lets them deny the other.
- Records of hospital visits or emergency care for leg circulation problems: Any ER visit, hospitalization, or urgent procedure for blocked blood flow in your legs is strong proof of how serious your PAD is. Bring in every one of those records, not just your regular doctor visits.
- Walking limits and pain distance: Write down or have your doctor note how far you can walk before leg pain stops you (claudication). This shows the real-world impact of PAD on your daily life and supports a higher rating, especially if you cannot safely do a treadmill test.
Evidence Cited in Published Peripheral vascular disease Decisions
We analyzed 19,002 published Board decisions involving peripheral vascular disease for condition-specific evidence, counting only case-specific mentions (boilerplate recitations excluded). "Favorable" is the share of decisions citing that evidence where every issue was granted or the outcome was mixed; the baseline across all these decisions is 58%, combining every diagnostic code below. Evidence appearing in a decision does not mean it decided the case. Descriptive of the published record, not a prediction.
By diagnostic code
These codes are grouped together above. They do not perform the same, so find your own code here rather than reading the combined figure. Codes retired in the schedule rewrites are left out, because their old decisions were judged under criteria that no longer apply.
Detected by phrase-reading the decision text with condition-specific vocabularies. Source: Board of Veterans' Appeals decisions, RateMyVSO analysis.
Board Grants on This Pairing, Dissected
These decisions show the Board granting service connection for peripheral arterial disease (also called peripheral vascular disease) as secondary to service-connected diabetes mellitus. Board decisions are not binding on other veterans' claims, but they show how the Board has weighed medical evidence in this type of claim.
Board grants PVD when a VA examiner ties it to service-connected diabetes Citation A26016965 (February 25, 2026), Direct Review docket
The record: An August 2024 VA examination confirmed a diagnosis of peripheral vascular disease. A separate December 2024 VA medical opinion, written by a different examiner, found that the condition was less likely than not related to active service directly, but was "likely related to" the Veteran's service-connected diabetes mellitus type II.
Why it won: The Board found the evidence at least in approximate balance on the question of nexus. It gave weight to the December 2024 VA opinion because that examiner considered the Veteran's medical history and directly linked the current PVD to his diabetes history. The Board noted there was no evidence in the record contradicting that connection, and resolved doubt in the Veteran's favor.
A VA examiner's own hedge ("not caused solely by diabetes") becomes the basis for a grant Citation A24024360 (May 9, 2024), evidence submission docket
The record: A private disability benefits questionnaire (DBQ) from Dr. M.H. found the Veteran's peripheral vascular disease was associated with his diabetes mellitus. A December 2019 VA examiner disagreed in part, stating the PVD was less likely than not caused "solely" by diabetes, and pointed to risk factors like decades of smoking, hypertension, and being a male over 50.
Why it won: The Board read the VA examiner's own wording carefully. Saying the PVD was not caused "solely" by diabetes implied that diabetes likely contributed to causing it. Combined with the private DBQ, the Board found the nexus evidence in equipoise and resolved doubt in the Veteran's favor.
An uncontroverted private opinion is enough to win Citation A25073194 (August 29, 2025), Direct Review docket
The record: The Veteran submitted an Artery and Veins DBQ diagnosing peripheral arterial disease, along with a Diabetes Mellitus DBQ opinion stating the PAD was at least as likely as not due to his diabetes. There was no VA opinion in the file contradicting this.
Why it won: The Board called the private opinion "uncontroverted" and gave it probative weight because it addressed both diagnosis and cause. Since nothing in the file rebutted it, the Board found the evidence at least in equipoise and granted the claim.
Multiple treating providers outweigh a single VA exam years earlier Citation A24019110 (April 17, 2024), Hearing docket
The record: Three different private providers, Dr. J.B. in an August 2017 nexus letter, Dr. D.D. in June 2021 treatment records, and Dr. M.B. in DBQs from May 2021 and November 2023, each stated the Veteran's peripheral vascular disease was caused by his long-standing diabetes. An April 2017 VA examination had concluded the opposite.
Why it won: The Board found the repeated, consistent statements from the Veteran's own treating providers, made in the ordinary course of treatment and not just for the claim, more probative than the single VA exam. The Board specifically said it held "multiple positive nexus reports from the Veteran's treating providers... to hold greater probative value" than the negative VA opinion.
What the Board Said in Recent Grants
These are the Board's own words, quoted from the findings in 5 recent granted decisions on this pairing. Each sentence is the finding the grant rested on, not a summary of it. Click a citation to read the full decision.
“The evidence is at least in equipoise that the Veteran's peripheral artery disease is due to his service-connected diabetes mellitus”
“Resolving all doubt in the Veteran's favor, his currently diagnosed peripheral artery disease is proximately due to his service-connected diabetes”
“The most probative evidence of record shows that the Veteran's peripheral artery disease was proximately caused by or aggravated by his service-connected diabetes mellitus, type II.”
“Carotid artery disease is caused by the Veteran's service-connected diabetes mellitus (DM).”
“The Veteran's peripheral artery disease is proximately due to his service-connected diabetes”
Quoted from published Board decisions on this pairing, most recent first. Descriptive of the published record, not a prediction about any individual claim. Search the full decisions in BVA Decision Search.
Why VA Denies, and How the Board Answered
The rationales below are the ones VA examiners actually used against this pairing in the published record, each paired with the Board's response.
- Read the left column first: if a VA opinion in your file uses one of these arguments, that is the reasoning your own evidence has to meet.
- The right column is the counter: it shows how the Board actually answered that argument, with the decision cited.
- A rationale appearing here is not a verdict: the same argument won some cases and lost others, on different records.
| VA examiner's rationale | How the Board answered it |
|---|---|
| The Veteran's peripheral vascular disease pre-existed his service-connected diabetes and was not aggravated by it, because the condition began years before the diabetes diagnosis and progressed as medically expected. | The Board found no competent evidence in the file to counter this opinion and denied the claim. It noted the Veteran was not competent, as a lay person, to give his own opinion on the medical cause of his condition (18150653). |
| A VA examiner actually found it at least as likely as not that the Veteran's peripheral vascular disease was related to his diabetes. | The Board still denied the claim because the underlying diabetes itself was not service-connected. Since there was no service-connected diabetes to serve as the primary disability, secondary service connection could not be granted "due to lack of legal merit" regardless of the positive nexus opinion (21010922). |
| No VA examination was performed at all because the Veteran's own filings attributed his conditions to diabetes rather than to an in-service event. | The Board agreed no exam was required under the low McLendon threshold, since the Veteran never claimed direct service incurrence, and denied the claim because diabetes was not service-connected, so there was no service-connected disability to link the peripheral vascular disease to (A20000786). |
If Granted: How Peripheral Arterial Disease Is Rated
The VA assigns one of these percentages based on what your medical record documents. Plain-language summary of the rating criteria at 38 CFR; the controlling text is the regulation itself.
| Rating | What the record has to show for DC 7114, Peripheral Arterial Disease |
|---|---|
| 100% | You qualify for this rating level if medical tests show that blood flow to your arms or legs is severely restricted. Specifically, you need at least one of these test results: an ankle/brachial index (a comparison of blood pressure in your ankle versus your arm) of 0.39 or lower, blood pressure in your ankle below 50, blood pressure in your toe below 30, or an oxygen measurement through your skin below 30. These numbers indicate that your peripheral arterial disease has progressed to the point where your limbs are getting dangerously little blood and oxygen. |
| 60% | Blood flow to your arms and legs is significantly reduced, as shown by specific medical tests that measure circulation. These tests include the ankle/brachial index (comparing blood pressure in your ankle to your arm), direct pressure measurements in your ankle or toe, or oxygen levels measured through your skin. Your test results must fall within certain ranges that indicate seriously impaired blood circulation, which typically causes symptoms like pain when walking, slow-healing wounds, or cramping in your legs. |
| 40% | You qualify if medical tests show that blood flow to your legs or feet is significantly reduced. This includes having an ankle/brachial index (a test comparing blood pressure in your ankle to your arm) between 0.54-0.66, ankle blood pressure between 66-83 mm Hg, toe blood pressure between 40-49 mm Hg, or oxygen levels measured through your skin between 40-49 mm Hg. These test results indicate your arteries are moderately blocked, restricting blood flow to your extremities. |
| 20% | You qualify at this level if medical tests show moderately reduced blood flow to your arms or legs. This includes having an ankle/brachial index (a comparison of blood pressure in your ankle versus your arm) between 0.67-0.79, ankle blood pressure of 84-99, toe blood pressure of 50-59, or reduced oxygen levels in your skin tissue measuring 50-59. These test results indicate your peripheral arterial disease is causing significant but not severe circulation problems in your extremities. |
Do's and Don'ts
Every item below comes from a pattern in the decisions on this pairing, not from general claim advice.
- Get a private medical opinion or DBQ that plainly states your peripheral arterial disease is "at least as likely as not" caused by your service-connected diabetes.
- Submit opinions from doctors who have actually treated you over time, not just a one-time reviewer. The Board gave extra weight to statements made during regular treatment, not just for the claim.
- Make sure your diabetes is already service-connected before filing the secondary claim. Several denials failed for this reason alone, regardless of the medical evidence.
- Point out if a VA examiner's own wording leaves room for diabetes as a contributing cause, even if the opinion is not perfectly worded in your favor.
- Submit more than one nexus opinion if you can. The Board has found repeated, consistent private opinions more persuasive than a single conflicting VA exam.
- Don't assume a positive nexus opinion alone guarantees a grant. If your diabetes itself is not service-connected, the secondary claim can be denied even with a favorable opinion.
- Don't rely only on your own lay statements about the medical cause of your condition. The Board has repeatedly found veterans not competent to offer that kind of opinion.
- Don't ignore evidence that your peripheral arterial disease started before your diabetes. The Board has denied claims where the record showed the vascular disease pre-existed the diabetes with no aggravation shown.
- Don't submit an opinion with a bare conclusion and no explanation. The Board has given little or no weight to opinions that state a conclusion without reasoning.
- Don't forget that these decisions are not binding precedent. What worked in one veteran's case does not guarantee the same result in another.
Quick Checklist Before You File
- Service connection already in place for Type 2 Diabetes, and a current medical diagnosis of peripheral arterial disease.
- Diagnostic testing, imaging, or clinical records documenting the peripheral arterial disease, whatever your provider used to diagnose and track it.
- A nexus opinion, whenever possible from a doctor familiar with peripheral arterial disease, stating it is at least as likely as not caused or aggravated by the type 2 diabetes, and naming the mechanism rather than just the conclusion.
- Lay statements: spouse, family, friends, or battle buddies describing what they've witnessed or noticed.
- Your STRs and any VA opinions already in the file on either condition. If a VA opinion already went against you, your submitted opinion or statement should address its specific reasoning.
For the mechanics of filing itself, see the Standard Claim Guide and the Fully Developed Claim Guide.
The Claims Process, Step by Step
A secondary claim moves through the same pipeline as any other. Understanding who does what helps you know who to contact and what to expect.
- You file the claim, naming Type 2 Diabetes as the service-connected primary and peripheral arterial disease as secondary. Directly with VA, through VA.gov, or with an accredited representative's help.
- VA assigns a Veteran Service Representative (VSR) to develop the claim: gather your service treatment records, VA and private medical records, and order a C&P exam if needed.
- The C&P exam is conducted, usually with the examiner asked to address the specific secondary theory (causation and aggravation both).
- The file goes to a Rating Veteran Service Representative (RVSR), the "rater," who weighs the medical evidence and decides service connection and, if granted, the rating percentage.
- VA issues the decision letter stating the outcome and the reasoning.
- If denied or under-rated, you choose an appeal lane, Supplemental Claim, Higher-Level Review, or a Board appeal, covered below.
Who's who: VSO vs. VSR vs. Rater vs. C&P Examiner
Your VSO
An accredited representative, agent, or attorney. Not a VA employee. Helps prepare and file, and can represent you on appeal. Has no authority to decide your claim.
VSR
VA staff who develops the claim: gathers records and schedules the exam. Does not decide the rating.
Rater (RVSR)
VA staff who reviews the complete file and makes the actual decision on service connection and percentage.
C&P Examiner
Conducts the exam and, where asked, gives a nexus opinion. Does not decide the claim, but the opinion's reasoning and legal framing carry real weight.
For the full walkthrough, see Inside Your Claim and Claim Stages.
DBQs and Your C&P Exam
A Disability Benefits Questionnaire (DBQ) is the standardized form the examiner completes for your condition. See the DBQ Guide for how these forms work and whether a private DBQ from your own doctor can be submitted instead of relying solely on a VA exam. For what to expect and how to prepare, see the C&P Exam Prep Guide, and be specific about how your peripheral arterial disease symptoms relate to your type 2 diabetes timeline, treatment, and any aggravation, that is the detail a nexus opinion relies on.
Reading Your Decision Letter, and What to Do If Denied
Your decision letter has a narrative "reasons and bases" section and a codesheet with the rating and effective date. See the Reading Your Decision Letter Guide or use the Letter Interpreter tool to decode your own letter. If denied, you have three main lanes:
- Supplemental Claim: refile with new and relevant evidence, such as a nexus opinion that addresses the mechanism and the specific VA rationale you're rebutting. See Supplemental Claim Guide.
- Higher-Level Review (HLR): a senior reviewer looks at the same evidence again, useful if the denial rested on a legal error. See HLR Guide.
- Board Appeal: your case goes to a Veterans Law Judge, with a direct review, evidence, or hearing docket. See Board Appeal Guide.
Not sure which lane fits? See the Appeals decision guide for a side-by-side comparison.
After You Win: Maintaining Your Rating
Keep documentation of ongoing treatment, follow-up evaluations, and any updated diagnostic testing for your peripheral arterial disease on file, this protects you if VA schedules a future reexamination. See Protect Your Rating for when a rating becomes protected and Future Reexaminations for what triggers one. If your peripheral arterial disease worsens, see the Rating Increase Guide.
Frequently Asked Questions
Does Type 2 Diabetes have to be highly rated to support a peripheral arterial disease secondary claim?
No. 38 CFR 3.310 looks at whether the service-connected Type 2 Diabetes caused or aggravated the peripheral arterial disease, not at how severe the Type 2 Diabetes rating is. Even a 0% service-connected primary can anchor a secondary claim.
What do the percentages on this page mean?
They are the historical outcomes of 611 published Board decisions on this exact pairing: 26% granted, 41% denied, 30% remanded. They describe decided appeals already on record. They do not predict what would happen in any individual case.
RateMyVSO. Educational resource. Not affiliated with the U.S. Department of Veterans Affairs. Not legal advice. All RateMyVSO tools are free. Find a VSO representative for personalized guidance.