Post-phlebitic syndrome, a term once prevalent in medical circles but now commonly referred to as Post-Thrombotic Syndrome, describes the damage that occurs following a deep vein thrombosis (DVT), or blood clot. 

Typically occurring in the lower extremities, a DVT can lead to various symptoms and complications. These include swelling, pain, heaviness, itching, fatigue, changes in skin color and appearance, and the emergence of varicose veins. However, not all symptoms are important for VA disability rating purposes. Regardless, veterans should document their symptoms in a Statement in Support of Claim.

This blog post is dedicated to providing essential information related to post-phlebitic syndrome and VA disability.

History for Post-Phlebitic Syndrome

During a Compensation and Pension (C&P) examination, the history documentation of post-phlebitic syndrome is completed in the Artery and Veins Disability Benefits Questionnaire (DBQ). This C&P assessment records particular symptoms related to the condition.

• No Symptoms: Some individuals may experience no symptoms associated with the condition. Even without symptoms, an individual may see or feel varicose veins in the affected extremity. 
• Aching Pain: Individuals may experience aching pain in the affected extremity, especially after prolonged standing or walking.
• Fatigue: Individuals may experience fatigue or decreased stamina in the affected extremity, especially after prolonged standing or walking, which can impact mobility and walking endurance.
• Symptom Control: As part of the history documentation for VA rating purposes, the examiner is to document whether the veteran’s symptoms are alleviated by elevating the extremity or utilizing compression hose. 
• Constant Pain: Individuals may experience constant pain in the affected extremity even at rest. 

Physical Examination for Post-Phlebitic Syndrome

When assessing Post-Phlebetic Syndrome for VA disability purposes, it’s important for the examiner to conduct a thorough physical examination to identify any underlying signs associated with the condition. The examiner should look to identify the presence of the following:

• Varicose Veins: If varicose veins develop as a result of the DVT, it is important for the examiner to note whether these veins are visible or palpable. “Palpable” refers to anything detectable by touch during an examination.
• Stasis Pigmentation: Stasis pigmentation refers to skin discoloration resulting from the accumulation of fluid and blood. Often described as “bronzing,” this condition can act as a discreet indicator of underlying fluid and blood buildup.
• Eczema: Venous injuries can exert pressure that irritates the skin, causing discomfort, itching, and the development of dry patches.
• Edema: Edema, or swelling in the lower extremity, is a common manifestation of venous disease. Edema may be intermittent or persistent. Severe cases of edema may present with “Massive board-like Edema,” indicating advanced vein disease. The phrase “Massive board-like Edema” is not a common medical term used in medicine. 
• Ulceration: Ulcers, or sores that arise due to inadequate blood circulation, can occur. These ulcerations might be either intermittent or persistent. The presence of an ulcer indicates a progression to a more advanced stage of the disease.
• Induration: Induration involves swelling beneath the skin, commonly known as subcutaneous induration. It occurs when fluid accumulates within the skin’s layers, causing the skin to harden.

Testing for Post-Phlebitic Syndrome

It’s important to note that diagnostic tests for venous insufficiency are not readily available in primary care clinics. When indicated, vascular specialists may order specialized tests.

Treatment for Post-Phlebitic Syndrome

Compression hosiery is often prescribed for various venous disorders, including post-phlebitic syndrome. The precise level of compression required should be determined by the patient’s healthcare provider.

Although the C&P examination does not serve the purpose of treating post-phlebitic syndrome, it is important to submit medical records that document treatment for the condition to the VA Evidence Intake Center. This can be accomplished by uploading the documents online in the VA system. 

Ratings for Post-Phlebitic Syndrome

For veterans seeking disability ratings, Post-Phlebitic Syndrome falls under code 7121, alongside varicose veins. The rating schedule offers varying degrees of compensation based on the symptoms and exam findings:

• 0%: Asymptomatic palpable or visible varicose veins
• 10%: Intermittent edema of extremity or aching and fatigue in leg after prolonged standing or walking, with symptoms relieved by elevation of extremity or compression hosiery
• 20%: Persistent edema, incompletely relieved by elevation of extremity, with or without beginning stasis pigmentation or eczema
• 40%: Persistent edema and stasis pigmentation or eczema, with or without intermittent ulceration
• 60%: Persistent edema or subcutaneous induration, stasis pigmentation or eczema, and persistent ulceration
• 100%: Massive board-like edema with constant pain at rest

Learn More

Additional insights can be gained by tuning into the Valor 4 Vet and the Exposed Vet Radio Show on April 11, 2024, expanding your knowledge on the subject.

For information on Post-Phlebitic Syndrome inside the DBQ, please refer to Section III of the Artery and Veins DBQ.