Arteriosclerosis obliterans:

Description Percentage

Ischemic limb pain at rest, and; either deep ischemic ulcers or ankle/ brachial index of 0.4 or less

100
Description Percentage

Claudication on walking less than 25 yards on a level grade at 2 miles per hour, and; either persistent coldness of the extremity or ankle/ brachial index of 0.5 or less

60
Description Percentage

Claudication on walking between 25 and 100 yards on a level grade at 2 miles per hour, and; trophic changes (thin skin, absence of hair, dystrophic nails) or ankle/brachial index of 0.7 or less

40
Description Percentage

Claudication on walking more than 100 yards, and; diminished peripheral pulses or ankle/brachial index of 0.9 or less

20

Note 1: The ankle/brachial index is the ratio of the systolic blood pressure at the ankle (determined by Doppler study) divided by the simultaneous brachial artery systolic blood pressure. The normal index is 1.0 or greater.

Note 2: Evaluate residuals of aortic and large arterial bypass surgery or arterial graft as arteriosclerosis obliterans.

 

Note 3: These evaluations are for involvement of 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.

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