What Raynaud's Phenomenon Is
Raynaud's phenomenon is an episodic vasospasm of the digital arteries in response to cold exposure or emotional stress, producing characteristic color changes of the fingers (and sometimes toes, nose, or ears). The classic triphasic response is pallor (white), followed by cyanosis (blue), and finally rubor (red) on rewarming - reflecting initial vasoconstriction, deoxygenation of stagnant blood, and reactive hyperemia respectively. Not all patients have all three phases, but the diagnosis requires reproducible vasospastic attacks with clear color demarcation.
Primary vs Secondary Raynaud's
Primary Raynaud's (Raynaud's disease) is idiopathic - vasospasm without an identifiable underlying disorder. It is more common in younger women, typically presents symmetrically in both hands, and has a benign course without tissue loss.
Secondary Raynaud's (Raynaud's syndrome) is associated with an underlying condition - connective tissue disease (scleroderma, systemic lupus, mixed connective tissue disease), atherosclerosis, hematologic disorders, occupational exposure (vibration, repetitive trauma), or cold injury. Secondary Raynaud's is often asymmetric, more severe, and can produce digital ulceration and tissue loss.
How the VA Rates Raynaud's Phenomenon
Raynaud's phenomenon is rated under 38 CFR 4.104, Diagnostic Code 7117, with five rating tiers based on attack frequency and tissue complications.
10 Percent
Characteristic attacks occurring one to three times a week.
20 Percent
Characteristic attacks occurring four to six times a week.
40 Percent
Characteristic attacks occurring at least daily.
60 Percent
Two or more digital ulcers and a history of characteristic attacks.
100 Percent
Two or more digital ulcers plus autoamputation of one or more digits and a history of characteristic attacks.
Note: Definition of Characteristic Attack
A Note to DC 7117 defines a characteristic attack as one consisting of sequential color changes of the digits of one or more extremities lasting minutes to hours. Without documentation of these color changes, attacks are not characteristic for rating purposes.
Note: Bilateral Rating
When the involvement is bilateral, the single overall rating is assigned (not separate ratings for each side). However, complications such as digital ulcerations are evaluated individually under the appropriate complication-based tier.
Diagnosis and Workup
A defensible Raynaud's claim is anchored in objective documentation.
Clinical Examination
Examination by a primary care physician, rheumatologist, vascular specialist, or occupational medicine specialist documenting the pattern, distribution, triggers, frequency, duration, and presence or absence of color changes during attacks. Photographs of the digits during an attack are powerful evidentiary support.
Cold-Provocation Testing
Cold-provocation testing - immersing the hands in cold water and documenting digital temperature recovery - can reproduce attacks under controlled conditions. Slow digital temperature recovery on infrared thermography supports the diagnosis.
Nailfold Capillaroscopy
Nailfold capillaroscopy distinguishes primary from secondary Raynaud's. Capillary dropout, dilated capillaries, and microhemorrhages suggest secondary Raynaud's associated with connective tissue disease.
Serologic Workup
ANA, ENA panel, complement levels, and other autoimmune serologies screen for connective tissue disease underlying secondary Raynaud's.
Vascular Imaging
Digital arterial Doppler, plethysmography, or angiography characterize the vascular involvement when atherosclerosis or large-vessel disease is suspected.
Service Connection Pathways
Raynaud's phenomenon in veterans is most commonly claimed through three pathways.
Cold Injury Residuals
Veterans with documented cold weather injury (frostbite, immersion foot, trench foot, or non-freezing cold injury) frequently develop chronic vasomotor instability and Raynaud's phenomenon in the affected extremities. Cold injury residuals are rated under DC 7122, but Raynaud's developing secondary to cold injury is rated separately under DC 7117 when the criteria are met. Service connection can be established directly through the documented cold injury or secondary to the service-connected cold injury residuals under 38 CFR 3.310.
Hand-Arm Vibration Exposure
Hand-arm vibration syndrome (HAVS), also called vibration white finger, is a recognized occupational disease in which chronic exposure to vibrating hand tools (chainsaws, jackhammers, grinders, heavy machinery, weapons systems with significant recoil) produces vascular, neurological, and musculoskeletal injury. The vascular component is Raynaud's phenomenon. Veterans whose service involved sustained vibration exposure can establish direct service connection with documented exposure and a current diagnosis.
Secondary to Connective Tissue Disease
Veterans with a service-connected connective tissue disorder (scleroderma, systemic lupus, rheumatoid arthritis, mixed connective tissue disease) can claim Raynaud's secondary to the autoimmune condition under 38 CFR 3.310.
Secondary to Atherosclerotic Disease
When Raynaud's-like vasospasm develops in the setting of service-connected atherosclerotic vascular disease, secondary service connection may apply.
Evidence That Strengthens the Claim
Strong Raynaud's claims include the following.
Specialist Diagnosis
Diagnosis from a rheumatologist, vascular specialist, or occupational medicine specialist using established criteria. The diagnosis should specify primary versus secondary Raynaud's and identify the proposed underlying or contributing cause.
Documented Attack Frequency
Contemporaneous attack diary documenting dates, triggers, duration, distribution, and color changes for each attack. Photographs of digits during attacks are powerful evidence. The rating turns on attack frequency, so frequency documentation is foundational.
Exposure Documentation
For cold injury claims: service treatment records, unit records, deployment locations, and lay statements from fellow service members documenting the exposure event or chronic cold environment. For HAVS claims: occupational history documenting the specific vibrating tools or equipment, hours of exposure, and duration over the service period.
Objective Testing
Nailfold capillaroscopy, cold-provocation thermography, vascular imaging, or serologic workup as clinically indicated.
Complication Documentation
For 60 percent and 100 percent ratings, documentation of digital ulcers (photographs, treatment records) and autoamputation (operative notes, photographs).
Nexus Opinion
A medical opinion that it is at least as likely as not (50 percent probability or greater) that the Raynaud's is caused by the documented in-service exposure or is secondary to a service-connected condition. The opinion should articulate the specific mechanism.
Common Rating Issues
Several recurring issues affect Raynaud's claims.
Symptom-Only Documentation
Attacks described by the veteran without documented color changes do not meet the Note to DC 7117 definition of characteristic attack. The medical record or contemporaneous patient documentation must include the color changes.
Pyramiding with Cold Injury Residuals
Veterans with both cold injury residuals (DC 7122) and Raynaud's (DC 7117) can be rated under both codes when the conditions involve different manifestations and different anatomic distributions. Pyramiding under 38 CFR 4.14 is avoided by ensuring the same disability is not rated twice.
Underestimated Frequency
Attacks may cluster in winter and become much less frequent in summer. The rating should reflect the average frequency over the year, not just a single examination snapshot. An annual attack log captures this variation.
Connective Tissue Workup Gap
When secondary Raynaud's is claimed without identifying an underlying disorder, the workup should include nailfold capillaroscopy and autoimmune serologies to either identify a contributing disorder or characterize the case as cold-injury-related, vibration-related, or idiopathic.
Related Ratable Conditions
Raynaud's phenomenon frequently co-exists with other ratable conditions.
Cold Injury Residuals
Chronic cold injury residuals are rated under DC 7122 with criteria including arthralgia, tissue loss, nail abnormalities, color changes, locally impaired sensation, hyperhidrosis, and X-ray abnormalities.
Peripheral Neuropathy
Cold injury and HAVS both produce peripheral nerve injury rated under the Diseases of the Peripheral Nerves table at 38 CFR 4.124a.
Scleroderma and Connective Tissue Disease
Systemic sclerosis is rated under DC 7821 with criteria for skin involvement, joint involvement, and systemic complications. Lupus is rated under DC 6350.
Carpal Tunnel Syndrome
Carpal tunnel syndrome is rated under DC 8515 (median nerve) and frequently coexists with HAVS.
Frequently Asked Questions
Raynaud's phenomenon is rated under 38 CFR 4.104, Diagnostic Code 7117, at 10 percent (characteristic attacks one to three times a week), 20 percent (four to six times a week), 40 percent (at least daily), 60 percent (two or more digital ulcers with characteristic attacks), or 100 percent (two or more digital ulcers plus autoamputation with characteristic attacks). A characteristic attack must include the sequential color changes lasting minutes to hours.
Yes. Veterans with documented in-service cold weather injury (frostbite, immersion foot, trench foot, non-freezing cold injury) frequently develop chronic vasomotor instability and Raynaud's phenomenon. Service connection can be established directly through the documented cold injury event or secondary to service-connected cold injury residuals under 38 CFR 3.310.
Hand-arm vibration syndrome (HAVS), also called vibration white finger, is a recognized occupational disease caused by chronic exposure to vibrating hand tools. Veterans whose service involved sustained vibration exposure - chainsaws, jackhammers, grinders, heavy machinery, weapons with significant recoil - can establish direct service connection for HAVS with documented exposure, a current diagnosis, and a medical nexus opinion. The vascular component is rated under DC 7117.
Primary Raynaud's is idiopathic and has a benign course. Secondary Raynaud's is associated with an underlying condition - connective tissue disease, cold injury, vibration exposure, atherosclerosis, or hematologic disorder - and can produce digital ulcers and tissue loss. For VA purposes, secondary Raynaud's is the more common veteran presentation and is the pathway through which most veterans establish service connection (cold injury or vibration exposure). The rating itself does not differ - both are rated under DC 7117 based on attack frequency and complications.
Need a Nexus Letter for Raynaud's Phenomenon?
Semper Solutus provides MD-authored medical opinions and nexus letters tying Raynaud's phenomenon to in-service cold injury, hand-arm vibration exposure, or service-connected connective tissue disease. Schedule a free consultation to discuss your claim.
Book a Free Consultation