38 CFR Part 4 — 38 CFR § 4.104
Angioneurotic Edema
dc-7118-angioneurotic-edema
Cardiovascular
Diagnostic code
7118
Why your DC matters: DC 7118 is the exact code the VA uses to rate this condition. It determines which symptoms unlock which percentage, what evidence the rater looks for, and which secondaries are most likely to be approved.
Last verified against 38 CFR (eCFR Part 4):
Rating criteria (38 CFR Part 4)
Diagnostic code 7118 — Angioneurotic Edema — is listed under 38 CFR § 4.104 in 38 CFR Part 4. The paragraphs below summarize how this code is used; the official schedule text controls exact percentages, formulas, and notes.
Schedule summary (educational, not a substitute for the regulation): Educational index row from the rating schedule naming convention; confirm exact diagnostic code, effective date, and criteria in the current eCFR Part 4.
Exact rating criteria: Open Part 4 in the eCFR (link under “Official source” below). Locate your diagnostic code number (7118) in the correct body-system subpart, or use Find in Page (Ctrl+F / ⌘F) for “7118”. Copy the verbatim rating table, including any parenthetical notes, exceptions, and cross-references, for the version of Part 4 that applies to your effective date.
Effective dates & which schedule version applies
Which diagnostic code, percentage, and effective date apply depends on the facts of your claim and the version of the rating schedule in force for the period being decided. Generally, VA applies the schedule in effect at the specified time under 38 U.S.C. § 5110 and implementing rules, subject to exceptions (e.g., protected ratings, liberalizing law changes—see regulation and VA manual policy as applicable).
For older claims, the **current** eCFR may not match the text that applied years ago. If your decision references a prior percentage or code, compare against the Part 4 text **as of** your claim’s relevant dates; historical Federal Register / CFR snapshots may be needed for precise comparison.
The “Last verified” date on this page is when we last checked this educational summary against the electronic CFR—not the date of any VA policy or your personal claim decision.
Notes for your claim
Evidence: Show that your diagnosis and severity match the factors the schedule names for DC 7118 (e.g., measurements, frequency, treatment, functional loss), with medical and lay evidence as appropriate.
C&P exams: Results should reflect the schedule’s requirements (correct joints measured, correct formulas). If the exam omits required findings, consider submitting records or requesting clarification.
If you disagree with the DC, percentage, or effective date, review the Part 4 text for your period and consider a supplemental claim or appeal with a VA-accredited representative.
This site does not provide legal advice.
Official source
38 CFR Part 4 (eCFR) — locate diagnostic code 7118 in the subpart for your body system (use Find in Page if needed).
DC 7118 (angioneurotic edema, also called angioedema) rates under § 4.104 (cardiovascular system) — surprising because angioedema is fundamentally an allergic / mast cell / complement-mediated condition. The placement reflects historical schedule organization. Rating ladder is 10/20/40% based on attack frequency + laryngeal involvement. Laryngeal involvement is the critical high-tier element because laryngeal edema is life-threatening (airway compromise). Conditions covered: hereditary angioedema (HAE, C1 esterase inhibitor deficiency), acquired angioedema (often medication-related — ACE inhibitors are a notorious cause), idiopathic angioedema. PACT Act / burn pit / chemical-exposure veterans may develop acquired angioedema with elevated frequency — though angioedema itself is NOT on the explicit PACT presumptive list, the underlying immune dysregulation may be. Distinct from urticaria (DC 7825), which is hives without deep tissue swelling.
Rating Tiers — What Each Percentage Requires
| Rating | What It Takes | Evidence That Supports It |
|---|---|---|
| 40% | Attacks without laryngeal involvement lasting one to seven days or longer and occurring more than eight times a year; OR attacks with laryngeal involvement of any duration occurring more than twice a year. | Attack diary documenting frequency + duration + presence/absence of laryngeal involvement. ER visits, EpiPen/Berinert/icatibant use records. |
| 20% | Attacks without laryngeal involvement lasting one to seven days and occurring five to eight times a year; OR attacks with laryngeal involvement of any duration occurring once or twice a year. | Attack diary + treatment records. |
| 10% | Attacks without laryngeal involvement lasting one to seven days and occurring two to four times a year. | Attack diary documenting 2-4 attacks/year. |
| 0% | Fewer than two attacks per year without laryngeal involvement. | Sparse attack history. |
What Qualifies Under DC 7118?
Angioneurotic edema (angioedema)
Recurrent attacks of deep dermal / subcutaneous / submucosal swelling affecting face, lips, tongue, larynx, extremities, or abdominal viscera. Mediated by bradykinin (HAE, ACE inhibitor-induced) or histamine (allergic). Distinct from urticaria (superficial hives).
Frequency + laryngeal involvement drive the tier
10% — 2-4 attacks/year without laryngeal involvement. 20% — 5-8/year without OR 1-2/year with laryngeal involvement. 40% — > 8/year without OR > 2/year with laryngeal involvement.
Subtype agnostic — HAE, acquired, idiopathic all rate same
Hereditary angioedema (HAE I/II/III, C1 esterase inhibitor deficiency), acquired (often ACE inhibitor-induced), idiopathic — all rate under DC 7118 with the same frequency/laryngeal involvement criteria.
Laryngeal involvement is life-threatening
Laryngeal edema can cause airway obstruction requiring intubation. The high-tier criteria reflect this severity — ANY laryngeal involvement, even mild voice changes, lifts the rating significantly.
Language Your Rater Needs to See
These are the exact (or near-exact) regulatory phrases that unlock specific tiers. If your DBQ or C&P report doesn't use this vocabulary, the rater may default to a lower percentage even when symptoms qualify.
“More than eight attacks per year without laryngeal involvement OR more than twice yearly with laryngeal involvement”
40% gate is disjunctive. Frequency path (> 8/year) OR severity path (> 2/year with laryngeal involvement) — either qualifies. Track BOTH frequency and laryngeal involvement carefully.
“Attacks WITH laryngeal involvement (airway, throat, voice)”
Laryngeal involvement is the high-tier driver. ANY laryngeal involvement, even once or twice yearly, lifts the rating to 20-40% range. Document explicitly: hoarseness, voice changes, throat swelling, stridor, intubation history.
“Angioneurotic edema (hereditary, acquired, idiopathic)”
Subtype matters for treatment but rating is the same. HAE = C1 esterase inhibitor deficiency, family history, lab confirmation. Acquired (ACE inhibitor-induced, post-medication). Idiopathic = no identifiable cause.
Evidence Checklist — Specific to This Condition
Attack diary (12+ months)
CRITICALDate + duration + body part affected (face, lips, extremities, abdomen, larynx) + treatment used. Drives every tier. Single most important evidence.
Allergy / immunology consult notes
CRITICALDiagnosis subtype (HAE I/II/III, acquired, idiopathic). C1 esterase inhibitor level + function + C4 level for HAE diagnosis.
Emergency department records for severe attacks
CRITICALER visits for laryngeal involvement, anaphylaxis-like presentations, airway compromise. Anchors severity.
Pharmacy printout for acute and prophylactic medications
CRITICALAcute: icatibant (Firazyr), ecallantide (Kalbitor), C1 inhibitor concentrate (Berinert, Cinryze). Prophylactic: danazol, lanadelumab (Takhzyro), berotralstat (Orladeyo). Use anchors disease severity.
Documentation of laryngeal involvement
IMPORTANTHoarseness, voice changes, throat swelling, stridor, intubation. Anchors high-tier gate.
Medication exposure history (ACE inhibitors)
IMPORTANTIf acquired angioedema, ACE inhibitor exposure (lisinopril, enalapril, etc.) is the most common cause. Document discontinuation.
Family history (for HAE)
SUPPORTINGAutosomal dominant inheritance. Family history of unexplained swelling episodes supports HAE diagnosis.
C&P Exam Tips
Bring 12-month attack diary printed
Frequency + duration + laryngeal involvement drives every tier. Single most important evidence.
Document laryngeal involvement explicitly
Voice changes, hoarseness, throat swelling, stridor. Even mild laryngeal involvement lifts the rating significantly.
Bring pharmacy printout for acute + prophylactic medications
Icatibant, ecallantide, C1 inhibitor, danazol use anchors disease severity.
Don't downplay attacks managed at home
Attacks managed with home injection (icatibant subcutaneous, ecallantide subcutaneous) count just as much as ER visits. Document every episode.
Common Mistakes That Cost Veterans Points
Not maintaining attack diary
Tier gates are entirely frequency-driven. Without a 12-month diary, the rater defaults to the lowest credible attack count. Build the diary BEFORE filing.
Missing laryngeal involvement documentation
Laryngeal involvement is the high-tier driver. Even mild voice changes or throat swelling count. Make sure laryngeal involvement is explicitly charted at every attack.
Confusing angioedema with urticaria (DC 7825)
Angioedema = deep dermal/subcutaneous swelling (face, lips, throat, abdomen, extremities). Urticaria = superficial dermal hives. Both can coexist. Different DCs, different rating mechanics.
Not pursuing acquired angioedema as ACE inhibitor side effect
ACE inhibitor-induced angioedema is a recognized adverse drug effect. If you developed angioedema after starting an ACE inhibitor for SC hypertension (DC 7101), the angioedema is a secondary to SC HTN via medication causation.
Tactical Plays
⚡ Build a 12-month attack diary BEFORE filing
Tier gates are entirely frequency-driven. 2-4/year = 10%. 5-8/year = 20%. > 8/year = 40%. WITH laryngeal involvement: 1-2/year = 20%, > 2/year = 40%. Without a diary, the rater defaults to the lowest credible attack count. Build the diary first — date + duration + body part affected + presence of laryngeal involvement + treatment used. This is the single most valuable evidence.
⚡ Document laryngeal involvement aggressively — it's the high-tier driver
Any laryngeal involvement (voice changes, hoarseness, throat swelling, stridor, intubation) lifts the rating significantly. Once or twice yearly with laryngeal involvement = 20%. More than twice yearly with laryngeal involvement = 40%. Make sure every attack with throat or voice involvement is explicitly charted by the provider.
⚡ If ACE inhibitor-induced — link as HTN secondary
ACE inhibitor-induced angioedema (lisinopril, enalapril, ramipril — class effect) is a recognized adverse drug reaction. If you developed angioedema while being treated with ACE inhibitor for SC hypertension (DC 7101), the angioedema is a direct secondary via medication causation. ACE inhibitor must typically be discontinued; switching to ARB usually resolves.
⚡ Pursue HAE-specific workup if recurrent or family history
Hereditary angioedema (HAE) is autosomal dominant — family history of unexplained swelling. C1 esterase inhibitor level (low in HAE I, dysfunctional in HAE II, normal in HAE III) + C4 level (low) confirms diagnosis. HAE has specific treatments (C1 inhibitor concentrate, icatibant, ecallantide, lanadelumab) — use of these medications anchors disease severity.
Secondary Conditions to File With This One
Hypertension (if ACE inhibitor-induced angioedema)
MODERATEDC 7101
ACE inhibitor-induced angioedema is a recognized adverse drug effect. If hypertension is SC and you were treated with ACE inhibitor, the angioedema is a secondary via medication causation.
Urticaria (if coexisting)
MODERATEDC 7825
Many patients with angioedema also have urticaria. Different presentations, different DCs, both rate independently.
Anxiety / depression secondary to chronic disease
MODERATEDC 9400 / 9434
Recurrent unpredictable swelling attacks with potential airway involvement causes significant anxiety. Mental health secondary recognized.
Airway / laryngeal scarring (post-severe attacks)
SITUATIONALRepeated laryngeal involvement may cause chronic airway changes. Rate separately if documented.
GI involvement (recurrent abdominal angioedema)
SITUATIONALHAE classically presents with abdominal attacks (intestinal wall edema). Recurrent abdominal pain, vomiting, partial obstruction. May warrant separate consideration.
Compensation Scenarios
2026 rates (effective Dec 1, 2025, per va.gov)
0% — single, no dependents
TOTAL
$0.00/mo
< 2 attacks/year without laryngeal involvement.
10% — single, no dependents
Base rating
$180.42
TOTAL
$180.42/mo
2-4 attacks/year without laryngeal involvement.
20% — single, no dependents
Base rating
$356.66
TOTAL
$356.66/mo
5-8 attacks/year OR 1-2 with laryngeal involvement.
40% — single, no dependents
Base rating
$795.84
TOTAL
$795.84/mo
> 8 attacks/year OR > 2 with laryngeal involvement.
40% DC 7118 + 30% DC 7101 HTN + 30% DC 9400 anxiety
Base rating
$1,808.45
TOTAL
$1,808.45/mo
Frequent angioedema + comorbid HTN + chronic anxiety — common HAE/acquired presentation.
Note: Amounts are approximations rounded to nearest dollar. Actual comp varies with effective date, dependents (spouse, children, parents — each adds), Aid & Attendance, and additional disabilities. Combined ratings use VA Math (§ 4.25), not simple addition.
Key Definitions
💧What is Angioneurotic Edema?
Angioneurotic edema = angioedema. Recurrent attacks of deep dermal, subcutaneous, or submucosal swelling — distinct from superficial urticaria (hives). Affects face, lips, tongue, larynx, extremities, or abdominal viscera. Mediated by bradykinin (HAE, ACE inhibitor-induced) or histamine (allergic). Attacks last hours to days; can be life-threatening when involving larynx.
↔️HAE vs. Acquired vs. Idiopathic — What's the Difference?
HAE (hereditary angioedema) = autosomal dominant, C1 esterase inhibitor deficiency or dysfunction. Family history. Acquired = often ACE inhibitor-induced (lisinopril, enalapril class effect) or rare C1 inhibitor-targeted antibody. Idiopathic = recurrent angioedema without identifiable cause. All rate under DC 7118 with same criteria.
🫁Why is Laryngeal Involvement the High-Tier Driver?
Laryngeal edema can cause airway obstruction, requiring emergency intubation or even cricothyroidotomy. The mortality risk justifies the elevated rating. ANY laryngeal involvement (voice changes, hoarseness, throat swelling, stridor) — even mild and once-yearly — lifts the rating to 20%; more than twice yearly = 40%.
💊ACE Inhibitor-Induced Angioedema
ACE inhibitor-induced angioedema is a class effect of all ACE inhibitors (lisinopril, enalapril, ramipril, etc.). Mediated by bradykinin accumulation. Occurs in ~0.1-0.7% of ACE inhibitor users; risk is higher in Black populations. Typically requires discontinuation and switch to ARB (which is generally safe). Recognized adverse drug effect with secondary SC pathway if treating an SC condition.
How to File Your Claim
Build 12-month attack diary
Date + duration + body part + laryngeal involvement + treatment. Single most important evidence.
Pull allergy/immunology consult notes with subtype diagnosis
HAE (C1 esterase inhibitor labs), acquired (ACE inhibitor exposure), or idiopathic.
Pull pharmacy printout for acute + prophylactic medications
Icatibant, ecallantide, C1 inhibitor concentrate, lanadelumab — anchors disease severity.
File 21-526EZ specifying 'angioneurotic edema (DC 7118)' — direct or secondary
If ACE inhibitor-induced, file as secondary to SC HTN.
File mental health secondary if chronic anxiety from attack unpredictability
DC 9400 GAD or DC 9434 depression secondary to chronic recurrent angioedema.
Typical Claim Timeline
File initial claim
Day 0–7: Submit VA Form 21-526EZ with all medical evidence on file
VA acknowledges claim
Week 1–2: Receive confirmation letter and claim tracking number
C&P examination scheduled
Month 1–3: VA contracts an exam vendor and sends you appointment notice
Attend C&P exam
Bring your full evidence package; describe symptoms on your worst days, not your best
Decision & rating notice
Month 3–6: Decision letter with rating percentage and effective date
First payment & retro back pay
Within 15 days of decision; retroactive to claim date (or effective date if earlier)
Timeline varies by case complexity and VA regional office workload. Some claims resolve faster; others take longer.
Important Considerations
Attack diary is the single most valuable evidence
Tier gates are entirely frequency-driven. Build the 12-month diary BEFORE filing — date + duration + laryngeal involvement + treatment used.
Laryngeal involvement is the high-tier driver
Any laryngeal involvement (voice changes, hoarseness, throat swelling) lifts the rating. Document explicitly at every attack.
ACE inhibitor-induced angioedema = SC secondary pathway
If treated with ACE inhibitor for SC HTN, ACE-induced angioedema is a direct secondary. Pharmacy records anchor the timeline.
Not urticaria — different DC
Angioedema (deep tissue swelling) = DC 7118. Urticaria (superficial hives) = DC 7825. Both can coexist; rate separately if both diagnosed.
Related Tools & Resources
Frequently Asked Questions
Why is angioedema rated under § 4.104 (cardiovascular)?
Historical schedule organization. Angioedema (DC 7118) is grouped with cardiovascular system because of vasomotor / vascular involvement. The pathophysiology is allergic / immune / bradykinin-mediated, not cardiovascular per se. The placement reflects schedule history rather than current understanding.
What's the difference between angioedema and urticaria?
Angioedema (DC 7118) = deep dermal / subcutaneous / submucosal swelling affecting face, lips, throat, larynx, abdomen, extremities. Lasts hours to days. Urticaria (DC 7825) = superficial dermal hives (welts). Lasts minutes to hours. Both can coexist; rate under separate DCs.
How is hereditary angioedema (HAE) rated differently?
Not differently — DC 7118 covers HAE, acquired angioedema, and idiopathic angioedema with the same frequency / laryngeal involvement criteria. Subtype diagnosis matters for treatment (HAE-specific medications: C1 inhibitor concentrate, icatibant, ecallantide, lanadelumab) and SC nexus (HAE family history, ACE inhibitor exposure), but rating tier is the same.
Can ACE inhibitor-induced angioedema be a secondary to my service-connected hypertension?
Yes — ACE inhibitor-induced angioedema is a recognized adverse drug effect. If you developed angioedema while being treated with ACE inhibitor (lisinopril, enalapril, ramipril, etc.) for SC hypertension (DC 7101), the angioedema is a direct secondary via medication causation. Document the timeline with pharmacy records.
How do I document laryngeal involvement?
Provider chart note explicitly stating throat involvement during attacks: voice changes, hoarseness, throat swelling, stridor, difficulty swallowing, sensation of throat closing. ER visits with documented throat swelling, intubation history, or laryngoscopy findings anchor severe involvement. Even mild voice changes count — make sure they're explicitly charted.
Official Regulatory Source
Angioneurotic edema rates under 38 CFR § 4.104, DC 7118 — 10/20/40% based on attack frequency + laryngeal involvement.
38 CFR § 4.104 — Cardiovascular System (eCFR) →Scroll to DC 7118 (between DC 7115 and DC 7120). Compare DC 7825 (urticaria, in § 4.118 skin) for differential diagnosis.
Next Steps
If your rating decision lists DC 7118, compare your current symptoms and documentation against the criteria above. Consider:
- Requesting a copy of your rating decision and C&P exam report from the VA
- Gathering all relevant medical records (VA and private providers)
- Documenting functional limitations and how they impact work and daily activities
- Obtaining a nexus letter if needed to establish or strengthen service connection
- Filing for secondary conditions that may be related to this primary condition
- Contacting a VA-accredited VSO, claims agent, or attorney to review your file
This is general educational information only — not legal or medical advice.
Also: DC code lookup (tools) lists the same index in a compact layout.
Source: 38 CFR Part 4, Diagnostic Code 7118 • va.gov
⚠️ Important Disclaimer
This page provides general educational information only based on public VA regulations (38 CFR) and va.gov resources. It is not legal, medical, or claims assistance. Ratings and service connections are decided case-by-case by the VA based on the individual veteran’s evidence. We do not prepare claims, generate documents, or provide personalized advice. Always consult a VA-accredited Veterans Service Organization (VSO), attorney, or your physician for help with your specific situation. Verify the latest rules on va.gov.