Cardiovascular (Heart)
(38 CFR § 4.104 – Schedule of Ratings, Cardiovascular System)
The VA evaluates heart conditions based on measurable cardiac function and the impact on physical activity.
The primary factors the VA uses are:
-
METs level (Metabolic Equivalents)
-
Left Ventricular Ejection Fraction (LVEF)
-
Episodes of congestive heart failure (CHF)
-
Cardiac hypertrophy or dilation on imaging
-
Continuous medication requirement
Heart ratings are largely objective and based on diagnostic testing.
What Are METs?
METs measure how much physical activity your heart can tolerate.
During a stress test (or estimated clinically), the VA determines at what METs level symptoms such as:
- Shortness of breath
- Fatigue
- Chest pain (angina)
- Dizziness
- Syncope (fainting)
Lower METs = more severe impairment.
General Heart Rating Levels
(Most heart conditions follow this structure — DC 7000–7020 range)
Common Service-Connected Heart Conditions
The VA applies the above criteria to conditions such as:
- Coronary artery disease (ischemic heart disease)
- Myocardial infarction (heart attack residuals)
- Cardiomyopathy
- Valvular heart disease
- Arrhythmias (some have separate codes)
- Coronary bypass surgery
- Atherosclerotic heart disease
Special Situations
After Heart Surgery
Temporary 100% ratings may apply following:
-
Bypass surgery
-
Valve replacement
-
Myocardial infarction
(Usually for a defined recovery period.)
Arrhythmias
Some rhythm disorders are rated separately depending on:
-
Frequency
-
Need for pacemaker
-
Hospitalizations
Common Diagnoses That May Apply
- Ankle sprain with chronic instability
- Osteoarthritis or degenerative joint disease (DJD)
- Post-traumatic arthritis
- Achilles tendon injury or rupture
- Post-surgical conditions (fusion, screws, arthroscopy)
- Pain on movement (38 CFR §4.59)
- Instability or dislocation may also be considered under functional impairment.
Bilateral conditions (both ankles) may qualify for bilateral factor adjustments (38 CFR §4.26).
Step 1. Helpful Videos
Please review the video’s that demonstrate the range of motion.
Step 2.
Review the Key Factors:
METs (Metabolic Equivalents) — MOST IMPORTANT
This is the primary driver of the rating.
METs measure how much physical activity causes:
- Shortness of breath
- Fatigue
- Angina (chest pain)
- Dizziness
- Syncope (fainting)
| METs Level | Typical VA Rating |
|---|---|
| ≤ 3 METs | 100% |
| 3–5 METs | 60% |
| 5–7 METs | 30% |
| 7–10 METs | 10% |
Key Vet Quiz Insight:
If a veteran can’t complete a stress test, the VA accepts interview-based METs estimates (very common).
Left Ventricular Ejection Fraction (LVEF)
Measures how well the heart pumps blood.
| LVEF % | VA Impact |
|---|---|
| < 30% | 100% |
| 30–50% | 60% |
| > 50% | Lower ratings or none |
Used heavily when stress testing isn’t possible.
Congestive Heart Failure (CHF)
Extremely important for higher ratings.
- Chronic CHF → 100%
- More than 1 episode in past year → 60%
Continuous Medication Requirement
If the condition:
- Requires daily medication, AND
- Symptoms don’t meet higher thresholds
Minimum rating: 10%
Hospitalization / Surgery Triggers
Some events automatically trigger temporary 100% ratings:
- Heart attack (myocardial infarction)
- Coronary bypass surgery
- Heart valve replacement
- Implantable cardioverter-defibrillator (ICD)
Usually 3 months to 1 year at 100%, then re-rated.
Common Rated Heart Conditions
All are rated using the same framework above:
- Ischemic Heart Disease (IHD)
- Coronary Artery Disease (CAD)
- Cardiomyopathy
- Heart valve disease
- Arrhythmias (some have separate codes)
- Hypertensive heart disease
Diagnosis alone does NOT determine rating — functional impact does.