Cardiovascular Conditions Rating Guide

The Rules That Decide Every Cardiovascular Claim

Most heart codes are rated on workload: how much physical exertion you can do before heart symptoms begin. That workload is measured in METs, and two other measures sit alongside it. Learn these rules once and they apply across almost every heart condition in the schedule.

1. Most heart conditions are rated on workload in METs

METs stands for metabolic equivalents, the level of exertion at which shortness of breath, fatigue, chest pain (angina), dizziness, or fainting begins. Light activity like walking slowly is a low number of METs; harder activity like climbing stairs quickly or heavy yard work is a higher number. The lower the METs level at which symptoms start, the higher the rating. A heart that produces symptoms with very little exertion is rated far higher than one that only struggles under heavy exertion.

2. Ejection fraction and heart-failure episodes matter alongside METs

Two other measures work alongside the METs level. The heart's ejection fraction is the percentage of blood the left ventricle pumps out with each beat; a lower ejection fraction points to a weaker heart. The rating also counts any episodes of congestive heart failure. A low ejection fraction or repeated heart-failure episodes can set the rating on their own, even when the METs number alone would place it lower.

3. When exercise testing is not safe, a METs estimate is allowed (38 CFR 4.100)

Some veterans cannot safely complete an exercise stress test because of the severity of their heart condition or another medical reason. When that is the case, 38 CFR § 4.100 allows the examiner to record a medically-supported estimate of the METs level instead. A test that could not be done safely is not a reason to deny or lower a rating.

4. Hypertension is the exception, rated on blood-pressure readings

Hypertension (high blood pressure, DC 7101) is not rated on METs. It is rated on your diastolic and systolic pressure readings, the two numbers in a blood-pressure measurement. Because a single reading can be misleading, the rating requires blood pressure confirmed by readings on multiple days, not one measurement taken at a single visit.

5. Ischemic heart disease is an Agent Orange presumptive

Ischemic heart disease (reduced blood flow to the heart, which includes coronary artery disease) is on the VA's list of conditions presumptively linked to herbicide exposure. Veterans with qualifying Agent Orange or other herbicide exposure generally do not have to prove that their heart disease is connected to service. See the PACT Act and presumptive conditions.

Find the Guide for Your Condition

The rules above apply across the board. For the exact rating table, the C&P exam, and the Board data for your specific condition, open the dedicated guide:

For any code not listed, including arrhythmias, valve conditions, and vascular disease, open its condition lookup page for the rating levels and Board data.

Common Secondary Conditions

Heart and vascular conditions are closely tied to other service-connected conditions, both as a cause and as a result. These are common secondary-claim pairings:

• Heart disease from diabetes or hypertension. Service-connected diabetes and high blood pressure both damage the heart over time, so heart disease is often claimed as secondary to one of them.
• Hypertension from other conditions. High blood pressure can develop secondary to service-connected sleep apnea, kidney disease, or PTSD.
• The ischemic-heart-disease presumptive. For veterans with qualifying herbicide exposure, ischemic heart disease is presumptively service-connected, a direct path rather than a secondary one.
• Mental health after a cardiac event. Depression or anxiety following a heart attack or living with chronic heart disease can be claimed as secondary to the physical condition.

See secondary conditions for how these links are established.

Evidence That Wins

• An exercise stress test reporting the METs level, the exertion at which your heart symptoms begin. For most heart conditions this is the single most important number in the file.
• An echocardiogram reporting the ejection fraction, the percentage of blood the left ventricle pumps, which can set the rating on its own when it is low.
• Records of any congestive-heart-failure episodes, dated and documented, since repeated episodes can raise the rating independently of the METs number.
• Multi-day blood-pressure readings for a hypertension claim, since a single reading is not enough to establish the rating.
• The matching DBQ for the condition, which prompts the examiner to capture the METs level, ejection fraction, and heart-failure history. See the DBQ guide.

Common Mistakes

Frequently Asked Questions