Cardiovascular Conditions Rating Guide

Heart and blood-vessel conditions share one framework under 38 CFR § 4.104. Most heart conditions are scored by how much physical exertion you can do before symptoms start, measured in a unit called METs. A weak heart, a bad valve, and coronary artery disease are read through the same handful of rules. Learn that metric once and you understand how your rating is set. This guide explains the shared rules, then points you to the detailed guide for your specific condition.

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.

The METs number is the whole claim for most heart conditions. If your exam does not report a METs level (from a stress test or a documented estimate under 4.100), the single most important piece of the rating is missing. For the exact rating table for your specific condition, open its guide or condition page below.

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:

Area	Guide	DC codes
Coronary artery disease	Coronary Artery Disease Guide	7005
Hypertension	Hypertension Guide	7101
Cold injury residuals	Cold Injury Guide	7122

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

Every Cardiovascular Diagnostic Code, With Board Outcomes

Every diagnostic code in this body system, ordered by how often it reaches the Board of Veterans' Appeals. Percentages are the share of each code's Board issues granted, denied, or remanded (sent back for more development); dismissed and other outcomes are not shown, so rows do not sum to 100%. Each code links to its full page: rating criteria, evidence notes, and secondary-condition data.

DC	Condition	Board appeals	Granted	Denied	Remanded
7101	Hypertensive vascular disease (hypertension and isolated systolic hypertension) Claims guide →	101,851	16.4%	36.2%	41.4%
7005	Arteriosclerotic heart disease (coronary artery disease) Claims guide →	51,858	18.5%	29.5%	46.1%
7114	Peripheral arterial disease	14,992	25.9%	41.7%	25.2%
7122	Cold injury residuals Claims guide →	13,346	17.9%	37.5%	40%
7120	Varicose veins	7,544	16.3%	42.3%	37.4%
7006	Myocardial infarction	4,503	21.7%	39%	32%
7121	Post-phlebitic syndrome of any etiology	3,913	17.2%	32.5%	45.7%
7000	Valvular heart disease (including rheumatic heart disease),	3,641	14.3%	35.2%	46.4%
7010	Supraventricular tachycardia	3,622	14.8%	26.4%	52.3%
7020	Cardiomyopathy	3,518	20.6%	34.7%	37%
7017	Coronary bypass surgery	2,569	23%	46.5%	21.6%
7007	Hypertensive heart disease	1,768	21.8%	35.9%	36.7%
7111	Aneurysm, any large artery	1,300	13.4%	31.2%	50.2%
7011	Ventricular arrhythmias (sustained)	1,010	23.9%	24.2%	47.1%
7117	Raynaud's syndrome (also known as secondary Raynaud's phenomenon or secondary Raynaud's)	801	17.9%	21.1%	55.9%
7009	Bradycardia (Bradyarrhythmia), symptomatic, requiring permanent pacemaker implantation	756	14.2%	33.9%	44.8%
7015	Atrioventricular block	723	18.4%	38.3%	35.7%
7002	Pericarditis	461	15%	36.7%	42.3%
7118	Angioneurotic edema	382	23.6%	35.9%	36.6%
7110	Aortic aneurysm: Ascending, thoracic, or abdominal	352	9.9%	31.3%	50.3%
7018	Implantable cardiac pacemakers	42	26.2%	42.9%	21.4%

Show 12 more codes with too few Board appeals to report (expand)

DC	Condition	Board appeals
7001	Endocarditis, or	Too few Board appeals to report
7003	Pericardial adhesions	Too few Board appeals to report
7004	Syphilitic heart disease	Too few Board appeals to report
7008	Hyperthyroid heart disease	Too few Board appeals to report
7016	Heart valve replacement (prosthesis)	Too few Board appeals to report
7019	Cardiac transplantation	Too few Board appeals to report
7112	Aneurysm, any small artery	Too few Board appeals to report
7113	Arteriovenous fistula, traumatic	Too few Board appeals to report
7115	Thrombo-angiitis obliterans (Buerger's Disease)	Too few Board appeals to report
7119	Erythromelalgia	Too few Board appeals to report
7123	Soft tissue sarcoma (of vascular origin)	Too few Board appeals to report
7124	Raynaud's disease (also known as primary Raynaud's)	Too few Board appeals to report

Counts from RateMyVSO's index of published BVA decisions, refreshed weekly. A remand is not a loss; it means the Board needed more evidence before deciding. Descriptive of the published record, not a prediction for any claim.

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.

Evidence Cited in Published Coronary artery disease Decisions

We analyzed 42,280 published Board decisions involving coronary artery disease for condition-specific evidence, counting only case-specific mentions (boilerplate recitations excluded). "Favorable" is the share of decisions citing that evidence where every issue was granted or the outcome was mixed; the baseline across all these decisions is 43.6%, combining every diagnostic code below. Evidence appearing in a decision does not mean it decided the case. Descriptive of the published record, not a prediction.

Heart attack, stent, or bypass documentedfavorable 50.8%

n = 13,340

Stress test or echocardiogram in the recordfavorable 52.3%

n = 8,700

Ischemic heart disease herbicide presumption addressedfavorable 59.9%

n = 5,620

Ejection fraction measuredfavorable 58.7%

n = 5,266

METs workload testing documentedfavorable 62.7%

n = 4,515

By diagnostic code

These codes are grouped together above. They do not perform the same, so find your own code here rather than reading the combined figure. Codes retired in the schedule rewrites are left out, because their old decisions were judged under criteria that no longer apply.

DC 7005 Arteriosclerotic heart disease (coronary artery disease)favorable 43.1%

n = 40,346 decisions · 2,773 granted

DC 7017 Coronary bypass surgeryfavorable 54%

n = 2,377 decisions · 237 granted

Evidence Cited in Published Hypertension Decisions

We analyzed 71,541 published Board decisions involving hypertension for condition-specific evidence, counting only case-specific mentions (boilerplate recitations excluded). "Favorable" is the share of decisions citing that evidence where every issue was granted or the outcome was mixed; the baseline across all these decisions is 58.9%. Evidence appearing in a decision does not mean it decided the case. Descriptive of the published record, not a prediction.

Blood pressure readings documentedfavorable 59.9%

n = 36,521

Antihypertensive medication documentedfavorable 64.9%

n = 12,818

Diastolic/systolic threshold findings discussedfavorable 65%

n = 12,043

Elevated readings or hypertension noted in servicefavorable 61.6%

n = 10,040

Evidence Cited in Published Peripheral vascular disease Decisions

We analyzed 19,002 published Board decisions involving peripheral vascular disease for condition-specific evidence, counting only case-specific mentions (boilerplate recitations excluded). "Favorable" is the share of decisions citing that evidence where every issue was granted or the outcome was mixed; the baseline across all these decisions is 58%, combining every diagnostic code below. Evidence appearing in a decision does not mean it decided the case. Descriptive of the published record, not a prediction.

Varicose veins or stasis findingsfavorable 55.7%

n = 5,006

Claudication documented (walking distance)favorable 61.3%

n = 2,110

Compression stockings documentedfavorable 61.1%

n = 1,044

Doppler study or ankle-brachial index documentedfavorable 57.8%

n = 926

Diminished pulses or trophic changes on examfavorable 73.5%

n = 752

By diagnostic code

DC 7114 Peripheral arterial diseasefavorable 59.7%

n = 14,426 decisions · 1,554 granted

DC 7120 Varicose veinsfavorable 52.4%

n = 4,686 decisions · 280 granted

Detected by phrase-reading the decision text with condition-specific vocabularies. Source: Board of Veterans' Appeals decisions, RateMyVSO analysis.

Symptoms Recorded in Granted Coronary artery disease Decisions

We analyzed 2,973 granted Board decisions involving coronary artery disease for symptoms named in sentences about the condition (rating-criteria recitations excluded). Descriptive of the published record, what the Board wrote down, not a checklist of what to report.

Chest pain (angina)share of granted 20.6%

n = 612

Shortness of breathshare of granted 6.3%

n = 186

Fatigueshare of granted 4.1%

n = 123

Dizziness or faintingshare of granted 3.6%

n = 107

Symptoms Recorded in Granted Peripheral vascular disease Decisions

We analyzed 1,831 granted Board decisions involving peripheral vascular disease for symptoms named in sentences about the condition (rating-criteria recitations excluded). Descriptive of the published record, what the Board wrote down, not a checklist of what to report.

Pain or aching in the legsshare of granted 9.2%

n = 169

Swelling (edema)share of granted 7.2%

n = 131

Leg cramping when walking (claudication)share of granted 5.2%

n = 95

Ulcerationshare of granted 4%

n = 74

Coldness of the extremityshare of granted 1.1%

n = 21

Numbnessshare of granted 1%

n = 18

Detected by phrase-reading the decision text with condition-specific vocabularies. Source: Board of Veterans' Appeals decisions, RateMyVSO analysis.

Common Mistakes

No stress test or METs estimate in the file. When the METs level is missing, the primary metric for the rating is missing. If a stress test could not be done safely, ask for a documented estimate under 38 CFR 4.100.
Relying on a single blood-pressure reading. Hypertension needs readings confirmed on multiple days. One measurement is not enough to establish or raise the rating.
Missing the Agent Orange presumptive. Ischemic heart disease is presumptively service-connected for veterans with qualifying herbicide exposure. Do not try to prove a link the presumption already provides.
Not connecting heart disease to service-connected diabetes. Diabetes damages the heart. Heart disease that follows a service-connected diabetes diagnosis is a common secondary claim that is easy to overlook.

Frequently Asked Questions

How does the VA rate heart conditions?

Most heart conditions are rated under 38 CFR 4.104 on workload, measured in METs, the level of physical exertion at which symptoms like shortness of breath, chest pain, fatigue, or dizziness begin. The lower the METs level at which symptoms start, the higher the rating. Two other measures, the ejection fraction and any congestive-heart-failure episodes, can also set the rating.

What are METs?

METs stands for metabolic equivalents, a measure of how much exertion an activity takes. Walking slowly is a low number of METs; climbing stairs quickly or doing heavy work is a higher number. The VA looks at the METs level at which your heart symptoms begin: symptoms at a low METs level mean a more severe, higher-rated condition.

How is high blood pressure rated?

Hypertension (DC 7101) is the exception to the METs framework. It is rated on your diastolic and systolic blood-pressure numbers, and the rating requires readings confirmed on multiple days, not a single measurement. See the hypertension guide for the exact thresholds.

Is heart disease an Agent Orange presumptive?

Ischemic heart disease, which includes coronary artery disease, is on the VA's Agent Orange presumptive list. Veterans with qualifying herbicide exposure generally do not have to prove the link between their heart disease and service. See the PACT Act page for the exposure rules.

What does ejection fraction mean for the rating?

Ejection fraction is the percentage of blood the left ventricle pumps out with each beat, measured on an echocardiogram. A lower ejection fraction points to a weaker heart. A low ejection fraction can set the rating on its own, even when the METs level alone would place it lower.

Related Tools and Guides

Coronary Artery Disease Guide

The METs rating table for DC 7005, plus the Agent Orange presumptive.

Hypertension Guide

How blood-pressure thresholds set the rating for DC 7101.

PACT Act and Presumptives

Herbicide exposure and the ischemic-heart-disease presumption.

Diabetes Guide

The service-connected condition heart disease is often secondary to.

Secondary Conditions

Linking heart disease and hypertension to another condition.

DBQ Guide

The exam forms that capture METs, ejection fraction, and heart failure.

Sources: 38 CFR 4.104, cardiovascular ratings. Educational only, not legal advice, and not a prediction of any individual claim. Rating criteria and case law change; confirm current details in 38 CFR Part 4. For help with your claim, find a VA-accredited representative.