Body system: Cardiovascular SystemRegulation: 38 CFR § 4.104
Hypertensive heart disease is heart damage from chronic high blood pressure, classically presenting with left ventricular hypertrophy (thickening of the heart's main pumping chamber) and over time progressing to diastolic dysfunction and heart failure. The VA rates this condition under the General Rating Formula for Diseases of the Heart (38 CFR § 4.104) from 10% to 100% based on the MET workload at which heart failure symptoms appear (dyspnea, fatigue, angina, dizziness, or syncope) and the presence of cardiac structural changes. Cardiac hypertrophy or dilatation on imaging supports a 30% rating. Continuous antihypertensive or other cardiac medication required for control supports a 10% rating. Note: the hypertension itself (without measurable heart involvement) is rated separately under DC 7101.
Rating levels
- 100% — You qualify for 100% if exercise testing (or clinical equivalent) shows that a workload of 3.0 METs or less brings on heart failure symptoms such as dyspnea, fatigue, angina, dizziness, or syncope. 3.0 METs is roughly equivalent to slow walking on a level surface, so this rating means even minimal activity provokes symptoms.
- 60% — You qualify for 60% if exercise testing shows that a workload of 3.1 to 5.0 METs brings on heart failure symptoms. The 3-5 MET range covers activities like light housework, slow walking, and dressing.
- 30% — You qualify for 30% if a workload of 5.1 to 7.0 METs brings on heart failure symptoms, OR if you have evidence of cardiac hypertrophy (LEFT ventricular hypertrophy is the classic hypertensive-heart-disease finding) or chamber dilatation confirmed by echocardiogram, Doppler echo, MUGA, or cardiac MRI. The 5-7 MET range covers brisk walking and stair climbing.
- 10% — You qualify for 10% if a workload of 7.1 to 10.0 METs brings on heart failure symptoms, OR if you require continuous medication (such as antihypertensives, beta blockers, ACE inhibitors, ARBs, diuretics, or other cardiac drugs) to keep symptoms and blood pressure under control. The 7-10 MET range covers jogging, vigorous cycling, or carrying heavy loads upstairs.