Body system: Cardiovascular SystemRegulation: 38 CFR § 4.104
Heart valve replacement (prosthesis) covers veterans who have had one or more of the heart's four valves (aortic, mitral, pulmonary, tricuspid) replaced with an artificial valve, mechanical or bioprosthetic. The VA rates this condition at 100% from the date of HOSPITAL ADMISSION for the valve-replacement surgery. At SIX MONTHS following hospital discharge, the VA conducts a MANDATORY examination using the General Rating Formula for Diseases of the Heart (38 CFR § 4.104). The post-exam rating may continue at 100% or transition to 60%, 30%, or 10% based on MET workload at which heart failure symptoms appear and any cardiac structural changes. Continuous medication required for control supports a 10% minimum (most prosthetic-valve veterans need lifelong anticoagulation). Any reduction from the 6-month exam (or any later exam) is subject to the due-process rules of 38 CFR § 3.105(e).
Rating levels
- 100% — You qualify for 100% starting on the date of HOSPITAL ADMISSION for heart valve replacement surgery. The 100% rating continues for an indefinite period covering the surgery and recovery. Per the Note below, the VA conducts a MANDATORY examination 6 months following hospital discharge to determine the rating going forward, which then transitions to the General Rating Formula tiers based on residuals.
- -1% — At SIX MONTHS following hospital discharge, the VA conducts a MANDATORY examination. The post-surgical rating is determined using the General Rating Formula for Diseases of the Heart (the MET-based tiers below) based on residuals from the valve replacement. Any rating reduction from that exam (or any later exam) is subject to the due-process protections of 38 CFR § 3.105(e), the veteran gets advance notice and an opportunity to submit evidence before the reduction takes effect.
- 100% — At the mandatory 6-month-post-discharge exam, if your residuals show a workload of 3.0 METs or less brings on heart failure symptoms, the 100% rating continues under the General Rating Formula. 3.0 METs is roughly slow walking on a level surface.
- 60% — At the mandatory 6-month exam, if your residuals show a workload of 3.1 to 5.0 METs brings on heart failure symptoms, the rating shifts to 60%.
- 30% — At the mandatory 6-month exam, if your residuals show a workload of 5.1 to 7.0 METs brings on heart failure symptoms, OR cardiac hypertrophy or dilatation on echo/MUGA/MRI, the rating shifts to 30%.
- 10% — At the mandatory 6-month exam, if your residuals show a workload of 7.1 to 10.0 METs brings on heart failure symptoms, OR you require continuous cardiac medication (anticoagulants for the prosthetic valve, antiarrhythmics, beta blockers, etc.) for control, the rating shifts to 10%. Note: most veterans with a prosthetic valve require lifelong anticoagulation (warfarin for mechanical valves; varies for bioprosthetic), which by itself supports the 10% minimum.