Heart & Circulation — VA Disability Ratings

How Heart & Circulation conditions are rated

Most heart conditions are rated on one scale, the General Rating Formula for Diseases of the Heart in 38 CFR §4.104, which applies "Unless otherwise directed." It measures the workload, in METs, at which heart failure symptoms appear: 10% for 7.1 to 10.0 METs or "continuous medication required for control," 30% for 5.1 to 7.0 METs or cardiac hypertrophy or dilatation confirmed by echocardiogram or an equivalent study, 60% for 3.1 to 5.0 METs, and 100% for 3.0 METs or less. Note (3) says heart failure symptoms include, but "are not limited to," breathlessness, fatigue, angina, dizziness, arrhythmia, palpitations, or syncope.

Section 4.100 sets out how the formula is applied. In every case the rater must find out whether cardiac hypertrophy or dilatation is present and whether continuous medication is needed. Even when those findings already support 10% or 30%, "METs testing is required in all cases except" when there is a medical contraindication or when a 100% evaluation can be assigned on another basis. When exercise testing cannot be done for medical reasons, Note (2) to §4.104 provides that "a medical examiner may estimate the level of activity," expressed in METs and "supported by specific examples, such as slow stair climbing or shoveling snow," that brings on symptoms.

Many codes begin with a period at 100%, and most then return to the general formula. A myocardial infarction is rated 100% during and for three months after the event, coronary bypass surgery for three months from admission, and symptomatic bradycardia requiring a permanent pacemaker (DC 7009) for one month after discharge. An implanted pacemaker under DC 7018 also starts with one month at 100%, but afterward is rated as an arrhythmia, with a 10% minimum. Heart valve replacement is rated 100% for an indefinite period from admission, with a mandatory examination six months after discharge, and cardiac transplantation for at least one year, with a 30% minimum afterward.

Arrhythmias follow a printed single-evaluation rule: "For DCs 7009, 7010, 7011, and 7015, a single evaluation will be assigned under the diagnostic code that reflects the predominant disability picture." Supraventricular tachycardia (DC 7010), which by its note includes atrial fibrillation and atrial flutter, is rated on ECG confirmation and treatment: 10% for one to four treatment interventions a year, or for continuous oral medication or vagal maneuvers to control it, and 30% for five or more interventions. A treatment intervention is intravenous medication adjustment, cardioversion or ablation for symptom relief. Asymptomatic bradycardia "is a medical finding only."

Hypertension (DC 7101) is rated on blood pressure readings rather than METs. The schedule prints 10% for diastolic pressure predominantly 100 or more or systolic pressure predominantly 160 or more, and as a minimum for someone with a history of diastolic pressure predominantly 100 or more "who requires continuous medication for control." It prints 20% for diastolic 110 or more or systolic 200 or more, 40% for diastolic 120 or more, and 60% for diastolic 130 or more, each measured as the predominant reading. Note (1) requires readings "taken two or more times on at least three different days," and Note (3) rates hypertension separately from hypertensive heart disease and other types of heart disease.

The vascular codes, including aneurysms, peripheral arterial disease, varicose veins, Raynaud's and cold injury residuals, carry their own criteria and are explained on their pages. Cor pulmonale, a form of heart disease that follows from a lung condition, is rated as part of the pulmonary condition that causes it (Note (1)). The hypertension and arrhythmia pages go through their tables level by level.