Coronary Artery Disease — VA Disability Rating Criteria (DC 7005)

Diagnostic Code 7005 · 38 CFR §4.104

What Is It?

Coronary artery disease is the buildup of plaque in the arteries that supply the heart, narrowing them and reducing blood flow. It causes chest pain, breathlessness, fatigue, and in severe cases heart attack. For the claim, the decisive fact is that VA almost never rates the diagnosis or the anatomy. DC 7005 carries no percentages of its own; the regulation lists it and sends you to the General Rating Formula for Diseases of the Heart, which is keyed entirely to METs — metabolic equivalents of task. One MET is the energy cost of standing quietly at rest, an oxygen uptake of 3.5 milliliters per kilogram of body weight per minute. Two veterans with identical ninety percent blockages can end up at 10 percent and 100 percent, because the schedule measures what your heart lets you do rather than what the catheterization film shows. Three things follow from that. The METs figure is the most important number in your file. The symptoms that count are specific ones the regulation names — breathlessness, fatigue, angina, dizziness, arrhythmia, palpitations, or syncope — so an examiner recording only chest pain leaves value on the table. And ischemic heart disease, the umbrella term that includes CAD, angina, and heart attack, is an Agent Orange presumptive, which for a qualifying veteran removes the need for a nexus opinion entirely.

Rating Criteria

Evidence Needed

• A confirmed diagnosis of coronary artery disease — cardiac catheterization, coronary CT angiography, or a positive stress test.
• A METs assessment. This is the single most important document in the file. Under 38 CFR 4.100 METs testing is required in all cases, with only two exceptions: a medical contraindication, or a case where 100 percent can be assigned on another basis.
• An interview-based METs estimate if exercise testing is contraindicated. The regulation permits the examiner to estimate the activity level that produces symptoms, expressed in METs and supported by specific examples such as slow stair climbing or shoveling snow.
• An echocardiogram. Cardiac hypertrophy or dilatation confirmed on echo, MUGA, or MRI supports 30 percent by itself. Section 4.100(a) requires that hypertrophy or dilatation, and the need for continuous medication, be ascertained in every case.
• A current medication list showing continuous cardiac medication, which independently supports the 10 percent level.
• Proof of qualifying service for the Agent Orange presumptive route, or a nexus opinion for a direct or secondary claim.
• Records of procedures and hospitalizations: stents, bypass, angioplasty, heart attacks, and admissions for chest pain, each with dates.
• A statement describing what you can and cannot do in ordinary terms — how far you walk before stopping, how many stairs, whether you still mow the lawn, how often you reach for nitroglycerin.

C&P Exam Tips

• The heart exam is a clinical interview plus a review of your cardiac testing. If you can safely exercise, a treadmill test sets the METs figure at which symptoms appear.
• If exercise testing is not safe for you, the examiner is expressly allowed to estimate METs from your reported activity tolerance. Come prepared with concrete examples rather than adjectives: one flight of stairs and then you stop, half a block on a cold morning, no longer able to carry a laundry basket upstairs.
• A stress test can overstate real life. Ten supervised minutes with adrenaline running is not the same as a workday, so if the treadmill number looks better than how you actually live, say so plainly and ask that your daily limits be recorded alongside the test result.
• Name the regulation's symptoms. Breathlessness, fatigue, angina, dizziness, arrhythmia, palpitations, and syncope are the ones the formula lists. If dizziness or palpitations are part of your picture, do not let chest pain be the only thing written down.
• Bring the echocardiogram report. Hypertrophy or dilatation is a standalone route to 30 percent and is easy for an examiner to overlook if the report is not in front of them.
• Bring the medication list. Continuous medication required for control is a standalone route to 10 percent.
• Mention every other service-connected condition that limits exertion. When a knee or a lung condition stops you before your heart does, the record needs to be clear about which limit the METs figure is measuring.
• Report frequency, not just presence: how many angina episodes a week, how often you use nitroglycerin, how many nights you sleep propped up.

How to File

File on VA Form 21-526EZ. For an Agent Orange presumptive claim, identify the qualifying service and let the presumption do the work — no nexus opinion is needed. For a direct claim, connect the disease to service events or to a documented in-service onset. For a secondary claim, name the service-connected condition it flows from, most commonly type 2 diabetes or hypertension, and get a nexus opinion from a cardiologist. Attach the catheterization or CTA report, the most recent stress test or METs assessment, the echocardiogram, and the medication list. If you have had a heart attack or bypass, give the dates: DC 7006 provides 100 percent during and for three months following a myocardial infarction confirmed by laboratory tests, and DC 7017 provides 100 percent for three months following hospital admission for coronary bypass surgery, after which the METs formula resumes. Claim hypertension separately if you have it; it is rated under its own code, DC 7101, and the PACT Act added it to the Agent Orange presumptive list on a phase-in that reaches every claimant on October 1, 2026.

Common Mistakes

• Missing the Agent Orange presumption. Ischemic heart disease — CAD, angina, heart attack — is presumptive for qualifying service in Vietnam and its inland waterways and within 12 nautical miles of its coast, the Korean DMZ between September 1, 1967 and August 31, 1971, and the locations the PACT Act added: Thailand base perimeters from January 1962 through June 1976, Laos, Cambodia at Mimot or Krek, Guam, American Samoa, and Johnston Atoll.
• Letting a stress test stand unchallenged when it overstates real-world capacity, instead of getting daily limits into the record alongside it.
• Not producing the echocardiogram. Cardiac hypertrophy or dilatation supports 30 percent on its own and is regularly missed.
• Not mentioning continuous medication, which supports 10 percent on its own.
• Skipping the secondary route. CAD secondary to service-connected type 2 diabetes or hypertension is well supported in the medical literature and frequently succeeds where a direct claim would not.
• Expecting a stent to carry an automatic temporary 100 percent. There is no diagnostic code for angioplasty or stenting; unlike bypass surgery, a stent leaves you rated on your ongoing METs.
• Assuming ejection fraction still drives the rating. The 2021 revision removed it from the general formula, and 38 CFR 4.100 no longer lists a measured ejection fraction as a reason to skip METs testing.
• Filing for the heart alone when the condition has stopped you working. TDIU pays at the 100 percent rate on a lower schedular rating when the disability prevents substantially gainful employment.

Frequently Asked Questions

Is coronary artery disease a presumptive condition for Agent Orange?

Yes. Ischemic heart disease — which includes coronary artery disease, angina, and heart attack — is presumptively connected to herbicide exposure. If you served in a qualifying location, VA presumes service caused it and you do not need a nexus opinion. Qualifying locations include Vietnam and its inland waterways and within 12 nautical miles of its coast, the Korean DMZ from September 1, 1967 to August 31, 1971, and the sites the PACT Act added: Thailand, Laos, Cambodia at Mimot or Krek, Guam, American Samoa, and Johnston Atoll.

What are METs and why do they matter?

METs measure exercise capacity. One MET is the energy cost of standing quietly at rest, defined in the regulation as an oxygen uptake of 3.5 milliliters per kilogram of body weight per minute. Slow walking is roughly 2 to 3 METs, brisk walking 4 to 5, and jogging 7 to 8. Because the General Rating Formula for Diseases of the Heart is built entirely on METs, that figure — not the degree of blockage — sets your percentage.

Do I have to take a treadmill stress test?

Usually. Under 38 CFR 4.100, METs testing is required in all cases even when the 10 percent (continuous medication) or 30 percent (hypertrophy or dilatation) criteria are already met. There are only two exceptions: a medical contraindication, or a case where 100 percent can be assigned on another basis. Where testing is contraindicated, the examiner may estimate your METs level from specific examples of what you can do.

Does the VA still use ejection fraction to rate heart disease?

No. The 2021 revision to 38 CFR 4.104 rebuilt the general formula around METs and, at the 30 percent level, cardiac hypertrophy or dilatation. Ejection fraction and episodes of congestive heart failure are no longer criteria, and 38 CFR 4.100 no longer lists a measured ejection fraction of 50 percent or less as a reason to skip METs testing. Ratings assigned under the older version remain protected from reduction on that basis alone.

Does a stent or bypass change my rating?

Bypass does; a stent generally does not. DC 7017 assigns 100 percent for three months following hospital admission for coronary bypass surgery, after which you return to the METs formula. There is no diagnostic code for angioplasty or stent placement, so a stent leaves you rated on your ongoing workload capacity. If the stent genuinely improves your exercise tolerance, expect the next examination to reflect that.

I had a heart attack — am I automatically rated 100 percent?

For a limited period. DC 7006 assigns 100 percent during and for three months following a myocardial infarction confirmed by laboratory tests. After that you are re-rated on your recovered workload under the METs formula, so the three-month window is the time to get a current METs assessment and an echocardiogram into the file.

Can I claim heart disease secondary to hypertension or diabetes?

Yes, and both are strong routes. Chronic high blood pressure and type 2 diabetes are well-established causes of coronary artery disease. Type 2 diabetes is an Agent Orange presumptive, and the PACT Act added hypertension to that list on a phase-in that reaches every claimant on October 1, 2026, so a veteran service connected for either may reach CAD as a secondary condition with a cardiologist's nexus opinion.

Will my hypertension be rated separately or folded into my CAD rating?

Separately. Hypertension has its own diagnostic code, DC 7101, and is rated on blood pressure readings rather than METs. Because the two codes compensate different impairments, both can be rated and combined. If you are service connected for CAD and also have documented hypertension, claim it in its own right.

Can I work and still receive a high CAD rating?

Sometimes, and TDIU exists for the cases where you cannot. If your CAD limits you to roughly 5 METs or less you are unlikely to sustain physical work, and frequent angina can rule out sedentary work as well. TDIU pays at the 100 percent rate even when the schedular rating is lower, provided the service-connected disability prevents substantially gainful employment.