VA Disability Rating for Implantable Cardiac Pacemakers (DC 7018)
Diagnostic Code 7018 · 38 CFR §4.104
What Is It?
An implantable cardiac pacemaker is a small device placed under the skin, usually near the collarbone, that sends electrical pulses to keep the heart beating at a normal rate. Pacemakers are used to treat slow heart rhythms (bradycardia), heart block, and certain types of heart failure. Veterans who need a pacemaker due to a service-connected heart condition can receive disability compensation. The VA assigns 100 percent for one month following hospital discharge for the implantation or re-implantation, then rates based on remaining symptoms and heart function.
Rating Criteria
| Rating | Criteria |
|---|---|
| 100% | Assigned for one month following hospital discharge for implantation or re-implantation of the pacemaker. Thereafter DC 7018 directs evaluation as supraventricular tachycardia (DC 7010), ventricular arrhythmias (DC 7011), or atrioventricular block (DC 7015). One hundred percent continues under DC 7011 where an automatic implantable cardioverter-defibrillator is in place, or under the General Rating Formula where a workload of 3.0 METs or less results in heart failure symptoms. |
| 60% | Reached through the code DC 7018 routes to: a benign atrioventricular block under DC 7015 is evaluated on the General Rating Formula, where a workload of 3.1 to 5.0 METs results in heart failure symptoms. |
| 30% | Reached through the code DC 7018 routes to: under the General Rating Formula, a workload of 5.1 to 7.0 METs results in heart failure symptoms, or there is evidence of cardiac hypertrophy or dilatation confirmed by echocardiogram or equivalent; or, under DC 7010, five or more treatment interventions in a year for supraventricular tachycardia confirmed by ECG. |
| 10% | Under the General Rating Formula, a workload of 7.1 to 10.0 METs results in heart failure symptoms, or continuous medication is required for control; or, under DC 7010, one to four treatment interventions in a year, or continuous oral medication or vagal maneuvers to control. The minimum rating with a pacemaker in place is 10 percent. |
Evidence Needed
- Operative report from pacemaker implantation surgery
- Hospital discharge summary with dates
- Pacemaker interrogation reports showing device settings and function
- Echocardiogram results documenting any cardiac hypertrophy or dilatation
- Stress test or METs estimation after the convalescent period
- Service connection evidence for the underlying heart condition that required the pacemaker
- Records of any pacemaker replacements or complications
C&P Exam Tips
- Bring your pacemaker identification card and all device interrogation reports
- Make sure the record shows the date of discharge from the implantation hospitalization, because the one-month 100 percent evaluation runs from discharge rather than from the date of the procedure
- Describe any symptoms you still experience despite the pacemaker — fatigue, dizziness, activity limitations
- If you have had device complications or replacements, bring those records
- Report honestly about your exercise tolerance and what activities you can and cannot do
How to File
File on VA Form 21-526EZ. Include the implantation operative report, discharge dates, device interrogation records, and evidence connecting the need for a pacemaker to your service-connected heart condition.
Common Mistakes
Not claiming the one-month 100 percent evaluation DC 7018 assigns 100 percent for one month following hospital discharge for implantation or re-implantation. File promptly, and check the effective date on the rating decision against the discharge summary. Assuming the pacemaker fixes everything Even with a pacemaker, you may have ongoing symptoms and limitations. Document these for your permanent rating evaluation. Not updating the VA about device replacements Pacemaker battery replacements and lead revisions are additional procedures that may qualify for new convalescent periods. Report every procedure to the VA.
Frequently Asked Questions
What is the minimum rating with a pacemaker?
The minimum permanent rating with a pacemaker in place is 10 percent. Your actual rating may be higher based on your heart function, symptoms, and exercise capacity.
Do I get another convalescent rating when the pacemaker battery is replaced?
DC 7018 assigns the one-month 100 percent evaluation following hospital discharge for implantation or re-implantation, so a generator replacement documented as a re-implantation can start a new period. File with the VA when you have a replacement procedure.
Can I still exercise with a pacemaker?
Most people with pacemakers can exercise, but you may have specific limitations your cardiologist has set. Your rating is based on your actual exercise capacity, not just the presence of the device.