Cardiovascular Conditions Rating Guide

Most heart codes are rated on workload: how much physical exertion you can do before heart symptoms begin. That workload is measured in METs, and two other measures sit alongside it. Learn these rules once and they apply across almost every heart condition in the schedule.

1. Most heart conditions are rated on workload in METs

METs stands for metabolic equivalents, the level of exertion at which shortness of breath, fatigue, chest pain (angina), dizziness, or fainting begins. Light activity like walking slowly is a low number of METs; harder activity like climbing stairs quickly or heavy yard work is a higher number. The lower the METs level at which symptoms start, the higher the rating. A heart that produces symptoms with very little exertion is rated far higher than one that only struggles under heavy exertion.

2. Two alternate paths sit beside METs; ejection fraction is not one of them

The current general formula has two alternate paths at the lower levels: cardiac hypertrophy or dilatation confirmed by qualifying imaging supports 30 percent, and the need for continuous medication supports 10 percent. The heart's ejection fraction is clinically useful evidence of how the heart is doing, but it is not a percentage level in the current general formula; the old ejection-fraction and congestive-heart-failure-episode thresholds belong to the pre-November 14, 2021 schedule.

3. When exercise testing is not safe, a METs estimate is allowed (38 CFR 4.100)

Some veterans cannot safely complete an exercise stress test because of the severity of their heart condition or another medical reason. When that is the case, 38 CFR § 4.100 allows the examiner to record a medically-supported estimate of the METs level instead. A test that could not be done safely is not a reason to deny or lower a rating.

4. Hypertension is the exception, rated on blood-pressure readings

Hypertension (high blood pressure, DC 7101) is not rated on METs. It is rated on your diastolic and systolic pressure readings, the two numbers in a blood-pressure measurement. Because a single reading can be misleading, the rating requires blood pressure confirmed by readings on multiple days, not one measurement taken at a single visit.

5. Ischemic heart disease and hypertension are herbicide presumptives

Ischemic heart disease (reduced blood flow to the heart, which includes coronary artery disease) is on the VA's list of conditions presumptively linked to herbicide exposure, and hypertension is now on that list as well. Veterans with qualifying Agent Orange or other herbicide exposure do not have to prove the medical link for those specific conditions. The presumption covers the listed conditions only, not all heart disease. See the Agent Orange presumptive list and the PACT Act guide.

For most diseases of the heart, the current general formula asks at what workload heart-failure symptoms begin. It does not use the old ejection-fraction and congestive-heart-failure episode thresholds that appeared in the pre-November 14, 2021 schedule.

The general formula is only one lane. Identify which lane the diagnosis is in before reading any single number:

Not every cardiovascular code uses the general formula. Hypertension, arrhythmias, vascular disease, aneurysms, and some surgery and transplant periods have their own criteria; the code atlas below shows the exact code. And one heart condition is rated somewhere else entirely: 38 CFR § 4.104 directs VA to evaluate cor pulmonale, right-heart disease caused by lung disease, as part of the pulmonary condition that causes it, not as a separate secondary heart claim.

Several cardiovascular codes assign a total evaluation for a set period after an event or procedure, then move to a different question. The dates are what drive those transitions.

The date that matters may be admission, discharge, implantation, treatment end, or the scheduled post-treatment examination, depending on the code. The operative report and the follow-up timeline can therefore be as important as the diagnosis label.

Presumptions in this body system attach to named diseases, not to the cardiovascular system as a whole.

• Herbicide presumption: ischemic heart disease and hypertension are on VA's herbicide-presumptive lists when the exposure and service requirements are met. Ischemic heart disease does not include hypertension, peripheral vascular disease, stroke, or every other heart diagnosis.
• Chronic-disease presumption: listed cardiovascular-renal diseases may qualify when the requirements, including the applicable manifestation period, are met (see 38 CFR § 3.307 and § 3.309).
• Direct: a current disease, an in-service disease, injury, or exposure, and a competent medical connection between them.
• Secondary or aggravated: a current cardiovascular disability caused or aggravated by a service-connected disability or its treatment, with the required medical link and, for aggravation, the applicable baseline analysis.
• Condition-specific rule: some former-prisoner-of-war, exposure, and treatment relationships use narrower rules. One presumption does not generalize to the whole cardiovascular system.

The rules above apply across the board. For the exact rating table, the C&P exam, and the Board data for your specific condition, open the dedicated guide:

For any code not listed, including arrhythmias, valve conditions, and vascular disease, open its condition lookup page for the rating levels and Board data.

Heart and vascular conditions are closely tied to other service-connected conditions, both as a cause and as a result. These are common secondary-claim pairings:

• Heart disease alongside diabetes or hypertension. Heart disease may be considered secondary to service-connected diabetes or high blood pressure when competent evidence establishes causation or aggravation in the individual record. Two diagnoses in the same file do not establish that link by themselves.
• Hypertension alongside other conditions. High blood pressure may be considered secondary to a service-connected condition such as sleep apnea, kidney disease, or PTSD when competent evidence establishes causation or aggravation in the individual record.
• The ischemic-heart-disease presumptive. For veterans with qualifying herbicide exposure, ischemic heart disease is presumptively service-connected, a direct path rather than a secondary one.
• Mental health after a cardiac event. Depression or anxiety following a heart attack or living with chronic heart disease can be claimed as secondary to the physical condition.

See secondary conditions for how these links are established.

What the file needs depends on the lane, and the dates matter as much as the findings:

• Exact diagnosis and code lane: the specific cardiovascular diagnosis, so it is clear whether the general formula, a hypertension code, an arrhythmia code, a vascular code, or a procedure code applies.
• Symptom-limited METs: an exercise test reporting the exertion level at which heart symptoms begin, or a medically supported interview estimate with the specific activities that produce symptoms when testing is contraindicated.
• Imaging for hypertrophy or dilatation: an echocardiogram, multigated acquisition scan, or MRI, which is the alternate path to 30 percent. Ejection fraction remains useful clinical information but is not a rating threshold in the current general formula.
• Rhythm and pressure records: electrocardiogram, Holter or event monitoring, ablation or cardioversion records for an arrhythmia, and serial blood-pressure readings where hypertension is claimed, since a single reading does not establish it.
• Medication and procedure history: continuous medication as the alternate path to 10 percent, plus operative reports, device records, and the admission, discharge, and treatment-end dates that move a claim between rating states.
• Ordinary functional impact: stairs, walking distance, carrying, sleep, and work limits described in everyday terms.

The matching DBQ prompts an examiner to capture the METs level, the imaging, and the medication history in the schedule's own terms.