VA Rating for Heart Conditions

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Coronary artery disease, heart failure, arrhythmias and valve disease — rated on METs workload, cardiac hypertrophy and continuous medication. This guide quotes the actual rating criteria from 38 CFR Part 4 for diagnostic code 7005 / 7010, explains what the C&P examiner measures, covers the presumptive and secondary routes to service connection, and lists the reasons these claims come back denied — and how each gets fixed.

How the VA rates heart conditions in 2026 — the exact criteria

These are the criteria a VA rater applies, quoted from the rating schedule (§ 4.100 – § 4.104). Your rating is the highest level whose wording your evidence meets — and evidence that never uses these words tends to be rated at the bottom.

General Rating Formula for Diseases of the Heart (DC 7005 coronary artery disease and most heart codes)

Heart failure symptoms include breathlessness, fatigue, angina, dizziness, arrhythmia, palpitations, or syncope. One MET is the energy cost of standing quietly at rest.

METs testing is required in all cases except when medically contraindicated or when 100 percent can be assigned on another basis; when exercise testing cannot be done, the examiner may estimate the MET level with specific examples (§ 4.100).

Ischemic heart disease is presumptive for Agent Orange exposure (38 CFR 3.309(e)), and the PACT Act added hypertension itself to the Agent Orange list — so hypertensive heart disease secondary to a presumptive hypertension is a common chain.

DC 7010 — Supraventricular tachycardia (atrial fibrillation and similar)

Honest ceiling: 60% at a workload of 3–5 METs.

What the C&P examiner measures

A METs determination — exercise stress test, or an interview-based estimate when testing is contraindicated — plus echocardiogram or equivalent for hypertrophy or dilatation, and the medication list. Tell the examiner exactly which activities bring on breathlessness, fatigue or chest pain (stairs, carrying groceries, yard work).

The questions that get at the rating criteria — answer them for yourself before the exam:

• Any heart stuff — stents, a bypass, chest pain when you push it?
• How far can you go before you have to stop — stairs, mowing, a block?

Service connection: presumptive, direct, or secondary

Ischemic heart disease (coronary artery disease, myocardial infarction, stable and unstable angina) is presumptive for Agent Orange exposure (38 CFR 3.309(e)); cardiovascular-renal disease within one year of separation is presumptive under 3.309(a). Hypertensive heart disease is claimed secondary to service-connected hypertension.

Every service-connection claim has three legs: a current diagnosis (the C&P exam can supply it), an in-service event, injury, exposure or an already-connected condition, and a link between the two — which the VA's own examiner addresses at the exam for direct and secondary claims, and which the law supplies for presumptive ones. You do not need a private opinion to file; you need one only if the VA denies for lack of nexus, and a supplemental claim within one year keeps your effective date.

Secondary conditions veterans miss

Conditions that commonly develop because of this one can be service-connected on top of it, each with its own rating:

• Ischemic heart disease from hypertension — If HTN is service-connected, the chain is literature-supported

Secondary-claim guides for this condition: Heart Conditions secondary to Hypertension →

What the medical literature says

Edmondson D. et al., American Heart Journal 166(5):806-14 (2013) — Posttraumatic stress disorder and risk for coronary heart disease: a meta-analytic review
Meta-analysis: PTSD independently predicts incident coronary heart disease. Why it matters: Heart condition secondary to service-connected PTSD.

NASEM, Veterans and Agent Orange: Update 2010
Ischemic heart disease associated with herbicide exposure — presumptive for exposed veterans. Why it matters: AO-exposed vet with IHD: presumptive.

Why heart conditions claims get denied — and the fix

• METs estimated high because the examiner did not ask about specific activities.
• Ischemic heart disease with Vietnam/Korean DMZ/Thailand service not conceded as presumptive.

A denial is a grade on the evidence packet, not a verdict on you. Filed as a supplemental claim within one year, the fix keeps your original effective date.

Filing it right the first time

1. Intent to File first. It locks your effective date for a year — back pay runs from that day, not from the day the package is ready.
2. File everything at once. Every condition with a real symptom and a plausible route — direct, presumptive, secondary, increase — goes in one claim. The VA's duty to assist schedules the exam and pulls your records; a condition held back "for more evidence" only starts its clock later.
3. Your statement in the criteria's words. A Statement in Support of Claim (VA Form 21-4138) that describes your worst days and your typical days using the language in the table above is the evidence the rater reads first.
4. Your records. VA records through Blue Button, decision letters and code sheet from VA.gov, and private records from each doctor's office or patient portal — or a signed 21-4142 so the VA pulls them.
5. Prepare for the exam. Know what the examiner measures (above) and answer honestly, including the bad days.

Frequently asked questions

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Rating criteria verified against eCFR (38 CFR Part 4) — last reviewed 2026-09-19. Regulations change; confirm anything decision-critical at ecfr.gov.