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VA rates cardiomyopathy under Diagnostic Code 7020 and the General Rating Formula for Diseases of the Heart in 38 CFR § 4.104. The current formula assigns 10, 30, 60, or 100 percent based primarily on the workload, measured in METs, that produces heart-failure symptoms.
Older articles often quote former cardiomyopathy criteria based on chronic congestive heart failure or left-ventricular ejection fraction. Ejection fraction remains medically important, but it is not a standalone percentage criterion in the current general formula.
TL;DR
- DC 7020 uses the current heart-disease formula: 10, 30, 60, or 100 percent.
- 10%: 7.1-10.0 METs produces heart-failure symptoms, or continuous medication is required.
- 30%: 5.1-7.0 METs produces symptoms, or imaging confirms cardiac hypertrophy or dilation.
- 60%: 3.1-5.0 METs produces symptoms.
- 100%: 3.0 METs or less produces symptoms.
- METs testing is generally required unless medically contraindicated or a 100-percent evaluation can be assigned on another basis.
- VA cannot pay twice for the same METs limitation under cardiomyopathy and another heart code.
- No verified condition-specific Board outcome dataset was available, so this page does not publish a grant-rate statistic.
Current DC 7020 Rating Formula
The current formula defines heart-failure symptoms to include breathlessness, fatigue, angina, dizziness, arrhythmia, palpitations, and syncope.
10 percent
- A workload of 7.1 to 10.0 METs produces heart-failure symptoms; or
- continuous medication is required for control.
30 percent
- A workload of 5.1 to 7.0 METs produces heart-failure symptoms; or
- echocardiogram or equivalent imaging confirms cardiac hypertrophy or dilation.
60 percent
A workload of 3.1 to 5.0 METs produces heart-failure symptoms.
100 percent
A workload of 3.0 METs or less produces heart-failure symptoms.
38 CFR § 4.100 requires VA to determine whether hypertrophy or dilation is present and whether continuous medication is needed. METs testing is required in most cases. If exercise testing cannot be performed for medical reasons, the examiner may estimate METs using specific activities that trigger symptoms.
Ejection Fraction and the Current Formula
An echocardiogram remains central to diagnosing and characterizing cardiomyopathy. The National Heart, Lung, and Blood Institute explains that echo shows heart size, shape, and pumping function, while cardiac MRI and other testing can help identify type and severity.
But the current VA formula does not assign a percentage from ejection fraction alone. A page that says “an EF under 30 automatically equals 100 percent” is quoting the former schedule. The current decision should identify the applicable METs, symptoms, imaging findings, and medication requirement.
Service Connection
Direct service connection
Direct service connection under § 3.303 may apply when cardiomyopathy began during service or a clinician links it to a documented in-service disease or injury, such as myocarditis or another cardiac event.
Secondary to coronary artery disease or hypertension
Under § 3.310, a cardiologist may link ischemic cardiomyopathy to service-connected coronary artery disease or hypertensive remodeling to service-connected hypertension. The opinion should identify the cardiomyopathy type and address competing causes, including genetic, viral, toxic, valvular, and other cardiac disease.
Cardiomyopathy itself is not automatically an herbicide-presumptive diagnosis. If the medical diagnosis is ischemic heart disease or coronary artery disease, the presumptive analysis belongs to that diagnosis. The record should not convert every cardiomyopathy into ischemic heart disease without cardiology support.
Cardiomyopathy and Pyramiding
One veteran may carry diagnoses of cardiomyopathy, coronary artery disease, hypertensive heart disease, and heart failure. VA still cannot compensate the same METs limitation, symptoms, or cardiac impairment multiple times under § 4.14.
A decision should identify the diagnostic code that best represents the service-connected disease and explain whether any separate manifestation is truly distinct.
What the C&P Record Should Establish
The record should include:
- the cardiomyopathy type and diagnostic basis;
- an echocardiogram or equivalent cardiac imaging;
- exercise-test METs, or a medically supported interview estimate with specific activities;
- the symptoms that appear at the stated workload;
- whether continuous medication is required;
- whether imaging confirms hypertrophy or dilation; and
- a medical opinion addressing direct or secondary service connection and competing causes.
Common Failure Modes
- Using the former congestive-heart-failure or ejection-fraction ladder as current law.
- Reporting an interview-based METs number without activity examples.
- Calling all cardiomyopathy ischemic without a cardiology diagnosis.
- Ignoring genetic, viral, valvular, toxic, or other competing causes.
- Seeking duplicate ratings for the same cardiac functional limitation.
- Treating a reduced ejection fraction as a substitute for the required current rating analysis.
Bottom Line
Current cardiomyopathy ratings under DC 7020 turn on METs, heart-failure symptoms, imaging-confirmed hypertrophy or dilation, and continuous medication. The strongest record pairs current testing with a cardiologist's explanation of the cardiomyopathy type and its connection to service or a service-connected disease.
Legal and medical sources: 38 CFR § 4.100, § 4.104, § 4.14, § 3.303, § 3.310, and NHLBI cardiomyopathy diagnosis guidance, checked August 14, 2026.