Heart Disease VA Rating

Heart disease at the VA is rated on a framework that surprises most veterans the first time they see it. The rating doesn't turn on which artery is blocked or how many stents you have. Since November 14, 2021, it turns mainly on one thing: how much physical work you can do before symptoms start. That workload is measured in metabolic equivalents, or METs, and one MET is the energy you use standing quietly at rest. The anchor code is 38 CFR § 4.104, DC 7005, for arteriosclerotic heart disease (coronary artery disease), and the same General Rating Formula for Diseases of the Heart covers most of the cardiac codes once any short-term 100 percent period ends.

For Vietnam-era veterans there is a second story that often matters more than the rating math: ischemic heart disease is an Agent Orange presumptive condition under 38 CFR § 3.309(e)). That changes the question from "prove your heart disease came from service" to "prove you served where exposure is presumed." This page covers the formula word for word, what the 2021 rewrite removed, the cardiac codes, how the C&P exam sets your METs figure, the ways to prove service connection, why claims get denied, and the secondary chains from hypertension, diabetes and sleep apnea.

TL;DR

• Heart disease is rated under 38 CFR § 4.104. The anchor code is DC 7005 (coronary artery disease). DC 7006 (heart attack), DC 7007 (hypertensive heart disease), DC 7000 (valvular heart disease) and DC 7017 (coronary bypass surgery) use the same formula after any short-term 100 percent period.
• The General Rating Formula for Diseases of the Heart was rewritten effective November 14, 2021. It now runs on METs, with two side routes: imaging-confirmed cardiac hypertrophy or dilatation at 30 percent, and continuous medication at 10 percent.
• Ejection fraction was deleted and appears nowhere in 38 CFR Part 4. Congestive heart failure was removed as a standalone criterion. Above 30 percent, the METs figure is now the only path.
• METs testing is required in every heart exam unless it is medically unsafe or a 100 percent rating applies on another basis (38 CFR § 4.100). When testing is unsafe, the examiner estimates METs from the activities that bring on symptoms.
• Ischemic heart disease is presumed service connected for covered herbicide service under 38 CFR § 3.309(e). Hypertension is excluded from that term.
• Heart disease is often claimed secondary to hypertension, PTSD, diabetes or sleep apnea under 38 CFR § 3.310.
• A ruling is one issue the Board decided in one decision; one decision often rules on several issues. Across 21,427 decided Board rulings on heart disease from 2021 to 2026, 25.3% were granted, 28.7% denied and 46.0% remanded, so remand is the most common outcome.

Heart disease VA rating criteria

Since the 2021 rewrite, most cardiac codes in 38 CFR § 4.104, DC 7005 included, carry no criteria of their own and point to the General Rating Formula for Diseases of the Heart. It reads as follows.

Workload of 3.0 METs or less results in heart failure symptoms: 100%

Workload of 3.1-5.0 METs results in heart failure symptoms: 60%

Workload of 5.1-7.0 METs results in heart failure symptoms; or evidence of cardiac hypertrophy or dilatation confirmed by echocardiogram or equivalent (e.g., multigated acquisition scan or magnetic resonance imaging): 30%

Workload of 7.1-10.0 METs results in heart failure symptoms; or continuous medication required for control: 10%

Note (2): One MET (metabolic equivalent) is the energy cost of standing quietly at rest and represents an oxygen uptake of 3.5 milliliters per kilogram of body weight per minute. When the level of METs at which breathlessness, fatigue, angina, dizziness, or syncope develops is required for evaluation, and a laboratory determination of METs by exercise testing cannot be done for medical reasons, a medical examiner may estimate the level of activity (expressed in METs and supported by specific examples, such as slow stair climbing or shoveling snow) that results in those symptoms.

Note (3): For this general formula, heart failure symptoms include, but are not limited to, breathlessness, fatigue, angina, dizziness, arrhythmia, palpitations, or syncope.

38 CFR § 4.100 adds two rules for applying the formula. Every heart exam has to determine whether cardiac hypertrophy or dilatation is present and whether you need continuous medication. And even when one of those side routes is met, METs testing is required in all cases except when it is medically contraindicated or a 100 percent rating can be assigned on another basis.

Three consequences follow.

• The METs figure carries almost the whole claim. Above 30 percent there is exactly one path, so how the number gets produced is the decisive question.
• The bands are narrow. The line between 60 and 100 percent is 3.0 versus 3.1 METs, and the line between 30 and 60 percent is 5.0 versus 5.1. A figure recorded vaguely invites the lower tier.
• Medication sets a floor. If you take a daily cardiac medication for your service-connected heart disease, that supports 10 percent even when your stress test looks reassuring.

At the rates effective December 1, 2025 (the 2026 rates), a veteran with no dependents is paid $180.42 a month at 10 percent, $552.47 at 30 percent, $1,435.02 at 60 percent and $3,938.58 at 100 percent.

What the 2021 rewrite removed

VA's cardiovascular final rule (86 FR 54089, September 30, 2021) took effect November 14, 2021, and removed two criteria that used to reach the top tiers.

Ejection fraction was deleted. The old formula gave 100 percent for an ejection fraction below 30 percent and 60 percent for 30 to 50 percent. The phrase now appears nowhere in 38 CFR Part 4. In the final rule, VA said ejection fraction was removed because it is poorly related to exercise tolerance, which METs measure. If you were told an echocardiogram showing a reduced ejection fraction is worth 100 percent, that advice dates from before the change.

Congestive heart failure was removed as a standalone criterion. The old formula gave 100 percent for chronic congestive heart failure and 60 percent for more than one acute episode in a year. Heart failure now enters only through the symptom list attached to a METs level.

A rating already in effect is not reduced just because the schedule changed, unless the condition has actually improved (38 CFR § 3.951(a)). If your claim reaches back before November 14, 2021, the old formula, with its ejection fraction and CHF routes, may still matter for that earlier period, so keep those records in the file.

The cardiac codes and what each one covers

The codes matter less than veterans expect, because past their short-term windows they nearly all use the same formula.

• DC 7005, arteriosclerotic heart disease (coronary artery disease). The anchor code. It carries only a note: when non-service-connected arteriosclerotic heart disease is superimposed on service-connected valvular or other heart disease, VA requests a medical opinion on which condition is causing the current symptoms.
• DC 7006, myocardial infarction. 100 percent during and for three months after a heart attack confirmed by laboratory tests, then the General Rating Formula.
• DC 7007, hypertensive heart disease. Heart disease caused by high blood pressure, rated on the formula. It is rated separately from hypertension itself (Note 3 to DC 7101).
• DC 7000, valvular heart disease. 100 percent during active infection with cardiac involvement and for three months after therapy ends, then the formula, with the diagnosis confirmed by examination and an echocardiogram, Doppler echocardiogram or cardiac catheterization.
• DC 7017, coronary bypass surgery. 100 percent for three months following hospital admission for surgery, then the formula.

There is no separate code for a stent. The Heart Conditions DBQ records a percutaneous coronary intervention (angioplasty) as a procedure, and the rating comes from the underlying code and your METs.

The heart C&P exam: how your METs figure gets set

The Heart Conditions DBQ is where the rating is built, and since 2021 one number decides it above 30 percent.

The form says every heart exam requires METs testing, either exercise-based or interview-based, except exams for supraventricular arrhythmias. An exercise stress test measures the workload at which symptoms appear. When a stress test cannot be done for medical reasons, the examiner gives an interview-based estimate from a cardiac activity questionnaire, and the form ties each band to everyday activities.

• 1 to 3 METs: eating, dressing, taking a shower, slow walking (2 mph) for 1 to 2 blocks
• Over 3 to 5 METs: light yard work such as weeding, mowing with a power mower, brisk walking (4 mph)
• Over 5 to 7 METs: walking up 1 flight of stairs, golfing without a cart, mowing with a push mower, heavy yard work such as digging
• Over 7 to 10 METs: climbing stairs quickly, moderate bicycling, sawing wood, jogging (6 mph)

Two more questions on the form decide a lot of ratings. The examiner is asked whether the METs level is due solely to the claimed heart condition, and if not, to estimate the METs level due to the heart alone and explain why. If a bad knee, lung disease or weight limits your activity, that question decides whether the cardiac figure holds up. The form also asks whether cardiac hypertrophy or dilatation is present, with a suggested order of ECG, then chest X-ray, then echocardiogram, which is the route to 30 percent without a METs limitation.

What to bring is a record of what brings on symptoms: how far you can walk before stopping, how many stairs you can climb, what yard work you have given up, and any fainting or swelling episodes. A symptom tracker log gives an interview-based estimate real facts to rest on, and C&P exam prep walks through the form.

How to prove service connection for heart disease

Agent Orange and ischemic heart disease

38 CFR § 3.309(e) lists "Ischemic heart disease (including, but not limited to, acute, subacute, and old myocardial infarction; atherosclerotic cardiovascular disease including coronary artery disease (including coronary spasm) and coronary bypass surgery; and stable, unstable and Prinzmetal's angina)." Under § 3.307(a)(6)(ii) it can appear at any time after service, as long as it reaches 10 percent, and continuous medication alone supports 10 percent.

A note in § 3.309(e) limits the term. Ischemic heart disease "does not include hypertension or peripheral manifestations of arteriosclerosis such as peripheral vascular disease or stroke," or any condition that does not meet the accepted medical definition. Hypertensive heart disease and valvular disease are different diagnoses, so they do not use this presumption unless ischemic heart disease is also diagnosed. Hypertension has its own presumption under the PACT Act; see hypertension.

Exposure is presumed for covered service, which now reaches beyond Vietnam to certain service in Thailand, Laos, Cambodia, Guam, American Samoa, Johnston Atoll and the Korean DMZ, each for set dates. The diabetes page lists the dates, and the presumptive conditions tool checks a service history against them. The presumption settles service connection, not the rating. Once connected, ischemic heart disease is still rated on METs.

Heart disease within one year of separation

38 CFR § 3.309(a) lists two relevant chronic diseases: "cardiovascular-renal disease," a term it applies to arteriosclerosis, nephritis and organic heart disease, and endocarditis, which it says covers all forms of valvular heart disease. Heart disease that reached 10 percent within a year of separation can be presumed service connected under § 3.307(a)(3).

Direct service connection

Outside the presumptions, a direct claim needs a current diagnosis, an in-service event or onset, and a medical opinion linking them. Heart disease is common in the general population, so a VA examiner can usually point to age, smoking, diet or family history. A direct claim needs an opinion that deals with those causes, not one that ignores them.

Why VA denies heart disease claims

Most heart denials and low ratings trace back to a handful of gaps, each with a fix.

No METs figure in the record. The notes document chest pain, shortness of breath and a diagnosis, but nobody translated the limitation into METs. Without it, the rater has no clean way to place you on the table. The fix is a stress test, or an interview-based estimate with the reason testing could not be done.

A claim built on ejection fraction. This is now the most expensive mistake available, because ejection fraction was deleted as a criterion in 2021. A file organized around it, with no METs figure and no imaging finding of hypertrophy or dilatation, can prove the diagnosis and still produce a low rating. Get the METs figure.

A METs limit not tied to the heart. The examiner records that you get winded at 4 METs but does not say whether the heart, lungs, weight or a joint is the cause. The fix is the DBQ question on METs due solely to the heart, answered with a reason.

Covered service not pinned down. A file that asserts exposure without dates, locations and unit records forces the harder direct analysis. The fix is the personnel and unit records.

A secondary opinion with no mechanism, or one that answers only causation. An opinion that says heart disease is "secondary to diabetes" with no reasoning carries little weight, and one that skips aggravation is inadequate under El-Amin v. Shinseki, 26 Vet. App. 136 (2013).

The Board section below shows how the Board ruled on heart disease appeals and why it remanded or denied them.

Heart disease and secondary claims

Heart disease is often a secondary condition. Under 38 CFR § 3.310, it can be service connected when a service-connected condition caused it, or when your heart disease is aggravated by your service-connected condition, meaning it would be less severe but for that condition (M21-1 V.ii.2.D). VA rates only the part above the baseline, so the opinion should describe the baseline. In the Board's 2021 to 2026 rulings, heart disease was claimed most often secondary to hypertension, then PTSD, diabetes and sleep apnea.

Hypertension. In a pooled analysis of one million adults in 61 prospective studies (Lewington and colleagues, Lancet, 2002), each 20 mm Hg higher usual systolic pressure (about 10 mm Hg diastolic) at ages 40 to 69 was associated with twofold differences in death rates from ischemic heart disease. Hypertension also shows up in the heart muscle itself: in a 2026 review of 51 echocardiography studies covering 74,632 people with hypertension (Gherbesi and colleagues, Journal of Hypertension), left ventricular hypertrophy, which the authors call a cardinal marker of hypertensive heart disease, was present in 36.6%. An echocardiogram showing hypertrophy can support both the link and a 30 percent rating. Secondary conditions to hypertension covers this chain with the Board's numbers.

Diabetes. In a 2010 pooled analysis of 102 prospective studies and 698,782 people (Emerging Risk Factors Collaboration, Lancet), diabetes carried a hazard ratio of 2.00 for coronary heart disease after adjustment for age, sex, smoking, systolic blood pressure and body-mass index. For a veteran with covered herbicide service, ischemic heart disease is presumptive on its own, which can make the secondary route unnecessary. See secondary conditions to diabetes.

Sleep apnea. In a 2017 meta-analysis of 16 cohort studies with 24,308 people (Xie and colleagues, BMJ Open), severe obstructive sleep apnea was associated with a relative risk of 1.63 for coronary heart disease and moderate sleep apnea with 1.38, while mild sleep apnea showed no significant association. A 2024 meta-analysis of 12 prospective studies (Amen and colleagues, Cureus) found no significant link across cardiovascular outcomes overall and no definitive causal one. An opinion on this chain should address how severe your sleep apnea is and how it has been treated.

PTSD. PTSD is the second most common condition heart disease is claimed secondary to at the Board. Secondary conditions to PTSD covers the conditions claimed secondary to PTSD and the Board's numbers for each.

For every chain, the opinion has to identify the mechanism, fit your timeline and deal with other causes. The Court of Appeals for Veterans Claims has said that "most of the probative value of a medical opinion comes from its reasoning" (Nieves-Rodriguez v. Peake, 22 Vet. App. 295 (2008)).

Pyramiding: what stacks in a heart claim

The pyramiding rule, 38 CFR § 4.14, says the evaluation of the same disability under various diagnoses is to be avoided. In heart claims, two cardiac diagnoses that limit the same exercise capacity generally do not earn two ratings off the same METs figure. For several arrhythmia codes (DCs 7009, 7010, 7011 and 7015), § 4.104 says outright that a single evaluation is assigned under the code that reflects the predominant disability picture.

What does stack is hypertension. Note 3 to DC 7101 says to evaluate hypertension separately from hypertensive heart disease and other heart disease, because blood pressure readings and cardiac workload are different impairments. Under 38 CFR § 4.25, a 30 percent heart rating combined with a 10 percent hypertension rating gives 37, which rounds to 40 percent. A condition like heart arrhythmia may also carry its own rating on its own criteria.

For TDIU, 38 CFR § 4.16(a) counts disabilities affecting a single body system, such as cardiovascular-renal, as one disability toward the 60 percent threshold, so heart disease and hypertension can be added together for that test. The TDIU guide covers the rest of the proof.

Questions veterans ask about heart disease

What is the VA rating for coronary artery disease?

Coronary artery disease is rated under DC 7005 on the General Rating Formula for Diseases of the Heart: 10 percent for 7.1 to 10.0 METs or continuous medication, 30 percent for 5.1 to 7.0 METs or imaging-confirmed hypertrophy or dilatation, 60 percent for 3.1 to 5.0 METs, and 100 percent for 3.0 METs or less.

What is the VA disability rating for a heart stent?

There is no separate rating for a stent. The heart condition behind it is rated on the formula, based on your METs and whether you need continuous medication; a heart attack adds 100 percent for three months under DC 7006, and bypass surgery adds 100 percent for three months under DC 7017.

Why was ejection fraction removed from VA heart ratings?

VA removed ejection fraction as a rating criterion effective November 14, 2021, saying it is poorly related to exercise tolerance, and it no longer appears anywhere in 38 CFR Part 4. A low ejection fraction can still support the diagnosis, but the rating now comes from METs, imaging-confirmed hypertrophy or dilatation, or continuous medication.

How does VA measure METs if I can't do a stress test?

When exercise testing cannot be done for medical reasons, the examiner estimates METs from the activities that bring on your symptoms (Note 2 to the formula). The DBQ ties each band to examples such as showering, brisk walking, climbing a flight of stairs or jogging.

Is ischemic heart disease presumptive for Agent Orange?

Yes. 38 CFR § 3.309(e) lists ischemic heart disease, including coronary artery disease, past heart attacks, coronary bypass surgery and angina, for veterans with covered herbicide service. Hypertension, peripheral vascular disease and stroke are excluded from that term.

Can heart disease be secondary to hypertension?

Yes. Hypertension is the condition heart disease is most often claimed secondary to at the Board, and hypertensive heart disease is rated separately from the hypertension itself. The opinion should tie the heart findings, such as hypertrophy on an echocardiogram, to your blood pressure history.

Bottom Line

Heart disease at the VA is rated on one framework, and since November 14, 2021 it rests on one measurement: workload in METs. The ejection fraction and congestive heart failure routes to 60 and 100 percent were deleted, which leaves the METs figure as the only path above 30 percent, with imaging-confirmed hypertrophy or dilatation at 30 percent and continuous medication at 10 percent. The cases that get the right rating have a clean METs figure attributed to the heart. For veterans with covered herbicide service, ischemic heart disease is presumptive, which settles service connection but not the rating. And heart disease is often a secondary claim, most often off hypertension, with diabetes and sleep apnea backed by large studies and PTSD close behind in the Board's rulings.

Related Conditions

Heart disease connects most often to hypertension, which is rated separately and is a cause of hypertensive heart disease, and to heart arrhythmia and cardiomyopathy. The secondary chains run through diabetes, sleep apnea and PTSD, and the circulation effects connect to peripheral vascular disease. The secondary conditions tool helps map the rest.

Methodology and Limitations

• Data source: Rating criteria are quoted from the current 38 CFR § 4.104 General Rating Formula for Diseases of the Heart and 38 CFR § 4.100, as published on eCFR (current through October 2026), with DC 7000, 7005, 7006, 7007, 7017 and Note 3 to DC 7101. The 2021 rewrite is "Schedule for Rating Disabilities: The Cardiovascular System," 86 FR 54089 (September 30, 2021), effective November 14, 2021. Presumptions are from 38 CFR §§ 3.307 and 3.309(a) and (e); secondary service connection from 38 CFR § 3.310 and M21-1 V.ii.2.D; pyramiding, combined ratings and TDIU from 38 CFR §§ 4.14, 4.25 and 4.16; preservation of ratings from 38 CFR § 3.951. Case law: El-Amin v. Shinseki, 26 Vet. App. 136 (2013), and Nieves-Rodriguez v. Peake, 22 Vet. App. 295 (2008). Exam content follows VA's Heart Conditions DBQ (version updated July 11, 2024). Studies: Lewington S, et al., "Age-specific relevance of usual blood pressure to vascular mortality," Lancet (2002), PMID 12493255; Gherbesi E, et al., "Left ventricular hypertrophy in hypertension," Journal of Hypertension (2026), PMID 42554265; Emerging Risk Factors Collaboration, "Diabetes mellitus, fasting blood glucose concentration, and risk of vascular disease," Lancet (2010), PMID 20609967; Xie C, et al., "Association of obstructive sleep apnoea with the risk of vascular outcomes and all-cause mortality," BMJ Open (2017), PMID 29275335; Amen S, et al., "Obstructive Sleep Apnea and Cardiovascular Diseases," Cureus (2024), PMID 39552969. Compensation figures are VA disability rates effective December 1, 2025 (the 2026 rates) for a veteran with no dependents.
• Sample size: Board figures in this post come from Claim Raven's read of every Board decision from 2021 to 2026 that it holds: 511,036 decisions containing 1,378,030 rulings. Of 23,316 Board rulings on heart disease, 21,427 were decided (granted, denied or remanded); the rest were dismissed, withdrawn or closed another way. Across 21,427 decided Board rulings on heart disease from 2021 to 2026, 25.3% were granted, 28.7% denied and 46.0% remanded. Board-wide, the grant rate on decided rulings is 24.7%, so heart disease runs 0.6 points above it. The decision window straddles the criteria on this page: the current formula took effect November 14, 2021, and an appeal covering an earlier period still applies the old formula, when ejection fraction and CHF history were independent routes to the higher tiers, to that period. Some of these outcomes describe that framework. The data also captures the outcome of each ruling rather than a per-code breakdown.
• Classification approach: Diagnostic code definitions and the current METs tiers are drawn from the regulatory text as amended effective November 14, 2021. The ejection fraction and congestive heart failure criteria described in older sources were deleted by that amendment. The presumptive analysis follows § 3.309(e). Secondary analysis follows § 3.310 and the standard for probative nexus opinions.
• Limitations:
• Some appeals in the 2021 to 2026 window cover periods before November 14, 2021, when the old formula still had ejection fraction and CHF routes. Some outcomes in this data describe that framework.
• The METs tiers are quoted from the current regulation, but application varies with how the exam is documented. Two veterans with the same disease can land in different tiers depending on whether the exam produced a clean METs figure.
• Agent Orange presumptive eligibility turns on specific service dates and locations that have changed over time. Whether a given veteran's service qualifies is a fact-specific question this page does not resolve.
• The studies cited describe associations in large populations. They do not prove that one condition caused heart disease in any individual veteran, which is the question a nexus opinion has to answer.
• Selection bias: Board-level patterns reflect cases that were appealed. Most heart claims resolve at the regional office and aren't in any Board dataset.
• These observations reflect patterns from the regulatory text, case law, and Board decisions. They are not predictions of individual outcomes.