Claim Raven explanation
What this means
This section identifies findings needed when applying the general heart-disease rating formula. It addresses continuous medication, evidence of enlargement or dilation of the heart, and METs testing.
METs describe the energy required for activity. The rule identifies exceptions to testing, including a medical contraindication, so the absence of an exercise test must be considered with the examiner's explanation and other findings.
How this helps your claim
This helps you understand whether a heart examination supplies the facts needed for rating. Read it alongside the specific heart criteria in § 4.104, not as a stand-alone percentage calculator.
What to check in your records
Use your decision, examination reports, and relevant records to check the following points.
- Find the medication history and imaging findings about heart size.
- Locate METs findings and the basis for how they were determined.
- Check the medical reason given if required testing was not performed.
Understand what the activity measurement represents
METs describe the energy cost of activity, and the heart-rating framework uses symptoms at specified activity levels. An exercise test and a clinically supported estimate are different forms of evidence. The report should explain the method used and any reason testing was not appropriate.
Keep findings about medication, enlargement or dilation with the relevant activity assessment. A statement that exercise is difficult may have several medical explanations. The examiner's account should clarify the heart-related findings rather than assuming every limitation in activity comes from the cardiovascular condition.
Should I perform strenuous exercise to estimate my own METs?
No. Testing can be medically inappropriate in some circumstances, which is why the regulation provides exceptions. Use the professional assessment and describe ordinary symptoms accurately. A self-directed exertion test is not a substitute for the required medical evaluation and can be unsafe.
Official regulatory text
38 CFR § 4.100
eCFR snapshot: September 3, 2026. Layout and spacing are adapted for reading. The full section and its tables are included below.
§ 4.100 Application of the general rating formula for diseases of the heart.
(a) Whether or not cardiac hypertrophy or dilatation (documented by electrocardiogram, echocardiogram, or X-ray) is present and whether or not there is a need for continuous medication must be ascertained in all cases.
(b) Even if the requirement for a 10% (based on the need for continuous medication) or 30% (based on the presence of cardiac hypertrophy or dilatation) evaluation is met, METs testing is required in all cases except:
(1) When there is a medical contraindication.
(2) When a 100% evaluation can be assigned on another basis.
(Authority: 38 U.S.C. 1155)
[71 FR 52460, Sept. 6, 2006, as amended at 86 FR 54093, Sept. 30, 2021; 86 FR 67654, Nov. 29, 2021]
Related references
- 38 USC § 1155: The law behind VA disability rating percentages
- 38 CFR § 4.1: What a VA disability rating measures
- 38 CFR § 3.159: VA duty to assist: records and examinations
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