Overview of VA Cardiovascular Ratings

Cardiovascular conditions affect the heart and blood vessels, impacting your body’s ability to circulate blood efficiently. Military service can lead to cardiovascular conditions through physical and psychological stress, environmental exposures, or lifestyle factors. This section explains how the VA rates cardiovascular conditions and provides detailed guidance for the most common conditions.

General Rating Principles for Cardiovascular Conditions

The VA rates most cardiovascular conditions based on several factors:

• Objective test results: Such as blood pressure readings, EKGs, stress tests, or echocardiograms
• Functional capacity: Measured in METs (metabolic equivalents), which indicate how much physical activity you can perform
• Symptoms: Such as chest pain, shortness of breath, fatigue, or dizziness
• Required treatments: Medications, procedures, or lifestyle modifications needed
• Impact on daily activities: How the condition affects your ability to work and perform daily tasks

Presumptive Service Connection for Cardiovascular Conditions

Certain cardiovascular conditions may qualify for presumptive service connection based on specific exposures:

Hypertension

Overview of Hypertension

Hypertension, commonly known as high blood pressure, is a condition where the force of blood against your artery walls is consistently too high. This can lead to serious health problems, including heart disease, stroke, and kidney damage.

Blood pressure is measured using two numbers:

• Systolic pressure: The top number, representing the pressure when your heart beats
• Diastolic pressure: The bottom number, representing the pressure when your heart rests between beats

Normal blood pressure is below 120/80 mm Hg. Hypertension is generally defined as blood pressure consistently at or above 130/80 mm Hg.

Military service can contribute to hypertension through various factors:

• Stress and psychological factors
• Physical demands
• Exposure to environmental hazards
• Dietary factors during service
• Sleep disruption
• Service-connected conditions that can cause or aggravate hypertension

Service Connection for Hypertension

There are several ways to establish service connection for hypertension:

VA Disability Ratings for Hypertension

Hypertension is rated under 38 CFR § 4.104, Diagnostic Code 7101. Ratings are based on blood pressure readings and required medications.

Rating	Criteria
60%	Diastolic pressure predominantly 130 or more
40%	Diastolic pressure predominantly 120 or more
20%	Diastolic pressure predominantly 110 or more; OR Systolic pressure predominantly 200 or more
10%	Diastolic pressure predominantly 100 or more; OR Systolic pressure predominantly 160 or more; OR Minimum evaluation for an individual with a history of diastolic pressure predominantly 100 or more who requires continuous medication for control

Evidence Needed for Hypertension Claims

To support your hypertension claim, gather the following evidence:

Tips for Successful Hypertension Claims

• Document Blood Pressure History: Obtain all available blood pressure readings from service and after discharge.
• Address Medication: If you take medication for hypertension, ensure this is well-documented, especially if you have a history of diastolic pressure of 100 or more.
• Consider Secondary Connection: If you have service-connected PTSD, diabetes, or other conditions that could cause or aggravate hypertension, pursue secondary service connection.
• Get Multiple Readings: VA often requires multiple blood pressure readings on different days to establish a diagnosis of hypertension.
• Address Presumptive Period: If your hypertension was diagnosed within one year after discharge, highlight this for presumptive service connection.

Coronary Artery Disease

Overview of Coronary Artery Disease

Coronary Artery Disease (CAD), also known as ischemic heart disease, is a condition where the coronary arteries that supply blood to the heart muscle become narrowed or blocked due to the buildup of plaque. This can lead to reduced blood flow to the heart, causing chest pain (angina), shortness of breath, or heart attack.

Symptoms of coronary artery disease include:

• Chest pain or discomfort (angina)
• Shortness of breath
• Pain in the neck, jaw, throat, upper abdomen, or back
• Fatigue
• Nausea
• Lightheadedness

Military service can contribute to coronary artery disease through various factors:

• Stress and psychological factors
• Physical demands
• Exposure to environmental hazards, including Agent Orange
• Dietary factors during service
• Service-connected conditions that can cause or aggravate CAD

Service Connection for Coronary Artery Disease

There are several ways to establish service connection for coronary artery disease:

VA Disability Ratings for Coronary Artery Disease

Coronary artery disease is rated under 38 CFR § 4.104, Diagnostic Code 7005. Ratings are based on symptoms, test results, and functional capacity measured in METs.

Rating	Criteria
100%	Chronic congestive heart failure; OR Workload of 3 METs or less results in dyspnea, fatigue, angina, dizziness, or syncope; OR Left ventricular dysfunction with an ejection fraction of less than 30%
60%	More than one episode of acute congestive heart failure in the past year; OR Workload of greater than 3 METs but not greater than 5 METs results in dyspnea, fatigue, angina, dizziness, or syncope; OR Left ventricular dysfunction with an ejection fraction of 30 to 50%
30%	Workload of greater than 5 METs but not greater than 7 METs results in dyspnea, fatigue, angina, dizziness, or syncope; OR Evidence of cardiac hypertrophy or dilatation on electrocardiogram, echocardiogram, or X-ray
10%	Workload of greater than 7 METs but not greater than 10 METs results in dyspnea, fatigue, angina, dizziness, or syncope; OR Continuous medication required

Evidence Needed for Coronary Artery Disease Claims

To support your CAD claim, gather the following evidence:

Tips for Successful Coronary Artery Disease Claims

• Highlight Agent Orange Exposure: If you served in a location qualifying for the Agent Orange presumption, make this clear in your claim.
• Get Comprehensive Testing: Ensure you have recent METs testing and ejection fraction measurements, as these are crucial for determining your rating.
• Document All Cardiac Events: Keep records of all heart attacks, procedures, and hospitalizations.
• Consider Secondary Connection: If you have service-connected diabetes, hypertension, or PTSD, pursue secondary service connection if direct or presumptive connection isn’t applicable.
• Address Functional Limitations: Explain how your CAD affects your ability to perform physical activities and work.

Heart Arrhythmias

Overview of Heart Arrhythmias

Heart arrhythmias are abnormal heart rhythms that occur when the electrical impulses that coordinate your heartbeats don’t work properly, causing your heart to beat too fast, too slow, or irregularly. There are several types of arrhythmias, including:

• Atrial fibrillation (AFib): Irregular and often rapid heart rate
• Atrial flutter: Similar to AFib but with a more organized electrical pattern
• Supraventricular tachycardia (SVT): Rapid heartbeat originating above the ventricles
• Ventricular tachycardia: Rapid heartbeat originating in the ventricles
• Ventricular fibrillation: Chaotic, irregular heartbeat that can be life-threatening
• Bradycardia: Slow heartbeat
• Heart block: Delayed or blocked electrical impulses

Symptoms of heart arrhythmias can include:

• Palpitations (feeling of skipped beats or fluttering)
• Racing heartbeat
• Slow heartbeat
• Chest pain
• Shortness of breath
• Lightheadedness or dizziness
• Fainting (syncope)
• Fatigue

Military service can contribute to heart arrhythmias through various factors:

• Stress and psychological factors
• Physical exertion
• Exposure to environmental hazards
• Traumatic injuries
• Service-connected conditions that can cause or aggravate arrhythmias

Service Connection for Heart Arrhythmias

There are several ways to establish service connection for heart arrhythmias:

VA Disability Ratings for Heart Arrhythmias

Heart arrhythmias are rated under various diagnostic codes in 38 CFR § 4.104, depending on the specific type of arrhythmia:

Arrhythmia Type	Diagnostic Code	Rating Criteria
Supraventricular Arrhythmias	7010	30%: Paroxysmal atrial fibrillation or other supraventricular tachycardia, with more than four episodes per year documented by ECG or Holter monitor 10%: Permanent atrial fibrillation (lone atrial fibrillation), or; one to four episodes per year of paroxysmal atrial fibrillation or other supraventricular tachycardia documented by ECG or Holter monitor
Ventricular Arrhythmias	7011	100%: Chronic congestive heart failure, or; workload of 3 METs or less results in dyspnea, fatigue, angina, dizziness, or syncope, or; left ventricular dysfunction with an ejection fraction of less than 30 percent 60%: More than one episode of acute congestive heart failure in the past year, or; workload of greater than 3 METs but not greater than 5 METs results in dyspnea, fatigue, angina, dizziness, or syncope, or; left ventricular dysfunction with an ejection fraction of 30 to 50 percent 30%: Workload of greater than 5 METs but not greater than 7 METs results in dyspnea, fatigue, angina, dizziness, or syncope, or; evidence of cardiac hypertrophy or dilatation on electrocardiogram, echocardiogram, or X-ray 10%: Workload of greater than 7 METs but not greater than 10 METs results in dyspnea, fatigue, angina, dizziness, or syncope, or; continuous medication required
Atrioventricular Block	7015	100%: Chronic congestive heart failure, or; workload of 3 METs or less results in dyspnea, fatigue, angina, dizziness, or syncope, or; left ventricular dysfunction with an ejection fraction of less than 30 percent 60%: More than one episode of acute congestive heart failure in the past year, or; workload of greater than 3 METs but not greater than 5 METs results in dyspnea, fatigue, angina, dizziness, or syncope, or; left ventricular dysfunction with an ejection fraction of 30 to 50 percent 30%: Workload of greater than 5 METs but not greater than 7 METs results in dyspnea, fatigue, angina, dizziness, or syncope, or; evidence of cardiac hypertrophy or dilatation on electrocardiogram, echocardiogram, or X-ray 10%: Workload of greater than 7 METs but not greater than 10 METs results in dyspnea, fatigue, angina, dizziness, or syncope, or; continuous medication or pacemaker required

Evidence Needed for Heart Arrhythmia Claims

To support your heart arrhythmia claim, gather the following evidence:

Tips for Successful Heart Arrhythmia Claims

• Document Episodes: Keep a detailed log of all arrhythmia episodes, including date, duration, symptoms, and any medical attention required.
• Get Objective Evidence: Ensure your arrhythmia is documented by ECG, Holter monitor, or event monitor, as required by the rating criteria.
• Address Functional Limitations: Explain how your arrhythmia affects your ability to perform physical activities and work.
• Consider Secondary Connection: If you have service-connected coronary artery disease, hypertension, or other conditions that could cause arrhythmias, pursue secondary service connection.
• Highlight Medication Requirements: Document all medications required to control your arrhythmia, as continuous medication requirement can qualify for a 10% rating.

Cardiomyopathy

Overview of Cardiomyopathy

Cardiomyopathy is a disease of the heart muscle that makes it harder for your heart to pump blood to the rest of your body. Over time, cardiomyopathy can lead to heart failure, arrhythmias, and other complications.

There are several types of cardiomyopathy:

• Dilated cardiomyopathy: The heart chambers enlarge and the heart muscle weakens
• Hypertrophic cardiomyopathy: The heart muscle thickens
• Restrictive cardiomyopathy: The heart muscle becomes rigid
• Arrhythmogenic right ventricular cardiomyopathy: Heart muscle is replaced by scar tissue
• Stress-induced cardiomyopathy (Takotsubo): Temporary heart muscle weakness triggered by stress

Symptoms of cardiomyopathy can include:

• Shortness of breath, especially with exertion
• Fatigue
• Swelling in the legs, ankles, and feet
• Bloating due to fluid buildup
• Cough while lying down
• Chest pain or pressure
• Heart palpitations
• Dizziness or lightheadedness
• Fainting

Military service can contribute to cardiomyopathy through various factors:

• Stress and psychological factors (particularly for stress-induced cardiomyopathy)
• Exposure to environmental toxins
• Viral infections during service
• Physical exertion
• Service-connected conditions that can cause or aggravate cardiomyopathy

Service Connection for Cardiomyopathy

There are several ways to establish service connection for cardiomyopathy:

VA Disability Ratings for Cardiomyopathy

Cardiomyopathy is rated under 38 CFR § 4.104, Diagnostic Code 7020. Ratings are based on symptoms, test results, and functional capacity measured in METs.

Rating	Criteria
100%	Chronic congestive heart failure; OR Workload of 3 METs or less results in dyspnea, fatigue, angina, dizziness, or syncope; OR Left ventricular dysfunction with an ejection fraction of less than 30%
60%	More than one episode of acute congestive heart failure in the past year; OR Workload of greater than 3 METs but not greater than 5 METs results in dyspnea, fatigue, angina, dizziness, or syncope; OR Left ventricular dysfunction with an ejection fraction of 30 to 50%
30%	Workload of greater than 5 METs but not greater than 7 METs results in dyspnea, fatigue, angina, dizziness, or syncope; OR Evidence of cardiac hypertrophy or dilatation on electrocardiogram, echocardiogram, or X-ray
10%	Workload of greater than 7 METs but not greater than 10 METs results in dyspnea, fatigue, angina, dizziness, or syncope; OR Continuous medication required

Evidence Needed for Cardiomyopathy Claims

To support your cardiomyopathy claim, gather the following evidence:

Tips for Successful Cardiomyopathy Claims

• Get Comprehensive Testing: Ensure you have recent ejection fraction measurements and METs testing, as these are crucial for determining your rating.
• Document All Episodes: Keep records of all heart failure episodes and hospitalizations.
• Address Functional Limitations: Explain how your cardiomyopathy affects your ability to perform physical activities and work.
• Consider Secondary Connection: If you have service-connected hypertension, diabetes, or other conditions that could cause cardiomyopathy, pursue secondary service connection.
• Highlight Medication Requirements: Document all medications required to manage your cardiomyopathy.

Aortic Stenosis

Overview of Aortic Stenosis

Aortic stenosis is a narrowing of the aortic valve opening, which restricts blood flow from the left ventricle to the aorta and to the rest of the body. This forces the heart to work harder to pump blood through the narrowed valve, which can lead to heart muscle thickening and eventually heart failure.

Types of aortic stenosis include:

• Congenital aortic stenosis: Present from birth due to abnormal valve development
• Calcific aortic stenosis: Most common type, caused by calcium buildup on the valve leaflets
• Rheumatic aortic stenosis: Result of rheumatic fever damage to the valve

Symptoms of aortic stenosis include:

• Chest pain or tightness
• Shortness of breath, especially with exertion
• Fatigue
• Dizziness or fainting
• Heart palpitations
• Swollen ankles and feet

Military service can contribute to aortic stenosis through various factors:

• Physical stress and exertion
• Exposure to environmental hazards
• Service-connected conditions that can accelerate valve deterioration
• Infections during service that could affect the heart valves

Service Connection for Aortic Stenosis

There are several ways to establish service connection for aortic stenosis:

VA Disability Ratings for Aortic Stenosis

Aortic stenosis is rated under 38 CFR § 4.104, Diagnostic Code 7007. Ratings are based on symptoms, test results, and functional capacity measured in METs.

Rating	Criteria
100%	Chronic congestive heart failure; OR Workload of 3 METs or less results in dyspnea, fatigue, angina, dizziness, or syncope; OR Left ventricular dysfunction with an ejection fraction of less than 30%
60%	More than one episode of acute congestive heart failure in the past year; OR Workload of greater than 3 METs but not greater than 5 METs results in dyspnea, fatigue, angina, dizziness, or syncope; OR Left ventricular dysfunction with an ejection fraction of 30 to 50%
30%	Workload of greater than 5 METs but not greater than 7 METs results in dyspnea, fatigue, angina, dizziness, or syncope; OR Evidence of cardiac hypertrophy or dilatation on electrocardiogram, echocardiogram, or X-ray
10%	Workload of greater than 7 METs but not greater than 10 METs results in dyspnea, fatigue, angina, dizziness, or syncope; OR Continuous medication required

Evidence Needed for Aortic Stenosis Claims

To support your aortic stenosis claim, gather the following evidence:

Tips for Successful Aortic Stenosis Claims

• Get Comprehensive Testing: Ensure you have recent echocardiogram results, METs testing, and ejection fraction measurements.
• Document Progression: Keep records showing how your aortic stenosis has worsened over time.
• Address Functional Limitations: Explain how your aortic stenosis affects your ability to perform physical activities and work.
• Highlight Any Procedures: Document any valve replacement or repair procedures.
• Consider Secondary Connection: If you have service-connected rheumatic heart disease or other valvular conditions, pursue secondary service connection.

Congestive Heart Failure

Overview of Congestive Heart Failure

Congestive heart failure (CHF), also known as heart failure, occurs when the heart muscle doesn’t pump blood as well as it should. This can result from various conditions that damage or overwork the heart muscle, causing blood to back up and fluid to build up in the lungs and other parts of the body.

Types of heart failure include:

• Systolic heart failure: The heart muscle doesn’t contract vigorously
• Diastolic heart failure: The heart muscle is stiff and doesn’t fill properly
• Left-sided heart failure: Fluid backs up into the lungs
• Right-sided heart failure: Fluid backs up into the abdomen, legs, and feet

Symptoms of congestive heart failure include:

• Shortness of breath, especially when lying down
• Fatigue and weakness
• Swelling in legs, ankles, and feet
• Rapid or irregular heartbeat
• Persistent cough or wheezing with white or pink blood-tinged phlegm
• Increased need to urinate at night
• Swelling of the abdomen
• Sudden weight gain from fluid retention
• Lack of appetite and nausea
• Difficulty concentrating

Military service can contribute to congestive heart failure through various factors:

• Underlying heart conditions that developed during or as a result of service
• Physical and psychological stress
• Exposure to environmental hazards
• Service-connected conditions that can lead to heart failure

Service Connection for Congestive Heart Failure

There are several ways to establish service connection for congestive heart failure:

VA Disability Ratings for Congestive Heart Failure

Congestive heart failure is rated under 38 CFR § 4.104, Diagnostic Code 7002. CHF typically receives high ratings due to its serious nature.

Rating	Criteria
100%	Chronic congestive heart failure; OR Workload of 3 METs or less results in dyspnea, fatigue, angina, dizziness, or syncope; OR Left ventricular dysfunction with an ejection fraction of less than 30%
60%	More than one episode of acute congestive heart failure in the past year; OR Workload of greater than 3 METs but not greater than 5 METs results in dyspnea, fatigue, angina, dizziness, or syncope; OR Left ventricular dysfunction with an ejection fraction of 30 to 50%
30%	Workload of greater than 5 METs but not greater than 7 METs results in dyspnea, fatigue, angina, dizziness, or syncope; OR Evidence of cardiac hypertrophy or dilatation on electrocardiogram, echocardiogram, or X-ray
10%	Workload of greater than 7 METs but not greater than 10 METs results in dyspnea, fatigue, angina, dizziness, or syncope; OR Continuous medication required

Evidence Needed for Congestive Heart Failure Claims

To support your CHF claim, gather the following evidence:

Tips for Successful Congestive Heart Failure Claims

• Document All Episodes: Keep detailed records of all heart failure episodes and hospitalizations.
• Get Comprehensive Testing: Ensure you have recent ejection fraction measurements and METs testing.
• Address Underlying Causes: If your CHF is caused by another service-connected condition, pursue secondary service connection.
• Highlight Functional Limitations: Explain how your CHF affects your ability to perform daily activities and work.
• Document Chronic Nature: If your CHF is chronic, this automatically qualifies for a 100% rating.

Aortic Aneurysms

Overview of Aortic Aneurysms

An aortic aneurysm is an abnormal bulge or ballooning in the wall of the aorta, the main artery that carries blood from the heart to the rest of the body. Aneurysms can be life-threatening if they rupture, making early detection and treatment crucial.

Types of aortic aneurysms include:

• Thoracic aortic aneurysm: Occurs in the chest portion of the aorta
• Abdominal aortic aneurysm: Occurs in the abdominal portion of the aorta
• Thoracoabdominal aneurysm: Spans both the chest and abdominal portions

Many aortic aneurysms don’t cause symptoms until they become large or rupture. When symptoms do occur, they may include:

• Deep, aching pain in the chest, back, or abdomen
• Shortness of breath
• Cough or hoarseness
• Difficulty swallowing
• Pulsating feeling in the abdomen

Military service can contribute to aortic aneurysms through various factors:

• Physical trauma or injury during service
• High blood pressure developed during service
• Exposure to environmental hazards
• Service-connected conditions that can weaken artery walls

Service Connection for Aortic Aneurysms

There are several ways to establish service connection for aortic aneurysms:

VA Disability Ratings for Aortic Aneurysms

Aortic aneurysms are rated under 38 CFR § 4.104, Diagnostic Code 7110. Ratings depend on the size and location of the aneurysm.

Rating	Criteria
100%	Aneurysm of aorta, large; OR With history of rupture; OR With cardiac involvement
60%	Aneurysm of aorta, moderately large
20%	Aneurysm of aorta, small

Evidence Needed for Aortic Aneurysm Claims

To support your aortic aneurysm claim, gather the following evidence:

Tips for Successful Aortic Aneurysm Claims

• Get Precise Measurements: Ensure your medical records include exact measurements of your aneurysm, as these determine your rating.
• Document Growth: Keep records showing any increase in aneurysm size over time.
• Address Underlying Causes: If your aneurysm is related to service-connected hypertension or other conditions, pursue secondary service connection.
• Highlight Any Complications: Document any rupture, dissection, or cardiac involvement.
• Regular Monitoring: Show that you’re receiving appropriate medical follow-up and monitoring.

Other Cardiovascular Conditions

In addition to the major cardiovascular conditions covered above, there are several other heart and vascular conditions that may be service-connected:

Peripheral Artery Disease (PAD)

PAD occurs when narrowed arteries reduce blood flow to the limbs. It’s often related to atherosclerosis and may be connected to Agent Orange exposure or other service-related factors.

Valvular Heart Disease

Various valve conditions (mitral valve prolapse, tricuspid regurgitation, etc.) may develop during or after service and can be rated based on their functional impact.

Pericarditis

Inflammation of the pericardium (the sac around the heart) can result from infections, autoimmune conditions, or other factors that may be service-related.

Deep Vein Thrombosis (DVT) and Pulmonary Embolism

Blood clots can develop due to prolonged immobility, injuries, or other service-related factors.

For any cardiovascular condition not specifically covered in this guide, the general principles of service connection and rating still apply. Work with qualified medical professionals and veterans’ advocates to ensure your claim is properly documented and submitted.