Heart Disease VA Rating and Diagnostic Code 7005 Criteria

METs workload tiers and mandatory notes in 38 CFR 4.104

Three binding notes precede the General Rating Formula in 38 CFR 4.104:

• Note (1) (Cor pulmonale): Cor pulmonale—right-sided heart disease secondary to lung disease—is evaluated as part of the pulmonary condition causing it (such as COPD or sleep apnea under 38 CFR 4.97).
• Note (2) (Definition and estimation of METs): 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 exercise testing cannot be done for medical reasons, a medical examiner may estimate the METs activity level (supported by everyday examples, such as slow stair climbing or shoveling snow) that triggers symptoms.
• Note (3) (Heart failure symptoms defined): For the General Rating Formula, heart failure symptoms include, but are not limited to, breathlessness, fatigue, angina, dizziness, arrhythmia, palpitations, or syncope.

Because Note (3) includes angina (chest pain), shortness of breath, fatigue, dizziness, palpitations, and syncope, a veteran does not need a clinical diagnosis of congestive heart failure to qualify for a 10%, 30%, 60%, or 100% METs evaluation.

Breakdown of the 10%, 30%, 60%, and 100% tiers

• 10% rating (Continuous medication or 7.1–10.0 METs): Awarded when daily medication is required to control coronary artery disease (beta-blockers, ACE inhibitors, ARBs, calcium channel blockers, statins or antiplatelets prescribed for CAD, or nitrates), or when heavy exertion of 7.1–10.0 METs (jogging, heavy shoveling, carrying heavy loads upstairs) produces cardiac symptoms.
• 30% rating (5.1–7.0 METs or cardiac hypertrophy/dilatation): Awarded when moderate exertion of 5.1–7.0 METs (climbing a flight of stairs at a normal pace, brisk uphill walking, pushing a lawn mower) causes symptoms, or when cardiac hypertrophy (thickened heart wall) or cardiac dilatation (enlarged chamber) is confirmed by echocardiogram or equivalent (MUGA scan or cardiac MRI).
• 60% rating (3.1–5.0 METs): Awarded when light-to-moderate exertion of 3.1–5.0 METs—walking on level ground at a normal pace, slow stair climbing, light yard work, or household chores—triggers angina, breathlessness, fatigue, dizziness, palpitations, or syncope.
• 100% rating (3.0 METs or less): Awarded when minimal activity of 3.0 METs or less—slow indoor walking, dressing, showering, eating, or sitting quietly at rest—results in heart failure symptoms.

When METs testing is required under 38 CFR 4.100

Evaluations under the General Rating Formula are governed by 38 CFR 4.100:

• 38 CFR 4.100(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.
• 38 CFR 4.100(b): Even if the requirement for a 10% evaluation (continuous medication) or a 30% evaluation (cardiac hypertrophy or dilatation) is met, METs testing is required in all cases except:
  1. When there is a medical contraindication, or
  2. When a 100% evaluation can be assigned on another basis.

Under § 4.100(b), an examiner cannot stop after noting daily medications (10%) or left ventricular hypertrophy on an echocardiogram (30%). Unless a 100% rating applies on another basis (such as the three-month period after a heart attack or bypass surgery), the examiner must determine the veteran’s METs capacity—using an interview-based METs estimate under Note (2) to § 4.104 whenever treadmill stress testing is medically contraindicated.

How the rating schedule changed: 2017 vs. November 14, 2021 revisions (ejection fraction and CHF)

Veterans reviewing older decisions often see criteria for left ventricular ejection fraction (LVEF) and congestive heart failure (CHF), or see a December 10, 2017 amendment date in the citation history of 38 CFR 4.104:

1. Pre-2021 criteria (71 FR 52457) and the December 10, 2017 endocrine rule (82 FR 50802): Under the 2006 schedule, Diagnostic Code 7005 allowed 100% for chronic congestive heart failure, workload of 3.0 METs or less, or left ventricular dysfunction with an ejection fraction of less than 30%; and allowed 60% for more than one episode of acute CHF in the past year, workload of 3.1 to 5.0 METs, or left ventricular dysfunction with an ejection fraction of 30% to 50%. Hypertrophy or dilatation for 30% could be shown by ECG, chest X-ray, or echocardiogram. The rule effective December 10, 2017 (82 FR 50802) revised the endocrine schedule and amended only Diagnostic Code 7008 (hyperthyroid heart disease) in 38 CFR 4.104.
2. The November 14, 2021 cardiovascular overhaul (86 FR 54089): Effective November 14, 2021, the VA consolidated DCs 7000, 7005, 7006, 7007, 7017, and 7020 under the General Rating Formula for Diseases of the Heart, removed ejection fraction (LVEF) percentages (<30% for 100% and 30%–50% for 60%) and chronic/acute CHF episodes as standalone rating criteria, and required echocardiogram or equivalent (MUGA or cardiac MRI) rather than resting ECG or X-ray alone to confirm cardiac hypertrophy or dilatation for 30%.

Under 38 CFR 3.951(a), ratings established before November 14, 2021 based on LVEF or CHF cannot be reduced solely due to the schedule revision unless a re-examination proves sustained material improvement under ordinary conditions of life.

Heart attacks (DC 7006), bypass surgery (DC 7017), stents, and implanted devices

Acute ischemic events, surgeries, and implanted cardiac devices carry specific temporary or permanent ratings under 38 CFR 4.104:

• Myocardial Infarction (DC 7006): Assigns 100% during and for three months following a myocardial infarction confirmed by laboratory tests; thereafter, residuals are rated under the General Rating Formula.
• Coronary Bypass Surgery (DC 7017): Assigns 100% for three months following hospital admission for CABG surgery; thereafter, residuals are rated under the General Rating Formula.
• Angioplasty and Stents (PCI): Rated under DC 7005 using the General Rating Formula unless performed during a laboratory-confirmed myocardial infarction (three months at 100% under DC 7006) or requiring inpatient hospitalization over 21 days under 38 CFR 4.29.
• Implantable Pacemakers (DC 7018 and DC 7009) and AICDs (DC 7011): Pacemaker implantation warrants 100% for one month after hospital discharge, followed by evaluation under the General Rating Formula or arrhythmia codes with a 10% minimum under DC 7018. An automatic implantable cardioverter-defibrillator (AICD) in place under DC 7011 warrants a continuous 100% rating.

Agent Orange presumptive service connection (38 CFR 3.309(e))

Under 38 CFR 3.309(e) and 38 CFR 3.307(a)(6), ischemic heart disease is a presumptive condition for tactical herbicide (Agent Orange) exposure:

• Covered conditions: 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.
• Note 2 exclusions: Under Note 2 to 38 CFR 3.309(e), the term ischemic heart disease does not include hypertension or peripheral manifestations of arteriosclerosis such as peripheral vascular disease or stroke, though the PACT Act of 2022 separately added hypertension as a standalone herbicide presumptive condition under 38 U.S.C. § 1116.

Qualifying service locations on the VA Agent Orange eligibility page include the Republic of Vietnam and Blue Water Navy waters (Jan. 9, 1962 – May 7, 1975), Thailand military bases (Jan. 9, 1962 – June 30, 1976), the Korean DMZ (Sept. 1, 1967 – Aug. 31, 1971), Laos (Dec. 1, 1965 – Sept. 30, 1969), Cambodia at Mimot or Krek (April 16–30, 1969), Guam or American Samoa (Jan. 9, 1962 – July 31, 1980), Johnston Atoll (Jan. 1, 1972 – Sept. 30, 1977), and herbicide-contaminated C-123 aircraft.

Direct, one-year chronic, POW, and secondary service connection (38 CFR 3.310)

Veterans without herbicide exposure can establish service connection through direct in-service evidence under 38 CFR 3.303, the one-year chronic disease presumption for arteriosclerosis under 38 CFR 3.309(a), the former Prisoner of War presumption for atherosclerotic heart disease and myocardial infarction under 38 CFR 3.309(c), or secondary service connection under 38 CFR 3.310(a):

• Claiming heart disease secondary to other conditions: With a qualified medical nexus opinion demonstrating causation or permanent aggravation, coronary artery disease may be claimed secondary to service-connected hypertension (DC 7101, which Note 3 directs the VA to rate separately from heart disease), diabetes mellitus (DC 7913, where Note 1 directs separate ratings for compensable diabetic cardiovascular complications), sleep apnea (DC 6847), or PTSD and mental health disorders (including via obesity as an intermediate step under VAOPGCPREC 1-2017).
• Secondary conditions caused by service-connected heart disease: Veterans with service-connected ischemic heart disease may file secondary claims under 38 CFR 3.310(a) for painful or unstable coronary bypass surgical scars on the chest or leg (DC 7804), secondary depression or anxiety (38 CFR 4.130), erectile dysfunction (DC 7522 with SMC-K), or secondary stroke or renal complications supported by medical nexus evidence.

How the C&P exam and Heart Conditions DBQ measure your condition

During a VA C&P exam, the clinician completes the Heart Conditions Disability Benefits Questionnaire (DBQ), verified on the VA Public Disability Benefits Questionnaires page:

1. Diagnoses, IHD Qualification, and Medications (Sections 1–2): Records ICD diagnoses, whether the condition meets the medical definition of Ischemic Heart Disease (2B), etiology (2C), and whether continuous medication is required (2D).
2. Cardiac Events and Procedures (Sections 3–9): Documents myocardial infarction dates (3A), arrhythmias and annual treatment interventions (4A), and procedures including PCI/stents, coronary artery bypass surgery, pacemakers, and AICDs (8A).
3. Hypertrophy, Dilatation, and Imaging (Sections 10–12): Records physical findings, surgical scars (11B), and whether cardiac hypertrophy (12A) or dilatation (12B) is documented by echocardiogram, MUGA, MRI, ECG, or X-ray (12C).
4. Exercise Stress Test vs. Interview-Based METs Test (Section 13): Records stress test results (13B) or why stress testing was medically contraindicated (13C), and records the interview-based METs test (13D) across (1–3 METs), (>3–5 METs), (>5–7 METs), or (>7–10 METs), identifying cardiac symptoms and the METs level attributable solely to the heart condition (13F–13G).

Combining ratings, TDIU, and getting accredited help

Separate ratings for coronary artery disease, hypertension, diabetes, and surgical scars combine under the whole-person formula in 38 CFR 4.25. Model your overall rating with our VA combined rating calculator. If a 60% heart rating (or a 40% rating combined to at least 70% overall) prevents substantially gainful employment, you may apply for Total Disability based on Individual Unemployability (TDIU) under 38 CFR 4.16(a) to receive compensation at the 100% rate.

For help with a claim or appeal, accredited Veterans Service Organizations (VSOs)—such as the DAV, VFW, and American Legion—provide representation free of charge, while VA-accredited claims agents and attorneys handle contested appeals. No representative can guarantee an outcome; verify credentials through the VA Office of General Counsel Accreditation Search.