The Department of Veterans Affairs (VA) provides disability compensation to veterans whose illnesses or injuries were incurred or aggravated during active military service. To qualify, a heart condition must first be officially linked to military service, and its severity must then be evaluated using the VA’s specific guidelines. The VA uses the Schedule for Rating Disabilities, specifically Title 38 of the Code of Federal Regulations, Part 4 (38 CFR Part 4), to ensure a consistent evaluation of all disabilities.
Establishing Service Connection
A veteran must establish a service connection for a heart condition to be compensable. This link can be proven in one of three primary ways, all requiring sufficient medical and service evidence.
Direct Service Connection
The most straightforward method is Direct Service Connection, where a condition began or was aggravated during active duty. This requires current medical evidence of the diagnosis, documentation of an event or injury in service, and a medical opinion, often called a nexus letter, that explicitly links the two.
Secondary Service Connection
An alternative is Secondary Service Connection, which applies when a heart condition develops as a consequence of another disability that is already service-connected. For instance, if service-connected kidney disease causes chronic hypertension, the resulting heart damage may be claimed as a secondary condition. This requires a medical professional to state that the compensated condition caused or aggravated the subsequent heart problem.
Presumptive Service Connection
The third method is Presumptive Service Connection, which bypasses the need for a specific in-service event or nexus letter. The VA presumes that certain heart conditions are service-connected if a veteran served in specific locations or time periods. For example, Ischemic Heart Disease is presumed connected for veterans exposed to Agent Orange, and certain heart diseases are presumed for former Prisoners of War. The PACT Act also expanded presumptive conditions related to toxic exposures, simplifying the link for affected veterans.
Recognized Heart and Vascular Conditions
The VA’s rating schedule addresses a wide array of heart and vascular conditions that may qualify for disability consideration. These conditions are evaluated under the cardiovascular section of 38 CFR Part 4, which includes diagnostic codes covering various cardiac and circulatory system disorders.
Ischemic Heart Disease (IHD), often called Coronary Artery Disease (CAD), is a frequent diagnosis involving narrowed arteries that reduce blood flow to the heart muscle. Chronic Heart Failure (CHF) is also a significant condition, involving the heart’s inability to pump blood efficiently enough to meet the body’s needs. The VA also rates conditions affecting the electrical system, such as Arrhythmias like Atrial Fibrillation (A-Fib), and issues with the heart’s mechanics, such as Valvular Heart Disease.
Hypertension (high blood pressure) is another widely recognized cardiovascular condition. Hypertension can lead to Hypertensive Heart Disease, where the heart muscle thickens and stiffens due to the continuous effort required to pump against high pressure. Other conditions, including Cardiomyopathy (disease of the heart muscle), Pericarditis (inflammation of the sac surrounding the heart), and various Aortic Aneurysms are also evaluated. The resulting percentage rating depends entirely on the degree of functional impairment.
Determining Disability Rating Severity
Once service connection is established, the VA determines the disability rating by assessing the severity of the heart condition. Ratings for most heart diseases are assigned at 10%, 30%, 60%, or 100% based primarily on the heart’s functional capacity. The main tool for this measurement is the Metabolic Equivalent of Task (METs) test, which quantifies the maximum energy expenditure a veteran can tolerate before experiencing symptoms like shortness of breath, fatigue, chest pain, or dizziness.
One MET represents the energy expended while sitting quietly (approximately 3.5 milliliters of oxygen consumed per kilogram of body weight per minute). A lower MET score indicates a more severe functional limitation. For instance, a 100% rating is assigned when a workload of three METs or less results in symptoms of heart failure. This level reflects an inability to perform even light activities, such as dressing or walking slowly.
A 60% rating is assigned when a workload between four and five METs causes symptoms, or when the Left Ventricular Ejection Fraction (LVEF) is between 30% and 50%. The LVEF measures how much blood the left ventricle pumps out with each contraction; a lower percentage indicates poorer pumping function. A 30% rating is given for symptoms that appear at a workload of six or seven METs, while a 10% rating is assigned if symptoms appear at a workload of eight to ten METs, or if the condition requires continuous medication.
Hypertension is an exception, as its rating is based on specific blood pressure measurements rather than the METs criteria. A 60% rating requires the diastolic pressure to be predominantly 130 mmHg or more, and a 40% rating is for a diastolic pressure predominantly 120 mmHg or more. Temporary 100% ratings are provided immediately following major procedures like heart transplantation or cardiac surgery (such as a bypass) to cover the acute recovery period before the final functional rating is determined.