The Basic Rating System
Heart Conditions Rated on the Basic Rating System
Other Heart Conditions
DBQ for Heart Conditions
Principles that Apply
Reminder: The VA will give a Military Disability Rating for each service-connected condition a service member has, but the DoD will only rate service-connected conditions that make a service member Unfit for Duty.
The Cardiovascular System is divided into two pages: The Heart and The Arteries and Veins.
The Basic Rating System
The majority of heart conditions are rated based on a set rating system. All the conditions will be listed below along with any deviations from this rating system.
Note: It is very important that the physician performing your exam gets an MET (metabolic equivalent of task) test done for ANY heart condition. An MET test, more often known as an exercise test, checks for how much oxygen is being used by the body to perform increasingly strenuous tasks. 1 MET equals the amount of oxygen a person uses when at rest. There are a very few cases where an MET test is not required, but the majority of the time it is essential to getting a proper heart rating. Be proactive and make sure an MET test is done!
The basic rating system:
A 100% rating is given if there is one or more of the following:
1) Continuous congestive heart failure
2) The condition scores 3 METs or less on an MET test and causes shortness of breath, fatigue, chest pain,
dizziness or fainting
3) Left ventricular dysfunction with an ejection fraction of less than 30%
A 60% rating is given if there is one or more of the following:
1) Two or more episodes of congestive heart failure in the past year
2) The condition scores 4 or 5 METs and causes shortness of breath, fatigue, chest pain, dizziness or fainting
3) Left ventricular dysfunction with an ejection fraction between 30 and 50%
A 30% rating is given if there is one or more of the following:
1) The condition scores 6 or 7 METs on an MET test and causes shortness of breath, fatigue, chest pain,
dizziness or fainting
2) Evidence (x-ray, electro-cardiogram, or echocardiogram) of hypertrophy or dilation. An electro-
cardiogram by itself can prove hypertrophy, but is not enough to prove dilation.
1) The condition scores 8, 9 or 10 METs and causes shortness of breath, fatigue, chest pain, dizziness or fainting
2) Continuous medication is required
A 100% rating is given for the following conditions while the condition is active and continues for the first three months following the end of treatment or hospitalization for the condition. After that, the conditions are rated based on the basic rating system.
– Code 7000: Valvular heart disease includes any disease, including rheumatic heart disease, that involves one or more valves of the heart. Rheumatic heart disease usually develops many years after the initial infection which causes the condition. Because of this, it can be judged to have existed prior to service and thus is not ratable even if it was not diagnosed before entering the military. Medical findings of murmurs or valvular lesions early in your career could be enough to prove it did exist prior to service.
– Code 7001: Endocarditis is the inflammation of the lining of the heart chambers and valves.
– Code 7002: Pericarditis is the inflammation of the covering tissue surrounding the heart.
– Code 7006: Myocardial infarction (or a “heart attack”) occurs when the blood flow to a part of the heart is blocked, thus causing damage to the heart muscle. (For DoD purposes, a heart attack which occurs while on active duty will be considered as caused by service unless it is clearly proven to not be related).
– Code 7017: Coronary bypass surgery is performed if there is a block in a coronary artery. The surgeon grafts veins or arteries from the aorta directly to the artery, thus bypassing the block. The three-month period for this condition begins the day of admission to the hospital for the procedure.
The following conditions are given a 100% rating for an “indefinite” period of time before they are rated on the basic rating system.
– Code 7011: Sustained ventricular arrhythmias are abnormal heart rhythms, most commonly too fast, that are located in the heart’s two lower chambers. These rhythms can come and go and are usually treated with medication or electric therapy. This condition receives the 100% rating the entire time it is being treated in the hospital or the entire time an implantable defibrillator is in place. If a pacemaker is implanted, then it is rated under code 7018.
– Code 7016: A heart valve replacement is performed when a valve of the heart is not functioning properly. It is replaced by an artificial valve that can perform the function of the damaged valve. This receives the 100% rating the entire time it is being treated in the hospital and for 6 months following discharge from the hospital. At the 6-month mark, the condition is reevaluated. It then either continues with the 100% rating or is rated based on the basic rating system.
– Code 7018: Cardiac pacemakers are implanted if the rhythm of the heart is too slow. This condition is rated 100% for the first 2 months following the surgery. After that, it is rated under the base condition that caused the irregular heart rhythm: supraventricular arrhythmias, ventricular arrhythmias, or an atrioventricular block. The minimum rating for a condition requiring a pacemaker is 10%. If a defibrillator is implanted, then it is rated under code 7011.
– Code 7019: Cardiac transplantation, a heart transplant, is rated 100% for one year from the date of admission to the hospital. After the one-year period, the condition is then reevaluated and rated on the basic rating system. The absolute minimum rating for this condition is 30%.
The following conditions do not have the 100% rating periods described for the above conditions. Instead, these are immediately rated on the basic rating system.
– Code 7003: Pericardial adhesions occur when the sac surrounding the heart sticks to the heart muscle and restricts its pumping action.
– Code 7004: Syphilitic heart disease occurs many years after the initial infection of syphilis. It causes inflammation in the heart that restricts blood flow to the heart itself. It can also cause syphilitic aortic aneurysms, but those should be rated under code 7110.
– Code 7005: Ischemic heart disease, Arteriosclerotic heart disease, Atherosclerotic heart disease, or Coronary artery disease all affect the coronary arteries. Arteriosclerosis is the thickening and hardening of the walls of the arteries, atherosclerosis is the narrowing and hardening of the arteries, and coronary artery disease is the blocking of the arteries from the build up of plaque. Often coronary artery disease is present with the other two. Coronary artery disease must be clearly documented to rate this condition.
– Code 7007: Hypertensive heart disease is caused by high blood pressure. Hypertension over many years can result in left ventricular hypertrophy and/or heart failure.
– Code 7015: Atrioventricular block occurs when the electrical impulses that allow the different parts of the heart to communicate and function are blocked. This must be associated with other evidence of heart disease to be considered unfitting. It is rated on the basic rating system with one addition: if a pacemaker is required, it is rated 10%.
– Code 7020: Cardiomyopathy is the deterioration of the heart muscle and its functioning for any reason. Any heart condition that is not covered by the other heart codes is rated here.
Other Heart Conditions
Cor pulmonale, the failure of the right side of the heart, is not a condition in and of itself, but is a result of another condition. Because of this, cor pulmonale is not ratable, but the underlying condition that causes it can be rated.
Code 7010: Supraventricular arrhythmias are abnormal heart rhythms, most commonly too fast, that are located in the heart’s two upper chambers. If episodes of abnormal heart rhythms occur 5 or more times a year, then it is rated 30%. A 10% rating is given if episodes of abnormal rhythm occur 1 to 4 times a year or if there is permanent atrial fibrillation with no evidence of other heart diseases or conditions. All episodes must be properly documented by an ECG test.
Code 7008: Hyperthyroid heart disease occurs when the thyroid produces too much thyroid hormone. This can affect the blood pressure, how the heart consumes oxygen, and how much blood the heart can pump. It can be rated only under code 7900 for hyperthyroidism unless atrial fibrillation is present. If it is present, then it can either rated under code 7900 or under code 7010 (superventricular arrhythmias), whichever gives the higher rating.
All other heart conditions will be rated analogously (see the Analogous and Equivalent Codes page) with one of the above ratings. The bottom line rule is to rate any condition under the code that BEST describes it, even if it is not exact. If a heart condition does not easily fit under one of the specific heart codes, then it is rated as cardiomyopathy under code 7020.
Principles that Apply
Pyramiding: A single condition can only be rated once! However, if another condition exists that is additional to the heart condition (not simply caused by it), then it can also be rated.
Probative Value: If two exams record the condition differently, the exam with the most thorough data and performed by the most qualified person in that specialty will be the exam the rating is based on.
A Tie Goes to the Veteran: If there are two equally strong exams with conflicting information, or if the condition can be equally rated under two different codes, then the one that gives the highest rating will be assigned. Every conflict should be resolved in favor of the higher rating.
Accurate Measurements: It is essential that the necessary information to rate your condition is recorded by the physician in your exam. With the information on this page, you should know what needs to be measured and recorded. Make sure this happens correctly to ensure that you receive a proper rating.
Hospital or Convalescent Ratings: Some conditions require periods of hospitalization or constant medical care (at-home nurse, etc.). Any condition that requires this is rated 100% during this intensive treatment. Once it ends, then the 100% rating will continue for a certain period. This period is 3 months unless another length (6 months, 1 year, etc.) is directly specified in the condition ratings. Some patients may need more time to recover than others, so the physician or Rating Authorities can lengthen this time period if they see fit.
Please see the VASRD Principles page for further guidance.