Getting Veterans Disability Compensation for Heart or Cardiovascular Problems

Veterans can be awarded service-connected disability compensation for various heart conditions. The VA uses a tool called the Schedule for Rating Disabilities to help determine what disability rating to assign you for conditions such as ischemic heart disease, coronary heart disease, aortic aneurysm, and atrial fibrillation ("afib").

Common Causes of Service-Related Heart Problems

Heart problems in veterans can arise from many different kinds of activities or injuries that occurred while enlisted. The VA first needs to establish that your heart condition was caused or worsened by your time on active duty (service connection).

Service connection for heart disease can be direct, presumptive, or secondary, depending on the causal relationship ("nexus") between an incident that occurred on active duty and your disabling heart condition.

Direct Service Connection for Heart Problems

Veterans who are exposed to hazardous environments or chemicals can develop symptoms of conditions such as ischemic heart disease. Prolonged stress is another contributor to cardiovascular disorders like coronary artery disease.

You can obtain a "direct service connection" for your heart condition if you can show:

• a diagnosis of a current heart condition using the criteria in the VA Rating Schedule
• military records of an in-service event that caused the heart disease, and
• medical evidence—typically including a doctor's opinion—showing a nexus that links the current diagnosed condition with the in-service event.

Presumptive Service Connection for Heart Problems

Military duty can involve activities that are dangerous enough for the VA to "presume'' that you'll develop a medical condition as a result. If you were involved in such activities within a specific period of time, you can establish a "presumptive service connection" based only on a diagnosis of a heart condition—without having to also show that an incident during your service caused it.

Other veterans with at least 90 days of continuous service can be eligible for presumptive service connection for conditions such as arteriosclerosis, endocarditis, and myocarditis. You can view all medical conditions that can form the basis of a presumed service connection on the VA's official list for presumptive disability benefits.

Secondary Service Connection for Heart Problems

You can establish a "secondary service connection" for conditions that don't have a direct or presumed link to an in-service incident, but are the result of another condition that does have that nexus. For example, recent medical studies suggest a link between diabetes and heart disease, as well as heart disease and PTSD. If you developed a non-cardiovascular disorder while enlisted that later caused or worsened your heart disease, you can get a disability rating for your heart problems.

How Does the VA Evaluate and Rate Heart Conditions?

The VA evaluates cardiovascular conditions using the VA Schedule for Rating Disabilities for diseases of the heart, arteries, and veins (diagnostic codes 7000 through 7124). Some common heart diseases included in the ratings schedule include:

• coronary artery disease
• aortic aneurysms
• ventricular arrhythmias
• congestive heart failure, and
• hypertension.

In addition to showing that your heart disease is service-connected, your condition must meet the requirements of one of three diagnostic methods recognized by the VA in the rating schedule.

Metabolic Equivalents (METS)

Heart conditions are generally evaluated by what the VA calls "metabolic equivalents" (METS). This is a medical test that's performed while you're exercising, often on a treadmill. The idea behind the METS method is that your heart's ability to provide oxygen so you can exercise indicates how well your heart is functioning. The more symptoms you have at higher levels of exercise—such as dizziness or fatigue—the higher your assigned rating will be.

Number of Episodes of Heart Failure

If your medical record contains evidence that you have had congestive heart failure, then your heart condition can be evaluated according to how frequently you have episodes of heart failure. The more frequent the episodes, the higher your disability rating will be.

Left Ventricular Dysfunction

Finally, the VA can evaluate heart conditions by looking for evidence of left ventricular dysfunction. Doctors can measure the way the heart's ventricle releases blood each time your heart beats in order to evaluate how severe your heart condition is. A special test is required to perform this measurement, called a multigated acquisition scan (MUGA). This test measures your heart's ability to pump blood, called the ejection fraction (EF).

Even if you have a diagnosis of a heart condition, if your heart condition isn't medically evaluated with one of the above methods, the VA won't award you compensation.

VA Ratings for Heart Conditions

The Schedule for Rating Disabilities has about two dozen diagnostic codes that the VA uses to evaluate heart diseases and related disorders of the arteries. The appropriate code will be determined by whether you have had a myocardial infarction (a heart attack), heart failure, valvular disease, or surgery such as a heart bypass.

For each code, the VA has several different fixed ratings, depending on your symptoms. Below is a list of the more common heart problems and how the VA rates them.

Coronary Artery Disease

Coronary artery disease occurs when the blood vessels of your heart become hard, narrow, blocked, or stretched. The disease can be documented by results from:

• electrocardiograms (EKG)
• treadmill stress tests
• a Holter monitor (a wearable device that tracks your heart's electrical activity)
• cardiac catheterization (placing a thin tube into your heart so the doctor can look at it), or
• angiography (a procedure for taking X-rays of your blood vessels).

Disability ratings for coronary artery disease are evaluated according to the general rating formula (above). For example, if you've had more than one episode of acute congestive heart failure in the past year, a METS level of 4.0, or an ejection fraction of 40%, your disability rating will be 60%.

Heart Attacks

Heart attacks ("myocardial infarctions") are rated at 100% for three months after they have occurred—after three months, the VA will re-evaluate the rating. Factors the VA will consider when determining the new rating include METS testing, frequency of heart failure, and the severity of ventricular dysfunction.

Coronary Bypass Surgery

If you have coronary bypass surgery, you'll receive a 100% rating for three months. After three months, the VA will adjust your rating (based on METS testing, frequency of heart failure, and any ventricular dysfunction).

Aortic Aneurysm

The VA will rate your aortic aneurysm at 100% if it is five centimeters or larger in diameter, prevents you from exerting yourself, or requires surgery.

Atrial Fibrillation ("Afib")

Also known as irregular heartbeats, "Afib" with bradycardia (slow ventricular response) is rated 100% for one month if you've been hospitalized for pacemaker implantation.

Hypertension

Hypertension is the medical term for high blood pressure. Because hypertension is technically classified under the ratings schedule as a disease of the arteries, the VA assigns different disability percentages than the general ratings for heart conditions.

Your rating for hypertension is based on how high your diastolic pressure (the bottom number in your blood pressure "fraction") or your systolic pressure (the top number) is.

• Diastolic pressure of 130 or more is rated at 60%.
• Diastolic pressure of 120 or more is rated at 40%.
• Diastolic pressure of 110 or more, or a systolic pressure of 200 or more, is rated at 20%.
• Diastolic pressure of 100 or more, or a systolic pressure of 160 or more, is rated at 10%.

Some veterans may have a diagnosis of hypertension, but don't experience any symptoms. Untreated hypertension can get worse over time, however, and develop into organ disorders that can cause problems with vision, breathing, and headaches, among other symptoms. If you develop coronary heart disease or another heart condition as a result of hypertension, you can obtain a separate disability rating for the heart problem.

VA Heart Conditions Worksheet for Ischemic and Non-Ischemic Heart Disease

You can help increase your disability rating by having your doctor fill out a disability benefits questionnaire (DBQ). Your doctor can complete the DBQ by checking boxes indicating:

• which heart conditions you've been diagnosed with
• what symptoms you exhibit on examination, and
• what medical tests you've had to confirm your diagnosis (including METS testing).

You can download a PDF of a blank DBQ for heart disease here. For more information, as well as blank DBQs for other physical and mental conditions, you can visit the VA's website on DBQs.

How to Apply for VA Disability for Your Heart Condition

You can submit an application for VA disability compensation online, in person or over the phone with your VA regional office, or by mailing an Application for Disability Compensation to the following address:

Department of Veterans Affairs
Claims Intake Center
PO Box 4444
Janesville, WI 53547-4444

To learn more about how to apply, read Nolo's article on applying for VA disability benefits.

_{Updated May 30, 2023}