Ischemic Heart Disease VA Disability Rating
- Service connection requires a current diagnosis, an in-service event or exposure, and a medical link (nexus) between the two.
- VA assigns ratings of 10% to 100% under diagnostic code 7005, using the criteria in the rating table below.
- The percentage assigned turns on METs, ejection fraction, heart failure.
- Measured at the C&P exam: METs, exercise stress test.
- Presumptive service connection may apply under the Agent Orange and the Former POW for veterans with qualifying service.
| Rating | Criteria |
|---|---|
| 10% | Workload greater than 7 METs but not greater than 10 METs results in dyspnea, fatigue, angina, dizziness, or syncope, or continuous medication required. |
| 30% | Workload 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. |
| 60% | More than one episode of acute congestive heart failure in the past year, or workload greater than 3 METs but not greater than 5 METs results in symptoms, or left ventricular dysfunction with ejection fraction 30 to 50 percent. |
| 100% | Chronic congestive heart failure, or workload of 3 METs or less results in symptoms, or left ventricular dysfunction with ejection fraction less than 30 percent. |
Illustrative scenarios showing how the criteria above are applied. These are educational examples, not a prediction of any individual veteran's rating.
Symptoms on a stress test between 5 and 7 METs
Illustrates 30%Situation. A veteran's stress test brings on shortness of breath and fatigue at a workload between 5 and 7 METs.
How the criteria apply. A workload greater than 5 but not greater than 7 METs producing dyspnea, fatigue, angina, dizziness, or syncope rates 30 percent. Heart conditions are rated largely on METs, a measure of exertion capacity, and on ejection fraction.
A heart-failure episode or low ejection fraction
Illustrates 60%Situation. A veteran had an episode of congestive heart failure this past year, and testing shows an ejection fraction around 40 percent.
How the criteria apply. More than one CHF episode in the past year, a workload of 3 to 5 METs with symptoms, or a left-ventricular ejection fraction of 30 to 50 percent rate 60 percent. The objective test numbers carry the rating.
VA looks at workload measured in METs and left ventricular ejection fraction.
What VA looks at
METs workload, ejection fraction, congestive heart failure episodes, medication needs.
Common exam and DBQ topics
Stress test results, echocardiogram findings, medication history.
Evidence that usually matters
Cardiology records, stress tests, echocardiograms.
Common misunderstandings
Continuous medication alone, even without symptoms, supports the 10 percent rating.
Drawn directly from the VA Disability Benefits Questionnaire (DBQ). The examiner records each item below; the rating then maps to the table above.
- Confirm diagnosis (CAD, MI, angina, cardiomyopathy) with the date of diagnosis.
- Record METs (metabolic equivalents) at which the veteran becomes symptomatic, this is the primary driver of the rating under DC 7005 (1-3 METs → 100%; 3-5 METs → 60%; 5-7 METs → 30%; 7-10 METs → 10%).
- Document left ventricular ejection fraction (LVEF). LVEF ≤30% → 100%; 30-50% → 60%.
- Record history of cardiac surgery, stents, bypass, ICD or pacemaker placement.
- Note current medications, episodes of CHF in the past year, and effect on daily activities and employment.
Small rules in the regulations decide a surprising number of claims. These are the ones that most often change a ischemic heart disease outcome. None of this is legal advice; it is a map of where to look.
Your rating is based mostly on an exertion measurement called METs, which captures how much activity brings on symptoms. A current exercise or estimated METs finding is central.
WhyIschemic heart disease is rated mostly on a workload measurement called METs, which captures how much exertion brings on symptoms, along with ejection fraction and any heart enlargement. A current exercise or estimated METs finding is central to the rating.
38 CFR 4.104Was this helpful?It is an Agent Orange presumptive, so qualifying exposure plus the diagnosis can prove service connection without showing a specific cause.
WhyIschemic heart disease is a presumptive condition for veterans with qualifying herbicide exposure, so the exposure plus the diagnosis can establish service connection without proving a specific cause.
38 CFR 3.309Was this helpful?
- What you and people around you witnessed is real evidence
You do not always need a doctor to prove a symptom you can see, hear, or feel. Statements from you, family, or fellow service members about things like pain, ringing in the ears, or panic attacks are competent lay evidence under 38 CFR 3.159. A clear buddy statement with dates and specifics can carry weight.
38 CFR 3.159 - A tie goes to you
When the evidence for and against a point is roughly equal, VA is required to decide in the veteran's favor. This benefit of the doubt rule lives in 38 CFR 3.102. You do not have to prove a claim beyond all doubt, only to bring the evidence to about even.
38 CFR 3.102 - An unbroken line of symptoms can stand in for a paper trail
For certain chronic conditions, showing symptoms that continued from service to now can help establish service connection even without a perfect record. This continuity of symptomatology idea comes from 38 CFR 3.303(b) and applies to the chronic diseases the regulation lists.
38 CFR 3.303 - If it happened in combat, your word can be enough that the event occurred
For anyone who served in combat, VA must accept your own account of what happened during that combat as proof the event took place, as long as it fits the conditions of your service, even when no record survives. This comes from 38 U.S.C. 1154(b). It does not by itself prove the injury, but it can establish the in service event.
38 U.S.C. 1154(b) - If it was not written down at entry, you are presumed to have entered healthy
Unless a condition was noted on your entrance exam, the law presumes you were sound when you entered service. To rebut that, VA has to show by clear and unmistakable evidence both that the condition existed before service and that service did not make it worse. See 38 CFR 3.304(b).
38 CFR 3.304 - You can reopen a denied claim with new and relevant evidence and keep your date
After a decision, a Supplemental Claim lets you add new and relevant evidence. If you file it within one year of the decision, you protect your original effective date, so back pay can reach further. See 38 CFR 3.2501.
38 CFR 3.2501 - Some conditions are presumed if they show up within a year of getting out
Certain chronic diseases, including hypertension, arthritis, and diabetes, that appear to a compensable degree within one year of leaving service are presumed connected to service, even without proof of a specific cause. See 38 CFR 3.307 and the list in 3.309.
38 CFR 3.309 - A diagnosis years later can still be service connected
A condition first diagnosed long after you left service can still be service connected if the evidence ties it back to something in service. You do not need a diagnosis while still in uniform. See 38 CFR 3.303(d).
38 CFR 3.303
- The same symptom is rated once, but separate problems are rated separately
VA cannot rate the same symptom twice, which is pyramiding under 38 CFR 4.14, but it can and should rate distinct problems on their own. A scar and the loss of motion under it, for example, can each be rated. The Esteban decision is the classic example.
38 CFR 4.14 - One service connected condition can open the door to another
A condition caused by, or made worse by, a service connected condition can be service connected too. Sleep apnea linked to weight gain from a service connected condition, or depression linked to chronic pain, are common examples. This secondary path is in 38 CFR 3.310.
38 CFR 3.310 - Your rating can change by time period
If a condition was worse during one stretch and better during another, VA can assign different ratings for those periods rather than one flat number. These are called staged ratings, and they flow from VA's duty to consider the whole recorded history under 38 CFR 4.1 and 4.2.
38 CFR 4.2 - Ratings are combined with a table, not added
Two disabilities at 50 and 50 do not make 100. VA combines them with the table in 38 CFR 4.25, working from the largest down, then rounds to the nearest 10 only at the very end. This is why a 30 and a 20 can land on 40, not 50.
38 CFR 4.25 - If the schedule does not fit your case, VA can rate outside it
When your disability picture is so unusual that the normal rating schedule does not capture it, for example frequent hospital stays or marked interference with work, VA can refer the case for an extraschedular rating. It is uncommon but real, under 38 CFR 3.321(b)(1).
38 CFR 3.321 - When you are between two ratings, the higher one should win
If your symptoms sit between two rating levels, VA is supposed to assign the higher one when your overall disability picture more nearly matches it. This is the reasonable doubt rule applied to ratings, in 38 CFR 4.7.
38 CFR 4.7 - You do not have to check every box on the list
The symptoms listed at each rating level are examples and guides, not a strict checklist. VA is not supposed to deny a level just because you do not have every single symptom named. See 38 CFR 4.21.
38 CFR 4.21
- You can lock in your start date before the full claim is ready
Filing an intent to file holds your effective date for up to a year while you gather evidence. If you complete the claim within that year, back pay can run from the intent to file date, not the later submission. See 38 CFR 3.155.
38 CFR 3.155 - Older ratings get harder to take away
A rating in place for 5 years is treated as stabilized, one in place for 10 years has protected service connection, and one in place for 20 years generally cannot be reduced below its level except for fraud. See 38 CFR 3.344, 3.957, and 3.951.
38 CFR 3.344 - VA cannot cut a rating without showing real, lasting improvement
To reduce a rating, VA generally has to show actual improvement under the ordinary conditions of life and work, not just one better exam. The rules are in 38 CFR 3.344, and a proposed reduction comes with notice and a chance to respond first.
38 CFR 3.344 - You can be paid at the 100 percent rate without a 100 percent rating
If service connected conditions keep you from holding steady, gainful work, VA can pay you at the 100 percent rate through TDIU, even if your combined rating is lower. Under the Rice decision, VA must consider TDIU whenever the record raises it, even if you never asked for it by name. See 38 CFR 4.16.
38 CFR 4.16 - Your back pay date is worth checking yourself
Your award usually runs from the date you filed or the date entitlement arose, whichever is later, with special rules for claims filed within a year of leaving service. Knowing your effective date under 38 CFR 3.400 is how you catch retroactive pay that came up short.
38 CFR 3.400 - A clear error in an old decision can be fixed back to day one
A final decision that contained a clear and unmistakable error can be revised at any time, and the correction runs back to the original date, not the date you pointed out the error. The bar is high: the error has to be undebatable. See 38 CFR 3.105(a).
38 CFR 3.105 - Needing help at home can add money on top of your rating
If you need help with everyday activities, or are largely confined to your home because of disability, you may qualify for Aid and Attendance or Housebound payments added to your monthly amount. See 38 CFR 3.350 and 3.352.
38 CFR 3.352 - Surgery can earn a temporary 100 percent rating while you heal
After certain surgeries, or when a service connected joint is immobilized in a cast, VA can grant a temporary 100 percent rating during recovery and then return you to your prior rating. It is easy to miss because you have to flag it. See 38 CFR 4.30.
38 CFR 4.30 - A long hospital stay can pay at 100 percent for that time
If you are hospitalized more than 21 days for a service connected condition, VA can pay you at the 100 percent rate for that period, then drop back to your regular rating afterward. See 38 CFR 4.29.
38 CFR 4.29 - Even a 0 percent rating is worth winning
A 0 percent rating still confirms the condition is service connected. That opens the door to secondary claims, to an increase later if it worsens, and can affect VA health care priority. Do not walk away from a noncompensable grant. See 38 CFR 4.31.
38 CFR 4.31 - A new law can pay you back to its start date
When a new law or presumption adds a condition, your benefits can reach back to the law's effective date, up to one year before you filed. This matters for PACT Act and other presumptive expansions. See 38 CFR 3.114.
38 CFR 3.114 - If VA later finds lost service records, your date can reach back
When VA later locates relevant official service records it did not have the first time, it must reconsider the claim, and the effective date can run back to your original filing, even years later. See 38 CFR 3.156(c).
38 CFR 3.156 - An increase can be backdated up to a year
For a condition that got worse, your higher rating can be paid up to one year before you filed, if the record shows the worsening was clearly there during that window. See 38 CFR 3.400(o)(2).
38 CFR 3.400 - One total rating plus 60 percent more can mean extra money
If you have a single disability rated 100 percent and other service connected disabilities adding to 60 percent or more, you may qualify for housebound special monthly compensation, paid on top of the 100 percent rate. See 38 CFR 3.350(i).
38 CFR 3.350
Find medical studies for Ischemic Heart Disease
These search starters open PubMed and PubMed Central (the National Library of Medicine's free databases) pre-filled for this condition. Strong, peer reviewed studies can help a qualified provider write a more persuasive nexus opinion.
Studies on how this condition develops and what raises the risk.
Research on how this condition is associated with or follows another.
Systematic reviews and meta analyses that summarize many studies.
Read complete studies for free in PubMed Central.
How does VA rate ischemic heart disease?
Mainly by how much activity your heart can handle, measured in METs, along with your ejection fraction and whether you need continuous medication. Lower exercise tolerance and weaker heart function point to higher ratings, up to 100 percent.
Is heart disease connected to Agent Orange?
Ischemic heart disease is on VA's Agent Orange presumptive list. If you had qualifying herbicide exposure, VA presumes the service connection, so you generally do not have to prove the cause, only the diagnosis and the exposure.
What is a MET, and why does VA care about it?
A MET is a simple measure of effort, where everyday activities like walking or climbing stairs cost a set number. VA uses the point where your heart symptoms kick in to set the rating, which is why a workload estimate is part of the heart exam.
You have three review lanes, pick the one that fits the situation.
Under the Appeals Modernization Act, a veteran has one year from a VA decision to file a Higher Level Review, a Supplemental Claim, or a Board Appeal, and filing within that one year window protects the original effective date.
Related conditions
Background reading
Supplemental articles that connect to this condition.
Vietnam era veterans and others exposed to Agent Orange can file claims for conditions VA presumes are linked to the herbicide, from ischemic heart disease and type 2 diabetes to several cancers. Here is the current presumptive list, who qualifies by location and dates of service, how to show exposure, and how the PACT Act widened eligibility.
The PACT Act expanded presumptive conditions for veterans exposed to burn pits and other toxins. Gulf War veterans have separate presumptive rules.
Since Feb 19, 2019, a veteran who disagrees with a VA decision picks from three review lanes: Higher Level Review, Supplemental Claim, or Board Appeal. This is a Walkthrough what each lane is, what it requires, what it costs in time, and how to keep your effective date protected.
Three VA programs cover children of veterans born with certain birth defects: Agent Orange spina bifida (Vietnam, Korea DMZ, Thailand), the Children of Women Vietnam Veterans (CWVV) program for 18 covered birth defects, and the Camp Lejeune Family Member Program (CLFMP) for in utero exposure. Each pays its own benefit, has its own form, and routes through the Denver Regional Office.
When the veteran was rated 100 percent service connected for the 8 continuous years before death AND was married to the surviving spouse during all 8 of those years, the spouse's monthly DIC is boosted by a fixed dollar amount. In 2024 the boost was approximately $351 per month. The boost stacks with the per-child add-on and with the A&A boost. The math, what proves the 8 years, and the catch most survivors do not see.
Rodriguez v. Peake (Fed. Cir. 2008) closed the hypothetical entitlement door on 1318. A survivor can no longer win by arguing the veteran should have been rated 100 percent during the qualifying period. Two narrow openings remain: a CUE motion that moves the effective date backward, and 38 CFR 3.156(c) when service department records are later associated with the file. How to read the record to know which opening, if any, is viable.
VA decision letters use a small vocabulary of words that decide everything for years to come: granted, denied, deferred, evaluation continued, remanded. Here is what each one actually means.
The four pieces that interact when a veteran dies, the surviving spouse's DIC, a child's Chapter 18 spina bifida allowance, the helpless child provision under 38 CFR 3.356, and the now-repealed SBP-DIC offset. How each is paid, by whom, and how they sit alongside each other after January 1, 2023.
A Higher Level Review is filed on VA Form 20-0996 and asks a senior VA adjudicator to look at the file again. No new evidence is allowed. This article walks the form, the informal conference, the duty to assist error path, the one year window, and where HLR is the right fit.
TDIU under 38 CFR 4.16 and a schedular 100 percent rating both pay the same monthly compensation, but they are not the same rating. Five things separate them: reducibility, SMC-S housebound eligibility, CHAMPVA for the family, Dependents Educational Assistance under Chapter 35, and the 8-year DIC additional allowance clock. This article walks through each difference and how to ask VA for a permanence designation when it matters.
Two federal concurrent-receipt programs restore military retired pay that used to be offset by VA disability compensation. CRDP is broader, taxable, and automatic at 50 percent VA. CRSC is narrower to combat related conditions, tax free, and requires an application to the service branch. A retiree eligible for both picks one each year. Math, eligibility, and how the open-season election works.
A nexus opinion is stronger when it cites peer reviewed medical literature. This guide shows you where to search (PubMed, PubMed Central, MedlinePlus, and the VA/DoD Clinical Practice Guidelines), how to search well, how to read a study, and how to hand the findings to a provider who writes your nexus letter.
When VA adds a new herbicide presumptive condition, the Nehmer court orders can reach the effective date back to an earlier claim or the date the condition became presumptive, not the date you file. Here is how 38 CFR 3.816 works, why VA is supposed to find these automatically, and how survivors are included.
38 USC 1311(a)(2) pays an additional monthly amount on top of base DIC if the veteran was rated totally disabling for the 8 years immediately preceding death AND the marriage covered those 8 years. TDIU counts as total. The clock starts on the effective date of the total rating, not the decision date. Retroactive TDIU grants, gap years, temporary total ratings, and late-in-life marriages all change the math. This article walks through worked examples for each.
For Guard and Reserve members, the type of duty you were on controls whether something can be service connected, and even whether you are a veteran for VA purposes. Here is how active duty, active duty for training (ACDUTRA), and inactive duty training (INACDUTRA) differ (38 CFR 3.6), and why a heart attack or stroke during drill counts.
Coronary artery disease is rated under DC 7005 (38 CFR 4.104) on the General Rating Formula for the heart, driven by the METs workload at which heart failure symptoms appear. Here is the full scale, why continuous medication alone reaches 10 percent, the post-event windows, and the Agent Orange route.
The burial allowance is one piece. Free burial in a national cemetery is another. Headstone, burial flag, Presidential Memorial Certificate, military funeral honors, and transportation of remains are each their own piece. For a qualifying non service connected death on or after October 1, 2025, the cash pieces can reach up to $2,004; a service connected death can bring up to $2,000, plus the in-kind value of the cemetery plot, headstone, and perpetual care.
The Blue Water Navy Vietnam Veterans Act of 2019 extended the Agent Orange presumption to veterans who served in the offshore waters of Vietnam, within 12 nautical miles, during the herbicide period (38 CFR 3.307). Here is what the law covers, why it matters, and how earlier effective dates can apply.
Your rating may also qualify you for state-level benefits.
VA compensation is federal, but every state layers its own benefits on top. Many states reduce or waive property tax for disabled veterans, and many offer license, tuition, or vehicle benefits at various rating levels. The thresholds, dollar amounts, and eligibility rules vary widely from state to state, so the reliable answer is always your own state's guide.
Put this rating to work
Free calculators and a guide to turn a rating percentage into real numbers. Nothing is saved to a server; your figures stay on your device.
Add this condition to your other ratings using VA math, not simple addition.
See the 2026 monthly payment for a rating, including dependents.
Estimate retroactive pay from your effective date.
How one service connected condition can support a claim for another.
Most recent human review on this page, August 19, 2026. Below is the review history across this page, its citations, and the supplemental articles it links to.
- August 19, 2026articleVA Burial Benefits Stack, Every Piece That Adds Up
- July 5, 2026articleHow VA Rates Coronary Artery Disease (DC 7005): METs and Agent Orange
- July 5, 2026articleReserve and Guard Service Connection: ACDUTRA, INACDUTRA, and Veteran Status
- July 5, 2026articleBlue Water Navy: Agent Orange Presumption for Offshore Vietnam Service
- July 5, 2026articleNehmer: Retroactive Effective Dates for Agent Orange Presumptive Conditions
- July 5, 2026articleFinding Peer-Reviewed Research to Support a Nexus Letter
