Rating Criteria by Level
Under 38 CFR 4.104, DC 7005, the VA evaluates arteriosclerotic heart disease on a four-level scale. Each level has multiple qualifying prongs, and meeting any single prong is enough. The VA must assign the higher evaluation whenever one prong is satisfied, even if the others are not.
Criteria: A workload greater than 7 METs but not greater than 10 METs produces dyspnea, fatigue, angina, dizziness, or syncope, or continuous medication is required to control the condition.
The continuous medication prong is the easier path at this level. If a cardiologist has you on nitrates, beta blockers, or antiplatelet therapy specifically for coronary artery disease, you meet the 10% standard regardless of how you perform on a stress test. Make sure the C&P examiner records the medication list and the condition it treats.
Criteria: A workload greater than 5 METs but not greater than 7 METs produces dyspnea, fatigue, angina, dizziness, or syncope, or there is evidence of cardiac hypertrophy or dilatation on electrocardiogram, echocardiogram, or X-ray.
Imaging findings are an independent route to 30%. If your echocardiogram shows left ventricular hypertrophy or chamber dilatation, you qualify at this level even when your METs test lands in the 10% range. Request that the examiner review your most recent echo report and cite the finding in the exam worksheet.
Criteria: A workload greater than 3 METs but not greater than 5 METs produces dyspnea, fatigue, angina, dizziness, or syncope, or left ventricular ejection fraction is 30 to 50 percent, or there has been more than one episode of acute congestive heart failure in the past year.
This is the most consequential level in the heart schedule. A 60% rating on its own meets the schedular threshold for TDIU, so a veteran who cannot work because of cardiac limitations can be paid at the 100% rate without a 100% schedular evaluation. Ejection fraction is measured on echocardiogram and is often the deciding number.
Key threshold: 60% alone qualifies you to apply for TDIU
Criteria: Chronic congestive heart failure, or a workload of 3 METs or less produces dyspnea, fatigue, angina, dizziness, or syncope, or left ventricular ejection fraction is less than 30 percent.
Any one of the three prongs is sufficient. Chronic congestive heart failure means an ongoing, documented condition rather than a single resolved episode. A separate 100% rating runs for three months after a documented myocardial infarction (DC 7006) and for three months after coronary bypass surgery (DC 7017), after which the VA re-examines and assigns a schedular level.
How to Service-Connect Ischemic Heart Disease
Ischemic heart disease is one of the few conditions where many veterans skip the nexus requirement entirely because of a presumption. There are three common routes:
Agent Orange Presumptive
Ischemic heart disease is a listed Agent Orange presumptive condition. If your service establishes herbicide exposure, a current diagnosis plus qualifying service is sufficient. No nexus letter and no in-service cardiac event is required.
Direct Service Connection
Chest pain complaints, an abnormal EKG, elevated cholesterol under treatment, or a cardiac event documented in your service treatment records supports direct connection. Coronary artery disease diagnosed within one year of separation may also qualify as a chronic disease presumptive.
Secondary to Another Rated Condition
Service-connected hypertension, sleep apnea, diabetes, or PTSD are all recognized contributors to coronary artery disease. A physician nexus opinion linking the rated condition to your heart disease establishes secondary service connection.
Burn pit and other toxic exposure claims are handled under the PACT Act, which expanded presumptive locations and conditions. Cardiovascular disease is not itself a PACT Act presumptive, but PACT Act service can support a direct exposure theory.
What Happens at Your C&P Exam
The examiner completes the Heart Conditions Disability Benefits Questionnaire. For ischemic heart disease, expect the examiner to:
- Confirm the diagnosis and the date it was established (catheterization, stress test, imaging)
- Order or review an exercise stress test and record the METs level at which symptoms appear
- Substitute an interview based METs estimate if a stress test is medically contraindicated
- Review your most recent echocardiogram for ejection fraction, hypertrophy, and dilatation
- Document every episode of congestive heart failure in the past twelve months
- List continuous cardiac medications and the condition each one treats
- Note any myocardial infarction, stent placement, or bypass surgery with dates
Bring your cardiology records, the full echocardiogram report showing ejection fraction, your stress test results, and a current medication list. If you cannot complete a stress test, describe the exact activity that stops you, such as one flight of stairs or a level city block, so the examiner can estimate METs accurately.
Secondary Conditions to Ischemic Heart Disease
Once ischemic heart disease is service-connected, related conditions can be claimed as secondary. Each carries its own rating and raises your combined percentage.
Congestive Heart FailureChronic CHF is a prong of the 100% criteria under DC 7005 rather than a separate rating, so it raises the heart evaluation itself.
ArrhythmiasAtrial fibrillation and other supraventricular arrhythmias are rated separately under DC 7010 and 7011. Rated 10 to 100%.
DepressionCardiac disease and activity limitation frequently trigger a depressive disorder. Rated 0 to 100% on the general mental disorders formula. See our depression page.
Erectile DysfunctionA recognized side effect of beta blockers and other cardiac medications. Typically 0% schedular with special monthly compensation (SMC-K) added.
Chronic Kidney DiseaseReduced cardiac output and long term cardiac medication use can impair renal function. Rated 0 to 100% depending on function studies.
Peripheral Artery DiseaseAtherosclerosis is systemic, so coronary disease often coexists with arterial insufficiency in the legs. Rated per extremity under DC 7114.
Diabetic veterans should also review peripheral neuropathy and depression, both of which commonly appear alongside cardiovascular claims.
SourcesLast reviewed: July 2026
Ischemic Heart Disease VA Rating FAQ
What is the VA rating for ischemic heart disease?
The VA rates ischemic heart disease under diagnostic code 7005 at 10%, 30%, 60%, or 100%. The level is set by a METs workload test, left ventricular ejection fraction, and whether congestive heart failure is present. A 60% rating pays $1,435.02/month and 100% pays $3,938.58/month at 2026 rates (veteran alone).
Is ischemic heart disease presumptive for Agent Orange?
Yes. Ischemic heart disease is on the VA list of Agent Orange presumptive conditions. If your service establishes herbicide exposure (Vietnam, the Korean DMZ, Thailand base perimeters, and other qualifying locations and dates), you do not need to prove a nexus. A current diagnosis plus qualifying service is enough.
What are METs and how do they set my heart rating?
METs measure oxygen use at a given activity level, with one MET being resting metabolism. The VA records the METs level at which you first get dyspnea, fatigue, angina, dizziness, or syncope. Over 7 and up to 10 METs is 10%, over 5 and up to 7 METs is 30%, over 3 and up to 5 METs is 60%, and 3 METs or less is 100%.
Does a heart attack get a 100% VA rating?
A documented myocardial infarction is rated 100% under DC 7006 for three months following the event. The VA then re-examines and assigns a rating on your METs level, ejection fraction, and congestive heart failure history. The same three month window applies after coronary bypass surgery under DC 7017.
Can ischemic heart disease alone qualify for TDIU?
Yes. A single 60% rating meets the schedular TDIU threshold by itself. If cardiac limitations prevent substantially gainful employment, you can be paid at the 100% rate through individual unemployability without reaching a 100% schedular evaluation.
Does continuous heart medication qualify for a VA rating?
Yes. Continuous medication required to control ischemic heart disease satisfies the 10% criteria on its own, even with a normal METs result. Nitrates, beta blockers, statins prescribed for coronary artery disease, and antiplatelet therapy all count when documented as treatment for the heart condition.
What if I cannot complete an exercise stress test?
If a stress test is medically contraindicated (unstable angina, recent infarction, severe deconditioning), the examiner provides an interview based METs estimate instead. That estimate carries the same weight in the rating decision. Describe the specific activities that trigger your symptoms, such as climbing one flight of stairs or walking a level block.
Can I get separate ratings for heart disease and hypertension?
Yes, in most cases. Hypertension is rated separately under DC 7101 and is not part of the DC 7005 criteria, so a separate evaluation is generally not pyramiding. The VA will not, however, assign two ratings for the same cardiac impairment under different heart diagnostic codes.