Heart conditions: METs, rhythm and the exam

How VA rates heart conditions

38 CFR 4.104

Heart conditions are rated in 38 CFR 4.104. Most of them share one formula built on METs, a measure of how much work your heart can support. One MET is the energy you use sitting at rest, so a higher number means more activity before symptoms start.

The question is how few METs it takes to bring on heart failure symptoms. The regulation says these include, but are not limited to, breathlessness, fatigue, angina, dizziness, arrhythmia, palpitations or syncope. The fewer it takes, the higher the rating.

The General Rating Formula for heart disease

38 CFR 4.104, General Rating Formula

• 100%: workload of 3.0 METs or less results in heart failure symptoms.
• 60%: more than 3.0 and up to 5.0 METs results in heart failure symptoms.
• 30%: more than 5.0 and up to 7.0 METs results in heart failure symptoms, or evidence of cardiac hypertrophy or dilatation confirmed by echocardiogram or an equivalent test such as a multigated acquisition scan or MRI.
• 10%: more than 7.0 and up to 10.0 METs results in heart failure symptoms, or continuous medication is required.

Cor pulmonale (right heart failure from lung disease) is rated under the lung schedule, not here. See asthma, COPD and lung ratings.

Conditions rated on the formula

38 CFR 4.104, DC 7000 to 7020

The formula is used for, among others:

• Valvular heart disease (7000), once any active infection ends
• Coronary artery disease (7005)
• Heart attack residuals (7006), after the first three months
• Hypertensive heart disease (7007)
• Hyperthyroid heart disease (7008)
• Cardiomyopathy (7020)
• Benign heart block (7015)

Other codes have their own rules, covered below. Heart disease from an overactive thyroid is also discussed on diabetes, thyroid and adrenal ratings.

How METs are measured

38 CFR 4.104, notes to the formula

• METs are normally found by an exercise stress test.
• When a laboratory test cannot be done for medical reasons, the examiner may estimate the METs level from an interview about daily activities, such as climbing stairs or walking.
• The exam form also asks which symptom appears at the lowest activity level, and whether the METs level is due only to the heart condition. If not, the examiner is asked to give the heart-only level and the reasoning.

Heart attack, surgery and transplant

38 CFR 4.104, DC 7006, 7016, 7017, 7019

• Heart attack (7006): 100% during and for three months after the attack, then the formula.
• Bypass surgery (7017): 100% for three months after surgery, then the formula.
• Valve replacement (7016): 100% with no end date, and a VA exam six months after discharge.
• Heart transplant (7019): 100% for a minimum of one year after the transplant, then the formula with a minimum of 30%, and an exam one year after discharge.
• Active valve, heart lining or sac infection (7000 to 7002): 100% during the infection and for three months afterward.

Pacemakers and abnormal heart rhythms

38 CFR 4.104, DC 7009 to 7018

• Sustained ventricular arrhythmia (7011): 100% from admission for treatment, or for an implanted defibrillator (AICD), with a VA exam six months later.
• Supraventricular tachycardia (7010): confirmed by ECG. 30% for five or more treatment interventions a year; 10% for one to four, or for continuous oral medication or vagal maneuvers.
• Slow heartbeat needing a permanent pacemaker (7009): 100% for one month after hospital discharge for implantation or re-implantation, then the General Rating Formula. A slow heartbeat without symptoms is a medical finding only and is not compensable.
• Implanted pacemaker (7018): 100% for one month after discharge for implantation or re-implantation, then rated as 7010, 7011 or 7015, with a minimum of 10%. An implanted defibrillator (AICD) is rated under 7011.
• Heart block (7015): benign cases use the formula; non-benign cases are rated as an implanted pacemaker.

Treatment interventions on the exam form include intravenous medicine adjustments, cardioversion and ablation for symptom relief.

High blood pressure is separate

38 CFR 4.104, DC 7101 and 7007

High blood pressure (hypertension, DC 7101) is rated under the arteries and veins section, and the schedule says to rate it separately from hypertensive heart disease. See hypertension VA ratings.

Peripheral artery disease, Raynaud’s, varicose veins and aneurysm are on arteries and veins VA ratings.

Kidney damage from long-standing high blood pressure is covered on kidney condition ratings.

Presumptive and secondary heart claims

Linked pages

Ischemic heart disease is on the Agent Orange presumptive list (see presumptive conditions by era). A heart disease can also be connected as a secondary condition to another service-connected condition. A rule for veterans with a service-connected amputation of a leg is explained on secondary conditions. Once connected, the condition is rated with the levels on this page. See nexus letters for medical opinions.

What VA’s heart exam form covers

VA Heart Conditions DBQ (updated 2024-07-11)

• Diagnosis checklist: heart attack, coronary artery disease, angina, arrhythmias, valve disease, heart block, endocarditis, pericarditis, heart failure, cardiomyopathy, hypertensive heart disease and others.
• Continuous medication: whether it is required and for which condition.
• Arrhythmia: treatment interventions per year (none, 1 to 4, 5 or more).
• Procedures and hospitalizations: angioplasty, bypass, transplant, pacemaker, AICD, valve replacement, with dates and facilities.
• Physical exam: heart rate, blood pressure, rhythm, heart sounds, neck vein distension, lungs, pulses and leg swelling.
• Testing: evidence of enlargement (hypertrophy or dilatation) and recent test results.
• METs: stress test results or an interview-based level, with symptoms and whether the heart alone explains it.
• Functional impact on work.

See Preparing for Your C&P Exam.

What I could not verify

• The rating levels come from the eCFR text of 38 CFR 4.104 (current as of October 16, 2026). eCFR is unofficial, and the official text wins over me. The METs-based formula replaced older wording in a revision of the heart schedule; I did not verify its effective date.
• I checked the heart exam form through a text reader of VA’s PDF, not line by line. The form itself is the authority.
• I did not restate every note and every diagnostic code in 4.104. Check the regulation for any code not described above.
• Arteries and veins, such as peripheral artery disease, Raynaud’s, varicose veins and aneurysm, are not covered on this page. They have their own page.
• I did not research medical causes of heart disease or which conditions lead to it, beyond what the linked pages say.