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CARDIOVASCULAR SECTION
Current Section: Cardiovascular Conditions
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Cardiovascular Conditions

Cardiovascular Conditions

Overview of VA Cardiovascular Ratings

Cardiovascular conditions affect the heart and blood vessels, impacting your body's ability to circulate blood efficiently. Military service can lead to cardiovascular conditions through physical and psychological stress, environmental exposures, or lifestyle factors. This section explains how the VA rates cardiovascular conditions and provides detailed guidance for the most common conditions.

General Rating Principles for Cardiovascular Conditions

The VA rates most cardiovascular conditions based on several factors:

  • Objective test results: Such as blood pressure readings, EKGs, stress tests, or echocardiograms
  • Functional capacity: Measured in METs (metabolic equivalents), which indicate how much physical activity you can perform
  • Symptoms: Such as chest pain, shortness of breath, fatigue, or dizziness
  • Required treatments: Medications, procedures, or lifestyle modifications needed
  • Impact on daily activities: How the condition affects your ability to work and perform daily tasks
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METs Explained

METs (metabolic equivalents) measure the energy cost of physical activities. One MET is the energy expended while sitting quietly.

  • 1-3 METs: Light activities like walking slowly, washing dishes
  • 3-5 METs: Light to moderate activities like brisk walking, light gardening
  • 5-7 METs: Moderate activities like jogging, mowing lawn
  • 7-10 METs: Vigorous activities like running, heavy manual labor
  • 10+ METs: Very vigorous activities like sprinting, competitive sports

Lower MET levels indicate more severe cardiovascular limitations.

Presumptive Service Connection for Cardiovascular Conditions

Certain cardiovascular conditions may qualify for presumptive service connection based on specific exposures:

Presumptive Conditions by Exposure

Agent Orange Exposure

For veterans who served in Vietnam, certain areas of Thailand, or other specified locations:

  • Ischemic heart disease (including coronary artery disease, atherosclerotic cardiovascular disease, and myocardial infarction)
Radiation Exposure

For veterans exposed to ionizing radiation during service:

  • Certain heart conditions may qualify if they develop as a result of radiation treatment for a service-connected cancer
Camp Lejeune Contaminated Water

For veterans who served at Camp Lejeune for at least 30 days between August 1953 and December 1987:

  • Cardiac birth defects in children of exposed veterans

Hypertension

Hypertension, or high blood pressure, is a common cardiovascular condition characterized by elevated pressure in the arteries. Military service can contribute to hypertension through stress, physical demands, or environmental factors. Hypertension is also a common secondary condition to many service-connected disabilities.

Establishing Service Connection for Hypertension

To establish service connection for hypertension, you need:

  1. Diagnosis of hypertension by a qualified medical professional
  2. Evidence of onset during service or within one year of discharge, or evidence of a service-connected condition that caused or aggravated your hypertension
  3. Medical nexus linking your current hypertension to service or to another service-connected condition
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Secondary Service Connection

Hypertension is often secondary to other service-connected conditions, including:

  • PTSD or other mental health conditions
  • Diabetes
  • Sleep apnea
  • Kidney disease
  • Pain conditions (due to pain medications)

If you have one of these service-connected conditions, you may be able to establish service connection for hypertension as secondary to that condition.

VA Rating Criteria for Hypertension

Hypertension is rated under Diagnostic Code 7101 based on blood pressure readings and required medications:

60%
Diastolic pressure predominantly 130 or more

Evidence for 60% Rating:

  • Multiple blood pressure readings showing diastolic pressure (bottom number) predominantly 130 or more
  • Medical records documenting severe hypertension
  • Documentation of complications from severe hypertension
  • Evidence of impact on daily activities and work
40%
Diastolic pressure predominantly 120 or more

Evidence for 40% Rating:

  • Multiple blood pressure readings showing diastolic pressure predominantly 120 or more
  • Medical records documenting moderately severe hypertension
  • Documentation of symptoms or complications from hypertension
  • Evidence of impact on daily activities and work
20%
Diastolic pressure predominantly 110 or more, or; systolic pressure predominantly 200 or more

Evidence for 20% Rating:

  • Multiple blood pressure readings showing diastolic pressure predominantly 110 or more, or systolic pressure (top number) predominantly 200 or more
  • Medical records documenting moderate hypertension
  • Documentation of symptoms or complications from hypertension
  • Evidence of impact on daily activities
10%
Diastolic pressure predominantly 100 or more, or; systolic pressure predominantly 160 or more, or; minimum evaluation for an individual with a history of diastolic pressure predominantly 100 or more who requires continuous medication for control

Evidence for 10% Rating:

  • Multiple blood pressure readings showing diastolic pressure predominantly 100 or more, or systolic pressure predominantly 160 or more
  • OR medical records showing a history of diastolic pressure predominantly 100 or more that now requires continuous medication for control
  • Prescription records showing continuous use of blood pressure medications
  • Medical records documenting mild to moderate hypertension
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Continuous Medication

If you have a history of diastolic pressure predominantly 100 or more and now require continuous medication to control your blood pressure, you qualify for at least a 10% rating even if your current blood pressure readings are lower due to medication.

Building a Strong Hypertension Claim

Evidence Checklist for Hypertension Claims

Required Medical Evidence
Military Records
Supporting Statements
Additional Evidence (if applicable)
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Hypertension Claim Tip

For secondary service connection claims, obtain medical literature that explains the physiological connection between your primary condition (like PTSD or diabetes) and hypertension. For example, studies show that PTSD can lead to chronic stress and elevated cortisol levels, which can cause or aggravate hypertension. Including this scientific evidence strengthens your claim.

Coronary Artery Disease

Coronary Artery Disease (CAD), also known as ischemic heart disease, is a condition where the coronary arteries that supply blood to the heart muscle become narrowed or blocked due to plaque buildup. This can lead to chest pain (angina), shortness of breath, heart attacks, and other complications.

Establishing Service Connection for Coronary Artery Disease

To establish service connection for coronary artery disease, you need:

  1. Diagnosis of coronary artery disease by a qualified medical professional
  2. Evidence of onset during service or within one year of discharge, or evidence of exposure to Agent Orange, or evidence of a service-connected condition that caused or aggravated your CAD
  3. Medical nexus linking your current CAD to service, to Agent Orange exposure, or to another service-connected condition
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Agent Orange Presumption

Ischemic heart disease (including coronary artery disease) is presumptively service-connected if you were exposed to Agent Orange during service. This includes veterans who:

  • Served in Vietnam between January 9, 1962, and May 7, 1975 (including brief visits ashore and service in inland waterways)
  • Served in or near the Korean DMZ between September 1, 1967, and August 31, 1971
  • Served on certain U.S. Navy or Coast Guard ships that operated in Vietnamese waters
  • Were involved in testing, storing, or transporting Agent Orange

With this presumption, you don't need to prove that your CAD was caused by your service—only that you have a current diagnosis and were exposed to Agent Orange.

VA Rating Criteria for Coronary Artery Disease

Coronary artery disease is rated under Diagnostic Code 7005 based on METs, ejection fraction, and symptoms:

100%
Chronic congestive heart failure, or; workload of 3 METs or less results in dyspnea, fatigue, angina, dizziness, or syncope, or; left ventricular dysfunction with an ejection fraction of less than 30 percent

Evidence for 100% Rating:

  • Medical documentation of chronic congestive heart failure
  • OR stress test showing workload of 3 METs or less causing symptoms
  • OR echocardiogram showing left ventricular ejection fraction less than 30%
  • Medical records documenting severe heart disease
  • Documentation of significant limitations in daily activities
  • Evidence of inability to work due to heart condition
60%
More than one episode of acute congestive heart failure in the past year, or; workload of greater than 3 METs but not greater than 5 METs results in dyspnea, fatigue, angina, dizziness, or syncope, or; left ventricular dysfunction with an ejection fraction of 30 to 50 percent

Evidence for 60% Rating:

  • Medical documentation of more than one episode of acute congestive heart failure in the past year
  • OR stress test showing workload of greater than 3 METs but not greater than 5 METs causing symptoms
  • OR echocardiogram showing left ventricular ejection fraction of 30 to 50%
  • Medical records documenting moderately severe heart disease
  • Documentation of hospitalizations for heart-related issues
  • Evidence of significant limitations in physical activities
30%
Workload of 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 on electrocardiogram, echocardiogram, or X-ray

Evidence for 30% Rating:

  • Stress test showing workload of greater than 5 METs but not greater than 7 METs causing symptoms
  • OR electrocardiogram, echocardiogram, or X-ray showing cardiac hypertrophy or dilatation
  • Medical records documenting moderate heart disease
  • Documentation of symptoms with moderate physical activity
  • Evidence of some limitations in daily activities
10%
Workload of greater than 7 METs but not greater than 10 METs results in dyspnea, fatigue, angina, dizziness, or syncope, or; continuous medication required

Evidence for 10% Rating:

  • Stress test showing workload of greater than 7 METs but not greater than 10 METs causing symptoms
  • OR prescription records showing continuous medication required for heart disease
  • Medical records documenting mild heart disease
  • Documentation of symptoms with vigorous physical activity
  • Evidence of minimal limitations in daily activities
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Key Terms

METs (Metabolic Equivalents): A measure of the energy cost of physical activities.

Ejection Fraction: The percentage of blood that leaves the left ventricle when it contracts. Normal is 55-70%.

Cardiac Hypertrophy: Enlargement of the heart muscle.

Congestive Heart Failure: A condition where the heart can't pump blood effectively, causing fluid buildup in the lungs and other body tissues.

Building a Strong Coronary Artery Disease Claim

Evidence Checklist for Coronary Artery Disease Claims

Required Medical Evidence
Military Records
Supporting Statements
Additional Evidence (if applicable)
💡

CAD Claim Tip

If you're a Vietnam-era veteran with coronary artery disease, focus on proving your exposure to Agent Orange rather than trying to establish a direct medical nexus. The presumptive service connection for ischemic heart disease is much easier to establish than direct service connection. Provide detailed information about your Vietnam service, including dates, locations, and units.

Case Study: Successful Coronary Artery Disease Claim

Veteran Profile

Navy veteran who served aboard a ship in the coastal waters of Vietnam from 1968-1969.

Condition

Coronary artery disease diagnosed in 2010, requiring stent placement and continuous medication.

Symptoms & Presentation
  • Chest pain with moderate physical activity
  • Shortness of breath when climbing stairs
  • Fatigue with exertion
  • Stress test showing symptoms at 6 METs
  • Echocardiogram showing ejection fraction of 45%
  • Required daily medications including statins, beta-blockers, and aspirin
  • History of stent placement in two coronary arteries
Evidence Submitted
  • Medical records confirming diagnosis of coronary artery disease
  • Cardiac catheterization report showing coronary artery blockages
  • Stress test results documenting symptoms at 6 METs
  • Echocardiogram showing ejection fraction of 45%
  • Military records confirming service aboard USS Newport News in Vietnamese waters
  • Ship's deck logs showing the vessel operated in inland waterways of Vietnam
  • Statement from cardiologist about severity and treatment of CAD
  • Personal statement describing impact on daily activities
Outcome

The veteran was awarded service connection for coronary artery disease based on presumptive exposure to Agent Orange. The VA assigned a 60% rating based on the ejection fraction of 45%, which falls within the 30-50% range specified for a 60% rating. The veteran was also awarded retroactive benefits dating back to when ischemic heart disease was added to the list of presumptive conditions in 2010.

Key Takeaways
  1. Establishing service in Vietnamese waters and inland waterways was crucial for the Agent Orange presumption
  2. Objective medical evidence (ejection fraction, METs) was essential for determining the appropriate rating
  3. The VA used the most favorable criteria (ejection fraction vs. METs) to assign the rating
  4. The veteran benefited from the retroactive application of the presumptive service connection
  5. No medical nexus opinion was required due to the presumptive service connection

See Also

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