Cardiovascular · 38 CFR 4.104 · Diagnostic Code 7005
Ischemic Heart Disease VA Disability Rating
TL;DR. Ischemic heart disease (coronary artery disease, post-MI, angina, atherosclerotic heart disease) rates under DC 7005 at 10 / 30 / 60 / 100% based on three alternative inputs: METs threshold (exercise capacity), ejection fraction, or evidence of cardiac hypertrophy/dilatation. The rater applies the worst of the three. IHD is Agent Orange presumptive since 2010 for Vietnam-era, Korean DMZ 1968-1971, Thailand-base, Blue Water Navy, and C-123 aircrew veterans. The rating frequently combines with hypertension (DC 7101) and post-MI conditions. Active myocardial infarction rates 100% for 3 months under DC 7006 before dropping to residuals.
What ischemic heart disease covers
IHD is an umbrella term for cardiac conditions caused by reduced blood supply to the heart muscle. The VA's rating umbrella under DC 7005 includes:
- Coronary artery disease (CAD).
- Atherosclerotic heart disease.
- Old healed myocardial infarction (after the 3-month acute period).
- Stable angina pectoris.
- Coronary artery bypass graft (CABG) residuals after 3 months.
- Coronary stent placement residuals.
Not included under DC 7005: hypertensive heart disease (DC 7007), valvular disease (DC 7000-7001), cardiomyopathy (DC 7020), arrhythmias (DC 7010-7011). These each have their own codes.
Full DC 7005 criteria
| Rating | Criteria (any one met) |
|---|---|
| 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. |
| 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 EKG, echocardiogram, or X-ray. |
| 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 ejection fraction of 30% to 50%. |
| 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 ejection fraction of less than 30%. |
How METs are measured
METs (metabolic equivalents of task) are a standardized measure of energy expenditure. 1 MET is the resting metabolic rate (sitting quietly). Higher METs values correspond to more strenuous activity. Common reference points:
- 1-2 METs: sitting, light desk work.
- 3-4 METs: walking 2-3 mph, light housework.
- 5-7 METs: walking briskly 4 mph, slow cycling, ballroom dancing.
- 7-10 METs: jogging, fast cycling, manual labor.
- >10 METs: running, competitive sports.
Measurement methods:
- Exercise stress test (Bruce protocol). The gold standard. The veteran exercises on a treadmill with stepped intensity until symptoms develop or target heart rate is reached. The METs level at symptom onset drives the rating.
- Pharmacologic stress test. When physical exercise is contraindicated, dobutamine or adenosine is used. Symptom-based METs estimate is recorded.
- Interview-based METs estimate. When any stress testing is medically contraindicated (severe arrhythmia, recent infarction, etc.), the examiner estimates the METs level at which symptoms would develop based on the medical history and ADL function. This estimate is acceptable evidence under the regulation.
The disjunctive criteria (this matters)
Each bracket lists multiple criteria connected by "OR." The rater applies the bracket if ANY one criterion is met. Practical effect: a veteran whose METs is borderline 30% may still rate 60% if ejection fraction is 35% or congestive heart failure occurred. Always document all three inputs.
Service-connection paths
Agent Orange presumption
IHD was added to 38 CFR 3.309(e) in 2010. Same qualifying service categories as diabetes: in-country Vietnam, Korean DMZ 1968-1971, Thailand base perimeter, Blue Water Navy (2019 BWNVAA, retroactive), C-123 aircrew. No nexus opinion needed; just qualifying service + current diagnosis. The vast majority of rated IHD cases come through this pathway.
Check Agent Orange / PACT Act eligibility →Direct service connection
For non-Vietnam veterans, direct service connection requires in-service onset (chest pain, EKG changes, infarction documented in STRs) or onset within one year of separation under the chronic-disease presumption for cardiovascular-renal disease (38 CFR 3.309(a)).
Secondary service connection
IHD frequently arises secondary to service-connected conditions:
- IHD secondary to hypertension (DC 7101). Chronic HTN drives coronary artery damage.
- IHD secondary to diabetes (DC 7913). Diabetes accelerates atherosclerosis.
- IHD secondary to PTSD (DC 9411). Sustained sympathetic activation contributes to cardiac stress; supported by multiple studies and VA M21-1 guidance.
- IHD secondary to sleep apnea (DC 6847). Untreated OSA is a major cardiac risk factor.
Evidence the VA looks for
- For Agent Orange presumption: DD-214 with qualifying service. For Blue Water Navy, ship deck logs in qualifying offshore waters.
- Current diagnosis. Coronary angiogram, CT angio, cardiac MRI, stress test with imaging, or echocardiogram showing wall-motion abnormalities.
- Stress test report. METs at symptom onset, target HR achieved, EKG changes.
- Echocardiogram. Ejection fraction, wall thickness (LV hypertrophy), chamber dimensions (dilatation).
- Hospitalization records. For 60% / 100% brackets — document CHF admissions.
- Medication list. Continuous medication (beta blocker, statin, antiplatelet, ACE inhibitor) supports the 10% bracket alternative.
- Cardiology notes. Specialist diagnostic and treatment notes carry substantial weight.
Common rating pitfalls
- Missing the Agent Orange presumption. Filed before 2010 and denied for nexus? File Supplemental Claim.
- Underutilizing ejection fraction. A 35% EF puts you at 60% even if METs is 6. Make sure the echo is in the record.
- Stale METs data. Stress tests from years ago may not reflect current capacity. Request an updated stress test if symptoms have progressed.
- Filing IHD without claiming hypertension. Most IHD veterans also have HTN. File together; rate separately.
- Underclaiming MI residuals. Old MI is service-connectable under DC 7005 (with residuals). The 3-month 100% under DC 7006 ends, but the residual MI rating continues.
Worked example
Veteran: Vietnam-era, in-country service 1968-1969. Diagnosed with CAD 2008 after MI; CABG x3 in 2012. 2024 echo shows EF 40%, mild LV hypertrophy. Stress test: symptom onset at 5 METs. Continuous beta blocker, statin, aspirin. Service-connected HTN 10%. Spouse.
- IHD DC 7005: 60% (any of: METs 5 = 30% bracket, EF 40% = 60% bracket, LV hypertrophy = 30% bracket. Worst applies = 60%).
- HTN DC 7101: 10%.
- Combine: 60 + 10 → 1 − 0.4 × 0.9 = 0.64 → 64% → rounded 60%.
- 2026 monthly compensation (veteran + spouse, 60%): $1,566.02/mo.
Annual award: $18,792. Ejection fraction was the dispositive criterion — not METs. Always document all three inputs.
Common secondary conditions
- Heart failure (DC 7020). Cardiomyopathy and CHF rate separately when not part of the IHD bracket basis.
- Hypertension (DC 7101). Rate separately.
- Arrhythmias (DC 7010-7011). Atrial fibrillation, supraventricular tachycardia.
- Depression secondary to cardiac disease. Recognized mental-health secondary pathway.
- Scars from CABG / stent placement (DC 7800-7806). Painful or unstable scars rate separately.
Sources cited in this article
- 38 CFR 4.104 — The Cardiovascular System (DC 7005, 7006)
- 38 CFR 3.309(e) — Agent Orange presumptive list
- VA.gov — Agent Orange exposure
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