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Ischemic Heart Disease (Coronary Artery Disease) VA Disability Rating
DC 7005 | 38 C.F.R. § 4.104 | M21-1, Part IV.ii.2.D
OVERVIEW
Ischemic Heart Disease (IHD), also called Coronary Artery Disease (CAD), is rated under DC 7005 using the General Rating Formula for Diseases of the Heart at 38 C.F.R. § 4.104. IHD is a presumptive condition for veterans with Agent Orange exposure under 38 C.F.R. § 3.309(e). Rating is based on METs (metabolic equivalents) — the workload at which heart failure symptoms (breathlessness, fatigue, angina, dizziness, syncope) develop.
RATING CRITERIA (4 LEVELS)
100% — Symptoms at ≤3.0 METs
Heart failure symptoms at workload of 3.0 METs or less. Equivalent to symptoms with slow walking or minimal exertion.
60% — Symptoms at 3.1-5.0 METs
Symptoms at 3.1-5.0 METs. Equivalent to level walking at 2-3 mph, light housework.
30% — Symptoms at 5.1-7.0 METs or cardiac hypertrophy/dilatation
Symptoms at 5.1-7.0 METs; OR evidence of cardiac hypertrophy or dilatation confirmed by echocardiogram, MUGA, or MRI.
10% — Symptoms at 7.1-10.0 METs or continuous medication
Symptoms at 7.1-10.0 METs; OR continuous medication required for control.
KEY EVIDENCE TO GATHER
-Cardiology records documenting CAD (catheterization, nuclear stress test, CT angiography)
-Exercise stress test with METs level documented
-Echocardiogram documenting ejection fraction, hypertrophy, or dilatation
-Agent Orange exposure records (for AO presumptive service connection)
-Records of cardiac events: MI, angina, revascularization
-Medication list (beta-blockers, statins, nitrates, aspirin)
SECONDARY CONDITIONS (4 MAPPED)
DC 7007
IHD is a primary cause of heart failure — rate separately under DC 7007.
DC 7010/7011
IHD causes atrial and ventricular arrhythmias — file separately.
DC 9434
Cardiac disease causes significant depression — independently ratable.
DC 7522
Cardiovascular disease and its medications cause erectile dysfunction.
C&P EXAM TIPS (5)
1.IHD is an Agent Orange presumptive — no nexus letter needed with AO exposure.
2.Demand an exercise stress test with METs documented. Without METs, you fall back on 10-30% criteria only.
3.If exercise testing is medically contraindicated, examiner must estimate METs based on specific activities.
4.Cardiac hypertrophy or dilatation on echo alone supports 30%.
5.Continuous medication (aspirin, statin, beta-blocker) supports 10% minimum.
RELEVANT CASE LAW
38 C.F.R. § 3.309(e) — Agent Orange Presumptives
Ischemic heart disease is presumptive for veterans with qualifying herbicide exposure, including coronary artery disease and angina pectoris.
38 C.F.R. § 4.104 General Rating Formula
One MET equals the energy cost of standing quietly at rest. When laboratory METs cannot be determined, examiner may estimate based on specific activity examples.
DOLLAR IMPACT
IHD at 10% (medication only): $175.03/mo. 30% (echo changes): $524.31/mo. 60%: $1,131.68/mo. Agent Orange presumptive IHD is one of the largest categories in the VA system — millions of Vietnam-era veterans have potential claims.
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NOT AFFILIATED WITH THE U.S. DEPARTMENT OF VETERANS AFFAIRS.
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