VA has presumed ischemic heart disease is linked to herbicide exposure since its final rule took effect on October 30, 2010, yet thousands of Vietnam-era and Thailand-era veterans still carry a 10% rating for a heart that struggles on a flight of stairs. The diagnosis is approved, the service connection is granted, and the percentage still feels wrong. Under 38 CFR 4.104, the difference between 10% and 30% is a single number — a metabolic equivalent, or MET, score of 7.0. Between 30% and 60% it is 5.0. This guide explains how that number is produced, what evidence controls it, and the 2026 rules that decide what an ischemic heart disease claim is actually worth.
Key Takeaways
- Understand that ischemic heart disease is rated under the General Rating Formula for Diseases of the Heart.
- Target the METs bands: 7.1 to 10.0 supports 10%, 5.1 to 7.0 supports 30%, 3.1 to 5.0 supports 60%, 3.0 or less supports 100%.
- Confirm presumptive exposure through a recognized location and date range, including five added by the PACT Act.
- Separate hypertension from heart disease, because 38 CFR 4.104 evaluates the two apart.
- Document cardiac hypertrophy or dilatation on echocardiogram, which supports 30% without any METs finding.
- Claim the temporary 100% windows tied to infarction, bypass surgery, and other cardiac procedures.
Table of Contents
- Who Qualifies and the Agent Orange Presumption
- The Evidence That Sets the Percentage
- How VA Assigns 10%, 30%, 60%, and 100%
- Filing or Increasing the Claim in Five Steps
- After Filing: Exam, Decision, and Appeal Lanes
- Frequently Asked Questions
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Who Qualifies: Ischemic Heart Disease and the Agent Orange Presumption
The pain point is familiar: a veteran has a cardiologist's diagnosis and a Vietnam tour on the DD214, and still gets a letter asking for proof the two are connected. For ischemic heart disease, that proof is often unnecessary. VA lists the condition among the illnesses it presumes are caused by herbicide exposure, so a veteran with qualifying service does not have to show the disease began in service.
Presumptive exposure attaches to specific places and dates. Service in the Republic of Vietnam, in its inland waterways, or on a vessel not more than 12 nautical miles seaward from the Vietnam and Cambodia demarcation line between January 9, 1962, and May 7, 1975, qualifies, as does service in or near the Korean DMZ between September 1, 1967, and August 31, 1971. The PACT Act added five more: any U.S. or Royal Thai base in Thailand (January 9, 1962 to June 30, 1976); Laos (December 1, 1965 to September 30, 1969); Mimot or Krek in Kampong Cham Province, Cambodia (April 16 to 30, 1969); Guam, American Samoa, or their territorial waters (January 9, 1962 to July 31, 1980); and Johnston Atoll, or a ship that called there (January 1, 1972 to September 30, 1977).
Veterans who transported, tested, stored, or otherwise used herbicides, and Air Force personnel with repeated contact with C-123 aircraft carrying traces of Agent Orange, also fall inside the presumption. Anyone outside these categories can still pursue direct service connection with evidence the condition started in service or scientific evidence linking it to herbicides.
What Counts as Ischemic Heart Disease, and What Does Not
VA's presumptive regulation draws a hard boundary. Ischemic heart disease does not include hypertension, and it does not include peripheral manifestations of arteriosclerosis such as peripheral vascular disease or stroke. Coronary artery disease, atherosclerotic heart disease producing clinically significant ischemia, and disease requiring coronary revascularization fall inside the definition. High blood pressure and prior stroke sit outside it, which matters, because the PACT Act separately added hypertension and monoclonal gammopathy of undetermined significance as presumptive conditions in their own right.
The Evidence That Sets the Percentage
Most underrated heart claims are not denied on service connection. They are underrated because the file holds a diagnosis and a medication list and nothing that measures function. VA does not rate the blockage; it rates what the heart can do under load. The regulation is explicit that one MET equals the energy cost of standing quietly at rest, an oxygen uptake of 3.5 milliliters per kilogram of body weight per minute. Every percentage in the heart schedule is anchored to that unit.
Medical Records and the METs Determination
The strongest file contains an exercise stress test with a recorded METs level at which symptoms appear. Where a laboratory determination of METs cannot be done for medical reasons, the regulation allows a medical examiner to estimate the level of activity in METs, supported by specific examples such as slow stair climbing or shoveling snow. That estimate carries weight, so the examples a veteran gives should be concrete and drawn from ordinary days, not best days.
Echocardiogram findings matter independently. Cardiac hypertrophy or dilatation confirmed by echocardiogram or an equivalent study, such as a multigated acquisition scan or cardiac MRI, supports a 30% evaluation on its own, with no METs finding required. Ejection fraction results, catheterization reports, cardiology notes, and a medication list documenting continuous therapy all belong in the record.
Service Records, Presumptive Locations, and Lay Statements
Exposure evidence is separate from severity evidence and is usually simpler. A DD214 showing dates and locations of service is the core document. Thailand base assignments, Korean DMZ units, and Johnston Atoll ship visits may require unit records, orders, or deck logs to place a veteran inside a covered window. Lay statements from spouses, adult children, and former unit members describe what the veteran can no longer do: the walk to the mailbox, the stop halfway up the driveway. Symptoms recognized by the regulation include breathlessness, fatigue, angina, dizziness, arrhythmia, palpitations, and syncope.
How VA Assigns 10%, 30%, 60%, and 100%
Ischemic heart disease is evaluated under diagnostic code 7005, arteriosclerotic heart disease (coronary artery disease), using the General Rating Formula for Diseases of the Heart in 38 CFR 4.104. The formula has four steps, and the bands do not overlap.
- 100% — a workload of 3.0 METs or less results in heart failure symptoms.
- 60% — a workload of 3.1 to 5.0 METs results in heart failure symptoms.
- 30% — a workload of 5.1 to 7.0 METs results in heart failure symptoms; or there is evidence of cardiac hypertrophy or dilatation confirmed by echocardiogram or equivalent imaging.
- 10% — a workload of 7.1 to 10.0 METs results in heart failure symptoms; or continuous medication is required for control.
Under the 2026 rate table effective December 1, 2025, a veteran with no dependents receives $180.42 monthly at 10%, $552.47 at 30%, $1,435.02 at 60%, and $3,938.58 at 100%. The gap between a 10% file and a 30% file is about $372 a month for a single veteran, decided entirely by where a stress test lands relative to 7.0 METs.
One more provision protects veterans with mixed cardiac histories. A note under diagnostic code 7005 directs that when non-service-connected arteriosclerotic heart disease is superimposed on service-connected valvular or other non-arteriosclerotic heart disease, VA is to request a medical opinion as to which condition is causing the current signs and symptoms.
The Temporary 100% Windows Many Veterans Never Claim
Several cardiac events carry their own total evaluations. A myocardial infarction confirmed by laboratory tests is rated 100% during the event and for three months afterward. Coronary bypass surgery is rated 100% for three months following hospital admission for the surgery. Cardiac transplantation carries 100% for a minimum of one year from admission, with a 30% minimum after. An automatic implantable cardioverter-defibrillator in place is rated 100%. After each window closes, the General Rating Formula resumes.
Filing or Increasing the Claim in Five Steps
Veterans frequently lose months of retroactive pay by gathering records first and filing later. The sequence below protects the effective date while the evidence is assembled.
- Submit an intent to file. VA Form 21-0966 sets a placeholder date. If the claim is completed within one year, the effective date generally reaches back to the intent to file date rather than the submission date.
- Confirm the exposure pathway. Match service dates and locations against VA's presumptive list, or identify the direct service connection evidence needed if the service falls outside it.
- Build the severity file. Request cardiology records, the most recent echocardiogram, any stress test with a METs value, and a current medication list showing continuous therapy.
- File the application. VA Form 21-526EZ is used for an original claim, a claim for increase, and a secondary claim. Increases and new conditions can travel on the same form.
- Track and respond. Monitor the claim on VA.gov and answer any development letter inside the stated window, because unanswered requests are decided on the record as it stands.
Original Claim, Increase, or Supplemental Claim
The lane depends on history. A veteran never rated for heart disease files an original claim. A veteran already service connected whose condition worsened files for increase on the same 21-526EZ. A veteran denied before the condition or location became presumptive files a Supplemental Claim on VA Form 20-0995, the route VA identifies for claims it now considers presumptive.
Claiming Related Conditions at the Same Time
Hypertension is evaluated separately from hypertensive heart disease and other types of heart disease under 38 CFR 4.104, and hypertension is now its own Agent Orange presumptive condition. Diabetes mellitus type 2, early-onset peripheral neuropathy, and other listed presumptives may also apply. Listing each condition by name prevents a single-issue decision from closing the door on the rest.
After Filing: Exam, Decision, and Appeal Lanes
The waiting stage is where most control is lost. VA will usually schedule a compensation and pension examination, and that examiner's METs finding frequently becomes the number in the decision. Preparation is not coaching. It is accuracy. A veteran who describes a good day at the exam and a bad day at home has given VA only the good day to rate.
The Cardiac C&P Exam
The examiner will ask what activity brings on breathlessness, fatigue, angina, dizziness, or syncope. Answers should describe a typical day, not the best day, and should use the concrete activity examples the regulation itself contemplates, such as slow stair climbing, shoveling snow, carrying groceries, or walking a level block. If a laboratory stress test was not performed, the examiner's estimate becomes the evidence, so vague answers produce vague estimates. Veterans may bring a written symptom log and private cardiology records to the appointment. Missing the exam without rescheduling can result in a decision made on the record as it stands, which for many veterans means the lowest supportable percentage.
Reading the Decision and Choosing a Lane
The rating decision states the percentage, the diagnostic code, the effective date, and the evidence considered. If the METs band in the decision does not match the medical evidence, three review lanes exist. A Higher-Level Review on VA Form 20-0996 asks a senior reviewer to find an error in the existing record, with no new evidence allowed. A Supplemental Claim on VA Form 20-0995 adds new and relevant evidence, such as a stress test performed after the decision. A Board appeal on VA Form 10182 sends the case to the Board of Veterans' Appeals. Each generally carries a one-year window from the decision date, and filing inside that year is what protects the original effective date.
Know Where the Claim Stands Before Filing
An ischemic heart disease claim rises or falls on two things: a documented exposure pathway and a functional measurement of the heart under load. Most veterans have one and are missing the other. The free VA Claim Readiness Test at avoyvet.com walks through the evidence a heart claim needs, flags the gaps before VA finds them, and points toward the right filing lane for the situation. AVOY Veteran Navigator AI™ is available at the same address for educational guidance on ratings, presumptive conditions, appeals, and survivor benefits.
Frequently Asked Questions
Does a stent or bypass automatically mean a higher VA rating?
Not permanently. Coronary bypass surgery carries a 100% evaluation for three months following hospital admission for the surgery, and a myocardial infarction confirmed by laboratory tests carries 100% during the event and for three months afterward. When those windows close, VA returns to the General Rating Formula and rates on current function: the METs level at which heart failure symptoms appear, or echocardiogram evidence of hypertrophy or dilatation. A veteran who has had revascularization but whose symptoms now appear above 7.0 METs may hold a 10% evaluation. The procedure shows the seriousness of the disease; the measurement afterward sets the percentage.
Why was a claim denied when high blood pressure and heart disease are both present?
VA's presumptive rule states that ischemic heart disease does not include hypertension. The two are separate conditions with separate diagnostic codes, and 38 CFR 4.104 directs that hypertension be evaluated separately from hypertensive heart disease and other types of heart disease. A claim filed only for ischemic heart disease will not produce a hypertension rating, and the reverse is equally true. The PACT Act added hypertension to the Agent Orange presumptive list in its own right, so a veteran with qualifying service and both diagnoses generally needs both claimed by name.
What if a stress test cannot be performed for medical reasons?
The regulation anticipates this. When the METs level at which breathlessness, fatigue, angina, dizziness, or syncope develops is required for evaluation and a laboratory determination by exercise testing cannot be done for medical reasons, a medical examiner may estimate the level of activity in METs, supported by specific examples such as slow stair climbing or shoveling snow. That estimate is valid evidence. Because it rests on described activity rather than measured output, the description matters: reporting an ordinary day with concrete examples produces a more accurate estimate than general statements about feeling tired.
Does an echocardiogram alone support a 30% rating?
It can. The 30% criterion has two independent paths. One is a workload of 5.1 to 7.0 METs producing heart failure symptoms. The other is evidence of cardiac hypertrophy or dilatation confirmed by echocardiogram or an equivalent study such as a multigated acquisition scan or magnetic resonance imaging. A veteran whose symptoms appear above 7.0 METs but whose echocardiogram documents hypertrophy or dilatation meets the second path. This is one of the most commonly missed findings in heart claims, because the imaging report often sits in a private cardiology file that VA never requested. Ordering a copy of every echocardiogram and submitting it with the claim costs nothing and can move a file an entire rating step.
Which service locations create presumptive Agent Orange exposure?
Seven pathways cover most veterans. Vietnam, its inland waterways, and vessels within 12 nautical miles of the Vietnam and Cambodia demarcation line (January 9, 1962 to May 7, 1975). In or near the Korean DMZ (September 1, 1967 to August 31, 1971). U.S. or Royal Thai bases in Thailand (January 9, 1962 to June 30, 1976). Laos (December 1, 1965 to September 30, 1969). Mimot or Krek in Kampong Cham Province, Cambodia (April 16 to 30, 1969). Guam, American Samoa, or their territorial waters (January 9, 1962 to July 31, 1980). Johnston Atoll (January 1, 1972 to September 30, 1977). Herbicide handling duties and C-123 aircraft contact also qualify.
A claim was denied years ago. Is it worth filing again?
VA directs veterans whose claims were denied before a condition or location became presumptive to file a Supplemental Claim on VA Form 20-0995, and it will review the case again. This applies to veterans denied before ischemic heart disease became presumptive in 2010, Blue Water Navy veterans denied before the 2019 law, and veterans denied before the PACT Act added Thailand, Laos, Cambodia, Guam, American Samoa, and Johnston Atoll. A Supplemental Claim requires new and relevant evidence, and a change in law affecting the case is the basis VA identifies for these filings. Retroactive payment is possible in certain cases.
How much is an ischemic heart disease rating worth in 2026?
Under the rate table effective December 1, 2025, a veteran with no dependents receives $180.42 monthly at 10%, $552.47 at 30%, $1,435.02 at 60%, and $3,938.58 at 100%. Rates increase with a dependent spouse, children, or dependent parents. Ischemic heart disease is rarely the only rated condition, and a single percentage does not equal a combined rating, because VA combines multiple disabilities under its own table rather than adding them. Payments are tax free and are not counted as taxable income. Current figures should always be confirmed on VA.gov, since rates change annually with the cost-of-living adjustment.
Educational information only — not legal, medical, or claim representation, and not affiliated with the U.S. Department of Veterans Affairs. For help filing or appealing, contact a VA-accredited VSO (often free), claims agent, or attorney. For current rates, forms, and deadlines, see VA.gov.
