VA Disability for Aortic Valve Replacement: Ratings and Reductions

VA disability compensation for aortic valve replacement starts with an automatic 100 percent rating from the day you are admitted to the hospital for surgery. That full rating continues until a mandatory VA reexamination six months after you are discharged, at which point your ongoing rating is set based on how your heart functions after recovery.¹ The rating only applies, though, if the valve condition is connected to your military service.

The 100 Percent Rating and the Six-Month Reexamination

Heart valve replacement is rated under Diagnostic Code 7016. The rating works in two phases. From the date of hospital admission for the surgery, you receive 100 percent. Six months after discharge, the VA schedules a mandatory examination and applies the General Rating Formula for Diseases of the Heart to set your ongoing percentage.¹

That six-month exam is the pivotal moment. The examiner completes a Disability Benefits Questionnaire that includes a METs workload assessment, a review of cardiac imaging, and documentation of symptoms. The result determines whether you stay at 100 percent or move to a lower rating.

How Your Post-Surgery Rating Is Calculated

The General Rating Formula assigns percentages based mainly on METs (metabolic equivalents), which measure how much physical exertion triggers cardiac symptoms such as breathlessness, fatigue, angina, dizziness, or syncope. One MET equals the energy cost of standing quietly at rest.²

100 percent: a workload of 3.0 METs or less produces heart failure symptoms, or you have chronic congestive heart failure.
60 percent: a workload of 3.1 to 5.0 METs produces heart failure symptoms.
30 percent: a workload of 5.1 to 7.0 METs produces heart failure symptoms, or there is cardiac hypertrophy or dilatation confirmed by echocardiogram or equivalent imaging.
10 percent: a workload of 7.1 to 10.0 METs produces heart failure symptoms, or you require continuous medication.

Before November 2021, left ventricular ejection fraction (LVEF) could independently support a rating: below 30 percent could justify 100 percent, and 30 to 50 percent could justify 60 percent. The VA removed LVEF from the General Rating Formula effective November 29, 2021, and ratings are now determined through METs testing, episodes of congestive heart failure, and secondary criteria like cardiac hypertrophy or medication dependence.³

Why Formal Stress Testing Matters

The VA prefers a formal exercise stress test to establish the METs level at which your symptoms appear. When a laboratory test cannot be done for medical reasons, the examiner uses an interview-based METs estimate through a cardiac activity questionnaire. If both have been done, the examiner is instructed to note which result more accurately reflects current cardiac function, and if other medical conditions also limit exercise capacity, the examiner must estimate the METs level attributable solely to the heart condition.²

The distinction is not academic. Without documented exercise-test results, the VA may default to the 10 percent level based solely on continuous medication use.⁴

Establishing Service Connection

None of the rating rules apply unless you first show that your aortic valve condition is linked to service. There are several routes.

Direct Service Connection

Direct service connection requires three elements: a current diagnosis, an in-service event or illness, and a medical nexus opinion from a qualified provider linking the two. The opinion must state that the condition is “at least as likely as not” caused or aggravated by the in-service event. Vague language that a condition “may be related” to service is legally insufficient.⁴

Secondary Service Connection

Under 38 C.F.R. § 3.310(a), any disability “proximately due to or the result of a service-connected disease or injury” qualifies for compensation.⁵ Conditions veterans commonly link to later heart disease include hypertension, PTSD, diabetes, and sleep apnea. Chronic high blood pressure, for example, accelerates atherosclerosis and increases the risk of heart failure, and medical literature recognizing that link can support a secondary claim.⁴

If you are claiming aggravation rather than direct causation, you must establish a baseline level of severity for the non-service-connected condition before the alleged worsening began.⁵

The Congenital Valve Problem

A frequent obstacle is the VA’s determination that an aortic valve condition is congenital. A bicuspid aortic valve, for instance, is a structural abnormality present from birth. The VA distinguishes between congenital “defects,” which are considered stationary in nature and cannot themselves be service-connected, and congenital “diseases,” which are capable of improving or deteriorating and can be directly compensated if military service aggravated them.⁶

Even a condition classified as a congenital defect can still support a claim if a disease or injury was superimposed over the defect during service. In one BVA case, service connection was granted after echocardiograms showed a measurable decline in heart function between entrance and exit from service, and the Board concluded the condition had been aggravated beyond its natural progression.⁷ In another, the Board denied service connection for a bicuspid aortic valve because the examiner found the veteran’s cardiomyopathy was a natural progression of the congenital defect rather than a result of service.⁶

Agent Orange and the PACT Act Do Not Apply

Ischemic heart disease is a presumptive condition for veterans with qualifying herbicide exposure.⁸ Valvular heart disease, including aortic stenosis and aortic valve replacement, is not.⁴ Filing an aortic valve claim as a presumptive Agent Orange condition will be denied. The PACT Act of 2022 expanded presumptive conditions for burn pit and other toxic exposures, adding cancers, respiratory illnesses, and hypertension for Vietnam-era veterans, but no cardiovascular or heart valve conditions.⁹ Aortic valve claims have to go through direct or secondary service connection.

Protecting Your Rating From Reduction

Any proposed reduction after the six-month exam has to follow 38 C.F.R. § 3.105(e):¹⁰

The VA must send written notice of the proposed reduction with detailed reasons.
You have 60 days from the notice to submit evidence that the current rating should be maintained.
Within 30 days you can request a predetermination hearing, conducted by VA personnel not involved in the proposed reduction. A timely request keeps benefits at the existing level until a final determination.
If the reduction is finalized, the lower rate takes effect on the last day of the month in which the 60-day notice period expires.

Several durational rules add further protection as time passes:¹¹

A rating held for five or more years cannot be reduced unless the VA shows sustained improvement rather than a temporary uptick.
After ten years, the VA can reduce a rating but cannot terminate service connection entirely.
A rating held at the same percentage for 20 years is protected from any reduction.
Veterans who were 55 or older at the time of the C&P exam that established the rating are generally protected from decreases.

When the Heart Condition Is Still Severe: TDIU and SMC

If your post-surgery rating drops below 100 percent but the heart condition prevents you from holding substantially gainful employment, Total Disability Individual Unemployability pays at the 100 percent rate. General eligibility requires either one disability rated 60 percent or higher, or a combined rating of 70 percent with at least one condition at 40 percent.¹² Under Rice v. Shinseki, the VA must consider TDIU as part of any pending claim for a higher rating when the record reasonably raises the issue, even without an explicit request.⁴

Special Monthly Compensation can apply on top of the schedular rating. SMC-S (housebound) may apply when you are substantially confined to the home due to heart failure, or when a 100 percent rating is combined with an additional service-connected disability rated 60 percent or more. SMC-L (aid and attendance) may be available if end-stage heart failure or recovery from a major cardiac event leaves you needing daily help with basic activities.⁴ Eligibility turns on functional impact rather than the specific diagnosis.¹³

Filing the Claim and Preparing for the Exam

Submit medical records documenting the diagnosis, the surgical procedure, hospital admission and discharge dates, and post-operative treatment. For direct and secondary claims, a nexus letter from a cardiologist or other qualified provider is essential. The opinion has to use the “at least as likely as not” standard and explain the physiological link between service, or a service-connected condition, and the valve disease.

At the C&P examination, functional capacity will be assessed through METs testing or an interview-based estimate. A recent formal exercise stress test on record helps, since its absence can leave you with a rating based only on medication use. Documenting the full range of your limitations, including the worst days rather than the best, helps the exam capture the real impact on daily life.⁴

If the claim is denied, you can file a Supplemental Claim with new and relevant evidence on VA Form 20-0995, request a Higher-Level Review, or appeal to the Board of Veterans’ Appeals.¹⁴ If the condition worsens after you already have a rating, file a claim for increased disability compensation on VA Form 21-526EZ rather than a Supplemental Claim.

1
Cornell Law Institute. 38 CFR 4.104 – Schedule of Ratings, Cardiovascular System
2
U.S. Department of Veterans Affairs. Disability Benefits Questionnaire – Heart Conditions
3
Federal Register. Schedule for Rating Disabilities – The Cardiovascular System Correction
4
Hill & Ponton. VA Disability Ratings for Heart Disease
5
Board of Veterans’ Appeals. BVA Decision, Citation Nr 1711728
6
Board of Veterans’ Appeals. BVA Decision, Citation Nr 22020821
7
Board of Veterans’ Appeals. BVA Decision, Citation Nr 1720422
8
U.S. Department of Veterans Affairs. Ischemic Heart Disease and Agent Orange
9
U.S. Department of Veterans Affairs. The PACT Act and Your VA Benefits
10
eCFR. 38 CFR 3.105 – Revision of Decisions
11
Veterans Disability Info. Protected VA Disability Ratings – When Can VA Reduce My Rating
12
Woods Lawyers. VA Heart Stents, Pacemakers, Surgery
13
U.S. Department of Veterans Affairs. Special Monthly Compensation Rates
14
U.S. Department of Veterans Affairs. Supplemental Claim