VA Disability for Ischemic Heart Disease: Ratings, METs, and Nehmer

The VA assigns an ischemic heart disease VA disability rating of 10%, 30%, 60%, or 100% under Diagnostic Code 7005, based mostly on how much physical exertion you can handle before symptoms like chest pain, shortness of breath, or dizziness appear. Exertion is measured in metabolic equivalents, or METs. Vietnam-era veterans who served in qualifying locations do not have to prove the condition was caused by service; the link is presumed.

What Counts as Ischemic Heart Disease

For VA purposes, ischemic heart disease covers any atherosclerotic heart disease that causes clinically significant ischemia or requires coronary revascularization. That includes coronary artery disease, past heart attacks (acute, subacute, or old myocardial infarction), coronary bypass surgery, coronary spasm, and stable, unstable, and Prinzmetal’s angina.¹

Two related conditions are outside the definition. Hypertension and peripheral vascular disease are not treated as ischemic heart disease, even though they share risk factors and often appear alongside it.² They can still be rated separately if they qualify on their own.

The Rating Tiers Under Diagnostic Code 7005

The rating criteria were amended effective November 14, 2021. For claims pending on or after that date, the VA evaluates the condition under both versions and applies whichever produces the higher rating.³

Pre-Amendment Criteria

100%: chronic congestive heart failure; or a workload of 3 METs or less producing dyspnea, fatigue, angina, dizziness, or syncope; or left ventricular dysfunction with an ejection fraction below 30%.
60%: more than one episode of acute congestive heart failure in the past year; or a workload greater than 3 but not more than 5 METs producing those symptoms; or an ejection fraction of 30% to 50%.
30%: a workload greater than 5 but not more than 7 METs producing symptoms; or evidence of cardiac hypertrophy or dilatation on ECG, echocardiogram, or X-ray.
10%: a workload greater than 7 but not more than 10 METs producing symptoms; or continuous medication required.

These criteria live at 38 CFR 4.104.⁴

Post-Amendment Criteria

The amended formula uses the same METs thresholds but broadens the list of qualifying symptoms. Where the old version specified dyspnea, fatigue, angina, dizziness, or syncope, the amended version uses “heart failure symptoms,” defined to include breathlessness, fatigue, angina, dizziness, arrhythmia, palpitations, and syncope.⁵ Arrhythmia and palpitations were added.

The amended version also removed two standalone pathways. Under the old criteria, an ejection fraction of 30% to 50% alone supported a 60% rating, and needing continuous cardiac medication alone supported a 10% rating. Those shortcuts are gone in the amended formula, which puts more weight on METs-based testing.³ For some veterans, that makes the older criteria the better route, which is why the VA must consider both.

What the METs Numbers Mean

One MET is the energy your body uses standing still at rest. The higher your tolerable METs before symptoms appear, the lower the rating. In practice:

1 to 3 METs: eating, dressing, showering, walking slowly a block or two.
Greater than 3 to 5 METs: light yard work, mowing with a power mower, walking briskly at about 4 mph.
Greater than 5 to 7 METs: climbing a flight of stairs, golfing without a cart, heavier yard work like digging.
Greater than 7 to 10 METs: climbing stairs quickly, moderate bicycling, jogging around 6 mph.

The VA prefers an exercise stress test to measure METs. When exercise testing is medically risky or impractical, the examiner uses an interview-based estimate, asking you to describe the lowest activity level that triggers your cardiac symptoms.⁶

How the C&P Exam Sets Your Rating

After you file, the VA generally schedules a Compensation and Pension exam. A VA physician or contracted doctor completes the Heart Conditions Disability Benefits Questionnaire, reviews your claims file, examines you, and pulls in testing results including ECG, chest X-ray, echocardiogram, CT angiography, and any coronary angiograms on record.⁷

The METs conversation is the piece that most directly drives your rating. Be specific about which activities trigger chest pain, breathlessness, fatigue, dizziness, or near-fainting, and be specific about which symptoms come from your heart rather than another condition. The DBQ requires the examiner to separate cardiac limitations from limitations caused by other health issues, so cardiac-specific detail keeps the METs figure honest.⁶

Getting Service-Connected Without Proving a Link

The VA added ischemic heart disease to its Agent Orange presumptive list on August 31, 2010, through a final rule at 75 FR 53202 amending 38 CFR 3.309(e).¹ If you qualify for the presumption of herbicide exposure and you have any form of ischemic heart disease, you do not need a nexus letter linking the diagnosis to service.⁸

The presumption reaches these locations and dates:

Republic of Vietnam, including territorial waters within 12 nautical miles: January 9, 1962 to May 7, 1975.
Thailand (U.S. or Royal Thai military bases): January 9, 1962 to June 30, 1976.
Korean DMZ: September 1, 1967 to August 31, 1971.
Laos: December 1, 1965 to September 30, 1969.
Cambodia (Mimot or Krek, Kampong Cham Province): April 16, 1969 to April 30, 1969.
Guam, American Samoa, and territorial waters: January 9, 1962 to July 31, 1980.
Johnston Atoll or ships that called there: January 1, 1972 to September 30, 1977.
C-123 aircraft crews: Air Force and Air Force Reserve personnel with regular, repeated contact with C-123s used to spray herbicides during the Vietnam era.

These reflect expansions from the PACT Act of 2022 and earlier legislation.⁹

Navy veterans who served offshore Vietnam but never went ashore or on inland waterways were denied Agent Orange benefits for decades. That ended after Procopio v. Wilkie, 913 F.3d 1371 (Fed. Cir. 2019), which held that the Agent Orange Act’s reference to the “Republic of Vietnam” includes the country’s territorial sea out to 12 nautical miles.¹⁰ Congress then passed the Blue Water Navy Vietnam Veterans Act of 2019 (Public Law 116-23), effective January 1, 2020, which codified the 12-mile coverage and added the Korean DMZ presumption.¹¹

Direct and Secondary Service Connection

If your service does not fit the presumption, two other paths remain. A direct claim needs medical evidence connecting the diagnosis to something specific in service, usually a nexus opinion from a physician. A secondary claim applies when ischemic heart disease was caused or aggravated by a condition that is already service-connected. Service-connected hypertension is a common basis, since hypertension is a known contributor to coronary artery disease.¹²

What Each Rating Pays

VA disability compensation is tax-free and paid monthly. As of December 1, 2025, the base rates for a veteran with no dependents are:

10%: $180.42
30%: $552.47
60%: $1,435.02
100%: $3,938.58

At 30% or higher, dependents add to the payment. A veteran rated 100% with a spouse and no children receives $4,158.17 per month.¹³ The rates adjust annually with the Social Security cost-of-living increase.

Reaching 100% Pay Below a 100% Schedular Rating

If your ischemic heart disease keeps you from working but your schedular rating is below 100%, Total Disability Based on Individual Unemployability (TDIU) pays at the 100% rate. Schedular TDIU requires a single service-connected disability rated at least 60%, or a combined rating of at least 70% with one disability rated at 40% or higher.¹⁴ The VA weighs your work history, education, and skills against what your cardiac symptoms let you do. Even when you fall short of the schedular thresholds, the VA can grant TDIU on an extra-schedular basis if the evidence shows you cannot maintain employment.

Secondary Conditions and How Ratings Combine

Once ischemic heart disease is service-connected, you can claim conditions it caused or worsened. Common ones include peripheral artery disease (the same atherosclerotic process), depression or anxiety tied to functional limitations, erectile dysfunction from reduced blood flow or cardiac medication (rated 0% but eligible for Special Monthly Compensation under SMC-K), stroke, and atrial fibrillation when supported by a physician’s opinion tying it to the heart disease.¹²

Hypertension is a difficult secondary claim in this direction. Medically, hypertension contributes to ischemic heart disease rather than the other way around, so proving IHD caused hypertension is uphill.¹²

Combined ratings do not add. The VA uses a table that treats each additional disability as affecting only your remaining capacity. A 60% rating for IHD plus a 30% rating for depression works out like this: 60% of 100 leaves 40% remaining, and 30% of that 40 is 12, giving a combined value of 72, which rounds to 70%.¹⁵ The rounding is why several rated conditions are often needed to reach the higher combined thresholds.

For severe cases, Special Monthly Compensation pays on top of the schedular rating: SMC-S when heart failure substantially confines you to your home,¹⁶ and SMC-L when end-stage heart failure or recovery from a major cardiac event leaves you needing regular help with daily activities.¹⁷ You cannot receive both at once; aid and attendance is the larger payment.

Retroactive Benefits and Nehmer

The Nehmer v. U.S. Department of Veterans Affairs class action, filed in 1986, produced a 1991 consent decree that governs retroactive benefits when the VA adds a condition to the Agent Orange presumptive list. The VA must search its own records, identify veterans previously denied for a newly recognized condition, and readjudicate those claims on its own.¹⁸

Adding ischemic heart disease in August 2010 triggered a review of more than 140,000 past claims for IHD, Parkinson’s, and B-cell leukemia.² Under Nehmer, veterans whose earlier claims were denied can get retroactive benefits back to the original filing date, not just the date of the new regulation. For new claims filed after August 31, 2010, retroactive pay reaches back to the regulation’s effective date or one year before the VA received the application, whichever is later.¹⁹ A November 2020 court order extended Nehmer protections to Blue Water Navy veterans previously denied under the old “boots on the ground” requirement.¹⁸

Filing and Appealing

Claims use VA Form 21-526EZ, filed online, by mail to the Claims Intake Center in Janesville, Wisconsin, in person at a regional office, by fax, or through an accredited Veterans Service Organization representative.²⁰ If you are not ready to file a full claim, an intent to file locks in a potential effective date and gives you 365 days to complete the application. As of early 2026, the VA reported an average processing time of 76.7 days.

If a decision goes against you, the Appeals Modernization Act of 2017 gives you three options, and you generally have one year from the decision to choose:²¹

Higher-Level Review: a senior reviewer reexamines the existing record for errors; no new evidence, but you can request an informal conference. The VA targets about 125 days.²²
Supplemental Claim: you submit new and relevant evidence, such as a private medical opinion or updated testing.
Board Appeal: a Veterans Law Judge reviews the case, with options for direct review, additional evidence, or a hearing.

1
Federal Register. Diseases Associated With Exposure to Certain Herbicide Agents
2
CCK Law. Nehmer Claims: What You Need to Know
3
Board of Veterans’ Appeals. BVA Decision 24002831
4
GovInfo. 38 CFR 4.104 – Schedule of Ratings, Cardiovascular System
5
Cornell Law Institute. 38 CFR 4.104
6
U.S. Department of Veterans Affairs. Heart Conditions Disability Benefits Questionnaire
7
U.S. Coast Guard. Heart Conditions DBQ Form
8
U.S. Department of Veterans Affairs. Agent Orange Exposure and VA Disability Compensation
9
U.S. Department of Veterans Affairs. Presumptive Service Connection Information
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VFW. VFW Blue Water Navy Vet Wins Federal Appeals Court Ruling
11
U.S. Department of Veterans Affairs. Blue Water Navy Veterans
12
Stateside Legal. Secondary Claims Ischemic Heart Disease
13
U.S. Department of Veterans Affairs. VA Disability Compensation Rates
14
Board of Veterans’ Appeals. BVA Decision 22014611
15
U.S. Department of Veterans Affairs. About VA Disability Ratings
16
Board of Veterans’ Appeals. BVA Decision 1813650
17
U.S. Department of Veterans Affairs. Examination for Housebound Status or Permanent Need for Regular Aid and Attendance
18
VA Office of Inspector General. VAOIG Report 23-01266-78
19
VA News. VA Publishes Final Regulation to Aid Veterans Exposed to Agent Orange
20
U.S. Department of Veterans Affairs. How to File a VA Disability Claim
21
U.S. Department of Veterans Affairs. Veterans Appeals Improvement and Modernization Act
22
U.S. Department of Veterans Affairs. Higher-Level Reviews