Ischemic Heart Disease VA Disability Rating: Criteria, Evidence & Pay

What is ischemic heart disease and how does it affect veterans?

Ischemic heart disease (IHD) is a group of conditions caused by reduced blood flow to the heart muscle. The term “ischemic” means inadequate blood supply. When the coronary arteries become narrowed or blocked — most commonly by atherosclerotic plaque — the heart muscle does not receive enough oxygen-rich blood to function properly. This results in chest pain (angina), shortness of breath, heart attack, heart failure, and potentially death.

Ischemic heart disease is one of the most consequential conditions for veterans, particularly those exposed to Agent Orange and other herbicide agents during the Vietnam era. The VA recognizes IHD as a presumptive condition for herbicide-exposed veterans, meaning the VA presumes the disease is connected to service without requiring proof of a direct link. This presumption was established based on extensive scientific research showing a significant association between herbicide exposure and cardiovascular disease.

IHD profoundly limits daily functioning. As the disease progresses, the heart’s pumping capacity diminishes. Veterans with IHD experience chest pain with exertion, shortness of breath during activities that were once routine, fatigue that limits what they can accomplish each day, and anxiety about their cardiac health. Advanced cases develop congestive heart failure, where the heart cannot meet the body’s demands, causing fluid buildup, severe exercise intolerance, and the need for constant medical management.

VA diagnostic code for ischemic heart disease

Ischemic heart disease is rated under Diagnostic Code (DC) 7005 per 38 CFR § 4.104, Schedule of Ratings — Cardiovascular System.

DC 7005 covers arteriosclerotic heart disease (coronary artery disease), which is the primary form of IHD. The rating criteria are based on objective cardiac function measurements: METs (metabolic equivalents) workload capacity, left ventricular ejection fraction, and the presence of congestive heart failure. The VA evaluates whichever criterion produces the most favorable rating for the veteran.

Important: The VA’s definition of IHD for presumptive purposes includes coronary artery disease (including coronary spasm) and coronary bypass surgery, stable/unstable/Prinzmetal’s angina, and myocardial infarction. It does not include hypertension, peripheral arteriosclerosis, or other conditions that do not fall within the medical definition of IHD.

Rating criteria for ischemic heart disease

The VA assigns IHD ratings at five possible levels. These criteria are identical to coronary artery disease under DC 7005:

0% rating

Criteria: The condition is diagnosed and service-connected but cardiac function is normal and does not meet the criteria for a 10% rating.

Monthly payment: $0 (but establishes service connection for secondary claims and future increases)

10% rating — $180.42/month

Criteria: Workload of greater than 7 METs but not greater than 10 METs results in dyspnea, fatigue, angina, dizziness, or syncope, or continuous medication required.

What this looks like: You can perform most daily activities without cardiac symptoms, but sustained moderate exertion causes shortness of breath, chest discomfort, or fatigue. You take daily cardiac medications. Your heart function is mildly impaired, and you manage with medication and activity modification.

30% rating — $552.47/month

Criteria: 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 ECG, echocardiogram, or X-ray.

What this looks like: Moderate activity triggers cardiac symptoms. Walking briskly, climbing stairs, or doing yard work causes shortness of breath, chest pain, or significant fatigue. Your heart has enlarged from the strain. You take multiple cardiac medications and carefully manage your physical activity level.

60% rating — $1,435.02/month

Criteria: 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 an ejection fraction of 30% to 50%.

What this looks like: Your IHD substantially limits daily functioning. Light activities are your maximum — slow walking, basic self-care, simple household tasks. Anything more strenuous causes symptoms. Your ejection fraction is reduced (30-50%), meaning your heart pumps less efficiently. You may have been hospitalized for congestive heart failure. Your daily life is significantly restricted, and you may have difficulty maintaining employment that requires any physical exertion.

100% rating — $3,938.58/month

Criteria: Chronic congestive heart failure, or workload of 3 METs or less results in dyspnea, fatigue, angina, dizziness, or syncope, or left ventricular dysfunction with an ejection fraction of less than 30%.

What this looks like: Your heart disease is severe and life-limiting. Even minimal physical activity — getting dressed, walking to the bathroom, standing for short periods — causes cardiac symptoms. You have chronic congestive heart failure requiring constant medication management. Your ejection fraction is severely reduced below 30%. You may have an implanted cardiac defibrillator. Your physical capacity is profoundly limited, and you likely need assistance with daily living activities.

What evidence do you need?

Service records

• Proof of qualifying service — For Agent Orange presumptive claims, you need documentation of service in Vietnam, Thailand (specific bases), or other covered locations during the applicable time period. DD-214, service personnel records, and deployment orders are key.
• Service treatment records showing any cardiovascular complaints or risk factors
• Records of herbicide exposure testing or health registry participation
• If claiming on a direct basis: evidence of cardiac symptoms or risk factors during service
• If claiming secondary: complete records for the primary condition

Medical evidence

• Current diagnosis of ischemic heart disease from a cardiologist
• Echocardiogram — Shows ejection fraction, chamber sizes, wall motion abnormalities, and overall cardiac function. This is critical for determining your rating level.
• Exercise stress test or pharmacological stress test — Determines your METs capacity and identifies ischemic changes during exertion
• Cardiac catheterization — Definitive evidence of coronary artery blockages showing the location, number, and severity of lesions
• ECG/EKG results — May show prior heart attack, ischemia, or hypertrophy
• Treatment records and medication lists (statins, beta blockers, ACE inhibitors, anticoagulants, nitrates)
• Records of cardiac procedures: stenting, coronary bypass surgery, pacemaker or defibrillator implantation
• Hospitalization records for heart failure, heart attacks, or angina episodes

Nexus letter

For Agent Orange presumptive claims, a nexus letter is not strictly required — the presumption provides the service connection. However, having one can help if there is any question about whether your specific cardiac condition qualifies as IHD. For direct or secondary claims, the nexus letter should explain the medical pathway connecting your IHD to service or to a primary service-connected condition.

Buddy statements

Statements from family members describing your physical limitations before and after the onset of IHD — what you can no longer do, episodes of chest pain or shortness of breath they have witnessed, hospitalizations, and the overall impact on your quality of life and ability to function.

Personal statement

Describe your service in Vietnam or other herbicide-exposed locations, your cardiac diagnosis and when it occurred, your current symptoms and limitations, and how IHD has changed your daily life. Detail what physical activities you can and cannot perform.

C&P exam tips for ischemic heart disease

What the examiner evaluates

• Confirmation of IHD diagnosis (must fall within the VA’s IHD definition)
• Current cardiac function: METs capacity, ejection fraction
• History of congestive heart failure, heart attacks, or angina
• Current medications and cardiac treatments
• History of cardiac procedures
• For Agent Orange claims: verification that the condition qualifies as IHD
• Impact on daily functioning and occupational capacity

How to prepare

1. Confirm your diagnosis qualifies as IHD. Make sure your medical records specifically diagnose a condition within the VA’s IHD definition: coronary artery disease, angina, or myocardial infarction. If your records use different terminology, ask your cardiologist to clarify in a letter.
2. Bring all cardiac testing. Echocardiogram results (especially ejection fraction), stress test results (especially METs), catheterization reports, and ECGs. These are the objective data points that determine your rating level.
3. Know your METs level and ejection fraction. These two numbers are the primary determinants of your rating. If your EF is below 50% or your METs are 5 or below, you may qualify for 60% or higher.
4. Document congestive heart failure episodes. If you have been hospitalized or treated for acute heart failure, bring those records. More than one episode in a year qualifies for 60%.
5. Bring proof of qualifying service. For Agent Orange claims, have your DD-214 and any records showing service in Vietnam or other covered locations.

Common mistakes

• Not having a cardiologist confirm the diagnosis specifically as ischemic heart disease
• Lacking recent cardiac testing (echocardiogram and stress test) to document current severity
• Underreporting physical limitations because you have gradually adapted over years
• Not claiming secondary conditions that have developed as a result of IHD
• Assuming hypertension counts as IHD for presumptive purposes (it does not — it has its own presumptive pathway)

Common secondary conditions linked to ischemic heart disease

IHD is often connected to other conditions that can increase your overall combined rating:

• Depression — The psychological impact of heart disease is significant. Reduced physical capacity, fear of cardiac events, and lifestyle limitations frequently cause depression. The American Heart Association recognizes depression as a significant comorbidity of heart disease.
• Sleep apnea — Sleep apnea places cardiovascular strain through oxygen desaturation and is commonly found in veterans with IHD. The conditions frequently co-occur and worsen each other.
• Erectile dysfunction — Vascular disease affecting the coronary arteries also affects other vascular beds, and cardiac medications commonly cause ED. This is a well-supported secondary claim.
• Hypertension — While hypertension is a risk factor for IHD, heart failure from IHD can also worsen blood pressure control. Both conditions may be separately rated.
• Peripheral artery disease — Atherosclerosis affecting coronary arteries frequently also affects peripheral arteries, causing claudication and other symptoms in the extremities.

How to calculate your monthly payment

Your total VA disability payment depends on your combined rating across all service-connected conditions. IHD at 60% or 100% combined with depression, hypertension, and other conditions can produce a significantly higher combined rating.

Use our VA disability calculator to:

• Calculate your combined rating with multiple conditions
• Understand how VA math combines ratings
• Estimate your monthly payment including dependents

For the full breakdown of payment amounts at every rating level, see our 2026 VA disability pay rates page.

Disclaimer: This content is for informational purposes only and does not constitute legal or medical advice. For personalized guidance on your VA disability claim, consult a VA-accredited Veterans Service Organization (VSO), attorney, or claims agent. You can find accredited representatives at VA.gov.