Atrial Fibrillation (AFIB) VA Disability Ratings
CCK Law: Our Vital Role in Veterans Law
What Is Atrial Fibrillation (AFIB)?
Atrial fibrillation (AFIB) is an irregular and often rapid heart rate that can increase your risk of strokes, heart failure, and other heart-related complications. During AFIB, the heart’s two upper chambers (i.e., the atria) beat chaotically and irregularly, thereby out of coordination with the two lower chambers (i.e., the ventricles) of the heart.
Some people with AFIB have no symptoms and are unaware of their condition until it is discovered during a physical examination. Those who do have AFIB symptoms may experience the following:
- Palpitations – sensations of a racing, uncomfortable, irregular heartbeat
- Weakness
- Reduced ability to exercise
- Fatigue
- Lightheadedness
- Dizziness
- Shortness of breath
- Chest pain
Furthermore, there are several types of atrial fibrillation:
- Paroxysmal AFIB – For this type of AFIB, symptoms may come and go, usually lasting for a few minutes to hours. Sometimes symptoms occur for as long as a week and episodes can happen repeatedly. Symptoms may go away on their own or require treatment.
- Persistent AFIB – With this type of AFIB, your heart rhythm does not go back to normal on its own. If you have persistent atrial fibrillation, you will need treatment such as an electrical shock or medications in order to restore your heart rhythm.
- Long-standing Persistent AFIB – This type of atrial fibrillation is continuous and lasts longer than 12 months.
- Permanent AFIB – In this type of AFIB, the abnormal heart rhythm cannot be restored. You will have atrial fibrillation permanently, and you will often require medications to control your heart rate and to prevent blood clots.
Abnormalities or damage to the heart’s structure are the most common cause of atrial fibrillation; however, other possible causes may include: high blood pressure, heart attack, coronary artery disease, lung diseases, sleep apnea, etc. If you are a veteran and believe your AFIB may be due to your time in service, you may qualify for VA disability benefits.
How Do I Prove Service Connection for Atrial Fibrillation?
In order to receive VA disability benefits for AFIB, you must first establish service connection. There are multiple methods to do so, but two of the most important are direct and secondary, which involve the following:
Direct Service Connection for Atrial Fibrillation
To establish direct service connection for AFIB, you must demonstrate the following three elements to VA:
- A current diagnosis of AFIB
- An in-service event, injury, or illness
- A medical nexus linking your atrial fibrillation to the in-service occurrence
For the medical nexus requirement of direct service connection, you will likely need to attend a Compensation & Pension (C&P) exam. Either a VA healthcare provider, or a VA-contracted healthcare provider, will provide an opinion as to whether your AFIB is at least as likely as not due to your time in service.
Secondary Service Connection for Atrial Fibrillation
A secondary service-connected condition is one that resulted from a separate condition that is already service-connected. Generally, to prove secondary service connection, a veteran must present a diagnosis of a potential secondary condition, as well as a doctor’s medical opinion linking the veteran’s primary condition to this newfound secondary one.
For example:
- Say a veteran is service-connected for a knee condition and later develops arthritis in that same knee.
- During a medical visit, the veteran’s doctor determines that it was the veteran’s already service-connected knee condition that caused their arthritis to develop.
- Here, the veteran’s arthritis may warrant secondary service connection if the veteran submits the proper evidence proving that it is the result of their already service-connected knee condition.
Secondary service connection can apply to many conditions, including AFIB. As indicated above, AFIB can be linked to high blood pressure, coronary artery disease, and sleep apnea, all of which many veterans suffer from.
When establishing secondary service connection, the medical nexus element remains very important. The nexus between your primary condition and your secondary condition must be clearly established in order to be granted secondary service connection.
Is There a Link Between PTSD and Increased Risk of AFIB?
Yes, there seems to be a significant link between PTSD and an increased risk of AFIB, as well as other cardiovascular conditions. One 2023 study claims that PTSD “precedes and predicts a range of cardiovascular conditions, including myocardial infarction, stroke, venous thromboembolism, heart failure, and atrial fibrillation.”
In addition, a 2018 study was the first to report a relationship between post-traumatic stress disorder (PTSD) and new cases of atrial fibrillation. This study included 1.06 million post-9/11 veterans who first accessed medical care with the Veterans Health Administration (VHA) from October 2001 to November 2014 and had no history of AFIB.
During an approximate 5-year follow-up period, 2,491 veteran patients were diagnosed with atrial fibrillation. Results from this study show that a new diagnosis of PTSD was associated with an increased risk for atrial fibrillation diagnosis.
Importantly, such results further raise the possibility that early detection and treatment of PTSD may reduce a patient’s risk for developing AFIB. The authors of this study call for further research to fully understand the behavioral and biological mechanisms underlying the relationship between PTSD and AFIB, as well as clinical trials to determine whether early treatment of PTSD can reduce AFIB risk.
Secondary Service Connection: PTSD and AFIB
As indicated above, secondary service connection may be warranted when a primary service-connected condition causes or aggravates a secondary condition. Therefore, if you are service-connected for PTSD and later develop AFIB, it is possible to file for secondary service connection. It may also be helpful to cite some of the research outlined above and explain to VA that there is an established link between PTSD and increased risk of atrial fibrillation.
How Does VA Rate Atrial Fibrillation (AFIB)?
VA rates AFIB under 38 CFR § 4.104 – Schedule of Ratings, Cardiovascular System – Diagnostic Code 7010. The rating criteria are as follows:
- 30% – paroxysmal atrial fibrillation or other supraventricular tachycardia, with more than four episodes per year documented by ECG or Holter monitor
- 10% – permanent atrial fibrillation (lone atrial fibrillation), or; one to four episodes per year of paroxysmal atrial fibrillation or other supraventricular tachycardia documented by ECG or Holter monitor
If you believe your condition warrants a higher rating than VA assigns, you have the right to file an appeal.
