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Veterans Law

Atrial Fibrillation (AFIB) VA Disability Ratings

October 7, 2020

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:

  • In this case it is called paroxysmal 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.
  • 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. This type of atrial fibrillation is continuous and lasts longer than 12 months.
  • 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.

Service Connection for Atrial Fibrillation

In order to receive VA disability benefits for AFIB, you must first establish service connection.  Importantly, service connection can be established in a number of ways, including the following:

Direct Service Connection

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

A secondary service-connected condition is one that resulted from a separate condition that is already service-connected.  For example, a veteran is service-connected for a knee condition and later develops arthritis in that knee.  Here, the veteran’s arthritis may warrant secondary service connection if it is the result of their 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.

Link Found Between PTSD and Increased Risk of AFIB

A 2018 study was the first to report a relationship between post-traumatic stress disorder (PTSD) and new cases of atrial fibrillation.  Since AFIB significantly impacts both patients and the healthcare system, researchers are committed to identifying risk factors and developing strategies to prevent and manage the condition.  As mentioned above, AFIB is linked to traditional cardiovascular risks, including hypertension (i.e., high blood pressure), diabetes, obesity, and sleep apnea.  However, data linking psychological stress and negative emotions to AFIB are also beginning to emerge.  PTSD has been linked to other cardiovascular disease (e.g., hypertension), but its relationship to AFIB was not previously explored.

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 be helpful to cite to the research outlined above and explain to VA that there is an established link between PTSD and increased risk of atrial fibrillation.

How VA Rates 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.