Ischemic Heart Disease and VA Disability Compensation

What is Ischemic Heart Disease?

Ischemic heart disease, also known as coronary artery disease, is the term given to heart problems caused by narrowed heart arteries.  When these arteries are narrowed, less blood and oxygen reach the heart muscle, leading to severe complications.  This condition is typically caused by a buildup of cholesterol plaque in the arteries.  Symptoms of ischemic heart disease include the following:

• Chest pain
• Shortness of breath
• Dizziness or lightheadedness
• Feeling of indigestion or heartburn
• Nausea, vomiting, or cold sweats
• Fatigue
• Heart attack

The most common treatment options for ischemic heart disease involve lifestyle changes, including increased exercise and dietary restrictions, medications, and in some cases, surgery.

Ischemic Heart Disease and Agent Orange Exposure

In July 2009, the Health and Medicine Division (formally known as the Institute of Medicine), concluded in its report “Veterans and Agent Orange: Update 2008”, that there is suggestive but limited evidence that exposure to Agent Orange is associated with an increased chance of developing ischemic heart disease.  As a result, veterans who served in the following locations during the specified time periods and later developed ischemic heart disease are entitled to service connection on a presumptive basis:

• Veterans with “boots on the ground”, those serving on inland waterways in Vietnam, and “blue water” Navy veterans between January 9, 1962 and May 7, 1975;
• Veterans who flew or worked in C-123 aircraft during the Vietnam War era; and
• Veterans who served along the Korean Demilitarized Zone (DMZ) between April 1, 1968 and August 31, 1971

Again, these veterans do not have to prove a connection between their ischemic heart disease and service to be eligible for VA health care and disability compensation.  Surviving spouses, dependent children, and dependent parents of veterans who were exposed to herbicides during military service and died as the result of ischemic heart disease may be eligible for VA survivors’ benefits.

VA Disability Ratings for Ischemic Heart Disease

VA generally rates ischemic heart disease under 38 CFR § 4.104 – Schedule of Ratings, Cardiovascular System, Diagnostic Code 7005.  Veterans are assigned a disability rating of 10, 30, 60, or 100 percent based on the following criteria:

• “100% – 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 percent
• 60% – 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 percent
• 30% – 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 electrocardiogram, echocardiogram, or X-ray
• 10% – workload of greater than 7 METs but not greater than 10 METs results in dyspnea, fatigue, angina, dizziness, or syncope, or; continuous medication required”

Direct Service Connection for Ischemic Heart Disease

Veterans who are not eligible for service connection for ischemic heart disease on a presumptive basis may still be entitled to VA disability compensation.  In this case, veterans will have to establish service connection on a direct basis by demonstrating that his or her ischemic heart disease is due to his or her military service.  This connection can be supported by treatment records, lay evidence, and a medical nexus letter.