Ischemic Heart Disease (IHD)

1. What This Condition Is

Ischemic heart disease, also called coronary artery disease or coronary heart disease, is a condition in which the arteries that supply blood to the heart become narrowed or blocked, reducing oxygen delivery to the heart muscle. It is the leading cause of death among veterans and is one of the most underrated service-connected conditions in the VA system.

For Vietnam-era veterans and others with qualifying Agent Orange exposure, the VA presumes IHD is caused by that exposure. You do not have to prove dioxin entered your bloodstream. You have to prove you served somewhere Agent Orange was used and that you have a current IHD diagnosis.

The rating for IHD is based on how hard your heart can work before symptoms appear -- not on your cholesterol, not on how many stents you have, not on whether you have had a bypass. Know the METs threshold system before you go to your C&P exam.

2. VA Rating Criteria

IHD is rated under Diagnostic Code 7005, 38 CFR § 4.104.

Agent Orange Presumptive Status: Under 38 CFR § 3.309(e), ischemic heart disease is a presumptive condition for veterans with qualifying Agent Orange exposure. Qualifying service includes Vietnam (January 9, 1962 through May 7, 1975), the Korean DMZ (September 1, 1967 through August 31, 1971), certain Royal Thai Air Force bases during the Vietnam era, C-123 aircraft crews exposed during and after the Vietnam era, and veterans with blue-water Navy service who served in the offshore territorial waters of the Republic of Vietnam (Blue Water Navy Vietnam Veterans Act of 2019, P.L. 116-23, removed the prior requirement to have entered inland waterways). The VA presumes the nexus if you served in a qualifying location and have a current IHD diagnosis.

METs explained: A MET (metabolic equivalent of task) measures exertional capacity. 1 MET is sitting at rest. Walking on level ground is about 3.5 METs. Climbing a flight of stairs is about 4-5 METs. If you become symptomatic during moderate activity, that is a 30% or 60% rating territory. Your cardiologist's stress test results or exercise tolerance test documents your MET threshold.

Note on the 100% rating: The 100% rating is not permanent unless the condition meets the criteria for a scheduler permanent and total rating. For TDIU purposes, IHD at 60% combined with other service-connected conditions may establish total disability.

3. What to Expect at Your C&P Exam

The examiner will review your cardiology records, stress test results, echocardiogram findings, catheterization reports, and surgical history. They will ask about symptoms during exertion -- specifically what activities cause chest pain, shortness of breath, dizziness, or fatigue, and at what level of exertion those symptoms begin.

This is the most important thing to communicate clearly: at what point in physical activity do you get symptoms? Describe specific activities. Walking uphill at a slow pace? Carrying groceries? Going up one flight of stairs? Those correspond to MET levels that directly determine your rating.

Bring your most recent echocardiogram (which documents ejection fraction) and your most recent exercise stress test or nuclear stress test (which documents MET capacity). If you have had a cardiac catheterization, angiogram, stent placement, or bypass surgery, bring those operative reports.

4. Evidence You Need to Win

For Agent Orange presumptives: Two things. A current diagnosis of ischemic heart disease from a cardiologist or internist -- coronary artery disease, angina, myocardial infarction, or coronary artery bypass are all IHD. And documented service in a qualifying location, typically established by your DD-214.

You do not need a nexus letter. 38 CFR § 3.309(e) creates the legal presumption. The VA may still request a C&P exam to rate the condition, but they cannot deny service connection based on lack of nexus for a confirmed presumptive.

For non-presumptive claims: Current IHD diagnosis, in-service event or exposure linked to cardiovascular risk, and a nexus letter from a cardiologist or internist opining that service was at least as likely as not a contributing factor.

DBQ: Request that the C&P examiner complete the Ischemic Heart Disease DBQ. Get the current version at va.gov/find-forms. A private cardiologist can complete this DBQ with your current test results.

Echocardiogram: Ejection fraction is one of the two rating anchors. Make sure your most recent echo is in your claims file. If your EF is below 50%, that directly maps to a rating.

Stress test results: MET capacity is the other rating anchor. Get the actual test results, not just a summary letter. The number of METs achieved before symptom onset or EKG changes is what the rater needs.

Personal statement: Describe what activities cause symptoms. Be specific and honest. Do not describe activities you can do without symptoms -- describe the ones that stop you.

5. Secondary Conditions to Consider

Hypertension: IHD and hypertension are often comorbid. If hypertension is not already service-connected, consider filing it secondary to IHD or as a co-primary Agent Orange presumptive (hypertension is now an Agent Orange presumptive under the PACT Act for qualifying veterans).

Arrhythmias: Atrial fibrillation and other arrhythmias are common complications of ischemic heart disease. File for arrhythmia separately under DC 7010 or DC 7011 if you have a documented diagnosis.

Heart failure (congestive heart failure): CHF is a direct progression of IHD in many veterans. If you develop CHF, file for it as a complication. At its most severe, CHF warrants a 100% rating under DC 7003.

Stroke (cerebrovascular accident): Coronary artery disease is a major risk factor for stroke. If you have had a stroke or TIA, file it secondary to service-connected IHD with a treating neurologist's nexus opinion.

Depression: Cardiac disease is one of the strongest predictors of clinical depression. Post-cardiac event depression is well-documented in medical literature. Secondary mental health claims under 38 CFR § 3.310 are viable with a treating provider's nexus.

Erectile dysfunction: Vascular disease from IHD directly impairs penile blood flow. File under DC 7522 secondary to IHD with a treating provider's nexus letter.

6. Common Mistakes That Kill Claims

Not knowing your MET level before the exam. Your rating depends on how many METs trigger your symptoms. If you cannot describe this at the exam, the examiner has to estimate. Get your stress test results. Know the number. Know what activity corresponds to it.

Not filing ejection fraction separately. If your echocardiogram shows reduced EF and your stress test shows tolerable METs, you should be rated by whichever criterion gives you the higher rating. Make sure the C&P examiner documents both. If they only address one, that is a basis for a Higher-Level Review.

Assuming the Agent Orange presumptive takes care of the rating. Presumptive status establishes service connection. It does not determine your rating. A 10% rating on an Agent Orange IHD claim is not unusual and it is often wrong. Know the rating criteria and contest underratings.

Not filing for secondary conditions. Arrhythmias, hypertension, and depression downstream from IHD are separately ratable. Most veterans file only for the heart condition and leave significant ratings on the table.

Waiting until after a cardiac event. The VA can rate IHD before a heart attack based on documented coronary artery disease, angina, and reduced cardiac capacity. Do not wait until you are in crisis to file.

7. FWD Assist Resources

The following FWD Assist HQ books apply directly to an IHD claim:

• The PACT Act Veteran's Guide -- Covers the Agent Orange presumptive list, qualifying service locations, and how to file for IHD and related conditions under current law.
• Secondary Conditions: The Hidden Ratings Most Veterans Miss -- Walks through arrhythmias, hypertension, depression, and erectile dysfunction as IHD downstream claims.
• The C&P Exam Playbook -- Prepares you to present MET capacity and ejection fraction accurately at your examination.
• TDIU: Total Disability Based on Individual Unemployability -- If IHD at 60% combined with other conditions prevents you from substantially gainful employment, this covers how to file for TDIU.
• The VA Appeals Playbook -- If you received an underrating on an IHD claim, covers HLR and Supplemental Claim pathways with new cardiac evidence.

Visit fwdassisthq.com for the full catalog.

8. Get Help Without a Claim Shark

Free accredited representation is available through VSOs including the DAV, VFW, American Legion, and AMVETS, and through your county veterans service office.

Under 38 USC 5905, charging upfront fees before an initial VA decision is a federal violation. Accredited attorneys and claims agents may charge fees only after an initial decision is issued, capped at 20% of past-due benefits recovered.

Verify accreditation at va.gov/ogc/accreditation.asp before working with any paid representative.

FWD Assist HQ provides education and tools, not representation. For active claims, always work with an accredited representative.