Metabolic Equivalents (METs) are the primary measurement the VA uses to rate many heart and cardiovascular conditions. One MET equals the energy expenditure at rest. Higher MET levels represent greater physical capacity. The VA rates based on how few METs the veteran can achieve — lower METs means greater impairment and a higher rating.
Common activities and their approximate MET levels: eating, dressing, or walking around the house (1-3 METs); light yard work, brisk walking, or climbing a flight of stairs (4-7 METs); heavy yard work, jogging, or cycling (8-10 METs); vigorous sports like running or competitive athletics (over 10 METs).
The VA prefers METs levels measured by exercise stress testing (treadmill test or cardiopulmonary exercise testing). However, if exercise testing cannot be performed or is medically contraindicated, the examiner can estimate METs levels through a clinical interview — asking the veteran about the activities they can and cannot perform.
Rating levels based on METs vary by specific diagnostic code, but the general framework for many heart conditions is: greater than 7 METs typically corresponds to a 10% rating; greater than 5 but not greater than 7 METs corresponds to 30%; greater than 3 but not greater than 5 METs corresponds to 60%; and 3 METs or less corresponds to 100%.
During the METs interview or testing, be honest about your actual activity limitations. If you cannot climb a flight of stairs without stopping, cannot walk briskly, or cannot perform moderate yard work, report those limitations clearly. The examiner translates your reported activity tolerance into a METs estimate, which directly determines your rating.
Some heart conditions can also be rated based on ejection fraction (a measure of heart pumping efficiency from an echocardiogram) or the presence of congestive heart failure. The VA uses whichever method produces the highest rating.