Diagnostic Code 7005 · 38 CFR §4.104
Coronary artery disease (CAD) occurs when plaque builds up in the arteries that supply blood to the heart, narrowing them and reducing blood flow. This can cause chest pain (angina), shortness of breath, fatigue, and in severe cases heart attacks. The most important thing to understand for your claim is that the VA almost never rates CAD on the diagnosis itself — it rates how much the disease limits you, measured in METs (metabolic equivalents of exercise). Two veterans with the same blocked artery can end up at 10% and 100%, because the rating turns on functional capacity, not the blockage. CAD falls under the VA's umbrella term 'ischemic heart disease,' which is a presumptive condition for Agent Orange exposure — a critical point covered below. Veterans may develop CAD from the physical and psychological stresses of service, from herbicide (Agent Orange) exposure, or as a condition secondary to service-connected diabetes or hypertension.
| Rating | Criteria |
|---|---|
| 10% | A workload of 7.1 to 10.0 METs produces heart-failure symptoms (breathlessness, fatigue, angina, dizziness, or palpitations); or you require continuous medication to control the condition. In practical terms, you can handle moderate activity but tire more easily than expected, or you are stable on daily heart medication. |
| 30% | A workload of 5.1 to 7.0 METs produces symptoms; or an echocardiogram (or MUGA scan or MRI) shows cardiac hypertrophy or dilatation. For example, brisk walking, climbing two flights of stairs, or heavy yard work brings on fatigue, chest discomfort, or shortness of breath. |
| 60% | A workload of 3.1 to 5.0 METs produces symptoms. Everyday tasks like walking at a normal pace, light housework, or carrying groceries trigger fatigue, chest discomfort, or shortness of breath. |
| 100% | A workload of 3.0 METs or less produces symptoms. Even minimal exertion — getting dressed or walking across a room — causes breathlessness, fatigue, or chest pain, and you cannot sustain meaningful physical activity. |
A diagnosis of CAD confirmed by cardiac catheterization, coronary CT angiography, or stress testing is required. The single most important piece of evidence is a METs assessment — either from an exercise stress test or, when a stress test cannot be done for medical reasons, from an interview-based estimate by the examiner. An echocardiogram helps, especially if it shows cardiac hypertrophy or dilatation, which supports a 30% rating on its own. For an Agent Orange presumptive claim you need proof of qualifying service; for a secondary claim you need a nexus opinion linking CAD to a service-connected condition such as type-2 diabetes or hypertension. Treatment records — medications (statins, beta-blockers, nitrates), procedures (stenting, bypass), and hospitalizations — document severity. Note: the VA revised this rating formula in 2021. It is now based on METs and, for the 30% level, cardiac hypertrophy or dilatation; it no longer uses ejection fraction (LVEF).