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7020
§ 4.104 Schedule of ratings—cardiovascular system.

Cardiomyopathy (heart muscle disease)

A disease of the heart muscle that may cause the heart to enlarge, thicken, or stiffen.

What the rating means

Cardiomyopathy is rated under the General Rating Formula for Diseases of the Heart in § 4.104. The formula has four possible ratings: 10%, 30%, 60%, and 100%.

The key measure is the workload level, expressed in METs (metabolic equivalents), at which heart failure symptoms appear. One MET equals the energy your body uses standing quietly at rest. Heart failure symptoms include breathlessness, fatigue, angina, dizziness, arrhythmia, palpitations, or syncope, but are not limited to those.

A 100% rating applies when symptoms develop at a workload of 3.0 METs or less. A 60% rating applies when symptoms develop between 3.1 and 5.0 METs. A 30% rating applies when symptoms develop between 5.1 and 7.0 METs, or when cardiac hypertrophy or dilatation is confirmed by echocardiogram or an equivalent imaging study. A 10% rating applies when symptoms develop between 7.1 and 10.0 METs, or when continuous medication is required for control.

Evidence that helps

Exercise stress test results are central evidence for this condition, because they show the MET level at which your symptoms appear. If exercise testing cannot be done for medical reasons, a medical examiner may estimate your MET level based on specific physical activities — such as slow stair climbing or shoveling snow — that bring on your symptoms.

For a 30% rating based on structural changes rather than MET level, you would need an echocardiogram, a multigated acquisition scan, or an MRI confirming cardiac hypertrophy or dilatation. For a 10% rating based on medication, records showing that continuous medication is required to control the condition support that level.

Medical records documenting your diagnosed cardiomyopathy, cardiology notes, and imaging reports all speak to the criteria above. Statements from you or people who know you describing how symptoms like fatigue, shortness of breath, or dizziness limit your physical activity can help connect your reported exertion level to the MET thresholds in the rating formula.

Secondary conditions

Conditions that are often caused or made worse by this one. If you have any of these, they may be claimable as secondary service connection.