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7016
§ 4.104 Schedule of ratings—cardiovascular system.

Heart valve replacement

Surgical replacement of a damaged heart valve with an artificial or biological valve.

What the rating means

After a heart valve replacement, VA rates you at 100% for an indefinite period beginning on the date you are admitted to the hospital for the surgery. Six months after you are discharged, VA requires a mandatory examination and then rates you under the General Rating Formula for Diseases of the Heart going forward.

Under that formula, the rating depends on the workload level, measured in METs (metabolic equivalents), at which you develop heart failure symptoms such as breathlessness, fatigue, angina, dizziness, arrhythmia, palpitations, or syncope. If symptoms appear at 3.0 METs or less, the rating is 100%. Symptoms at 3.1 to 5.0 METs produce a 60% rating. Symptoms at 5.1 to 7.0 METs, or confirmed cardiac hypertrophy or dilatation on echocardiogram or equivalent imaging, produce a 30% rating. Symptoms at 7.1 to 10.0 METs, or a requirement for continuous medication to control the condition, produce a 10% rating. Any change in rating following the mandatory exam is governed by the provisions of 38 CFR § 3.105(e).

Evidence that helps

For the initial 100% period, hospital records confirming the date of admission for valve replacement surgery and the date of discharge are the key evidence.

For ratings under the General Rating Formula after the mandatory six-month examination, exercise stress test results that report the MET level at which you develop symptoms carry the most weight. If an exercise test cannot be done for medical reasons, a medical examiner may estimate the MET level based on specific activities, such as slow stair climbing, that bring on your symptoms. For a 30% rating based on structural changes rather than a MET threshold, an echocardiogram, multigated acquisition scan, or magnetic resonance imaging showing cardiac hypertrophy or dilatation is needed. For a 10% rating based on medication, records showing that continuous medication is required to control your heart condition support that level. Your own statements describing which everyday activities trigger breathlessness, fatigue, dizziness, or other symptoms can help connect your reported experience to the MET criteria.

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.