Hypertensive Heart Disease VA Rating Guide

Overview

Hypertensive heart disease is structural heart change (left-ventricular hypertrophy, dilatation, dysfunction) caused by chronic high blood pressure. It is rated separately from the hypertension itself.

It uses the same METs / ejection-fraction tier structure as ischemic heart disease (DC 7005), but under its own diagnostic code (DC 7007).

PACT Act note: hypertension and 'monoclonal gammopathy of undetermined significance' (MGUS) became presumptive under the PACT Act in 2024; hypertensive heart disease developing from a presumptive hypertension is therefore eligible for secondary service connection on a streamlined basis for covered Vietnam-era and post-9/11 veterans.

How to Establish Service Connection

• Direct: in-service onset of cardiac hypertrophy or dysfunction documented during active service.
• Secondary (most common path): hypertensive heart disease secondary to service-connected hypertension — well-established medical pathway.
• Presumptive: for veterans with PACT Act-covered service, the underlying hypertension is presumptive, and hypertensive heart disease can flow as a secondary.
• Agent Orange: hypertension is also a presumptive condition under the PACT Act for Vietnam-era veterans, and the secondary heart-disease pathway applies.

Rating Criteria

Paraphrased from 38 CFR § 4.104, Diagnostic Code 7007

See what each percentage pays in 2026 and how it combines with your current rating →

Evidence Checklist

• Echocardiogram showing left-ventricular hypertrophy, dilatation, or reduced ejection fraction.
• Cardiac stress test with measured METs (treadmill, Bruce protocol).
• EKG showing LVH or strain pattern.
• Documentation of service-connected hypertension and continuous antihypertensive medication.
• Cardiology nexus opinion linking the structural heart change to long-standing hypertension.
• PACT Act exposure documentation when claiming through the presumptive route.

Common pitfalls VA sees

• Assuming a hypertension rating already covers heart disease — they are separate conditions and rated independently.
• Filing only on a 'hypertension' theory when an echo already documents structural change. File the specific DC 7007 condition.
• Skipping the nexus opinion when filing as a secondary — even an obvious medical pathway should have a clinician's written opinion.

Common Secondary Conditions

Conditions frequently service-connected as secondary to Hypertensive Heart Disease:

What the C&P Exam Documents

General information about how this condition is typically evaluated. This is not coaching on what to say and is not a substitute for medical or legal advice.

• →If you cannot complete a stress test, the examiner can estimate METs based on activity tolerance documented in cardiology and primary care notes.
• →Bring a list of antihypertensive medications and dosages, and any dose-escalation history — chronic medication on its own supports at least 10%.
• →If you have been hospitalized for CHF in the past year, make sure those records are in the file before the exam.

Frequently Asked Questions