Ischemic Heart Disease
Coronary artery disease, heart attack and angina — a long-standing presumptive for herbicide-exposed veterans.
Ischemic heart disease is the umbrella the VA uses for reduced blood flow to the heart muscle — coronary artery disease, arteriosclerotic and atherosclerotic heart disease, a prior heart attack, angina, and the residuals of bypass surgery or coronary stents. For veterans with qualifying Agent Orange or tactical-herbicide exposure, it has been a recognized presumptive condition for years, and no nexus letter is required — a formal diagnosis is enough.
This is separate from hypertension, which the VA treats as its own presumptive condition and specifically excludes from ischemic heart disease. Here is what ischemic heart disease is, why the exposure link is presumed, and exactly what each rating level requires.
Understanding Ischemic Heart Disease
Ischemic heart disease develops when cholesterol plaque narrows or blocks the coronary arteries, starving the heart muscle of oxygen. It produces chest pain (angina), shortness of breath, fatigue on exertion, and — when an artery closes off — a heart attack. The VA groups coronary artery disease, atherosclerotic and arteriosclerotic heart disease, myocardial infarction, angina, and coronary bypass or stent residuals under this single heading.
The exposure link the VA now accepts for you
The VA recognizes ischemic heart disease as presumptively connected to exposure to Agent Orange and other tactical herbicides. Veterans who served in a qualifying location and timeframe — Vietnam, the Korean DMZ, certain Thailand air-base perimeters and other designated sites — do not have to prove the link between their service and their heart disease; the connection is presumed once the diagnosis is established.
Because this is a presumptive condition, you do not have to prove the science of how your service caused it. If you have a qualifying diagnosis and served in a covered location during a covered period, the VA presumes the connection — your job is to file, attend the exam, and make sure the rating reflects how badly it truly affects you.
Why this hits women differently
Heart disease in women is chronically under-recognized — symptoms are more often atypical and are frequently attributed to anxiety or fatigue rather than a cardiac cause. Women veterans with qualifying exposure are entitled to the same presumption, and a clear diagnosis plus an exercise-tolerance (METs) measurement is what secures the correct rating.
What the VA Pays for Ischemic Heart Disease
Ischemic Heart Disease is rated under 38 CFR 4.104, Diagnostic Code 7005 (arteriosclerotic heart disease / coronary artery disease). Here is exactly what each level requires, in plain English — not a table you have to decode.
A workload of 7.1 to 10 METs produces symptoms such as chest pain, shortness of breath, fatigue, dizziness or fainting; or continuous medication is required to control the condition.
A workload of 5.1 to 7 METs produces symptoms; or an echocardiogram, ECG or X-ray shows cardiac hypertrophy (enlargement) or dilatation of the heart.
More than one episode of acute congestive heart failure in the past year; or a workload of 3.1 to 5 METs produces symptoms; or the left-ventricular ejection fraction is 30 to 50 percent.
Chronic congestive heart failure; or a workload of 3 METs or less produces symptoms; or a left-ventricular ejection fraction below 30 percent.
Source: 38 CFR 4.104, Diagnostic Code 7005 (arteriosclerotic heart disease / coronary artery disease). Every percentage here is a starting point set by federal regulation, not a promise — your actual rating depends on your records and exam. An accredited representative can confirm exactly what fits your case.
One rating is rarely the whole picture
This condition does not stand alone. The VA combines it with every other service-connected condition you carry using its combined-ratings math — so a presumptive claim can push your overall rating higher than this one number suggests. And if your toxic-exposure conditions together make it impossible to hold steady, gainful work, you may qualify for TDIU (Total Disability based on Individual Unemployability) and be paid at the 100% rate even if no single condition reaches 100%. This is one of the most overlooked ways women veterans are underpaid.
Getting this rated at its true severity
Bring the results of any stress test, echocardiogram, cardiac catheterization or ejection-fraction measurement to your exam, and describe what activity brings on chest pain or breathlessness so the METs level is captured accurately. Note every heart medication and any bypass or stent procedure. An accredited representative can confirm the presumption applies and that the rating reflects your true exercise tolerance, not just a resting snapshot.
Do you qualify for Ischemic Heart Disease?
Under the PACT Act, a presumptive claim comes together when two things are true at once: you have a diagnosis of ischemic heart disease, and your service falls inside one of the covered toxic-exposure windows below. When both are met, the VA presumes your condition is service-connected — you do not have to prove how the exposure caused it.
Post-9/11 service
Afghanistan, Djibouti, Egypt, Jordan, Lebanon, Syria, Uzbekistan or Yemen — or the airspace above them — on or after September 11, 2001.
Gulf War-era service
Bahrain, Iraq, Kuwait, Oman, Qatar, Saudi Arabia, Somalia or the United Arab Emirates — or the airspace above them — on or after August 2, 1990.
Agent Orange & other exposures
Vietnam, Thailand, the Korean DMZ, Camp Lejeune and other recognized sites each carry their own presumptive rules and dates on top of the burn-pit windows.
Not sure whether your dates and locations line up? That is one of the most common reasons a valid claim gets denied — and one of the easiest to fix with the right records. An accredited representative can confirm your covered service before you file.
Filing a claim for Ischemic Heart Disease, step by step
You can file a PACT Act claim on your own — but knowing the order of operations keeps it from stalling. Here is what the process looks like from start to decision.
Confirm the diagnosis
Make sure the condition is documented in your medical records — from the VA or a private doctor. A clear, current diagnosis is the first half of a presumptive claim.
Establish your covered service
Pull your DD-214, deployment orders and duty history to show you served in a covered location during a covered period. This is the second half — and once both are met, the VA presumes the link.
File the claim
File for disability compensation and specify the condition and your toxic exposure. You can file it yourself, but an accredited representative can file it correctly the first time and make sure nothing is left off.
Attend the C&P exam
The VA will schedule a Compensation & Pension exam. Describe your symptoms on your worst days, not your best — the rating is set from what the examiner records.
You do not have to do this alone
A free, no-obligation record review will tell you whether ischemic heart disease fits the presumptive rules for your service — and exactly what to file. Scroll down to request yours.
The PACT Act & Toxic Exposure, Explained
A couple of clear, trustworthy explainers on the PACT Act and toxic-exposure benefits from official sources. Watch whenever you are ready.
The PACT Act and Your VA Benefits
The Department of Veterans Affairs explains what the PACT Act changed — expanded health care, new presumptive conditions, and who qualifies after toxic exposure.
Ask About the Toxic Exposure Screening
The Veterans Health Administration walks through the free 5–10 minute toxic exposure screening every enrolled veteran can get — and why it starts your exposure record.
These videos are shared for general education from official and third-party sources. They are not legal advice, and watching them is never required to get help with your claim.
See every presumptive condition, or read how the PACT Act works.
Think this fits your record?
We focus on veterans the VA has already denied or under-rated. We do not take brand-new (initial) claims, and we do not take every case.
Guidance from a VA-accredited claims agent (#45147). Any figures are estimates that depend on your situation and the VA's decision — not legal or medical advice, and not the VA.