Hypertensive heart disease is rated by the VA under Diagnostic Code 7007, with disability ratings of 10%, 30%, 60%, or 100% based on a combination of METs (metabolic equivalent) testing results, ejection fraction, cardiac hypertrophy, and episodes of congestive heart failure. In 2026, a 100% rating pays $3,938.58 per month for a veteran with no dependents, while a 10% rating pays $180.42. This guide breaks down the exact criteria for each rating level, how the VA measures heart function, and how to file or appeal a claim.
What Is Hypertensive Heart Disease, and How Is It Different From Hypertension Alone?
Hypertensive heart disease occurs when chronic high blood pressure damages the heart muscle, causing it to thicken, enlarge, or weaken over time. It's a distinct diagnosis from hypertension (high blood pressure) itself, and the VA rates the two conditions differently.
- Hypertension alone is rated under Diagnostic Code 7101, based strictly on blood pressure readings (systolic and diastolic numbers), maxing out at 60%.
- Hypertensive heart disease is rated under Diagnostic Code 7007, based on how well the heart actually functions, measured primarily through METs testing, ejection fraction, and evidence of heart enlargement or failure. This code can reach a 100% rating.
If your blood pressure has caused measurable heart damage, such as left ventricular hypertrophy, an enlarged heart on echocardiogram or x-ray, or reduced ejection fraction, you should be rated under 7007, not 7101. Veterans are sometimes under-rated because their claims file only reflects blood pressure numbers and not the cardiac workup showing heart damage. Getting the correct diagnostic code applied can significantly increase a monthly payment.
VA Rating Criteria for Hypertensive Heart Disease (Diagnostic Code 7007)
The VA's rating schedule for the cardiovascular system evaluates hypertensive heart disease using METs (a measure of how much physical exertion the heart can handle before symptoms occur), along with objective test findings like echocardiograms, ejection fraction, and history of congestive heart failure.
| Rating | Criteria |
|---|
| 100% | Chronic congestive heart failure, or workload of 3 METs or less results in dyspnea, fatigue, angina, dizziness, or syncope, or left ventricular dysfunction with an ejection fraction less than 30% |
| 60% | More than one episode of acute congestive heart failure in the past year, or workload of greater than 3 METs but not greater than 5 METs results in dyspnea, fatigue, angina, dizziness, or syncope, or left ventricular dysfunction with an ejection fraction of 30% to 50% |
| 30% | Workload of greater than 5 METs but not greater than 7 METs results in dyspnea, fatigue, angina, dizziness, or syncope, or evidence of cardiac hypertrophy or dilatation on echocardiogram, EKG, or x-ray |
| 10% | Workload of greater than 7 METs but not greater than 10 METs results in dyspnea, fatigue, angina, dizziness, or syncope, or continuous medication is required to control the condition |
A veteran only needs to meet one of the listed criteria at a given level, not all of them, to qualify for that rating. For example, a veteran whose echocardiogram shows cardiac hypertrophy automatically qualifies for at least 30%, even if their METs testing comes back higher than the 5 to 7 range, because the criteria are written as "or" conditions, not "and" conditions.
Understanding METs Testing
METs measure the amount of oxygen your body uses during physical activity. A METs test (often part of an exercise stress test) estimates how much exertion causes cardiac symptoms like chest pain, shortness of breath, dizziness, or fainting. Lower METs tolerance means the heart cannot handle much exertion before symptoms appear, which corresponds to a more severe rating.
Common activity comparisons the VA references:
- 10 METs: strenuous activities like swimming, jogging at 6 mph, or heavy yard work
- 7 METs: moderate activities like walking briskly, golfing without a cart, or climbing stairs
- 5 METs: light activities like walking at 4 mph or vacuuming
- 3 METs: minimal activities like slow walking, light housework, or eating
If actual METs testing is medically contraindicated (for example, if it would put the veteran at serious risk), the examiner may estimate METs based on the veteran's reported symptoms and other clinical findings.
2026 VA Disability Compensation Rates
VA disability payments increased 2.8% for 2026 following the annual cost-of-living adjustment (COLA), effective December 1, 2025. Here's what a hypertensive heart disease rating pays per month, depending on dependent status.
| Rating | Veteran Alone | Veteran with Spouse | Veteran with Spouse + 1 Child |
|---|
| 10% | $180.42 | $180.42 | $180.42 |
| 30% | $552.47 | $617.47 | $665.47 |
| 60% | $1,435.02 | $1,569.02 | $1,656.02 |
| 100% | $3,938.58 | $4,163.16 | $4,254.16 |
Rates for 10% ratings do not change based on dependents, since additional dependent compensation only applies at 30% and above. Veterans with additional dependents, such as multiple children or dependent parents, receive higher amounts than shown here. Check current figures on the VA's compensation rate tables, since these are adjusted annually.
How to Get Service Connection for Hypertensive Heart Disease
To get a hypertensive heart disease rating, you first need service connection, meaning the VA agrees your heart condition is linked to your military service. There are three common paths:
1. Direct Service Connection
You developed hypertensive heart disease during or as a result of active duty service. This requires:
- A current diagnosis of hypertensive heart disease
- An in-service event, injury, or illness (such as documented high blood pressure during service)
- A medical nexus linking the current condition to that in-service event
2. Secondary Service Connection
Most hypertensive heart disease claims are filed as secondary conditions, connected to an already service-connected condition such as hypertension, PTSD, diabetes, or sleep apnea. To win a secondary claim, you need:
- A current diagnosis of hypertensive heart disease
- An existing service-connected condition (most commonly hypertension)
- A nexus letter or medical opinion stating it is at least as likely as not (50% or greater probability) that your service-connected condition caused or aggravated your heart disease
If you already have a hypertension rating under Diagnostic Code 7101, and your blood pressure has caused measurable heart damage, a secondary claim for hypertensive heart disease under 7007 is often the most direct path to a higher combined rating.
3. Presumptive Service Connection
Under the PACT Act, hypertension itself became a presumptive condition for Vietnam-era veterans exposed to Agent Orange, with full implementation beginning October 1, 2026 (veterans who are 85 or older, homeless, or terminally ill may qualify sooner). While hypertensive heart disease is not itself on the presumptive list, veterans with presumptive hypertension who go on to develop heart damage can file a secondary claim for the heart condition using the same nexus requirements above. Separately, ischemic heart disease is already a presumptive condition for Agent Orange, Camp Lejeune, and certain burn pit exposures, and is rated under a related diagnostic code (7005), so veterans should have their cardiologist clarify which specific heart diagnosis applies.
Evidence You Need to Support Your Claim
Because the rating depends on objective cardiac testing, not just symptoms, strong medical evidence makes the biggest difference in the outcome. Gather:
- Echocardiogram results showing ejection fraction, chamber size, and any hypertrophy or dilatation
- METs testing or exercise stress test results, or a treating physician's estimate if testing is contraindicated
- EKG results documenting cardiac abnormalities
- Blood pressure logs over time showing the hypertension history
- Treatment records showing continuous medication use for the heart condition
- Hospitalization records for any congestive heart failure episodes
- A nexus letter from a cardiologist or treating physician connecting the condition to service or to a service-connected condition
How to File a Claim
- Gather medical evidence. Get copies of echocardiograms, stress tests, EKGs, and treatment notes from your cardiologist or primary care provider.
- File VA Form 21-526EZ (Application for Disability Compensation and Related Compensation Benefits) online through VA.gov, by mail, or with help from a Veterans Service Organization (VSO).
- Attend the Compensation & Pension (C&P) exam. The VA will schedule a cardiac exam, which typically includes a review of your echocardiogram, an EKG, and either a METs test or a clinical estimate of your METs tolerance.
- Wait for the rating decision. The VA will issue a decision letter with your assigned percentage and effective date.
- Appeal if needed. If the rating doesn't reflect your actual heart function, or the wrong diagnostic code was applied, you can file a Supplemental Claim with new evidence, request Higher-Level Review, or appeal to the Board of Veterans' Appeals.
Can Hypertensive Heart Disease Combine With Other Ratings for TDIU?
If your combined disability ratings don't reach 100% schedular, but your hypertensive heart disease and other service-connected conditions together prevent you from maintaining substantially gainful employment, you may qualify for Total Disability based on Individual Unemployability (TDIU). TDIU pays at the 100% compensation rate even if your combined schedular rating is lower, as long as you meet the percentage thresholds (generally one condition rated at least 60%, or a combined rating of 70% with one condition at least 40%) and can show the condition prevents you from working.
Frequently Asked Questions
What is the highest VA rating for hypertensive heart disease?
The highest rating is 100%, awarded when a veteran has chronic congestive heart failure, a workload of 3 METs or less causing cardiac symptoms, or left ventricular dysfunction with an ejection fraction below 30%. In 2026, this pays $3,938.58 per month for a veteran with no dependents.
Can I get separate ratings for hypertension and hypertensive heart disease?
No. The VA does not allow separate ratings for hypertension (Diagnostic Code 7101) and hypertensive heart disease (Diagnostic Code 7007) for the same underlying condition, since this would be considered pyramiding (rating the same disability twice). Once heart damage is confirmed, the condition is typically rated under 7007 instead of 7101, using whichever code gives the higher, more accurate rating.
Does hypertensive heart disease qualify as a presumptive condition?
Not directly, but hypertension itself is presumptive for Vietnam-era veterans exposed to Agent Orange, with full implementation starting October 1, 2026. Veterans with presumptive hypertension who develop hypertensive heart disease can file a secondary service connection claim for the heart condition, which uses a lower evidence burden than a fresh direct service connection claim.
What if I disagree with my C&P exam results?
You can request a Supplemental Claim with new and relevant evidence, such as a second echocardiogram or an independent medical opinion, or request Higher-Level Review if you believe the examiner misapplied the rating criteria. Many veterans successfully appeal low ratings by submitting a private cardiologist's nexus letter and updated testing.
How often will the VA reevaluate my heart disease rating?
The VA typically schedules future exams for ratings that are not considered static or permanent, often every 2 to 5 years, especially at higher percentages where heart function could improve or worsen. If your condition has been stable for years, you can request the VA designate it as static to avoid repeat exams.
Are VA disability payments for hypertensive heart disease taxable?
No. VA disability compensation, including payments for hypertensive heart disease, is not subject to federal or state income tax.
If you're a veteran managing a service-connected heart condition, you may also qualify for additional benefits like Medicaid, SNAP, or Medicare depending on your income and household situation. Use the free eligibility screener at /screener to see what else you may qualify for.
