How Veterans Get TDIU for Their Heart Conditions

Veterans with heart-related conditions connected to their military service can receive disability benefits from the U.S. Department of Veterans Affairs (VA). Such heart conditions are listed in diagnostic codes 7000 through 7123 of the VA disability schedule of ratings for the cardiovascular system.

Your heart condition ratings can often qualify for total disability individual unemployability (TDIU) benefits depending on your situation.

In this article, you will learn more about the listed heart conditions and how they may qualify for TDIU benefits. 

Explain How TDIU Benefits Work

The VA awards TDIU benefits to veterans whose disability prevents them from obtaining substantially gainful employment. This form of disability benefit allows veterans who may not have a 100% disability rating to still receive full benefits because their disability is so severe that it impacts their ability to work.

Requirements for TDIU Benefits

To qualify, you must be a veteran with a service-connected disability and without a dishonorable discharge. Additionally, your disability must meet one of two requirements:

• Have your disability rated 60 percent or higher.
• Have multiple disabilities with a minimum combined rating of 70 percent. However, one of those disabilities must have a rating of at least 40 percent.

If your service-connected disability does not meet percentage standards, you may still be eligible for TDIU benefits if your disability prevents you from finding employment. In this scenario, you can have the rating board submit your case to the Compensation Service Director of the VA for extra-schedular consideration.

TDIU Benefits and the 5-Year Rule

A rating for TDIU benefits is not permanent despite receiving 100 percent total disability benefits. Rather, a TDIU benefit rating is temporary. This means the VA can terminate your TDIU benefits under two circumstances.

The first circumstance is if you were to obtain substantially gainful employment. However, marginal employment or other protected work will usually not cause termination of TDIU benefits. Please be cautious before entering into any form of employment before or after receiving a TDIU rating to avoid unintentionally terminating your TDIU benefits.

The second terminating circumstance is if your disabling medical condition improves enough to obtain substantially gainful employment. The VA may, after a single medical exam, reduce or terminate your TDIU benefits if your condition has improved.

If your disability rating has been in place for five years or longer, then you have a VA stabilized rating. The stabilized rating is informally known as the 5-year rule. Under the 5-year rule, the VA cannot terminate benefits unless your medical condition shows sustained improvement. This usually requires multiple examinations by the VA.

Cardiovascular System Ratings in Diagnostic Codes 7000 to 7123

If you were recently diagnosed with a heart condition in the VA ratings schedule, your owed benefits – TDIU or otherwise – will depend on the rating assigned to your condition.

The VA will apply the schedule of rating descriptions in 38 CFR Section 4.104 to rate your heart condition. Most of the rating percentages for heart conditions are categorized at 10 percent, 30 percent, 60 percent, and 100 percent. Our VA disability rating calculator can help you determine an estimate of your monthly benefits based on your ratings and other relevant factors like marital status.

How the VA Measures the Seriousness of Your Service-Connected Heart Condition

The severity of a heart disease or related medical procedure is generally rated through a few different metrics.

• Chronic or acute congestive heart failure: Congestive heart failure happens when fluids fill up the chambers of the heart and cause the heart to pump blood inefficiently. Symptoms include shortness of breath, coughing, chest pain, rapid breathing, and possibly fainting. The VA will assign a 100 percent rating for conditions causing chronic heart failure and a 60 percent rating for multiple acute heart failure episodes in the past year.
• MET level: A measurement of your metabolic equivalent (MET) level that causes breathing difficulty, fatigue, chest pain, dizziness, or loss of consciousness. A MET is a measurement of the energy your heart uses when performing physical activity. The VA notes one MET as the energy cost of standing quietly at rest. For most heart conditions, the VA will assign a 100 percent rating for a MET level of three or less and a 60 percent rating for a MET level between three and five.
• Ejection fraction: An ejection fraction is a measurement of how much blood pumps out of your heart with each contraction and is reflected as a percentage. A normal ejection fraction ranges from 50 to 75 percent. The VA will rely on records of your left ventricle’s ejection fraction because it is the heart’s main pumping chamber. Ejection fractions are commonly measured with an echocardiogram or an MRI. Where applicable, the VA will assign a 100 percent rating for conditions causing an ejection fraction of less than 30 percent. A 60 percent rating will be given for ejection fractions between 30 and 50 percent.
• Evidence of cardiac hypertrophy or dilation: Cardiac hypertrophy describes an increase in the thickness of the heart muscle. Cardiac dilation, on the other hand, refers to an increase in the size of the inside cavity of one or more chambers of the heart. Both are measured using an electrocardiogram, echocardiogram, or x-ray. That said, the VA generally relies on this metric to rate heart conditions at 30 percent, which is less than the percentage needed to get TDIU benefits.

Heart Diseases

The heart is a complex organ with many valves, chambers, linings, and other subparts. Several of the VA diagnostic codes are for conditions that affect a particular part of the heart or affect the heart’s ability to receive or distribute blood. Unless noted otherwise, the VA rates each listed condition in this section at 100 percent if you have chronic heart failure, a MET level less than three, or an ejection fraction less than 30 percent. Alternatively, a 60 percent rating is given if you have acute heart failure, a MET level between three and five, or an ejection fraction between 30 and 50 percent.

• Valvular heart disease: Any damage or disease affecting any one of the heart valves will fall under Diagnostic Code 7000. The heart valves control the flow of blood from one heart chamber to the next. Most valvular diseases exist at birth or come from various infections. Rheumatic heart disease – which is permanent heart valve damage stemming from strep throat – also falls under this code.

The VA will give a 100 percent rating during any active infection causing valve damage and for three months following the end of any related therapy. Afterward, a rating of at least 60 percent is given for disease causing more than one acute heart failure in the past year, three METs level, or an ejection fraction of 30 to 50 percent.

• Endocarditis: This is an inflammation of the endocardium – the inner lining of the heart chambers – often caused by infection. Veterans with damaged or artificial heart valves are most at risk for endocarditis. Under Diagnostic Code 7001, the VA initially gives a 100 percent rating for three months after the end of related therapy for an active infection.
• Pericarditis: Inflammation of the fibrous sac that surrounds the heart, known as the pericardium. The VA ratings for pericarditis are identical to endocarditis.
• Pericardial adhesions: Pericarditis can cause adhesions to form on the pericardium that can restrict the movement of the heart as its chambers fill with blood and decrease heart function.
• Syphilitic heart disease: If left untreated, a bacterial infection called syphilis can cause serious damage to the heart valves or other blood vessels, including inflammation of the aorta. 
• Hyperthyroid heart disease: The thyroid gland’s overproduction of the thyroxine hormone is known as hyperthyroidism. Hyperthyroidism can cause a wide range of heart diseases, and the VA will apply the ratings for the particular cardiovascular diagnostic code at issue.
• Arteriosclerotic heart disease (coronary artery disease): This refers to the buildup of plaque from fats, cholesterol, and other substances along the walls of your arteries that can restrict the flow of blood to the heart. Lack of blood flow and oxygen can cause chest pain and discomfort called ischemic heart disease.
• Cardiomyopathy: A disease of the heart muscle that restricts the heart’s ability to pump blood throughout your body.

Conditions Secondary to Ischemic Heart Disease

Ischemic heart disease can cause other qualifying conditions with its own diagnostic code, such as heart attacks and hypertensive heart disease. The VA will assign a 100 percent rating for the three months after a heart attack before reevaluating the veteran’s rating.

Arrhythmias and Abnormal Heart Rates

Heart arrhythmias occur when electrical impulses that tell your heart chambers when to beat do not function properly. Sometimes, the dysfunction of the electric impulses comes from an atrioventricular block or sinus tachycardia. This can result in a heartbeat that is either too fast, too slow, or otherwise irregular.

When the irregular heart rate is above the left or right ventricle, it is called a supraventricular arrhythmia. When a supraventricular arrhythmia is too fast, it is called supraventricular tachycardia. The highest rating a veteran can receive for supraventricular tachycardia is 30 percent, making it ineligible for TDIU benefits without other disabilities. 

However, the VA allows higher ratings for more serious ventricular arrhythmias. Under Diagnostic Code 7011, the VA assigns ventricular arrhythmias a 100 percent rating for an indefinite period after any of the following events:

• Admission to the hospital for an initial evaluation.
• Admission to the hospital for a ventricular aneurysmectomy.
• Placement of an automatic implantable cardioverter-defibrillator (AICD).   

Diagnostic Codes for Heart-Related Medical Procedures

Many heart-related diseases and conditions result in necessary medical intervention through surgical procedures. The VA recognizes the disabling impact these heart-related procedures have on veterans through listed diagnostic codes.

• Heart valve replacement: The VA awards a 100 percent rating as of the date of admission for heart valve replacement. The VA will then perform a mandatory evaluation six months after the replacement surgery to determine the appropriate rating. 
• Coronary bypass surgery: This is a procedure used to restore blood flow to the heart by redirecting blood flow from a blocked artery. Sometimes, this involves the use of a heart stent to flatten the plaque in the artery and support the artery wall. The VA rates heart stents and other bypass surgeries at 100 percent for three months after hospital admission.
• Implantable cardiac pacemaker: A 100 percent rating is given for two months after hospital admission for the implantation or reimplantation of a pacemaker. Afterwards, the veteran will be rated under the diagnostic code for the applicable arrhythmia or atrioventricular block.
• Heart transplant: A 100 percent rating is applied for the first year following discharge from the hospital before a mandatory VA exam will determine your rate moving forward.

Artery and Vein-Related Conditions

In addition to diseases of the heart, the VA ratings for the cardiovascular system include other conditions primarily affecting the veins and arteries connected to the heart.

• Hypertensive vascular disease: High blood pressure can receive a rating of 60 percent when you have a diastolic pressure of 130 or more and confirmed by readings taken two or more times on at least three different days.  
• Aneurysm: Ratings for an aortic aneurysm under Diagnostic Code 7110 are 60 or 100 percent. The VA will reevaluate the rating six months after discharge from the hospital for any surgical correction of an aneurysm. The VA will rate an aneurysm in a large artery based on the associated limb pain or cramp-like pain – also known as claudication – experienced while walking.
• Other vein conditions: Traumatic arteriovenous fistula, arteriosclerosis obliterans, Buerger’s disease, Raynaud’s syndrome, angioneurotic edema, erythromelalgia, varicose veins, post-phlebitic syndrome, cold injury residuals, and soft tissue sarcoma. Most of these conditions are rated based on the presence of pain, swelling, eczema, cold sensitivity, numbness, ulcers, etc.

Receiving Your TDIU Benefits for Heart Conditions

Heart conditions and their treatment can be both life-threatening and life-altering. Your recovery can be lengthy and require that you avoid physical activity and stress-inducing environments like work.

Receiving TDIU benefits in these cases can be critical to maintaining a high quality of life while living with your heart condition. Woods & Woods is a family-owned law firm that has been helping veterans secure their TDIU and other disability benefits since 1985. We have a large staff of attorneys, doctors, psychiatrists, and other professionals experienced in the claims process, including the appeal of VA decisions over rate assessment or denial of benefits.

At Woods and Woods, the Veteran’s Firm, we’ve helped thousands of veterans with their VA disability applications and appeals. We’ve been adding staff and lawyers during the Covid pandemic to better serve disabled veterans in difficult times.

Call us today to discuss your VA disability appeal or your first application. The call is free and we won’t charge you a single fee until we win your case. We even pay for the postage for all of the documentation you send to our office. You can look for a VA disability attorney near you or call us and join the thousands of veterans living off of VA disability thanks to Woods and Woods.

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