Arteriosclerotic heart disease is defined as any sclerosis, thickening, hardening and/or loss of elasticity of the walls of the arteries of the heart which can reduce or obstruct blood flow. It is also diagnosed as ischemic heart disease and coronary artery disease. Coronary artery disease refers to any narrowing or obstruction of arterial spaces that interferes with the passage of blood through the arteries of the heart (cardiac perfusion).

The cause of arteriosclerotic heart disease is unknown. Risk factors include: hypertension; elevated blood lipids, particularly cholesterol and triglycerides, (elevated levels of low-density lipoprotein [LDL] and reduced levels of high-density lipoprotein [HDL]); cigarette smoking; high-fat, high-carbohydrate diets; diabetes mellitus; obesity; male gender; and a family history of heart disease. Presumed risk factors also include physical inactivity, and increasing age. The most common cause of coronary artery disease is atherosclerosis. Other causes of coronary artery disease include: arteritis, coronary artery spasms, certain infectious diseases, and congenital defects in the coronary vascular system.

Signs and symptoms of the condition may include: angina, chest pain or pressure occurring during walking, but subsiding with rest, and dyspnea. Other signs and symptoms may include: nausea, vomiting, weakness, diaphoresis, and cool extremities.

The functional abilities of cardiac patients can be classified in terms of metabolic equivalents (METs). The classification is generally as follows:

• Light to medium housework is 2 to 4 METs

• Heavy housework or yard work is approximately 5 to 6 METs

• Strenuous activity would be 7 to 10 METs, etc.

To determine the limitations on patient's functional abilities, the METs are considered in accordance with what symptoms are exhibited when the activities are carried out. For example, if a patient is performing activity at the 2 to 4 MET level and experiences dyspnea, fatigue, dizziness or fainting, the patient is considered to have low functional abilities, thus making the effects of coronary artery disease significant.

Tests for the condition include: an electrocardiogram (EKG), a coronary angiography, stress-testing echocardiogram, and serum lipid studies.

Treatment of the condition focuses on reducing myocardial oxygen demands, and increasing myocardial oxygen supply. Medications used in the treatment may include: vasodilators, beta-adrenergic blockers, or calcium channel blockers. In addition, coronary artery bypass graft (CABG) surgery, percutaneous transluminal coronary angioplasty (PTCA), or laser angioplasty may be done. Treatment may also include: a low-fat diet, recommendation to stop smoking, and treatment of risk factors, including obesity, diabetes mellitus, and hypertension, if they are present.

Residual effects range from a permanent reduction in activity levels to complete freedom of activity.

• May be entitled to special monthly compensation where the Veteran has a single service-connected disability rated as 100% with additional service-connected disability or disabilities independently ratable at 60% or more, which are separate and distinct from the 100% service-connected disability and involves different anatomical segments or bodily systems. See  38 CFR 3.350(i)(1) – Special Monthly Compensation (SMC).

• Cardiovascular Disease - Ischemic heart disease, or other cardiovascular disease (including hypertension) which develops subsequent to the service-connected amputation of one lower extremity at or above the knee, or service-connected amputations of both lower extremities at or above the ankles, shall be held to be a proximate result of the service-connected amputation or amputations (See 38 CFR 3.310(b) [Cardiovascular disease]) 

• This disease shall be granted service connection although not otherwise established as incurred in or aggravated by service if manifested to a compensable degree within the applicable time limits under 38 CFR 3.307 following service in a period of war or following peacetime service on or after January 1, 1947, provided the rebuttable presumption provisions of 38 CFR 3.307 are also satisfied [ 38 CFR 3.309 .  [Disease subject to presumptive service connection], 38 CFR 3.309 (a) [chronic disease].

• If a Veteran is a former prisoner of war, this disease shall be service connected if manifest to a degree of disability of 10 percent or more at any time after discharge or release from active military, naval, or air service even though there is no record of such disease during service, provided the rebuttable presumption provisions of 38 CFR 3.307 are also satisfied [ 38 CFR 3.309 (c) Disease subject to presumptive service connection].

• Arteriosclerotic Heart Disease - Arteriosclerotic heart disease, also diagnosed ischemic heart disease and coronary heart disease, is a disease of the heart due to diminution of blood supply to the heart muscle on account of arteriosclerotic narrowing of the lumen of one or both coronary arteries.

• Service connects any sudden development, during service, of coronary occlusion or thrombosis. However, mere identification of coronary heart disease upon routine examination early in service is not a basis for service connection.

• IHD became a condition presumptively associated with herbicide exposure effective August 31, 2010.  This was a liberalizing change of law. Therefore, unless an earlier effective date is available under the provisions of 38 CFR 3.816, consider the application of 38 CFR 3.114(a) when granting presumptive SC for IHD related to herbicide exposure under the provisions of 38 CFR 3.307(a)(6) and 38 CFR 3.309(e).

• If a Veteran was exposed to an herbicide agent during active military, naval, or air service, this disease shall be service-connected if the requirements of 38 CFR 3.307(a)(6) are met even though there is no record of such disease during service, provided further that the rebuttable presumption provisions of 38 CFR 3.307(d) are also satisfied. [38 CFR 3.309(e)]

Notes

• Evaluate cor pulmonale, which is a form of secondary heart disease, as part of the pulmonary condition that causes it.

• One MET (metabolic equivalent) is the energy cost of standing quietly at rest and represents an oxygen uptake of 3.5 milliliters per kilogram of body weight per minute. When the level of METs at which breathlessness, fatigue, angina, dizziness, or syncope develops is required for evaluation, and a laboratory determination of METs by exercise testing cannot be done for medical reasons, a medical examiner may estimate the level of activity (expressed in METs and supported by specific examples, such as slow stair climbing or shoveling snow) that results in those symptoms.

• For this general formula, heart failure symptoms include, but are not limited to, breathlessness, fatigue, angina, dizziness, arrhythmia, palpitations, or syncope.

• If non-service-connected arteriosclerotic heart disease is superimposed on service-connected valvular or other non-arteriosclerotic heart disease, request a medical opinion as to which condition is causing the current signs and symptoms.

• The rating criteria for cardiovascular conditions underwent full-scale revision effective on November 14, 2021 and January 12, 1999.  A regulatory change was effective August 13, 1998, updated criteria for cold injury residuals under 38 CFR 4.104, DC 7122.  The changes are not considered liberalizing and should not be used as the basis for reduction unless the disability has actually improved.