Heart valve replacement (prosthetic) involves excision of the affected valve and substituting a mechanical or biological prosthesis.

The heart valves can malfunction either by leaking (valve regurgitation) or by failing to open adequately (valve stenosis). Either problem can seriously interfere with the heart's ability to pump blood. Sometimes a valve has both problems. If severe symptoms are experienced and they can not be managed with medications or diet, valve replacement surgery is indicated.

The first indications of mitral stenosis are usually difficulty in breathing or fatigue. If these symptoms become severe and are accompanied by hemoptysis, arrhythmias, pulmonary hypertension or an enlarged right ventricle or both, replacement surgery is indicated. In mitral insufficiency, replacement is indicated when difficulty in breathing, fatigue, and palpitations interfere with daily activity, or if acute situations should occur, e.g., rupture of a muscle. In addition, in aortic insufficiency, replacement is indicated if the patient experiences palpitations; dizziness; shortness of breath on exertion; angina; murmurs; and evidence of enlargement of the left ventricle on x-ray, echocardiogram, and electrocardiogram (EKG). Finally, indications for replacement in aortic stenosis depend on both the degree of manifestations and the extent of the stenosis evaluated during cardiac catheterization. The aforementioned measures are necessary since severe stenosis can occur without symptoms.

EKG is used to reveal left atrial enlargement if the patient is in sinus rhythm. In addition, left atrial enlargement, mitral valve calcification, and signs of pulmonary congestion can all be evaluated via chest x-ray. Doppler echocardiography is the test of choice for investigating and diagnosing the severity of stenosis. Moreover, the measure assists also in determining whether intervention is needed, and the type of intervention that would be most appropriate. Echocardiography also allows accurate differentiation of mitral stenosis amongst other diagnostic possibilities.

Heart valve replacement is a treatment for the aforementioned conditions.

The mortality rate associated with valve replacement is largely dependent upon the degree of functional disability prior to surgery. Overall, the mortality rate is said to be relatively low. However, it can result in serious complications, e.g., hemorrhage, ceberal vascular accident (CVA), bacterial endocarditis (within days or months), and the artificial valve may fail as the device ages.

• 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).

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.

• Six months following discharge from inpatient hospitalization, disability evaluation shall be conducted by mandatory VA examination using the General Rating Formula. Apply the provisions of § 3.105(e) of this chapter to any change in evaluation based upon that or any subsequent examination.

• 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.