Ischemic and non-ischemic heart disease, arrhythmias, valve disease, infections of the heart and cardiac surgery are documented for VA disability claims on this 10-page questionnaire. The clinician lists diagnoses, states which qualify as ischemic heart disease and their etiology, records MIs, arrhythmia treatment interventions per year, procedures and hospitalizations, then documents cardiac hypertrophy or dilatation and a METs level. The form requires a METs level for nearly every heart exam.
The Veteran's treating or examining clinician completes the form and signs the Section XVI examiner's certification. The Veteran answers the interview-based METs questions but fills in no part of the form.
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Heart Conditions (Including Ischemic and Non-Ischemic Heart Disease, Arrhythmias, Valvular Disease and Cardiac Surgery) Disability Benefits Questionnaire
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No exercise test is required if it is medically contraindicated, a prior test reflects current function, or it is not part of the treatment plan and carries significant risk. In those cases the examiner performs an interview-based METs test, recording the lowest activity level at which the Veteran reports breathlessness, fatigue, angina, dizziness or syncope.
Item 2B asks the examiner to list conditions that meet the generally accepted medical definition of ischemic heart disease, and item 2C asks for each condition's etiology and its relationship to the IHD. The distinction matters to VA when it decides which conditions are connected to service.
Section VIII records non-surgical and surgical procedures: percutaneous coronary intervention, coronary artery bypass surgery, heart transplant, pacemaker or AICD implantation and valve replacement, each with dates, facility and the condition that required it. Other cardiac hospitalizations go in Section IX with admission and discharge dates.