Heart valve replacement VA Rating
How VA rates Heart valve replacement under diagnostic code 7016, what evidence decides the percentage, and the reasons these claims get denied or under-rated.
Heart valve replacement is rated under diagnostic code 7016. In the VA Schedule for Rating Disabilities it appears as Heart valve replacement (prosthesis), within the Cardiovascular System section of 38 CFR Part 4.
The essentials
| Diagnostic code | 7016 |
|---|---|
| Rating schedule name | Heart valve replacement (prosthesis) |
| Body system | Cardiovascular System |
| Examination form | CARDIO Heart conditions |
How VA rates heart valve replacement
Heart valve replacement has no percentage criteria of its own. It is rated under the General Rating Formula for Diseases of the Heart, the same scale VA applies to every condition in that group — so the percentage turns entirely on how your symptoms measure against these levels, not on the diagnosis itself.
| Rating | Criteria |
|---|---|
| 100% | Workload of 3.0 METs or less results in heart failure symptoms |
| 60% | Workload of 3.1-5.0 METs results in heart failure symptoms |
| 30% | Workload of 5.1-7.0 METs results in heart failure symptoms; or evidence of cardiac hypertrophy or dilatation confirmed by echocardiogram or equivalent (e.g., multigated acquisition scan or magnetic resonance imaging) |
| 10% | Workload of 7.1-10.0 METs results in heart failure symptoms; or continuous medication required for control |
- Note: 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…
Criteria quoted from 38 CFR Part 4, Subpart B (eCFR edition 2026-01-01). Where a rating depends on measurements, the figures in your examination report are what decide it — which is why an examination that skipped a required measurement is worth challenging.
Other names for this condition
VA and treating providers may use different terms for the same condition. If your records use any of these, they may still support a claim for Heart valve replacement:
- Prosthetic heart valve
What evidence decides the rating
For cardiovascular system conditions, these are the findings VA weighs when assigning a percentage. If your examination did not address them, the examination may be inadequate for rating purposes — which is itself an argument on appeal.
- METs testing — either an exercise stress test or an interview-based METs estimate with the examiner's rationale
- Left ventricular ejection fraction
- Evidence of congestive heart failure episodes and their frequency
- For hypertension: predominant diastolic and systolic readings, and whether continuous medication is required
Why these claims get denied or under-rated
These are the failure patterns we see most often on heart valve replacement and related cardiovascular system claims:
- No METs testing was performed and no interview-based estimate with rationale was provided
- Hypertension denied because current readings are controlled by medication, without addressing what the readings would be without it
- Predominant readings were taken from a single visit rather than across the record
If your claim was denied or under-rated
A denial is not the end of the claim. Which route is right depends on why VA decided the way it did:
- Higher-Level Review — when the evidence already in the file supports a grant and VA got the decision wrong, or the examination was inadequate.
- Supplemental Claim — when you have new and relevant evidence, such as a private nexus opinion.
- Board Appeal — when you need a Veterans Law Judge to decide, or want a hearing.
- Clear and Unmistakable Error — when a decision more than a year old contains an undebatable error, which can recover retroactive pay.
Effective dates matter as much as the percentage. See effective dates and back pay for how far back an award can reach.
Sources
Related conditions
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This page is educational information, not legal advice. VA rules and deadlines change — always confirm details with the official source (38 CFR, M21-1) or your accredited claims agent. Borne Accredited Claims is an accredited VA claims agent under 38 CFR §14.629 and is not part of, or endorsed by, the Department of Veterans Affairs. We do not guarantee any specific outcome.