If the VA already service-connected your ischemic heart disease (also called IHD, coronary artery disease, CAD, heart disease), it can cause or worsen other conditions that are ratable on their own. These "secondary" claims are where many veterans leave money on the table. Below is what a service-connected ischemic heart disease commonly leads to, why, and what evidence each one takes.
Many veterans with ischemic heart disease (IHD) also have numbness, tingling, or burning in the feet or hands. There is no automatic rule that makes neuropathy secondary to IHD, so it helps to know the three routes VA can use:
IHD and early-onset peripheral neuropathy are both on the herbicide (Agent Orange) presumptive list in 38 CFR 3.309(e). The catch for neuropathy: under 38 CFR 3.307(a)(6)(ii) it must have shown up to a degree of 10 percent or more within one year of your last herbicide exposure. Neuropathy that started years later usually needs one of the routes below.
VA service-connects a condition that is "proximately due to or the result of" a service-connected one, or that it made worse. For neuropathy this is case-specific: you need a current diagnosis and a doctor's opinion that your IHD, or its treatment, at least as likely as not caused or aggravated it, with the medical reasoning. VA does not presume this link.
Type 2 diabetes is also on the 3.309(e) list. If diabetes is service-connected and your neuropathy is diabetic, the claim usually runs through diabetes rather than the heart. Conditions secondary to diabetes →
Neuropathy is rated nerve by nerve under 38 CFR 4.124a, by how severe the paralysis is. For the sciatic nerve (the most common for the legs, DC 8520):
| Sciatic nerve (DC 8520) | Rating |
|---|---|
| Mild incomplete paralysis | 10% |
| Moderate incomplete paralysis | 20% |
| Moderately severe incomplete paralysis | 40% |
| Severe incomplete paralysis, with marked muscular atrophy | 60% |
| Complete paralysis (the foot dangles and drops) | 80% |
When the involvement is wholly sensory (numbness, tingling, pain without weakness), 38 CFR 4.124a says the rating should be for the mild, or at most the moderate, degree. Each leg or arm is rated separately and the bilateral factor applies.
A secondary claim only works if the primary condition (ischemic heart disease) is already service-connected, and you have a nexus — a doctor's opinion that it is "at least as likely as not" the cause. Nexus letter sample and template →
The same vascular disease that narrows heart arteries narrows the arteries involved in erections, and cardiac medications add to it. ED is usually rated 0% but service connection unlocks tax-free SMC-K for loss of use of a creative organ.
What you'd need: A diagnosis of ED, your cardiac medication list, and a nexus opinion linking the ED to the heart disease or its treatment. No percentage rating is needed to get SMC-K.
Living with a serious cardiac condition is a recognized cause of secondary depression and anxiety; VA grants mental-health conditions caused or aggravated by chronic physical illness.
What you'd need: A mental-health diagnosis from a provider and a nexus opinion connecting it to the burden of the heart disease.
Advanced coronary disease can progress to heart failure, which is rated more highly. If your cardiac function has worsened, an increased evaluation or a distinct rating may apply.
What you'd need: An echocardiogram (ejection fraction), a workload/METs assessment, and current cardiology records.