38 CFR Part 4 — 38 CFR § 4.104
Syphilitic heart disease — VA Diagnostic Code 7004
Cardiovascular
Diagnostic code
7004
38 CFR § 4.104 lists Diagnostic Code 7004 as “Syphilitic heart disease:”. The title ends with a colon. The rating cell is empty. The next cell is a note that evaluates syphilitic aortic aneurysms under DC 7110. The table caption “Diseases of the Heart” carries this headnote: “[Unless otherwise directed, use this general rating formula to evaluate diseases of the heart.]” The brackets are in the headnote. Appendix B to Part 4 indexes “Syphilitic heart disease.” with a period and without the colon.
Reviewed 2026-10-05. Text checked against the eCFR versioner full-text XML for 2026-10-01 on 2026-10-05. Title 38 was up to date as of 2026-10-01 and last amended on 2026-08-27. The § 4.104 source note prints 62 FR 65219, Dec. 11, 1997, as amended at 63 FR 37779, July 14, 1998; 71 FR 52460, Sept. 6, 2006; 79 FR 2100, Jan. 13, 2014; 82 FR 50804, Nov. 2, 2017; 86 FR 54093, Sept. 30, 2021; 86 FR 62095, Nov. 9, 2021. The § 4.100 source note prints 71 FR 52460, Sept. 6, 2006, as amended at 86 FR 54093, Sept. 30, 2021; 86 FR 67654, Nov. 29, 2021.
The rating criteria at each level
7004 Syphilitic heart disease — the note this code prints
Rating %: —
Criteria (verbatim). Note: Evaluate syphilitic aortic aneurysms under DC 7110 (Aortic aneurysm: Ascending, thoracic, abdominal).
| Rating % | Criteria (verbatim) |
|---|---|
| — | Note: Evaluate syphilitic aortic aneurysms under DC 7110 (Aortic aneurysm: Ascending, thoracic, abdominal). |
General Rating Formula for Diseases of the Heart — the headnote, unless otherwise directed
Rating %: 100
Criteria (verbatim). Workload of 3.0 METs or less results in heart failure symptoms
Rating %: 60
Criteria (verbatim). Workload of 3.1-5.0 METs results in heart failure symptoms
Rating %: 30
Criteria (verbatim). 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)
Rating %: 10
Criteria (verbatim). Workload of 7.1-10.0 METs results in heart failure symptoms; or continuous medication required for control
| Rating % | Criteria (verbatim) |
|---|---|
| 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 (1): Evaluate cor pulmonale, which is a form of secondary heart disease, as part of the pulmonary condition that causes it.
Note (2): 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.
Note (3): For this general formula, heart failure symptoms include, but are not limited to, breathlessness, fatigue, angina, dizziness, arrhythmia, palpitations, or syncope.
The DC 7004 note ends with a period. Its parenthetical is “Aortic aneurysm: Ascending, thoracic, abdominal.” It does not contain the word “or.”
The DC 7005 note, about superimposed arteriosclerotic heart disease, is printed on DC 7005. It is not printed on DC 7004.
The headnote is the direction to the general formula. The DC 7004 note is a direction for syphilitic aortic aneurysms. The DC 7004 row does not itself say “use the General Rating Formula,” which is a sentence printed on other heart codes, including the thereafter line of DC 7002.
DC 7110 is titled “Aortic aneurysm: Ascending, thoracic, or abdominal:”. That title contains “or” and ends with a colon. The DC 7004 parenthetical does not contain “or” and ends with a period. Appendix B indexes “Aortic aneurysm: ascending, thoracic, abdominal.” with a lowercase “ascending,” without “or,” and with a period. Those three wordings are not the same.
38 CFR § 4.100 says: “Whether or not cardiac hypertrophy or dilatation (documented by electrocardiogram, echocardiogram, or X-ray) is present and whether or not there is a need for continuous medication must be ascertained in all cases.” Paragraph (b) says METs testing is required in all cases except: “(1) When there is a medical contraindication. (2) When a 100% evaluation can be assigned on another basis.” That requirement still applies when the 10% continuous-medication line or the 30% hypertrophy or dilatation line is already met. Note (2) is the examiner-estimate rule when exercise testing cannot be done for medical reasons.
The formula does not print a 0 percent line. 38 CFR § 4.31 says that in every instance where the schedule does not provide a zero percent evaluation for a diagnostic code, a zero percent evaluation shall be assigned when the requirements for a compensable evaluation are not met. DC 7000 is “Valvular heart disease (including rheumatic heart disease),” and that title ends with a comma. DC 7005 is arteriosclerotic heart disease (coronary artery disease). Its title ends with a period. 38 CFR § 4.7 assigns the higher rating when the disability picture more nearly approximates the criteria required for that rating. Otherwise, the lower rating will be assigned. 38 CFR § 4.6 requires each element affecting the evidence to be studied so that decisions will be equitable and just.
The 2026-10-01 text of 38 CFR § 3.309 does not contain “syphil.” It lists “Cardiovascular-renal disease, including hypertension,” and the parenthetical names organic heart disease. That row has no diagnostic code. It does not assign DC 7004.
Source: 38 CFR § 4.104, Diagnostic Code 7004 and the General Rating Formula for Diseases of the Heart, eCFR full-text XML for 2026-10-01.
What the words mean in your records
The note is the direction
Syphilitic aortic aneurysms are evaluated under DC 7110. The parenthetical in the DC 7004 note omits “or.” The DC 7110 title includes “or.”
METs, unless that note directs otherwise
The heart-formula lines are 100, 60, 30, and 10. The hyphens in 3.1-5.0, 5.1-7.0, and 7.1-10.0 are hyphens in the regulation. The formula has no 0 percent line.
The 7005 note stays on 7005
The request for a medical opinion about superimposed arteriosclerotic heart disease is the DC 7005 note. DC 7004 does not print it.
Evidence that speaks to each level
The DC 7004 note
What the rater needs to see. Whether the finding is a syphilitic aortic aneurysm, which the note sends to DC 7110.
Where that usually lives. The imaging and the DC 7110 criteria, including the word “or” in that code’s own title.
100 through 10 under the heart formula
What the rater needs to see. The MET workload that results in heart failure symptoms, or the hypertrophy, dilatation, or continuous-medication findings on the 30 and 10 percent lines, when the aneurysm note is not the direction being used.
Where that usually lives. The exercise test, or the examiner’s estimate when Note (2) applies, and § 4.100.
VA’s public DBQ list, checked October 5, 2026, names “Heart Conditions” under Cardiovascular. The file is Heart Conditions.
The exam form
DC 7004 prints a note and no percentage of its own. The heart formula prints 100, 60, 30, and 10. This page does not say the form replaces those lines.
Related codes and how they interact
DC 7110 is the code the note names.
The DC 7110 title is “Aortic aneurysm: Ascending, thoracic, or abdominal:”. The DC 7004 parenthetical drops “or.”
Secondary conditions and presumptions
Section 3.309 does not contain “syphil,” and it does not assign DC 7004. Cardiovascular-renal disease, including hypertension, stays a family row without a diagnostic code.
A separate question, when a presumption does not decide it, is a medical question on the facts under 38 CFR § 3.310. Paragraph (a) covers disability proximately due to or the result of a service-connected disease or injury. Paragraph (b) covers increase in severity and requires a medical baseline.
Short answers
How does VA rate syphilitic heart disease?
Under 38 CFR § 4.104, Diagnostic Code 7004 directs syphilitic aortic aneurysms to DC 7110. Unless otherwise directed, the Diseases of the Heart headnote uses the general rating formula: 100, 60, 30, and 10. Education only. VA decides on the evidence.
Is syphilitic heart disease named in the chronic-disease list?
The 2026-10-01 text of § 3.309 does not contain “syphil.” It does not assign DC 7004. Cardiovascular-renal disease, including hypertension, is a separate row and has no diagnostic code.
FAQ
What does DC 7004 print for syphilitic heart disease?
A note: evaluate syphilitic aortic aneurysms under DC 7110. The parenthetical is “Aortic aneurysm: Ascending, thoracic, abdominal.” It does not say “or.” The Diseases of the Heart headnote says to use the general rating formula unless otherwise directed. That formula is 100, 60, 30, and 10. Education only.
Is the DC 7110 title the same as the parenthetical?
No. DC 7110 is “Aortic aneurysm: Ascending, thoracic, or abdominal:”. It includes “or” and ends with a colon. The DC 7004 parenthetical has no “or” and ends with a period.
Does the arteriosclerotic-heart note sit on this code?
No. That note is printed under DC 7005. DC 7004 does not print it.
Next steps
- Read the decision for DC 7004 and whether it used the aneurysm note or the heart formula.
- The free worksheet is a place to write the code, the findings, and the records you already have. It does not file a claim or protect a filing date. An accredited representative is at find a VSO.
- Other cardiovascular codes are on the cardiovascular diagnostic-code index. The category page is cardiovascular conditions.
Education only. Not legal or medical advice. My Claim Packet is not a VA-accredited representative and does not file claims. VA decides every claim on its own evidence.
Other codes in this body system
Nearby catalog entries in Cardiovascular, ordered by diagnostic code number. All Cardiovascular codes
- DC 7000Valvular heart disease
- DC 7001Endocarditis
- DC 7002Pericarditis
- DC 7003Pericardial adhesions
- DC 7005Arteriosclerotic heart disease
- DC 7006Myocardial infarction
- DC 7007Hypertensive heart disease
- DC 7008Hyperthyroid heart disease
- DC 7009Bradycardia (Bradyarrhythmia), symptomatic, requiring permanent pacemaker implantation
- DC 7010Supraventricular tachycardia
- DC 7011Ventricular arrhythmias
- DC 7015Atrioventricular block
- DC 7016Heart valve replacement
- DC 7017Coronary bypass surgery
- DC 7018Implantable cardiac pacemakers
- DC 7019Cardiac transplantation
Also: DC code lookup (tools) lists the same index in a compact layout.
Source: 38 CFR Part 4, Diagnostic Code 7004 • va.gov
⚠️ Important Disclaimer
This page provides general educational information based on public VA regulations and VA.gov resources. It is not legal or medical advice, and My Claim Packet is not a VA-accredited representative. Any worksheets or draft documents produced by the tools must be reviewed for accuracy and are not filed with VA for you. Ratings and service connection are decided case-by-case from the individual record. Consult a VA-accredited VSO, claims agent, attorney, or qualified clinician for help with your situation, and verify current rules using the linked official source.