38 CFR Part 4 — 38 CFR § 4.104
Implantable cardiac pacemakers — VA Diagnostic Code 7018
Cardiovascular
Diagnostic code
7018
38 CFR § 4.104 lists Diagnostic Code 7018 as “Implantable cardiac pacemakers.” For one month following hospital discharge for implantation or re-implantation, the rating is 100. Thereafter, evaluate as supraventricular tachycardia (DC 7010), ventricular arrhythmias (DC 7011), or atrioventricular block (DC 7015). The minimum is 10. The note sends automatic implantable cardioverter-defibrillators to DC 7011.
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 rating criteria at each level
7018 Implantable cardiac pacemakers
Rating %: 100
Criteria (verbatim). For one month following hospital discharge for implantation or re-implantation
Rating %: —
Criteria (verbatim). Thereafter:
Rating %: —
Criteria (verbatim). Evaluate as supraventricular tachycardia (DC 7010), ventricular arrhythmias (DC 7011), or atrioventricular block (DC 7015).
Rating %: 10
Criteria (verbatim). Minimum
| Rating % | Criteria (verbatim) |
|---|---|
| 100 | For one month following hospital discharge for implantation or re-implantation |
| — | Thereafter: |
| — | Evaluate as supraventricular tachycardia (DC 7010), ventricular arrhythmias (DC 7011), or atrioventricular block (DC 7015). |
| 10 | Minimum |
7010 Supraventricular tachycardia — one code DC 7018 names
Rating %: 30
Criteria (verbatim). Confirmed by ECG, with five or more treatment interventions per year
Rating %: 10
Criteria (verbatim). Confirmed by ECG, with one to four treatment interventions per year; or, confirmed by ECG with either continuous use of oral medications to control or use of vagal maneuvers to control
| Rating % | Criteria (verbatim) |
|---|---|
| 30 | Confirmed by ECG, with five or more treatment interventions per year |
| 10 | Confirmed by ECG, with one to four treatment interventions per year; or, confirmed by ECG with either continuous use of oral medications to control or use of vagal maneuvers to control |
7011 Ventricular arrhythmias (sustained) — one code DC 7018 names
Rating %: 100
Criteria (verbatim). For an indefinite period from the date of inpatient hospital admission for initial medical therapy for a sustained ventricular arrhythmia; or, for an indefinite period from the date of inpatient hospital admission for ventricular aneurysmectomy; or, with an automatic implantable cardioverter-defibrillator (AICD) in place
| Rating % | Criteria (verbatim) |
|---|---|
| 100 | For an indefinite period from the date of inpatient hospital admission for initial medical therapy for a sustained ventricular arrhythmia; or, for an indefinite period from the date of inpatient hospital admission for ventricular aneurysmectomy; or, with an automatic implantable cardioverter-defibrillator (AICD) in place |
7015 Atrioventricular block — one code DC 7018 names
Rating %: —
Criteria (verbatim). Benign (First-Degree and Second-Degree, Type I):
Rating %: —
Criteria (verbatim). Evaluate under the General Rating Formula.
Rating %: —
Criteria (verbatim). Non-Benign (Second-Degree, Type II and Third-Degree):
Rating %: —
Criteria (verbatim). Evaluate under DC 7018 (implantable cardiac pacemakers).
| Rating % | Criteria (verbatim) |
|---|---|
| — | Benign (First-Degree and Second-Degree, Type I): |
| — | Evaluate under the General Rating Formula. |
| — | Non-Benign (Second-Degree, Type II and Third-Degree): |
| — | Evaluate under DC 7018 (implantable cardiac pacemakers). |
General Rating Formula for Diseases of the Heart — used where DC 7015 or the DC 7011 note directs it
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 under DC 7018: Evaluate automatic implantable cardioverter-defibrillators (AICDs) under DC 7011.
DC 7010 Note (1): Examples of supraventricular tachycardia include, but are not limited to: Atrial fibrillation, atrial flutter, sinus tachycardia, sinoatrial nodal reentrant tachycardia, atrioventricular nodal reentrant tachycardia, atrioventricular reentrant tachycardia, atrial tachycardia, junctional tachycardia, and multifocal atrial tachycardia.
DC 7010 Note (2): For the purposes of this diagnostic code, a treatment intervention occurs whenever a symptomatic patient requires intravenous pharmacologic adjustment, cardioversion, and/or ablation for symptom relief.
DC 7011 note: When inpatient hospitalization for sustained ventricular arrhythmia or ventricular aneurysmectomy is required, a 100-percent evaluation begins on the date of hospital admission with a mandatory VA examination six months following hospital discharge. Evaluate post-surgical residuals under 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 Diseases of the Heart caption says: Unless otherwise directed, use this general rating formula to evaluate diseases of the heart. DC 7018 directs its own one-month line, the thereafter sentence, and the minimum of 10. Non-benign DC 7015 directs the reader back to DC 7018. Benign DC 7015 directs the reader to the general formula.
The “Thereafter:” row and the evaluate-as row have empty rating cells. The minimum row is 10. A blank rating cell on this page marks that layout. It is not an extra level. 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.
Note (2) of the general formula says one MET 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 a laboratory determination of METs by exercise testing cannot be done for medical reasons, an examiner may estimate the level of activity, expressed in METs and supported by specific examples, such as slow stair climbing or shoveling snow. Note (3) says heart failure symptoms include, but are not limited to, breathlessness, fatigue, angina, dizziness, arrhythmia, palpitations, or syncope. Note (1) says to evaluate cor pulmonale as part of the pulmonary condition that causes it.
A change in evaluation under the DC 7011 note follows 38 CFR § 3.105(e).
Source: 38 CFR § 4.104, Diagnostic Code 7018 and the codes it names, eCFR full-text XML for 2026-10-01.
What the words mean in your records
One month following hospital discharge
The 100 percent line is “For one month following hospital discharge for implantation or re-implantation.” It dates the month from hospital discharge. It does not say hospital admission.
The minimum of 10
The word on that row is “Minimum,” and the rating cell is 10. The row sits under the thereafter instruction. DC 7018 does not print a 0 percent line.
The loop between DC 7018 and non-benign DC 7015
DC 7018 says to evaluate thereafter as DC 7010, DC 7011, or DC 7015. Non-benign atrioventricular block under DC 7015 says to evaluate under DC 7018. Benign atrioventricular block says to evaluate under the General Rating Formula. The schedule prints both sentences.
Evidence that speaks to each level
100 — one month
What the rater needs to see. Hospital discharge for implantation or re-implantation, and the one-month period that line uses.
Where that usually lives. The discharge summary and the implantation date.
Thereafter — DC 7010, 7011, or 7015
What the rater needs to see. The code among those three that the thereafter sentence uses, including the DC 7010 intervention count, the DC 7011 100 percent line, or the benign or non-benign DC 7015 instruction.
Where that usually lives. The ECG and the treatment record the chosen code names.
Minimum 10
What the rater needs to see. The minimum row under DC 7018, which prints 10.
Where that usually lives. The same cardiac record after the one-month line.
AICD
What the rater needs to see. The DC 7018 note sends an automatic implantable cardioverter-defibrillator to DC 7011.
Where that usually lives. The implant record that names an AICD rather than a pacemaker alone.
VA’s public DBQ list, checked October 5, 2026, names “Heart Conditions” under Cardiovascular. The file is Heart Conditions.
The exam form
DC 7018 prints the one-month line, the thereafter sentence, the minimum of 10, and the AICD note. This page does not say the form replaces those lines.
Related codes and how they interact
The general formula is not the DC 7018 row
The caption of Diseases of the Heart says to use the general formula unless otherwise directed. DC 7018 directs otherwise. DC 7005 is arteriosclerotic heart disease, which uses that formula. The DC 7011 note uses the formula for post-surgical residuals. Benign DC 7015 uses the formula. Those are the directions the schedule prints.
38 CFR § 4.14 says the evaluation of the same disability under various diagnoses is to be avoided, and that the evaluation of the same manifestation under different diagnoses is to be avoided.
Secondary conditions and presumptions
The 2026-10-01 text of 38 CFR § 3.309 does not contain “pacemaker.” Section 3.309(a) lists endocarditis and cardiovascular-renal disease, including hypertension. Section 3.309(e) lists ischemic heart disease in the words of that paragraph. Those sentences do not name DC 7018.
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
What is the VA rating for an implantable cardiac pacemaker?
Under 38 CFR § 4.104, Diagnostic Code 7018 is 100 percent for one month following hospital discharge for implantation or re-implantation. Thereafter it is evaluated as DC 7010, DC 7011, or DC 7015, with a minimum of 10 percent. Education only. VA decides on the evidence.
Is a pacemaker named in § 3.309?
The 2026-10-01 text of § 3.309 does not contain the word pacemaker.
FAQ
How does VA rate an implantable cardiac pacemaker under DC 7018?
For one month following hospital discharge for implantation or re-implantation, the rating is 100 percent. Thereafter, evaluate as DC 7010, DC 7011, or DC 7015. The minimum is 10 percent. An AICD is evaluated under DC 7011. Education only.
Does non-benign heart block go back to DC 7018?
Yes. DC 7015 says non-benign second-degree type II and third-degree atrioventricular block is evaluated under DC 7018. Benign first-degree and second-degree type I block is evaluated under the General Rating Formula.
What counts as a treatment intervention under DC 7010?
Note (2) says a treatment intervention occurs whenever a symptomatic patient requires intravenous pharmacologic adjustment, cardioversion, and/or ablation for symptom relief.
Next steps
- Read the decision for DC 7018, the discharge date, and whether DC 7010, DC 7011, or DC 7015 was used after the month.
- 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 heart codes are on the cardiovascular diagnostic-code index.
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 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 7019Cardiac transplantation
- DC 7020Cardiomyopathy
- DC 7101Hypertensive vascular disease
- DC 7110Aortic aneurysm: ascending, thoracic, abdominal
- DC 7111Aneurysm, large artery
- DC 7112Aneurysm, small artery
- DC 7113Arteriovenous fistula, traumatic
- DC 7114Peripheral arterial disease
Also: DC code lookup (tools) lists the same index in a compact layout.
Source: 38 CFR Part 4, Diagnostic Code 7018 • 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.