METs Testing for VA Disability: Metabolic Equivalents in Heart Ratings

A metabolic equivalent of task (MET) represents the basal oxygen consumption of an individual at rest, clinically defined as 3.5 milliliters of oxygen per kilogram of body weight per minute. In VA disability evaluations, METs serve as the objective benchmark for physical functional capacity. Measuring the workload level at which cardiac symptoms arise allows adjudicators to assess the real-world occupational impact of heart disease.

The General Rating Formula for Diseases of the Heart establishes four discrete workload tiers: 100% for workload of 3 METs or less resulting in dyspnea, fatigue, angina, dizziness, or syncope; 60% for workload of greater than 3 METs but not more than 5 METs; 30% for workload of greater than 5 METs but not more than 7 METs (or objective evidence of cardiac hypertrophy or dilatation); and 10% for workload of greater than 7 METs but not more than 10 METs (or continuous medication required for control). Workload capacity above 10 METs yields 10% only when continuous medication is necessary.

Under 38 CFR 4.100, when the General Rating Formula for Diseases of the Heart applies, a laboratory determination of METs by exercise testing is required, except in two specific circumstances: (a) when exercise testing is medically contraindicated, or (b) when a 100% evaluation can be assigned on another basis. Exercise testing is commonly performed using a treadmill or bicycle ergometer to record the workload in METs at which symptoms such as dyspnea, fatigue, angina, dizziness, or syncope develop. A treadmill test is one clinical testing modality rather than a standalone statutory mandate.

Many veterans cannot safely undergo laboratory exercise testing due to post-infarction instability, severe orthopedic disabilities, peripheral neuropathy, or persistent arrhythmias. In such cases, 38 CFR 4.104 Note (2) authorizes the medical examiner to estimate the level of physical activity, expressed in METs, that precipitates cardiac symptoms. The estimate must be supported by specific activity examples: activities requiring 2 to 3 METs include dressing, showering, or walking 2 miles per hour; activities requiring 4 to 5 METs include climbing a flight of stairs, mowing the lawn with a power mower, or carrying groceries; activities requiring 6 to 7 METs include brisk walking at 4 miles per hour or heavy yard work.

When reviewing a completed C&P exam, veterans should check Section IV of the VA Heart Conditions DBQ to verify how METs were determined. If the examiner relied on activity estimation rather than laboratory exercise testing, confirm that the medical contraindication is clearly documented and that the specific physical activities and resulting symptoms recorded in the report accurately portray your daily functional ceiling.