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Evidence checklist

Atrioventricular Block (Heart Block)

DC 701538 CFR § 4.104Cardiovascular

Evidence strength

Mark what you already have below and your evidence strength appears here.

Target
Saved locally
01

Specialist opinion

Highest value0 of 4 collected
ECG documenting AV block degree and typeCritical

Electrocardiogram confirming AV block type: first-degree (prolonged PR), second-degree (Mobitz I or II — Wenckebach), or third-degree (complete heart block). Mobitz II and complete block are higher severity.

Private provider · independent opinion
Holter monitor or event recorder documenting conduction pauseCritical

24-48 hour Holter monitor or long-term event monitor documenting symptomatic pauses, syncope correlation, and ventricular escape rhythm.

Private provider · independent opinion
Nexus opinion linking AV block to service ("at least as likely as not")Critical

A medical opinion connecting AV block to service-connected myocarditis, Lyme disease from service in endemic areas, cardiac surgery during service, or other in-service cause.

Private provider · independent opinion
Exercise stress test with METs estimationCritical

Stress test documenting functional exercise capacity and heart rate response. METs level is a primary rating driver for cardiac conditions.

Private provider · independent opinion
02

Treatment records

0 of 2 collected
Pacemaker implant records (if applicable)

Documentation of pacemaker implantation for high-degree AV block. Pacemaker-dependent patients may be rated separately under diagnostic code 7018.

VA or private records · written request
Syncope or presyncope documentation

Medical records or emergency records documenting syncopal episodes (loss of consciousness) or presyncope (near-fainting) caused by conduction pauses.

VA or private records · written request
03

Lay statements

0 of 1 collected
Buddy statement from spouse, family, or fellow service member

A written statement from someone who can describe observable symptoms and how your condition affects daily life.

You or a witness · VA Form 21-4138 or 21-10210How to get this →
04

Benefits questionnaire

0 of 1 collected
Completed DBQ Heart ConditionsCritical

Standardized form capturing ECG/Holter findings, METs, pacemaker status, and functional limitations from AV block.

Provider-completed · VA DBQ formHow to get this →
05

Service records

0 of 1 collected
Service treatment records (STRs)Critical

Military medical records showing in-service treatment, complaints, or injuries related to this condition.

NPRC / milConnect · SF-180
Condition guideRating criteria and what VA looks forBuddy statement builderGuided VA Form 21-10210

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