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Evidence checklist

Cardiac Pacemaker Implant

DC 701838 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 3 collected
Nexus opinion linking pacemaker-requiring condition to serviceCritical

A medical opinion connecting the underlying cardiac condition that required pacemaker implantation to military service.

Private provider · independent opinion
Post-implant exercise stress test with METs estimationCritical

Stress test documenting functional exercise capacity after pacemaker implantation. METs level drives the cardiac rating assigned after the mandatory 100% evaluation period.

Private provider · independent opinion
Echocardiogram with ejection fraction

Echocardiography documenting EF and any structural changes. Pacemaker-induced cardiomyopathy (pacing-induced LV dysfunction) is documented here.

Private provider · independent opinion
02

Treatment records

0 of 3 collected
Pacemaker implant records and device interrogation reportsCritical

Implant operative report documenting device type, indication, and lead placement. Follow-up device interrogation (remote or in-clinic) records showing pacing percentage and dependency.

VA or private records · written request
Documentation of primary condition requiring pacemakerCritical

Medical records establishing the underlying condition that necessitated pacemaker implantation (complete heart block, sick sinus syndrome, bradyarrhythmia). The underlying condition may be separately ratable.

VA or private records · written request
Pacemaker generator replacement records (if applicable)

Records of pulse generator replacements, demonstrating ongoing device dependency and continued treatment burden.

VA or private records · written request
03

Lay statements

0 of 2 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 →
Personal statement describing symptoms and functional impact

Your own written account of how this condition affects your daily activities, work, and relationships. Describe your worst days.

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 device records, METs, ejection fraction, and functional limitations in pacemaker-dependent veterans.

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

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