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Evidence checklist

Ventricular Arrhythmia

DC 701138 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 5 collected
ECG and Holter monitor documenting ventricular arrhythmia typeCritical

Electrocardiogram and 24-48 hour Holter monitor confirming ventricular arrhythmia: PVCs (premature ventricular contractions), non-sustained VT, sustained VT, or ventricular fibrillation. Episode frequency and duration are critical.

Private provider · independent opinion
Echocardiogram with ejection fractionCritical

Echocardiography documenting EF and structural heart disease (cardiomyopathy, prior MI) that is the substrate for ventricular arrhythmia. EF below 35% typically triggers ICD implantation.

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

A medical opinion connecting ventricular arrhythmia to service-connected cardiomyopathy, prior MI, ischemic heart disease, toxic exposure, or other in-service cardiac condition.

Private provider · independent opinion
Exercise stress test with METs (if safe to perform)Critical

Stress test documenting functional exercise capacity in METs — the primary driver of the heart condition rating percentage. May include exercise-induced arrhythmia documentation.

Private provider · independent opinion
Electrophysiology (EP) study and ablation records

EP study documenting inducible VT, VT origin, and ablation procedures. Documents arrhythmia mechanism and treatment history.

Private provider · independent opinion
02

Treatment records

0 of 1 collected
ICD (implantable cardioverter-defibrillator) records and shock logCritical

ICD implant records, device interrogation reports, and ICD shock log documenting appropriately-treated ventricular arrhythmia episodes. ICD shock data is powerful objective evidence of life-threatening arrhythmia.

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 arrhythmia type, ECG/Holter findings, ICD records, METs, ejection fraction, and functional limitations from ventricular arrhythmia.

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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