Proposed Rule2026-01875
Providing a Minimum Evaluation for Bradycardia
Primary source
Metadata and text below are from the Federal Register, a public-domain U.S. government work. Always verify the official published version before relying on it for any legal matter.
Published
January 30, 2026
Issuing agencies
Veterans Affairs Department
Abstract
The Department of Veterans Affairs (VA) proposes to revise diagnostic code (DC) 7009, Bradycardia (Bradyarrhythmia), to provide a minimum 10% evaluation after pacemaker implantation. This revision will allow VA to align DC 7009 with DC 7018, Implantable cardiac pacemakers. VA also proposes to remove Note (1) found under DC 7009.
Full Text
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<title>Federal Register, Volume 91 Issue 20 (Friday, January 30, 2026)</title>
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[Federal Register Volume 91, Number 20 (Friday, January 30, 2026)]
[Proposed Rules]
[Pages 4024-4026]
From the Federal Register Online via the Government Publishing Office [<a href="http://www.gpo.gov">www.gpo.gov</a>]
[FR Doc No: 2026-01875]
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DEPARTMENT OF VETERANS AFFAIRS
38 CFR Part 4
RIN 2900-AS40
Providing a Minimum Evaluation for Bradycardia
AGENCY: Department of Veterans Affairs.
ACTION: Proposed rule.
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SUMMARY: The Department of Veterans Affairs (VA) proposes to revise
diagnostic code (DC) 7009, Bradycardia (Bradyarrhythmia), to provide a
minimum 10% evaluation after pacemaker implantation. This revision will
allow VA to align DC 7009 with DC 7018, Implantable cardiac pacemakers.
VA also proposes to remove Note (1) found under DC 7009.
DATES: Comments must be received by March 31, 2026.
ADDRESSES: You may submit comments through <a href="http://www.regulations.gov">www.regulations.gov</a> under
RIN 2900-AS40. That website includes a plain-language summary of this
rulemaking. Instructions for accessing agency documents, submitting
comments, and viewing the rulemaking docket are available on
<a href="http://www.regulations.gov">www.regulations.gov</a> under ``FAQ.''
FOR FURTHER INFORMATION CONTACT: Argentina Hauser and Cintia
Darlington, Veterans Benefit Administration, (202) 461-9700.
SUPPLEMENTARY INFORMATION:
I. Background
VA published a final rule in the Federal Register at 86 FR 54089 on
September 30, 2021, that amended the portion of the rating schedule
that addresses the cardiovascular system and added DC 7009 to evaluate
symptomatic bradyarrhythmia that requires pacemaker implantation.
Bradycardia is characterized by a resting heart rate slower than 60
beats per minute, and bradyarrhythmia is a slow heart rate resulting
from an irregular heartbeat or arrhythmia. See ``Bradyarrhythmia,''
Cleveland Clinic, <a href="https://my.clevelandclinic.org/health/diseases/23349-bradyarrhythmia">https://my.clevelandclinic.org/health/diseases/23349-bradyarrhythmia</a> (last visited January 12, 2026). Like other types of
arrhythmias or heart conditions, providers may recommend pacemaker
implantation to help regulate and maintain a healthy heartrate. Id.;
see also ``Pacemakers, Who Needs Them,'' National Heart, Lung, and
Blood Institute, <a href="https://www.nhlbi.nih.gov/health/pacemakers/who-needs">https://www.nhlbi.nih.gov/health/pacemakers/who-needs</a>
(last visited January 12, 2026).
Prior to establishing this new DC, VA evaluated bradyarrhythmia
requiring pacemaker implantation under DC 7018, Implantable cardiac
pacemakers. Therefore, VA intended to mirror the criteria within DC
7018, which allowed VA to properly evaluate bradyarrhythmia while
distinguishing it from other arrhythmias. However, VA did not provide a
minimum evaluation under DC 7009.
II. Minimum Evaluation
VA is proposing to add a minimum 10% evaluation under DC 7009 after
pacemaker implantation. Currently, VA uses DC 7009 to assign a
temporary 100% evaluation for one month following hospital discharge
for implantation or re-implantation of a pacemaker. Thereafter, VA
evaluates the condition using the General Rating Formula for Diseases
of the Heart with no minimum evaluation. However, under DC 7018, VA
assigns a temporary 100% evaluation for one month following hospital
discharge for implantation or re-implantation of a pacemaker, but
thereafter VA evaluates the condition as supraventricular tachycardia
(DC 7010), ventricular arrhythmias (DC 7011), or atrioventricular block
(DC 7015) with a minimum 10% evaluation. Since both DCs involve
pacemaker implantation, the criteria for DC 7009 should also include a
minimum 10% evaluation after pacemaker implantation or re-implantation
to align it with DC 7018. Additionally, this action is comparable to
the assignment of 10% evaluation for other diseases of the heart when
continuous medication is required. While it is possible that Veterans
with bradyarrhythmia treated by a pacemaker
[[Page 4025]]
may qualify for a 10% evaluation or higher under the General Rating
Formula for Diseases of the Heart due to their metabolic equivalent
workload, requirement for continuous medication, or evidence of cardiac
hypertrophy or dilatation, VA is proposing to revise DC 7009 to ensure
there is no disparity between DCs 7009 and 7018 regarding minimum
evaluations.
III. Note (1)
VA is also proposing to remove Note (1) under DC 7009. Within Note
(1), VA defines Bradycardia (bradyarrhythmia) as conduction
abnormalities leading to a heart rate below 60 beats per minute and
provides the five general classes of bradyarrhythmia, which are (1)
sinus bradycardia, (2) atrioventricular (AV) junctional (nodal) escape
rhythm, (3) AV heart block (second or third degree) or AV dissociation,
(4) atrial fibrillation, or flutter with a slow ventricular response,
and (5) idioventricular escape rhythm. VA originally added Note (1) to
define bradycardia and aid rating personnel in comprehending and
assessing bradycardia. While Note (1) is informative, it could
potentially lead to confusion if the American Heart Association or some
other authoritative organization proposes to change the definition or
the bradyarrhythmia classes. Since it is not necessary to include a
definition or the classifications of bradycardia within 38 CFR 4.104,
the removal of Note (1) is appropriate. Due to the proposed removal of
Note (1), VA must redesignate Note (2) as the only note under DC 7009.
Executive Orders 12866, 13563, and 14192
VA examined the impact of this rulemaking as required by Executive
Orders 12866 (Sept. 30, 1993) and 13563 (Jan. 18, 2011), which direct
agencies to assess all costs and benefits of available regulatory
alternatives and, if regulation is necessary, to select regulatory
approaches that maximize net benefits. The Office of Information and
Regulatory Affairs has determined that this rulemaking is not a
significant regulatory action under Executive Order 12866, as
supplemented by Executive Order 13563. This proposed rule is not
expected to be an Executive Order 14192 regulatory action because this
rule is not significant under Executive Order 12866. The Regulatory
Impact Analysis associated with this rulemaking can be found as a
supporting document at <a href="http://www.regulations.gov">www.regulations.gov</a>.
Regulatory Flexibility Act
The Secretary hereby certifies that the adoption of this proposed
rule will not have a significant economic impact on a substantial
number of small entities as they are defined in the Regulatory
Flexibility Act (5 U.S.C. 601-612). This certification is based on the
fact that small entities or businesses are not impacted by revisions to
the VA Schedule for Rating Disabilities . Therefore, pursuant to 5
U.S.C. 605(b), this rule is exempt from the initial and final
regulatory flexibility analysis requirements of sections 603 and 604.
Unfunded Mandates
This proposed rule would not result in the expenditure by State,
local, and Tribal governments, in the aggregate, or by the private
sector, of $100 million or more (adjusted annually for inflation) in
any one year.
Paperwork Reduction Act
This proposed rule contains no provisions constituting a collection
of information under the Paperwork Reduction Act of 1995 (44 U.S.C.
3501-3521).
List of Subjects in 38 CFR Part 4
Disability benefits, Pension, Veterans.
Signing Authority
Douglas A. Collins, Secretary of Veterans Affairs, approved this
document on January 27, 2026 and authorized the undersigned to sign and
submit the document to the Office of the Federal Register for
publication electronically as an official document of the Department of
Veterans Affairs.
Nicole R. Cherry,
Alternate Federal Register Liaison Officer, Department of Veterans
Affairs.
For the reasons stated in the preamble, VA proposes to amend 38 CFR
part 4 as set forth below:
PART 4--SCHEDULE FOR RATING DISABILITIES
Subpart B--Disability Ratings
0
1. The authority citation for part 4, subpart B continues to read as
follows:
Authority: 38 U.S.C. 1155, unless otherwise noted.
0
2. Amend Sec. 4.104 by revising the entry for DC 7009 to read as
follows:
Sec. 4.104 Schedule of ratings--cardiovascular system.--
cardiovascular system.
Diseases of the Heart
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Rating
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* * * * * * *
7009 Bradycardia (Bradyarrhythmia) symptomatic, requiring
permanent pacemaker implantation:
For one month following hospital discharge for 100
implantation or re-implantation.......................
Thereafter:
Evaluate under the General Rating Formula.
Minimum............................................ 10
Note: Asymptomatic bradycardia (bradyarrhythmia) is a
medical finding only. It is not a disability subject to
compensation.
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* * * * *
0
3. Amend appendix A to part 4 by revising the entry for diagnostic code
7009 to read as follows:
[[Page 4026]]
Appendix A to Part 4--Table of Amendments and Effective Dates Since
1946
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Diagnostic
Sec. code No.
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* * * * * * *
7009 Added November 14, 2021;
criterion and note [INSERT
EFFECTIVE DATE OF FINAL RULE].
* * * * * * *
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[FR Doc. 2026-01875 Filed 1-29-26; 8:45 am]
BILLING CODE 8320-01-P
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</html>Indexed from Federal Register on January 30, 2026.
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