Bruce,
As Jack said, there is an important distinction between a pacemaker and a AICD. And the SECNAVINST has guidance about rating pacemakers that require at least a 30% TDRL finding (though the VA criteria is actually less generous).
Here is a breakdown of the references:
VASRD Codes:
7018 Implantable cardiac pacemakers:
For two months following hospital admission for implantation or
reimplantation 100
Thereafter:
Evaluate as supraventricular arrhythmias (DC 7010), ventricular
arrhythmias (DC 7011), or atrioventricular block (DC 7015).
Minimum 10
Note: Evaluate implantable Cardioverter-Defibrillators (AICD’s) under DC 7011.
7011 Ventricular arrhythmias (sustained):
For indefinite period from date of hospital admission for initial evaluation
and medical therapy for a sustained ventricular arrhythmia, or; for
indefinite period from date of hospital admission for ventricular
aneurysmectomy, or; with an automatic implantable Cardioverter-
Defibrillator (AICD) in place 100
Chronic congestive heart failure, or; workload of 3 METs or less results
in dyspnea, fatigue, angina, dizziness, or syncope, or; left ventricular
dysfunction with an ejection fraction of less than 30 percent 100
More than one episode of acute congestive heart failure in the past year,
or; workload of greater than 3 METs but not greater than 5 METs
results in dyspnea, fatigue, angina, dizziness, or syncope, or; left
ventricular dysfunction with an ejection fraction of 30 to 50 percent 60
Workload of greater than 5 METs but not greater than 7 METs results in
dyspnea, fatigue, angina, dizziness, or syncope, or; evidence of
cardiac hypertrophy or dilatation on electrocardiogram,
echocardiogram, or X-ray 30
Workload of greater than 7 METs but not greater than 10 METs results
in dyspnea, fatigue, angina, dizziness, or syncope, or;
continuous medication required 10
Note: A rating of 100 percent shall be assigned from the date of hospital admission for initial evaluation and medical therapy for a sustained ventricular arrhythmia or for ventricular aneurysmectomy. Six months following discharge, the appropriate disability rating shall be determined by mandatory VA examination. Any change in evaluation based upon that or any subsequent examination shall be subject to the provisions of §3.105(e) of this chapter.
SECNAVINST 1850.4E:
Enclosure 9, 7000 Series code 1, c.,:
2. Placement of a cardiac pacemaker no longer warrants a 30 percent minimum rating in the VASRD but in accordance with paragraph 9008 the member
generally will be put on the TDRL for at least one period of evaluation.
3. Placement of an AICD (Automatic Implantable Cardioverter-Defibrillator) warrants the unique application of a 100 percent observation rating and placement on the TDRL*.
9008 Indwelling Foreign Bodies
Service members with cardiac, vascular or neurosurgical conditions that require indwelling foreign bodies (e.g., pacemakers , defibrillators, venous umbrellas, and ventriculoperitoneal shunts) who are Unfit will be ratable at a minimum of 30 percent for an 18-month observation period following placement of the device.
*As a point of law, I question the "automatic" TDRL finding. I tend to think that there are circumstances where a permanent finding is appropriate, but this issues would be highly dependent on the specific facts of the case.
A well drafted MEB is very important in such cases (though, really, this is true of all cases).