Disease of the cardiovascular system is the leading cause of morbidity and mortality among the adult population in the United States. Physicians performing impairment ratings attributable to cardiovascular disease are required to correlate the extent of the disease and its impact on a person’s daily activities. A person’s final impairment determination may vary based on the specific guidelines used (American Medical Association Guides to the Evaluation for Permanent Impairment, Social Security, State Worker Compensation requirements, etc.), the version of the guidelines (year, edition), and each guide’s specific criteria. The examiner needs to know which rating system to use, the system’s criteria, critical definitions, and potential limitations.