“I had a heart attack — how many percent is that?” Here too there is no single number, but for an entirely different reason than with cancer.
Section 9 was replaced in full by a 2016 amendment, and the new wording is a matrix: one axis is what is measured in the tests — ejection fraction or the severity of the valvular impairment. The other axis is how you function — the NYHA class or the result of a stress test. The percentage sits at the intersection.
And that explains a recurring complaint: “I have heart disease and I got nothing.” The table says so explicitly — there is a combination marked “no disability”.
First axis: the functional class
| Symptoms | Class |
|---|---|
| No limitation of physical activity; ordinary daily physical activity does not cause fatigue, palpitations, shortness of breath or angina | I |
| Slight limitation of physical activity, comfortable at rest and when carrying out light ordinary daily activity; more than ordinary physical activity causes fatigue, palpitations, shortness of breath or angina | II |
| Marked limitation of physical activity, comfortable at rest; ordinary daily activity such as walking up to 100 metres causes fatigue, palpitations, shortness of breath or angina | III |
| Inability to carry out any physical activity without discomfort; signs of cardiac failure, pulmonary or systemic congestion, shortness of breath and angina appear at rest and increase on exertion | IV |
| Criterion | Class |
|---|---|
| More than 9 minutes (METS > 11) | I |
| 6 to 9 minutes (11 ≥ METS > 7) | II |
| 3 to 6 minutes (7 ≥ METS ≥ 5) | III |
| Less than 3 minutes (METS < 5) | IV |
Second axis: what is measured in the tests — and the matrix
Coronary heart disease
The table applies to coronary heart disease with a myocardial infarction documented on an ECG, on cardiac imaging or on an ECHO, or to coronary disease with reversible ischaemia, or a catheterisation showing a blockage of over 50% in a coronary artery.
| Ejection fraction | I | II | III | IV |
|---|---|---|---|---|
| Above 60% | No disability | 5% | 10% | 15% |
| 45%–60% | 20% | 25% | 30% | 35% |
| 30%–44% | 40% | 45% | 50% | 60% |
| Below 30% | 70% | 80% | 90% | 100% |
Valvular heart disease
| Degree of impairment | I | II | III | IV |
|---|---|---|---|---|
| Mild | 0 | 10% | 20% | 30% |
| Moderate | 30% | 40% | 50% | 60% |
| Severe | 70% | 80% | 90% | 100% |
The Regulations do not leave “mild / moderate / severe” to free discretion — they define them numerically, for each valve separately. For aortic regurgitation (AR), for example, the distinction is by LVEDD: up to 58 mm mild, 58–65 mm moderate, above 65 mm severe. For mitral regurgitation (MR), LVEDD or left atrial (LA) size is examined. For aortic stenosis (AS) — by peak gradient and valve area.
💡 What this means in practice
Two people with exactly the same ejection fraction — say 50% — can come out with 20% or with 35%, a gap that comes entirely from the functional class. And conversely, a normal ejection fraction with normal functioning is the one cell in the table marked “no disability”. The diagnosis alone entitles you to nothing.
Source: Section 9 of the Schedule of Impairments, in the wording replaced by the 5776 amendment. The section contains further tables and detailed measurement thresholds for each valve; the central matrices are reproduced here, in the Appendix to the National Insurance Regulations (Determination of Degree of Disability for Work Injuries), 5716–1956, as it appears in the National Insurance Institute’s Disability Tests book. The full Disability Tests book (Hebrew). The quotations are reproduced for information only. The actual determination is made by the medical committee alone, and the Regulations are updated from time to time. The Regulations are enacted in Hebrew and the Hebrew text is the only binding version; the English here is our working translation, and section numbers and percentages are given exactly as they appear in the original.
What your file should contain
Because both axes rest on tests, this is one of the fields in which the quality of the file decides almost everything:
- An up-to-date echocardiogram with a numerical ejection fraction — not “preserved systolic function” but a number. That is the vertical axis of the table.
- A stress test under the BRUCE protocol with the duration of the test and the METS value. That is the horizontal axis.
- If a stress test cannot be carried out — medical confirmation that the reason is not cardiac, and a dobutamine echo or pharmacological scan in its place.
- The catheterisation report with the percentage of arterial blockage
- The hospital discharge letter after the infarction
- Cardiology follow-up over time — the documents need to describe day-to-day functioning, not just the finding
- A Holter monitor or documentation of arrhythmias, if there are any
An echo without a number, and a stress test that was never carried out, leave both axes of the table empty. There is no way to place the file in a cell.
How we help
At Yad Otefet we help you get ready for the committee: working out which sections are relevant to your condition as it is documented today, finding the gap between the symptoms and what the file actually says, and helping you prepare the documents. We do not appear before committees in your place and we do not give medical or legal advice — the determination is the committee’s alone.
Want to know which cell your file sits in?
We will go through the tests and explain what is missing to place the file — with no obligation
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