Diaphragm Rupture or Herniation — VA Rating (DC 5324)

Diagnostic Code 5324 · 38 CFR §4.73

What Is It?

Diaphragmatic rupture or herniation is a tear in the diaphragm — the dome-shaped muscle separating the chest from the abdomen and driving breathing. When it is torn by trauma, abdominal contents can push up into the chest through the defect and produce chronic respiratory and digestive symptoms long after the acute injury has healed. The classic mechanisms are blast injury, high-speed vehicle trauma with rapid deceleration, penetrating injury crossing the chest–abdomen junction, and crush injury; smaller tears can go undetected for years before enlarging. Although DC 5324 sits in the muscle-injury schedule at 38 CFR §4.73, it does not use the slight/moderate/severe muscle-injury framework and it carries no percentages at all. Its rating cell is empty and the entry reads, in full, "Diaphragm, rupture of, with herniation. Rate under diagnostic code 7346." That destination has itself been rewritten: since the 2024 digestive rule, DC 7346 is "Hiatal hernia and paraesophageal hernia" with an empty rating cell of its own and the instruction "Rate as esophagus, stricture of (DC 7203)." So the real chain is DC 5324 to DC 7346 to DC 7203, and DC 7203's table — 80 / 50 / 30 / 10 / 0 — is where the percentages finally live.

Rating Criteria

Evidence Needed

Chest X-ray often shows displaced abdominal contents but is unreliable for smaller defects; CT of the chest and abdomen is the standard study and characterizes the size and location of the defect and which organs have herniated. Pulmonary function tests document any restrictive deficit. The original trauma records and any subsequent repair records establish the in-service event and the disease course. Because the chain ends at DC 7203, the evidence that actually sets the percentage is what that code asks for: findings documented by barium swallow, CT, or EGD, a history of dysphagia, and a record of what treatment it requires — how many dilatations per year, whether any used steroids, whether a stent was placed, whether surgical correction or a PEG tube was needed. Where the functional impact is respiratory rather than esophageal, pulmonary function testing supports evaluation under the respiratory schedule instead.

C&P Exam Tips

Bring the original trauma records, current CT or MRI, pulmonary function tests, and any operative reports. Because the chain ends on an esophageal code, ask the examiner to document swallowing specifically — whether there is dysphagia, what it takes to manage it, and what procedures have been required and how often — rather than describing the hernia in general terms. Separately, describe the respiratory picture: shortness of breath on exertion, positional breathing difficulty, what you can no longer lift or climb. Where herniated organs are compressing lung, ask that evaluation under the respiratory schedule be considered as well, since that route is keyed to pulmonary function testing and reaches higher figures than an esophageal evaluation on a mild picture would.

How to File

File VA Form 21-526EZ listing diaphragmatic rupture or herniation under DC 5324 and note the chain the schedule sets out — DC 5324 to DC 7346 to DC 7203 — because DC 5324 carries no percentage of its own. Attach the original trauma records, current chest and abdomen imaging, pulmonary function testing, any operative reports, and the swallowing workup including barium swallow, CT, or EGD findings. Where the functional impact runs mainly through respiratory restriction, ask that evaluation under the respiratory schedule be considered alongside the esophageal route.

Common Mistakes

Expecting DC 5324 to be rated on the muscle-injury framework. It sits in §4.73 but carries no percentages and no slight/moderate/severe criteria — the entry is one sentence routing the claim to DC 7346. Working from the old hiatal hernia ladder of 60 / 30 / 10: the 2024 digestive rewrite removed it, and DC 7346 now routes to DC 7203. Filing without imaging that shows the defect. Leaving the respiratory route unmentioned when herniated organs are compressing lung and pulmonary function testing shows restriction.

Frequently Asked Questions

What percentage does DC 5324 pay?

None on its own. The rating cell beside "5324 Diaphragm, rupture of, with herniation. Rate under diagnostic code 7346" in 38 CFR §4.73 is empty. And DC 7346 no longer carries figures either — the 2024 digestive rule retitled it "Hiatal hernia and paraesophageal hernia" and made it route onward to DC 7203, esophagus, stricture of. DC 7203 is where the percentages are: 80, 50, 30, 10, and 0.

Why does a diaphragm injury end up on an esophageal code?

Because the schedule sends it there. A torn diaphragm with herniation produces the same anatomical problem a hiatal or paraesophageal hernia does — abdominal contents displaced through the diaphragm — so §4.73 rates it under DC 7346, and since 2024 DC 7346 rates as esophageal stricture under DC 7203. That final table is keyed to documented dysphagia and to the treatment it requires: dilatation counted per year, steroid-assisted dilatation, stent placement, surgical correction, or a PEG tube. Notes under DC 7203 define what recurrent and refractory mean in that context, and those two definitions decide three of its five rows.

Can a small diaphragmatic injury get bigger over time?

Yes. Defects can slowly enlarge as repeated abdominal pressure from breathing, coughing, lifting, and straining stretches the existing tear. Veterans sometimes go decades between the original trauma and the diagnosis of a symptomatic hernia, particularly where the initial imaging missed a small defect. A late diagnosis does not break service connection when the original trauma event is documented in the service treatment records.