Breathing & Lungs — VA Disability Ratings

How Breathing & Lungs conditions are rated

The respiratory schedule at 38 CFR §4.97 runs from the nose and sinuses through the larynx to the lungs and pleura, and §4.96 sets special rules that apply across it. Upper-airway codes in the 6500s, such as chronic sinusitis and rhinitis, have their own criteria, and sinusitis has its own general formula.

The rule that shapes most lung claims is the single rating in §4.96(a). Ratings under diagnostic codes 6600 through 6817 and 6822 through 6847 "will not be combined with each other." Instead, the rater assigns a single rating under the code that "reflects the predominant disability," elevated to the next higher evaluation "where the severity of the overall disability warrants such elevation." Asthma, COPD and sleep apnea all fall in that range, so a veteran with two of them receives one rating, which may be raised a step, rather than two ratings combined. Where there is lung or pleural involvement, respiratory neoplasms (DC 6819 and 6820) are not combined with each other or with codes in those ranges either. The 6500-series codes are not in the ranges §4.96(a) names.

Lung function drives much of the schedule. For chronic bronchitis, emphysema, COPD, interstitial lung disease and restrictive lung disease (DC 6600, 6603, 6604, 6825 to 6833 and 6840 to 6845), §4.96(d)(1) requires pulmonary function tests, except where a maximum exercise capacity test of record shows 20 ml/kg/min or less, where pulmonary hypertension, cor pulmonale or right ventricular hypertrophy has been diagnosed, where there has been acute respiratory failure, or where outpatient oxygen is required. The obstructive codes use FEV-1, the FEV-1/FVC ratio and DLCO (SB); the interstitial formula uses FVC and DLCO (SB). Asthma (DC 6602) uses FEV-1 and FEV-1/FVC, with medication criteria as alternatives, such as daily inhalational or oral bronchodilator therapy at 30%.

For those same §4.96(d) codes, which do not include asthma, the section also decides which result controls. Post-bronchodilator results are used unless they are poorer than the pre-bronchodilator results, in which case the pre-bronchodilator values are used. When different tests would put the rating at different levels, the rater uses "the test result that the examiner states most accurately reflects the level of disability." When test results and clinical findings disagree, the tests control unless the examiner states why they are not valid. If DLCO is not of record, alternative criteria apply as long as the examiner states why the test would not be useful or valid. And if FEV-1 and FVC are both greater than 100 percent, a decreased FEV-1/FVC ratio cannot support a compensable rating.

Sleep apnea syndromes, whether obstructive, central or mixed (DC 6847), are rated on treatment and effects rather than on breathing tests: 0% for "Asymptomatic but with documented sleep disorder breathing," 30% for "Persistent day-time hypersomnolence," 50% when the condition requires use of a "breathing assistance device such as continuous airway pressure (CPAP) machine," and 100% for chronic respiratory failure with carbon dioxide retention or cor pulmonale, or a tracheostomy. Because DC 6847 sits inside the §4.96(a) range, it is not combined with asthma, COPD or other codes in that range.

A few codes rate on episodes or treatment instead. Bronchiectasis (DC 6601) can be rated on incapacitating episodes of infection, defined as episodes requiring "bedrest and treatment by a physician," or as chronic bronchitis. Sarcoidosis (DC 6846) is rated on corticosteroid needs and organ involvement, or as chronic bronchitis with extra-pulmonary involvement rated under the body system involved. The asthma, COPD and sleep apnea pages go through their tables level by level.