VA Disability Rating for Diaphragm Paralysis (DC 6840)
Diagnostic Code 6840 · 38 CFR §4.97
What Is It?
Diaphragm paralysis or paresis is a condition where one or both sides of the diaphragm — the large muscle that drives breathing — cannot move properly due to nerve damage. This significantly reduces breathing capacity because the diaphragm is responsible for most of the work of inhaling. Veterans may develop this condition from phrenic nerve injury during chest or neck surgery, combat injuries, blast exposure, or as a complication of other service-connected conditions. Bilateral paralysis (both sides) is especially serious and can require mechanical ventilation.
Rating Criteria
| Rating | Criteria |
|---|---|
| 100% | FEV-1 less than 40 percent predicted, or FEV-1/FVC less than 40 percent, or DLCO less than 40 percent, or need for mechanical ventilation or supplemental oxygen. |
| 60% | FEV-1 of 40 to 55 percent predicted, or FEV-1/FVC of 40 to 55 percent, or DLCO of 40 to 55 percent. |
| 30% | FEV-1 of 56 to 70 percent predicted, or FEV-1/FVC of 56 to 70 percent, or DLCO of 56 to 65 percent. |
| 10% | FEV-1 of 71 to 80 percent predicted, or FEV-1/FVC of 71 to 80 percent, or DLCO of 66 to 80 percent. |
Evidence Needed
- Pulmonary function tests showing restrictive pattern
- Chest X-ray or fluoroscopy showing elevated hemidiaphragm or absent movement
- Sniff test (fluoroscopic evaluation of diaphragm motion)
- Nerve conduction study of the phrenic nerve if available
- Records of the causative injury, surgery, or condition
- Service medical records linking the nerve damage to military service
C&P Exam Tips
- PFT results determine your rating — make sure testing includes upright and supine measurements if possible, since diaphragm paralysis worsens when lying down
- Bring the sniff test or fluoroscopy results showing the paralyzed diaphragm
- Describe how symptoms worsen when lying flat — this is characteristic of diaphragm paralysis
- Report exercise limitations and any need for supplemental oxygen
- If the paralysis resulted from surgery, bring the operative report
How to File
File on VA Form 21-526EZ with PFT results, imaging showing the paralyzed diaphragm, and evidence of the causative service event.
Common Mistakes
Only getting upright PFTs Diaphragm paralysis significantly worsens when lying down. Ask for supine PFT measurements to show the full severity. Not getting a sniff test A fluoroscopic sniff test directly demonstrates the paralyzed diaphragm and is important diagnostic evidence.
Frequently Asked Questions
Can diaphragm paralysis be caused by surgery?
Yes. Phrenic nerve injury during cardiac, thoracic, or neck surgery is a common cause. If the surgery was for a service-connected condition, the paralysis can be claimed as secondary.
Is bilateral paralysis rated higher?
Bilateral paralysis causes more severe breathing impairment, which typically results in worse PFT values and therefore a higher rating.