Laryngeal Stenosis and Laryngeal Trauma Residuals — VA Disability Rating Criteria (DC 6520)

Diagnostic Code 6520 · 38 CFR §4.97

What Is It?

Laryngeal stenosis is narrowing of the airway at the voice box. In 38 CFR 4.97 it has one code and one entry: DC 6520, "Larynx, stenosis of, including residuals of laryngeal trauma (unilateral or bilateral)." That single code covers both the narrowing itself and the scarring, webbing and cartilage damage left behind by an injury, and it covers one side or both. Service pathways are intubation for surgery or evacuation, blast and penetrating neck trauma, inhalation and chemical burns, prolonged tracheostomy, and radiation to the neck. What makes this code different from the rest of the respiratory schedule is the second half of every criterion. DC 6520 does not read on FEV-1 alone: each row requires an FEV-1 value AND a Flow-Volume Loop compatible with upper airway obstruction. The Flow-Volume Loop is the shape of the curve a spirometer draws, and a fixed upper-airway obstruction flattens both the inspiratory and expiratory limbs. Without that finding in the report, a low FEV-1 reads as ordinary lung disease and the criteria are not met. The entry also carries one alternative — "Note: Or evaluate as aphonia (DC 6519)" — and a permanent tracheostomy reaches 100 percent on its own, with no pulmonary-function value required. This page also answers for DC 6504: an earlier version of this site rated laryngeal stenosis under that number, but 38 CFR 4.97 lists DC 6504 as "Nose, loss of part of, or scars," a 30 and 10 percent disfigurement entry that has nothing to do with the larynx.

Rating Criteria

Evidence Needed

Spirometry reporting FEV-1 as a percentage of predicted AND the Flow-Volume Loop, with the interpreting physician's statement that the loop is compatible with upper airway obstruction. A numeric FEV-1 with no loop commentary is the single most common reason a well-founded claim under this code stalls. Add direct visualisation — flexible or rigid laryngoscopy, or bronchoscopy — describing the level and percentage of narrowing, CT or MRI of the neck showing the stenotic segment, operative reports for any dilation, laser division, stent, tracheal resection or tracheostomy, and the service record of the causative event: the intubation, the blast, the burn, the wound. If the voice rather than the airway is the disabling part, get an ENT or speech-language pathology assessment describing whether speech is possible at all and whether it is possible above a whisper, because that is the language DC 6519 uses.

C&P Exam Tips

Ask for the Flow-Volume Loop by name and ask that the report say whether it is compatible with upper airway obstruction. Bring the laryngoscopy images or report to the examination so the narrowing is documented independently of the breathing numbers. Describe stridor — the high-pitched sound on breathing in — and when it appears: at rest, on exertion, at night. If you have a permanent tracheostomy, make sure the examiner records it as permanent, because that is a stand-alone route to 100 percent that does not depend on any pulmonary-function value. If your voice is the bigger problem, say so and describe it in the schedule's own terms: whether you can communicate by speech at all, and whether you can speak above a whisper. Note that the post-bronchodilator rule in 38 CFR 4.96(d) does not reach this code — that provision applies to DC 6600, 6603, 6604, 6825 through 6833 and 6840 through 6845, and DC 6520 is not on the list.

How to File

File under DC 6520 on VA Form 21-526EZ with spirometry that includes the Flow-Volume Loop, laryngoscopy, and the service record of the injury or intubation. Two structural points are worth knowing. First, the non-combination rule in 38 CFR 4.96(a) reaches DC 6600 through 6817 and 6822 through 6847 — DC 6520 sits below that range, so a laryngeal rating is not swallowed by a separate lung rating and the two are combined normally under 38 CFR 4.25. Second, the Note offering aphonia is an election between evaluations, not a second rating: VA takes the code that produces the higher evaluation on the evidence, so a veteran whose airway is only mildly narrowed but who cannot speak above a whisper is usually better served by DC 6519.

Common Mistakes

Submitting an FEV-1 without a Flow-Volume Loop. Every row of DC 6520 is conjunctive — the value and the loop finding both have to be there. Assuming the general restrictive-lung numbers apply: FEV-1/FVC, DLCO and maximum exercise capacity carry rows under the General Rating Formula for Restrictive Lung Disease at DC 6840 through 6845, not under this code, and quoting them here invites a denial that reads as though the criteria were never met. Treating the aphonia Note as a second rating rather than an alternative. Letting a permanent tracheostomy be recorded as temporary. And filing the claim under DC 6504, which is the schedule's entry for loss of part of the nose or nasal scars.

Frequently Asked Questions

What is a Flow-Volume Loop and why does DC 6520 require one?

It is the loop-shaped graph a spirometer draws of airflow against lung volume. A narrowing above the vocal cords flattens the curve in a characteristic way, which is how the test distinguishes an upper-airway obstruction from disease inside the lungs. DC 6520 names it in all four rows, so an FEV-1 value on its own does not meet any of them.

Does a tracheostomy mean 100 percent?

A permanent tracheostomy is written into the 100 percent row as an alternative to the FEV-1 criterion, so it reaches 100 percent by itself. A temporary tracheostomy does not; once it is reversed, the rating is set by the residual FEV-1 and Flow-Volume Loop findings.

What happened to DC 6504?

Nothing — it is a live code, but it is not the larynx. 38 CFR 4.97 lists DC 6504 as "Nose, loss of part of, or scars," rated 30 percent when both nasal passages are exposed and 10 percent for loss of part of one ala or other obvious disfigurement, with a Note directing evaluation as disfiguring scars of the head, face or neck under DC 7800 instead where that fits better. Laryngeal stenosis has always belonged to DC 6520.

Can I be rated for laryngeal stenosis and a lung condition at the same time?

Yes. The bar on combining respiratory ratings in 38 CFR 4.96(a) applies to DC 6600 through 6817 and 6822 through 6847. DC 6520 is outside that range, so it combines with a lung rating under the ordinary combined-ratings table in 38 CFR 4.25.

My airway is fine but I have lost my voice. What code applies?

DC 6519, aphonia, which the Note to DC 6520 offers as an alternative. Constant inability to communicate by speech is 100 percent; constant inability to speak above a whisper is 60 percent. Incomplete aphonia is evaluated as chronic laryngitis under DC 6516.

Is there a 0 percent rating?

Not in the listed criteria — the lowest row is 10 percent. Where the requirements for a compensable evaluation are not met, 38 CFR 4.31 provides a 0 percent evaluation, which establishes service connection and preserves the claim for a later increase.