Pleural Effusion, Pleural Fibrosis and Chronic Pleurisy — VA Disability Rating Criteria (DC 6845)

Diagnostic Code 6845 · 38 CFR §4.97

What Is It?

Pleural effusion is fluid collecting between the layers of tissue lining the lung and the chest wall; pleural fibrosis, also called pleural thickening, is scarring of those membranes; and pleurisy is inflammation of them, whether it is the dry or fibrinous kind that produces the classic knife-like pain on breathing in or the kind that goes on to produce fluid. 38 CFR 4.97 gives all of it one lasting-disability code — DC 6845, "Chronic pleural effusion or fibrosis" — because what the schedule rates is the restriction the pleura leaves behind, not the name of the inflammation that caused it. The code has no criteria of its own: it is one of six codes (DC 6840 through 6845) governed by the General Rating Formula for Restrictive Lung Disease, and that formula is driven by three pulmonary-function numbers — FEV-1 as a percentage of predicted, the FEV-1/FVC ratio, and DLCO by the single-breath method — with maximum oxygen consumption and cor pulmonale findings entering at the top row. Note the formula's floor: the lowest row is 10 percent at FEV-1 of 71 to 80 percent predicted, and there is no 0 percent row at all. The formula also ends with the alternative "Or rate primary disorder," so where the pleural disease is a manifestation of something else, that something else can be rated instead. One provision is written specifically for pleurisy: Note (1) assigns 100 percent for pleurisy with empyema, with or without pleurocutaneous fistula, until resolved. Common service pathways are asbestos exposure aboard ship, tuberculosis and other infections, penetrating chest trauma, thoracic surgery, and radiation. DC 6842 is sometimes cited for pleurisy, including on an earlier version of this site, but 38 CFR 4.97 lists DC 6842 as "Kyphoscoliosis, pectus excavatum, pectus carinatum" — chest-wall deformities, which happen to sit in the same formula but are a different disease entirely.

Rating Criteria

Evidence Needed

Complete pulmonary function testing is the claim: FEV-1 with percentage predicted, the FEV-1/FVC ratio, and DLCO by the single-breath method. Any one of the three can carry a row, so an incomplete study — spirometry without DLCO — can cost a tier. Add imaging that establishes the pleural disease itself (chest radiograph, CT of the chest, or pleural ultrasound), any thoracentesis or pleural biopsy results, and the exposure history: for asbestos, the rating and shipboard occupation, and for infectious causes, the treatment record. If the top row is in play, bring the echocardiogram or catheterization report showing pulmonary hypertension or right ventricular hypertrophy, any documented episode of acute respiratory failure, and the oxygen prescription.

C&P Exam Tips

Ask for post-bronchodilator values and for DLCO to be included, and check that the report states percentage predicted rather than raw numbers — the criteria are written entirely in percentages predicted. Mention the pleural diagnosis specifically so the examination is not written up as generic restrictive disease. If you use supplemental oxygen at home, say so plainly: outpatient oxygen therapy is a stand-alone route to 100 percent in this formula, independent of any spirometry value. Three notes to the formula are worth raising if they fit: a 100 percent rating is assigned for pleurisy with empyema, with or without pleurocutaneous fistula, until resolved; following episodes of total spontaneous pneumothorax, 100 percent is assigned as of the date of hospital admission and continues for three months from the first day of the month after discharge; and gunshot wounds of the pleural cavity with a retained bullet or missile in the lung, with pain or discomfort on exertion, or with scattered rales or some limitation of diaphragm excursion or lower chest expansion, are rated at least 20 percent disabling.

How to File

File under DC 6845 with complete pulmonary function testing including DLCO, the imaging that establishes the pleural disease, and the exposure or injury history. Two structural rules shape the strategy. 38 CFR 4.96(a) provides that ratings under DC 6600 through 6817 and 6822 through 6847 will not be combined with each other — a single rating is assigned under the code reflecting the predominant disability, with elevation to the next higher evaluation where the severity of the overall disability warrants it. So with several lung conditions the argument is which is predominant and whether elevation is warranted, not how to stack them. And the formula itself ends with "Or rate primary disorder," so where the pleural finding is a manifestation of an underlying disease, ask that the primary disorder be rated if that produces more. Muscle-injury ratings for shoulder girdle Groups I to IV are separately rated and combined with respiratory ratings, but Muscle Group XXI (DC 5321) is not.

Common Mistakes

Submitting spirometry without DLCO. Any one of FEV-1, FEV-1/FVC or DLCO can establish a row, and DLCO is often the one that is worst in pleural disease. Expecting a 0 percent row in the formula — there is none; the lowest listed evaluation is 10 percent. Not mentioning home oxygen, which is an independent route to 100 percent. Trying to combine DC 6845 with another respiratory code, when 38 CFR 4.96(a) directs a single predominant evaluation with possible elevation instead. And overlooking the notes: the empyema provision, the three-month post-pneumothorax total rating, and the 20 percent minimum for pleural-cavity gunshot wounds with a retained missile. Filing pleurisy under DC 6842, which is the chest-wall deformity entry (kyphoscoliosis, pectus excavatum, pectus carinatum), rather than under DC 6845.

Frequently Asked Questions

Is there a 0 percent rating under DC 6845?

Not in the formula. The General Rating Formula for Restrictive Lung Disease runs 100, 60, 30 and 10 percent, and the 10 percent row is FEV-1 of 71 to 80 percent predicted. Where no listed criterion is met, 38 CFR 4.31 supplies a 0 percent evaluation, which still establishes service connection.

Which pulmonary function number is used?

Whichever of the three puts you in the higher row — FEV-1 percent predicted, the FEV-1/FVC ratio, or DLCO by the single-breath method. They are written as alternatives, joined by "or," so a normal FEV-1 does not defeat a qualifying DLCO.

Does home oxygen get me to 100 percent?

Outpatient oxygen therapy is listed in the 100 percent row as one of its alternatives, alongside cor pulmonale, right ventricular hypertrophy, pulmonary hypertension shown by echocardiogram or catheterization, and episodes of acute respiratory failure. It does not depend on a spirometry value.

What happens after a collapsed lung?

Note (2) to the formula assigns 100 percent following episodes of total spontaneous pneumothorax, running from the date of hospital admission and continuing for three months from the first day of the month after discharge. Note (1) separately assigns 100 percent for pleurisy with empyema, with or without pleurocutaneous fistula, until resolved.

I have a retained fragment in my lung from a gunshot wound. Does that matter?

Yes. Note (3) provides that gunshot wounds of the pleural cavity with a bullet or missile retained in the lung, with pain or discomfort on exertion, or with scattered rales or some limitation of diaphragm excursion or lower chest expansion, are rated at least 20 percent disabling. Disabling injuries of shoulder girdle muscle Groups I to IV are separately rated and combined; Muscle Group XXI is not.

Can I be rated for both asbestosis and pleural fibrosis?

Not as two combined ratings. 38 CFR 4.96(a) bars combining ratings under DC 6600 through 6817 and 6822 through 6847 with each other; VA assigns a single rating under the predominant code, elevated to the next higher evaluation where the overall severity warrants. Conditions outside the respiratory schedule are combined normally under 38 CFR 4.25.

How is pleurisy rated — is there a code just for it?

There is no separate code for pleurisy in the current schedule. An acute attack that resolves leaves nothing to rate; where it becomes chronic or leaves fluid or scarring behind, it is DC 6845 and the rating comes from the pulmonary-function numbers in the General Rating Formula for Restrictive Lung Disease. The one exception is written into the formula itself: Note (1) assigns 100 percent for pleurisy with empyema, with or without pleurocutaneous fistula, until it resolves.

What is DC 6842, then?

38 CFR 4.97 lists DC 6842 as "Kyphoscoliosis, pectus excavatum, pectus carinatum" — the chest-wall deformities. It is a live code and it takes the same General Rating Formula for Restrictive Lung Disease, which is why it can look interchangeable with this one, but it describes the shape of the chest wall rather than disease of the pleura.

Does dry (fibrinous) pleurisy rate differently from pleurisy with an effusion?

Not by name. Both are evaluated under DC 6845 on how much lung function is left. Dry pleurisy that heals without scarring usually produces no compensable measurement, so the practical difference is what the pulmonary-function test and the imaging show, not which form the inflammation took.