Primary Pulmonary Hypertension — VA Disability Rating Criteria (DC 6817)
Diagnostic Code 6817 · 38 CFR §4.97
What Is It?
Primary pulmonary hypertension — pulmonary arterial hypertension, or PAH — is abnormally high blood pressure in the arteries of the lungs with no identifiable external cause. It forces the right side of the heart to work against a load it was never built for, and over time that produces right ventricular hypertrophy and right heart failure. The code is DC 6817, "Pulmonary Vascular Disease." The reason to know that precisely is that 38 CFR § 4.97 does not merely route primary pulmonary hypertension to DC 6817 — it names the condition, in those words, as the FIRST clause of the code's 100 percent row. There is no graduated ladder beneath it for this diagnosis: the 60, 30 and 0 percent rows all describe thromboembolic pictures (anticoagulant therapy, inferior vena cava surgery, resolution of an acute pulmonary embolism), not degrees of primary PAH. DC 6838 is a different disease entirely — § 4.97 assigns it to aspergillosis, a fungal lung infection rated on the General Rating Formula for Mycotic Lung Disease.
Rating Criteria
| Rating | Criteria |
|---|---|
| 100% | Primary pulmonary hypertension, or; chronic pulmonary thromboembolism with evidence of pulmonary hypertension, right ventricular hypertrophy, or cor pulmonale, or; pulmonary hypertension secondary to other obstructive disease of pulmonary arteries or veins with evidence of right ventricular hypertrophy or cor pulmonale. |
| 60% | Chronic pulmonary thromboembolism requiring anticoagulant therapy, or; following inferior vena cava surgery without evidence of pulmonary hypertension or right ventricular dysfunction. |
| 30% | Symptomatic, following resolution of acute pulmonary embolism. |
| 0% | Asymptomatic, following resolution of pulmonary thromboembolism. The code's Note directs that other residuals following pulmonary embolism be evaluated under the most appropriate diagnostic code — chronic bronchitis (DC 6600) or chronic pleural effusion or fibrosis (DC 6844) are § 4.97's own examples — but that evaluation is not combined with any of the evaluations above. |
Evidence Needed
Right heart catheterization results, which remain the definitive test for the diagnosis. An echocardiogram showing elevated pulmonary pressures and right heart changes. Imaging or catheterization evidence of right ventricular hypertrophy or cor pulmonale, which is what the 100 percent row requires for the thromboembolic and secondary-obstructive branches even though it requires nothing beyond the diagnosis for primary PAH. A six-minute walk test and the current medication list showing PAH-specific therapy document severity for the record even though the schedule does not tier on them. Documentation ruling out secondary causes is what establishes the condition as primary rather than secondary, and that distinction decides which clause of the 100 percent row applies.
C&P Exam Tips
Get the right heart catheterization report into the file — it is the document that establishes the diagnosis the 100 percent row names. Ask the examiner to state the diagnosis in the schedule's own words, "primary pulmonary hypertension," because that phrase is the criterion. WHO Functional Class, six-minute walk distance and prostacyclin therapy are all worth documenting as evidence of severity, but be aware that none of them appears in § 4.97 — a decision that grades you down because your functional class is II is applying a standard the schedule does not contain. Note also § 4.96(a): ratings under DC 6600 through 6817 and 6822 through 6847 are not combined with each other, so if you carry another rated lung condition the rater assigns one evaluation under the predominant code.
How to File
File for primary pulmonary hypertension with right heart catheterization results confirming the diagnosis. Include all current treatment records and functional assessments. If related to another service-connected condition, file as secondary with a nexus opinion.
Common Mistakes
Relying only on echocardiogram estimates without right heart catheterization confirmation. Not documenting WHO Functional Class. Failing to submit six-minute walk test results. Not claiming secondary conditions like right heart failure.
Frequently Asked Questions
What is the difference between primary and secondary pulmonary hypertension for VA purposes?
Both live under the same diagnostic code, DC 6817, and the difference is which clause of its 100 percent row you meet. Primary pulmonary hypertension is named on its own, with no additional requirement. Pulmonary hypertension secondary to other obstructive disease of the pulmonary arteries or veins also reaches 100 percent, but only with evidence of right ventricular hypertrophy or cor pulmonale. Pulmonary hypertension arising from a lung disease such as COPD or interstitial fibrosis, or from left heart disease, is a different situation again — see the secondary pulmonary hypertension page. There is no DC 6838 or DC 6839 route for any of this; § 4.97 assigns those numbers to aspergillosis and mucormycosis.
Is primary pulmonary hypertension always rated at 100 percent?
Under the schedule as written, a documented diagnosis of primary pulmonary hypertension satisfies the 100 percent criterion by itself — the row names the condition and attaches no severity qualifier to it. The 60, 30 and 0 percent rows below it describe chronic thromboembolism, post-IVC-surgery status and resolution of an acute pulmonary embolism, none of which is primary PAH. If a decision assigns 30 or 60 percent for a confirmed primary pulmonary hypertension, that is worth reading against the text of DC 6817 before the appeal window closes.