Secondary Pulmonary Hypertension — VA Disability Rating Criteria (DC 6817)
Diagnostic Code 6817 · 38 CFR §4.97
What Is It?
Secondary pulmonary hypertension develops as a consequence of something else — most often chronic obstructive pulmonary disease, interstitial lung disease, sleep apnea, chronic blood clots, or left heart disease. Two things about how 38 CFR § 4.97 handles it are worth knowing before filing, and neither is obvious from the code list. The first is the code: there is no separate diagnostic code for secondary pulmonary hypertension. DC 6839 is mucormycosis, a fungal infection. The vascular causes belong to DC 6817, "Pulmonary Vascular Disease," whose 100 percent row expressly covers "pulmonary hypertension secondary to other obstructive disease of pulmonary arteries or veins with evidence of right ventricular hypertrophy or cor pulmonale," as well as chronic pulmonary thromboembolism with the same evidence. The second is that when the cause is a lung disease rather than a vascular one, pulmonary hypertension is already written into that condition's own 100 percent row: the obstructive formula shared by DC 6600 through 6604 lists "pulmonary hypertension (shown by Echo or cardiac catheterization)" at 100 percent, and so does the General Rating Formula for Interstitial Lung Disease at DC 6825 through 6833. So the finding usually raises the underlying rating rather than earning a second one.
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. Where the pulmonary hypertension is secondary to a lung disease rather than to disease of the pulmonary arteries or veins, the evaluation is not made here at all: it is made under the underlying condition's own formula, where pulmonary hypertension shown by echocardiogram or cardiac catheterization is itself the 100 percent criterion. |
Evidence Needed
An echocardiogram or right heart catheterization showing elevated pulmonary pressures — and, for the DC 6817 route, evidence of right ventricular hypertrophy or cor pulmonale, because the 100 percent row requires it for the secondary branch even though it does not for primary PAH. Documentation of the underlying cause and its service connection. A medical opinion linking the pulmonary hypertension to the service-connected condition. Records establishing whether the cause is vascular (obstructive disease of the pulmonary arteries or veins, chronic thromboembolism) or parenchymal (COPD, interstitial disease) — that single fact decides which code the evaluation is made under.
C&P Exam Tips
Make sure the examiner records right ventricular hypertrophy or cor pulmonale if either is present; on the secondary branch of DC 6817 that finding is not supporting detail, it is the criterion. If your pulmonary hypertension follows from an already service-connected lung condition, ask that the finding be documented in that condition's examination as well, because it is the 100 percent criterion inside that code's own formula. Bring the nexus opinion. Be ready for § 4.96(a): ratings under DC 6600 through 6817 and 6822 through 6847 are not combined with each other, so the practical question at the examination is which disability is predominant, not how many can be listed.
How to File
File as a secondary condition to your existing service-connected respiratory or cardiac condition. Include a medical nexus opinion explaining how your service-connected condition caused pulmonary hypertension. Submit echocardiogram or catheterization results and functional assessments.
Common Mistakes
Not filing as secondary to the underlying condition. Lacking a nexus opinion connecting the two conditions. Not getting right heart catheterization for definitive diagnosis. Failing to document functional limitation separately from the underlying lung condition.
Frequently Asked Questions
Can I get a separate rating for secondary pulmonary hypertension on top of my lung condition?
No — and the bar is more specific than the general pyramiding rule. 38 CFR § 4.96(a) says ratings under DC 6600 through 6817 and 6822 through 6847 "will not be combined with each other," and directs that a single rating be assigned under the diagnostic code reflecting the predominant disability, with elevation to the next higher evaluation where the overall severity warrants it. Pulmonary hypertension secondary to a service-connected lung disease is therefore worth arguing as a route to a higher single rating, not as a second rating. That is not a downgrade of the claim: pulmonary hypertension shown by echocardiogram or cardiac catheterization is the 100 percent criterion inside both the obstructive formula (DC 6600 through 6604) and the interstitial formula (DC 6825 through 6833).
My sleep apnea is service-connected — can that cause pulmonary hypertension?
Chronic untreated or undertreated sleep apnea is a recognized cause of secondary pulmonary hypertension, and a medical opinion explaining the connection supports secondary service connection. The rating mechanics differ from the other lung causes, though. DC 6847 has its own criteria — 0, 30, 50 and 100 percent, keyed to daytime hypersomnolence, breathing-assistance devices, and chronic respiratory failure with carbon dioxide retention or cor pulmonale — and unlike DC 6600 through 6604 it has no pulmonary hypertension clause. It is still inside § 4.96(a)'s non-combination list. So the argument is either that cor pulmonale is present, which is in DC 6847's own 100 percent row, or that the pulmonary vascular disease is the predominant disability and belongs under DC 6817. There is no DC 6839 route; that code is mucormycosis.