Pulmonary Tuberculosis, Chronic, Far Advanced, Inactive — VA Disability Rating Criteria (DC 6721)

Diagnostic Code 6721 · 38 CFR §4.97

What Is It?

DC 6721 covers chronic pulmonary tuberculosis classified as far advanced and inactive — the infection has arrested, though scarring, cavitation and fibrosis may remain. DC 6721 through 6724 sit in 38 CFR 4.97 under the heading "Ratings for Pulmonary Tuberculosis Entitled on August 19, 1968." Public Law 90-493 repealed 38 U.S.C. 356, which had provided graduated ratings for inactive tuberculosis, and 38 CFR 4.96(b) preserves the repealed section for any veteran who on 19 August 1968 was receiving or entitled to receive compensation for tuberculosis — directing that the use of those protective provisions be mentioned in the discussion portion of every rating that applies them. A case first evaluated after that date is rated under DC 6730, 6731 or 6732 instead. None of the four inactive codes carries a percentage of its own — their rating cells in 38 CFR 4.97 are empty. All four are governed by the General Rating Formula for Inactive Pulmonary Tuberculosis, printed immediately beneath them, and that formula measures time rather than lung function: 100 percent for two years after the date of inactivity, 50 percent thereafter for four years or in any event to six years, 30 percent thereafter for five years or to eleven years, then a permanent minimum of 30 percent following far advanced lesions, or 20 percent following moderately advanced lesions where there is continued disability, and otherwise 0 percent. Two things follow. The date of inactivity is the axis the whole schedule turns on. And the lesion extent documented while the disease was active — not current pulmonary function testing — is what sets the floor after eleven years. For DC 6721 the formula has a floor. Far advanced lesions diagnosed at any time while the disease process was active carry a permanent minimum of 30 percent, which is the highest floor the formula provides. That single sentence removes the bottom two rows from this code: neither the 20 percent step for moderately advanced lesions nor the 0 percent "otherwise" row can apply, because the minimum holds. So the reachable set under DC 6721 is 100, 50 and 30 percent, and for a veteran decades past the date of inactivity the operative figure is the permanent 30. Note (2) to the block bars combining the graduated 50 and 30 percent ratings and the permanent 30 and 20 percent ratings for inactive pulmonary tuberculosis with ratings for other respiratory disabilities; following thoracoplasty the rating is for removal of ribs combined with the rating for collapsed lung, and resection of ribs incident to thoracoplasty is rated as removal. 38 CFR 4.96(a) adds that in cases protected by Pub. L. 90-493 the graduated 50 and 30 percent ratings will not be elevated.

Rating Criteria

Evidence Needed

Two documents carry this claim and neither is a current pulmonary function test. First, the date of inactivity, stated as a date — every graduated step is counted from it, so a treatment record, a rating decision, or a physician statement fixing that date is the single most valuable item in the file. Second, the lesion classification recorded while the disease was active: far advanced, moderately advanced, or minimal. That classification sets the permanent minimum and it can only come from the active-phase record — radiology reports, hospital summaries, the original rating decision, or the award letter. Add whatever establishes entitlement to compensation for tuberculosis as of 19 August 1968, because that is what places the case in this protected block. Current imaging and spirometry are still worth submitting: they support a separately rated residual respiratory condition where the tuberculosis evaluation itself has run down.

C&P Exam Tips

Ask the examiner to state the date of inactivity and the lesion extent in the report, in those words. This schedule is not graded on how you breathe today, so a strong description of current symptoms will not raise the tuberculosis evaluation — but it can support a separate residual diagnosis such as pleural fibrosis (DC 6845) or restrictive impairment, and that is where current spirometry and imaging do work. If the active-phase records are incomplete, bring anything that describes lesion extent; the difference between "far advanced" and "minimal" in a fifty-year-old radiology report is the difference between a permanent 30 percent floor and 0 percent.

How to File

File under DC 6721 and lead with the date of inactivity and the lesion classification, then the evidence of entitlement as of 19 August 1968. Ask expressly that the decision state both the date of inactivity and the lesion extent, and that it discuss the protective provisions of Pub. L. 90-493 as 38 CFR 4.96(b) requires. Where the graduated period has expired and no permanent minimum applies, the productive claim is not an increase under DC 6721 but a separate claim for the residual lung disease — pleural effusion or fibrosis under DC 6845, restrictive impairment under the General Rating Formula for Restrictive Lung Disease, or bronchiectasis or obstructive disease under their own codes. Note (2) blocks combining the graduated and permanent inactive ratings with other respiratory ratings, so the two routes are alternatives rather than additions.

Common Mistakes

Arguing current pulmonary function. The inactive formula counts years since inactivity and lesion extent, not FEV-1. Not pinning the date of inactivity, which leaves every graduated step uncalculable. Overlooking the permanent 30 percent minimum, which is the whole point of this code and which no lapse of time removes. Assuming this block applies to a modern tuberculosis claim — it applies only to veterans entitled to compensation for tuberculosis on 19 August 1968, with everyone else under DC 6730 through 6732. And trying to stack the graduated inactive rating on another respiratory code, which Note (2) forbids; the separate residual claim is the route that works.

Frequently Asked Questions

Does DC 6721 have criteria of its own?

No. Its rating cell in 38 CFR 4.97 is empty. The percentage comes from the General Rating Formula for Inactive Pulmonary Tuberculosis printed beneath the four inactive codes.

How is the graduated schedule counted?

From the date of inactivity. One hundred percent for the first two years, 50 percent thereafter for four years or in any event to six years, and 30 percent thereafter for five years or to eleven years. After eleven years only a permanent minimum can keep the evaluation above zero.

What is my permanent minimum?

Thirty percent, permanently. The formula provides a minimum of 30 percent following far advanced lesions diagnosed at any time while the disease process was active, so under DC 6721 the evaluation does not drop below 30 no matter how long ago the disease became inactive.

Why does my current breathing test not change the rating?

Because this formula does not read pulmonary function. Current impairment is claimed as a separate residual condition — pleural effusion or fibrosis under DC 6845, or restrictive impairment under the General Rating Formula for Restrictive Lung Disease — although Note (2) prevents that rating from being combined with the graduated or permanent inactive tuberculosis rating.

Does this schedule apply to a tuberculosis claim filed today?

No. DC 6721 through 6724 are preserved by Pub. L. 90-493 for veterans who on 19 August 1968 were receiving or entitled to receive compensation for tuberculosis, as 38 CFR 4.96(b) explains. Anyone else is rated under DC 6730, 6731 or 6732.

Can the graduated 50 or 30 percent rating be elevated?

No. 38 CFR 4.96(a) states that in cases protected by Pub. L. 90-493 the graduated 50 and 30 percent ratings for inactive tuberculosis will not be elevated, even though elevation to the next higher evaluation is otherwise available when a single predominant respiratory code is assigned.