The Respiratory System

Topics:
Respiratory Rating System
Diseases of the Nose and Sinuses
Diseases of the Throat
Restrictive Lung Diseases
Obstructive Lung Diseases
Interstitial Lung Diseases
Pulmonary Vascular Diseases
Fungal Infections (Mycotic Lung Disease) of the Lung
Bacterial Infections of the Lung
Sleep Apnea
Tuberculosis of the Respiratory System
Cancer and Tumors of the Respiratory System
Other Respiratory Conditions
DBQ for Respiratory Conditions
Principles that Apply

Reminder: The VA will give a Military Disability Rating for each service-connected condition a service member has, but the DoD will only rate service-connected conditions that make a service member Unfit for Duty.

The respiratory system is a network of organs that brings air into the body, absorbs the oxygen into the blood stream, and then exhales carbon dioxide. The respiratory system is made up of the nose, sinuses, pharynx, larynx, trachea, lungs, and bronchi (bronchial trees).

Military Disability ratings for the respiratory system

Air is brought into the body through the nose or mouth. It then passes down the pharynx through the trachea to the bronchi in the lungs. The bronchi then transport the air to the areas of the lungs where the blood absorbs the oxygen. After this process is complete, the left over air is then pushed back up the trachea. While passing through the larynx, it passes over the vocal cords, which enables speech, before exiting the nose or mouth.

When rating conditions of the respiratory system, it is important to note that the following conditions cannot be rated together (only one of them can be rated): 6600-6847. The only exception to this is if one of the conditions is either a cancer or tumor (codes 6819 and 6820) and the other is a condition that does NOT affect the lungs themselves. In this case only can more than one condition with a code between these numbers be rated together.

If you have more than one respiratory condition make sure to check that they aren’t one of these listed here. If they are, only one of them can be rated. You must use the condition that is the most severe or dominant, not necessarily the one that will give the highest rating. If the secondary conditions affect the overall health significantly, then the rating for the dominant condition can be increased to the next higher rating.

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Respiratory Rating System

Not all respiratory conditions are rated on this system, but the definitions of the tests found below will come into play with many conditions even if they do not use the exact same system.

Ratings for the respiratory system are based on how well the lungs take in air, absorb oxygen into the blood, and then exhale the left over gases. Pulmonary function tests (PFTs) are performed to record the proper functioning of the lungs and their affects on the entire body. Because the oxygen the lungs intake goes into the blood stream, severe lung conditions can affect the heart. If the heart is affected, it is essential that proper heart tests are run as part of the PFTs. Below is a list of important tests and test results that are necessary for ratings.

– Spirometry: This is a set of tests that records the functioning of the lungs and the airways leading to the lungs. These tests should be done before and after medication is taken, and sometimes numerous times over a long period, to properly reflect the severity of the condition. If they are not performed after taking medication, then the physician must explain why not on the medical report. If the results of the spirometry are used to rate the condition, then the test results AFTER the medication is taken are the ones that must be used unless the test results from before the medication are worse (this would be very unusual). The following result measurements are used for rating purposes:

– Forced Vital Capacity (FVC) is the total maximum amount of air that you can exhale after taking a full breath. It is reported as a volume of air and also as a percentage of the average, healthy person like you.

– Forced Expiratory Volume in 1 second (FEV-1) is the maximum amount of air that you can blow out in 1 second. The results of these measurements are noted as a volume of air and as a percentage of the measurements of a normal person your age, height, ethnicity, and sex. So if the average, healthy person like you can expel 4.5 liters of air, and you can expel 4.0 liters of air, then your FEV-1 result would be 89% (4.0/4.5 = 89%). 70% and above is considered normal.

The ratio of FEV-1 to Forced Vital Capacity (FVC) is another measurement used for ratings. The ratio is determined by dividing the FEV-1 by the FVC, and will be noted as a percentage. If the FEV-1 measurement is 3.5 liters and the FVC measurement is 5.0 liters, then the FEV-1/FVC would be 70% (3.5/5.0 = 70%). 75% and above is considered normal. If both the FEV-1 and the FVC’s measurements are higher than their predicted values, then this ratio cannot be used to rate the condition.

– A Flow-Volume Loop can be calculated from the results of a spirometry. It charts the entire lung capacity and the ability to move air through the airways by first inhaling completely, then forcefully exhaling completely, and then quickly inhaling again. The results of this test are shown on a graph, but the graphs themselves are unimportant for rating. The important information is the physician’s analysis of the chart. In this analysis it should be clearly stated whether or not there is an obstruction that is blocking the airflow. This could be an upper airway obstruction, extrathoracic obstruction or intrathoracic obstruction.

– The Diffusion Capacity of the Lung for Carbon Monoxide by the Single Breath Method (DLCO (SB)) is another test used for rating. In addition to testing the function of the airways, this test also measures the ability of the lungs to absorb gasses. After inhaling a certain amount of carbon monoxide, the test measures how much is absorbed by the lungs into the blood stream by measuring how much is left in the air that is exhaled. The result of this test that is necessary for rating is again given as the percentage of a normal, healthy person your age, height, ethnicity, and sex. Eighty percent and above is considered normal.

– Exercise testing: This test determines how much oxygen the body uses when functioning at its maximum capacity. “Maximum capacity” is defined as the maximum amount of physical activity that can be repeated and sustained by the individual. So just running at the maximum speed for 2 seconds is not the maximum capacity. Instead, it would be the maximum speed that can be sustained for more like 10 minutes, etc. Each person has a different maximum capacity. The ratable result of this test is the amount of oxygen (in milliliters, ml) used by your body weight (in kilograms, kg) per minute (min). It should look like this: 20 ml/kg/min.

– Heart tests: Because the lungs supply the blood and heart with oxygen, lung conditions often cause heart problems. If the heart is involved, then an echocardiogram or a cardiac catheterization or other tests of the heart may be necessary to properly rate the condition.

Not all of these tests must be done in every instance. Obviously, if the condition is not severe enough to affect the heart, then the heart tests are not needed. A complete spirometry is almost ALWAYS needed unless the exercise test results are 20ml/kg/min or less, the heart tests show pulmonary hypertension, there have been 1 or more episodes of respiratory failure, or when regular oxygen therapy is needed at home.

When deciding which test result to use to rate the condition, the one that the examining physician feels most closely reflects the nature of the condition must be used. If they all accurately reflect the condition, then the one that gives the highest rating can be used. If any of the test results are not consistent with the other tests or overall condition, then the examining physician must explain why that test result should not be used to rate the condition.


The ratings:

The following table has all the tests, conditions and their ratings. Remember that only one rating can be given for a respiratory condition. The one that best reflects the overall condition must be used unless they all represent it equally. Then the one that gives the highest rating is used.

Test

Result/Condition

Rating

FEV-1

Less than 40%

100%

FEV-1

40-55%

60%

FEV-1

56-70%

30%

FEV-1

71-80%

10%

FEV-1/FVC

Less than 40%

100%

FEV-1/FVC

40-55%

60%

FEV-1/FVC

56-70%

30%

FEV-1/FVC

71-80%

10%

DLCO (SB)

Less than 40%

100%

DLCO (SB)

40-55%

60%

DLCO (SB)

56-65%

30%

DLCO (SB)

66-80%

10%

Exercise Test

Less than 15 ml/kg/min with the limitation caused by a heart or respiratory condition.

100%

Exercise Test

15-20 ml/kg/min with the limitation caused by a heart or respiratory condition.

60%

Heart Test/Conditions

Cor pulmonale

100%

Heart Test/Conditions

Right ventricular hypertrophy

100%

Heart Test/Conditions

Pulmonary hypertension

100%

Other

1 or more episodes of respiratory failure

100%

Other

Requires oxygen treatments at home

100%



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Diseases of the Nose and Sinuses

The nose is connected to a group of hollow openings in the bones of the skull called the sinuses. The ethmoid sinuses are located between the eyes under the bridge of the nose. The frontal sinuses are located above the eyebrows. The maxillary sinuses are located to either side of the nose in the cheekbones, and the sphenoid sinuses are located behind the eyes. The nasal passage is divided in half by the septum.

Military Disability ratings for the respiratory system

Code 6502: Deviation of the nasal septum is a condition where the septum blocks one or both of the nasal passages. This is only ratable if it occurred because of a traumatic injury. If it is blocking 50% of the nasal passage, either 50% on both sides or 100% on one side, it is rated 10%.

Code 6504: Loss of part of the nose or significant scarring is rated 30% if both nasal passages are exposed or 10% if there is an obvious disfigurement. It can either be rated under this code or under code 7800 for disfigurement if it would give a higher rating.

Code 6522: Allergic or vasomotor rhinitis is the swelling of the tissues lining the nasal passage because of allergies or other inhaled triggers like smoke, fumes, etc. This causes the nose to become stuffy and runny. If the rhinitis is fairly constant and there are growths forming in the tissues, it is rated 30%. If there are no growths in the tissues, but 50% of the nasal passages on both sides or 100% on one side is blocked, it is rated 10%.

Code 6523: Bacterial rhinitis is the swelling of the tissues lining the nasal passage because of a bacterial infection, causing congestion and a runny nose. If the condition causes rhinoscleroma, it is rated 50%. If there is rhinitis and the nasal concha grows abnormally into the nasal passages and causes 50% of both or 100% of one to be blocked, it is rated 10%.

Code 6524: Granulomatous rhinitis is the swelling of the tissues lining the nasal passage with abnormal cell growths that are not caused by bacteria. If the condition is lethal midline Wegener’s granulomatosis, it is rated 100%. This condition causes the blood vessels in the nose to swell and lumps to form that often cause deformities to form and the airways to become blocked. The condition is not curable, but it is treatable and not always lethal. Any other type of rhinitis that causes lumps to form in the nose is rated 20%.

Sinusitis Rating System

Sinusitis occurs when the sinuses swell and is most often caused by infection or allergy. Most sinusitis is easily cleared up within 2 weeks, and so it is only ratable if it is chronic. Sinusitis can occur in each of the different sinuses or in all at the same time (“pansinusitis”). Treatments range from medication to surgery.

If the sinusitis is constant or near-constant with headaches, tenderness to the touch, and the discharge of puss or crusting after repeated surgeries, or if a radical surgery was performed and there is ongoing infection in the facial bones (osteomyelitis), it is rated 50%.

If there are 3 or more incapacitating episodes each year that requires 4 to 6 weeks of antibiotic treatment, or if there are more than 6 episodes (not incapacitating) each year of headaches, tenderness and the discharge of puss or crusting, it is rated 30%.

If there are 1 or 2 incapacitating episodes each year that requires 4 to 6 weeks of antibiotic treatment, or if there are 3 to 6 episodes each year of headaches, tenderness, and the discharge of puss or crusting, it is rated 10%.

Anything less is rated 0%.

Sinusitis codes:

– Code 6510: Pansinusitis
– Code 6511: Ethmoid sinusitis
– Code 6512: Frontal sinusitis
– Code 6513: Maxillary sinusitis
– Code 6514: Sphenoid sinusitis

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Diseases of the Throat

Military Disability ratings for the respiratory system

The throat is comprised of the pharynx, larynx and trachea. The pharynx is the part of the throat that connects the nose, mouth, trachea, and esophagus. At the bottom of the pharynx, the trachea splits from the esophagus and leads to the lungs (the esophagus leads to the stomach). Near the top of the trachea is the larynx or “voice box”. This is where the vocal cords are located.

Code 6516: Chronic laryngitis is the swelling of the larynx that regularly lasts more than 3 weeks. If it causes hoarseness when speaking and there are either growths in the larynx or on the vocal cords, or if there are pre-cancerous tumors, it is rated 30%. If it causes hoarseness when speaking and the vocal cords or larynx walls are swollen, it is rated 10%.

Code 6518: A laryngectomy is the removal of the larynx. In a total laryngectomy, the entire larynx is removed, and the trachea is separated from the pharynx. After a total laryngectomy, breathing is done through a hole in the throat. A total laryngectomy is rated 100%. A partial laryngectomy is not rated under this code, but is rated on any lasting symptoms like laryngitis (code 6516), the inability to speak (code 6519), or a narrowed larynx (code 6520).

Additional compensation may be given by the VA for the loss of the larynx. See the Special Monthly Compensation to see if your condition qualifies.

Code 6519: Aphonia is the inability to speak that is caused by an infection, injury or disease. If it is caused by a psychological condition, it is not ratable. If you cannot communicate through speech at all, it is rated 100%. If you can speak, but not louder than a whisper, it is rated 60%. If you have been diagnosed with incomplete aphonia, and you can speak, but there are times when you can’t or it is very difficult to, then the condition is rated as laryngitis under code 6516.

Your condition may also qualify for additional compensation by the VA. Please see the Special Monthly Compensation page for more information.

Code 6520: Stenosis of the larynx is when the larynx narrows and the opening to the trachea becomes unusually small, causing difficulty speaking and breathing. If the larynx was injured, then any leftover symptoms from the injury can also be rated under this code. These conditions are either rated on the following system, or as the inability to speak, code 6519, whichever is most appropriate for the condition and provides the higher rating.

If the FEV-1 is less than 40% and the Flow-Volume Loop shows an upper airway obstruction, or if there is a permanent tracheostomy, then it is rated 100%. If the FEV-1 is 40-55% and the Flow-Volume Loop shows an upper airway obstruction, it is rated 60%. If the FEV-1 is 56-70% and the Flow-Volume Loop shows an upper airway obstruction, it is rated 30%. If the FEV-1 is 71-80% and the Flow-Volume Loop shows an upper airway obstruction, it is rated 10%.

Code 6521: Any injuries of the pharynx are rated under this code. If the injuries caused the pharynx at any point (up near the nasal passage to down near the larynx) to narrow or become completely blocked, or if the soft palate has been removed or is missing because of injury, chemical burns or growths on it, or if the soft palate cannot move and causes difficulty swallowing and speaking, it is rated 50%.

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Restrictive Lung Diseases

Restrictive lung diseases are all conditions that limit how much the lungs can expand when a breath is taken. All restrictive lung disease conditions are rated on the Respiratory Rating System.

If the main symptoms of the condition are not properly rated by this system, then it can be rated under the most serious symptom. For example, if the blood is not getting enough oxygen, the heart could be damage, but the Respiratory Rating System only gives ratings for the heart if it is very severe. If, however, the heart condition is not so severe but is the main symptom of the condition, it can be rated on that heart condition under the appropriate heart code.

Code 6840: If the diaphragm is paralyzed or moves incorrectly, it can limit the expansion of the lungs.

Code 6841: If there is an injury of the spinal cord that limits the movement of the lungs, it is rated under this code.

Code 6842: Three different conditions are rated under this code. Kyphoscoliosis is the abnormal curving of the spine both side-to-side and back-to-front. Pectus excavatum is a condition where the ribs and sternum grow inward, causing a caved-in chest. Pectus carinatum is the opposite of pectus excavatum. It occurs when the ribs and sternum grow outward in the middle of the chest. Each of these conditions limits the space the lungs need to inflate.

Code 6843: A few different things are also rated under this code. A hernia occurs when the lung pushes through the chest wall.

A collapsed lung (pneumothorax) is a condition where air gets between the lung and the chest wall, causing it to not properly inflate. If the lung collapses with no previous symptoms or conditions, it is rated 100%. This 100% rating continues for 3 months after discharge from the hospital. Any left over symptoms will then be rated on the Respiratory Rating System.

Any other conditions or defects of the chest wall that keeps the lung from inflating properly is also rated under this code. If there is a gunshot wound to the chest and either the bullet is still in the lung, there is pain or discomfort with breathing or movement, there is a crackly/wheezing sound in the lungs, or the lower chest or diaphragm cannot expand fully, the minimum rating for the condition is 20%.

In the case of a gunshot wound to the lungs, the muscles in Group XXI, then ones that control breathing, cannot be rated also. Only a muscle rating or a lung rating, whichever provides the higher rating. If shoulder muscles are affected as well, however, they can be rated separately since they do not directly impact breathing.

Code 6844: If any surgery, like a lobectomy or pneumonectomy, was performed on the lung and it is healed, but the lung is still unable to fully inflate, it is rated under this code.

Code 6845: Ongoing pleural effusion occurs when excess fluid builds up between the lung and the chest wall, and fibrosis occurs when excess connective tissues build up between the lung and the chest wall. These conditions are rated on the Respiratory Rating System.

Pleurisy with empyema would also be rated under this code. This condition occurs when pus builds up between the lung and the chest wall from a bacterial infection. This condition is rated 100% while the infection is active. Once it is resolved, any left over symptoms are rated on the Respiratory Rating System.

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Obstructive Lung Diseases

Obstructive lung diseases cause the airway to the lungs to become blocked. Often there is significant swelling of the tissues and the airways collapse easily. Most of these conditions are rated on the Respiratory Rating System, but some have some small differences.

Code 6600: Chronic bronchitis is the swelling of the bronchi in the lungs. The swelling causes them to narrow and block the passage of air.

Code 6603: Pulmonary emphysema is a disease that gets worse over time and is normally caused by smoking or being exposed to pollution for a long time. It causes the tissues that hold the shape of the lungs to die, thus causing the lungs to collapse and loose their shape.

Code 6604: Chronic obstructive pulmonary disease (COPD) is simply the presence of chronic bronchitis and/or emphysema. It is rated exactly the same as both bronchitis and emphysema, and the code can be used interchangeably. If both are present, then only one rating can be given under this code.

Code 6601: Bronchiectasis is a condition where part of the bronchial tree becomes enlarged and causes obstruction of the airflow. This is a permanent condition that cannot be reversed.

It is either rated on the Respiratory Rating System or on incapacitating episodes below, whichever provides the highest rating. The definition of an “incapacitating episode” for rating this condition is a period where there is an active infection in the lungs, and it requires bed rest and treatment by a physician.

If there are a total of at least 6 weeks of incapacitating episodes each year, it is rated 100%.

If there are a total of 4 to 6 weeks of incapacitating episodes each year, or if there is constant coughing of mucous mixed with puss or blood that requires near-constant antibiotic treatment with anorexia and weight loss, it is rated 60%.

If there are a total of 2 to 4 weeks of incapacitating episodes each year, or if there is daily coughing occasionally of muscous mixed with puss or blood that requires between 4 to 6 weeks of antibiotic treatment 3 or more times a year, it is rated 30%.

If there is occasional coughing with infections requiring antibiotics 2 or more times a year, it is rated 10%.

Code 6602: Asthma is a condition where the airways and bronchi swell, causing them to close up.

This condition has slightly different rating requirements than the Respiratory Rating System. These are outlined in the table below.

It is important to note that it is difficult to get a proper test for asthma since the tests must be run while an attack is happening. An FEV-1 test done when there is not an attack will give normal results that will not properly define the condition. A methacoline challenge test is often done instead since the methacoline triggers an asthma attack. Once the methacoline is inhaled and an asthma attack begins, the spirometry tests are performed. After the tests are done, medications are given to treat the asthma attack. If spirometry is done with and without methacoline, the condition is rated on the methacoline results.

If FEV-1 and FVC tests with methacoline are not performed, then asthma can be rated based on the kind of medication that is used to treat the condition or on the severity of the condition based on the number of ER visits. In these cases, however, the physician must clearly record a thorough history of asthma attacks.

Test

Result/Condition

Rating

FEV-1

Less than 40%

100%

FEV-1

40-55%

60%

FEV-1

56-70%

30%

FEV-1

71-80%

10%

FEV-1/FVC

Less than 40%

100%

FEV-1/FVC

40-55%

60%

FEV-1/FVC

56-70%

30%

FEV-1/FVC

71-80%

10%

ER visits

2 or more attacks per week with respiratory failure that requires ER visits to save life

100%

ER visits

Requires monthly ER visits to save life

60%

Medication

Requires daily high doses of steroids or immunosuppressive medications taken by mouth or by injection*

100%

Medication

Requires the use of steroids or immunosuppressive medications taken by mouth or by injection 3 or more times a year*

60%

Medication

Requires occasional use of inhaled anti-inflammatory medication*

30%

Medication

Requires daily bronchodilator therapy taken by mouth or inhaled*

30%

Medication

Requires occasional bronchodilator therapy taken by mouth or inhaled*

10%

*A definition of these medications is listed below.

Swelling is the biggest problem with asthma, and so the majority of medications that treat asthma are for controlling swelling.

Swelling is often a reaction of the immune system to things it doesn’t like. Immunosuppressive medications suppress this response, allowing the airways to remain open in an asthma attack. Similarly, steroids taken by mouth or injection are able to greatly reduce swelling. Both of these treatments are only used for the most severe cases of asthma and only when all the other medications listed below do not satisfactorily treat the condition. Some of the most common medications in these categories are Prednisone, Prednisolone, Decadron, Deltasone, Dexamethasone, Medrol, Orasone, Pediapred, and Prelone.

Inhaled anti-inflammatory medications are steroids, but a smaller dose than oral or injected steroids. These reduce swelling and mucus production. They are used to prevent asthma attacks. Some of the most common medications in this category are Aerobid (Flunisolide), Flovent HFA (Flutocasone HFA), Azmacort (triamcinolone), Ipratropium Bromide (Atrovent), Asmanex, Pulmicort, and Qvar. The following are a combination of an anti-inflammatory medication and a bronchodilator (discussed next), but they are rated as anti-inflammatory medication: Advair (Fluticasone and Salmeterol), Duleva, and Symbicort.

Bronchodilators are used by pretty much anyone with asthma. These keep the bronchi from swelling and blocking the airway. They are all inhaled, and there are short-acting and long-acting bronchodilators. Short-acting ones are the rescue inhalers that work very quickly and last between 1 hour and 4 hours. Common short-acting bronchodilators include Proventil, Albuterol, Ventolin, Salbutamol, AccuNeb, Levosalbutamol, Levalbuteral, Xopenex, Terbutaline, Bricanyl, Pirbuteral, Maxair, Procaterol, Metaproterenol, Alupent, Fenoterol, Bitolterol mesylate, and Ritodrine.

Long-acting bronchodilators are used to control asthma and prevent attacks. Common long-acting bronchodilators include Sereveut, Salmeterol, Formoterol, Foradil, Symbicort, Bambuterol, Clenbuterol, and Indacaterol.

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Interstitial Lung Diseases

Interstitial lung diseases are conditions that affect the tissues surrounding the air sacs in the lungs. All are rating on the same rating system except Sarcoidosis.

Code 6846: Sarcoidosis is a condition where lumps form on the tissues surrounding the air sacs, bronchi and small blood vessels in the lungs.

This condition can either be rated on the Respiratory Rating System as chronic bronchitis (code 6600) or on the following system, whichever provides the higher rating. If it is rated on the Respiratory Rating System as chronic bronchitis, the final code would look like this: 6846-6600. The first four-digit code defines the condition as sarcoidosis, and the second four-digit code tells how it is rated. If it affects any other system besides the heart and respiratory system, an additional rating can be given for those symptoms.

The ratings:

If the condition causes the right ventricle in the heart to swell and fail because of high blood pressure between the heart and lungs, or if there is congestive heart failure, or if it causes lung disease that continually gets worse despite treatment, with fever, night sweats and weight loss, it is rated 100%.

If it requires high doses of oral or injected steroids to control the condition, it is rated 60%. If it requires regular low doses or occasional high doses of oral or injected steroids, it is rated 30%.

If it causes the lymph nodes to swell in the lungs but it causes no symptoms or impairment, it is rated 0%.

Interstitial Lung Disease Rating System

All other interstitial lung conditions are rated on the following system. This system is similar to the Respiratory Rating System and uses the same spirometry tests, so further information about the tests and results can be found there.

Test

Result/Condition

Rating

FVC

Less than 50%

100%

FVC

50-64%

60%

FVC

65-74%

30%

FVC

75-80%

10%

DLCO (SB)

Less than 40%

100%

DLCO (SB)

40-55%

60%

DLCO (SB)

56-65%

30%

DLCO (SB)

66-80%

10%

Exercise Test

Less than 15 ml/kg/min with the limitation caused by a heart or respiratory condition.

100%

Exercise Test

15-20 ml/kg/min with the limitation caused by a heart or respiratory condition.

60%

Heart Test/Conditions

Cor pulmonale

100%

Heart Test/Conditions

Pulmonary hypertension

100%

Other

Requires oxygen treatments at home

100%


Code 6825: Diffuse interstitial fibrosis is a group of conditions where the tissues in the lung swell, become damaged, and then turn into scar tissue.

Code 6826: Desquamative interstitial pneumonitis is a condition where lumps form in the tissues of the lungs. Most often it is caused by smoking.

Code 6827: Pulmonary alveolar proteinosis causes protein to build up in the air sacs of the lungs.

Code 6828: Eosinophilic granuloma of the lung is a condition where cells from bone marrow are deposited in the lungs.

Code 6829: Drug-induced pulmonary pneumonitis and fibrosis is pneumonitis or fibrosis in the lungs caused by a reaction to medication taken for another condition.

Code 6830: Radiation-induced pulmonary pneumonitis and fibrosis is pneumonitis or fibrosis in the lungs caused by a reaction to radiation exposure or treatment.

Code 6831: Hypersensitivity pneumonitis (extrinsic allergic alveolitis) is the swelling of the tissues in the lungs caused by breathing in a substance like dust or mildew.

Code 6832: Pneumoconiosis (silicosis, anthracosis, etc.) is a lung disease caused by breathing in dust over a long period of time. This is most commonly seen in coal miners.

Code 6833: Asbestosis is lung condition caused by breathing in asbestos over a long period of time.

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Pulmonary Vascular Diseases

Code 6817: All pulmonary vascular diseases are rated under this code. These conditions affect the blood vessels leading to and from the lungs.

If the condition causes pulmonary hypertension, chronic pulmonary thrombo-embolism with pulmonary hypertension, right ventricular hypertrophy, right heart failure, or pulmonary hypertension with right heart failure or right ventricular hypertrophy caused by the blockage of arteries or veins in the lungs, it is rated 100%.

If the condition causes pulmonary thrombo-embolism that requires anticoagulant therapy, it is rated 60%. A 60% rating is also given if surgery has been done on the inferior vena cava and there is no evidence of pulmonary hypertension or any other problems with the right ventricle.

If there has been a pulmonary embolism and it has been treated and cleared, but the conditions still causes symptoms, it is either rated 30% under this code or it can be rated under the code of the symptom (like 6600 for bronchitis or 6844 for pleural effusion or fibrosis), whichever provides the highest rating. Only one code can be used, however, even if there are multiple symptoms. If there are no symptoms, it is rated 0%.

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Fungal Infections (Mycotic Lung Disease) of the Lung

Mycotic lung diseases are caused by inhaling fungal spores. These conditions are rated on the following system.

If the infection continues over a long period of time and causes fever, weight loss, night sweats, or coughing up large amounts of blood, it is rated 100%.

If it continues over a long period of time and requires treatment to keep it under control, and there are only minor symptoms like occasionally coughing up a little bit of blood or mucous, it is rated 50%.

If it continues over a long period of time and only have minor symptoms like occasionally coughing up a little bit of blood or mucous, it is rated 30%.

If the condition is healed and there are no symptoms, it is rated 0%.

The conditions:

Code 6834: Histoplasmosis of the lung is a fungal infection caused by breathing in the fungus Histoplasma capsulatum. If the infection remains in the lungs, it is normally short-lived and treatable. If, however, it disseminates, it can be fatal.

Code 6835: Coccidioidomycosis is caused by the fungus Coccidioides immitis that is located in the soil in southwestern United States (California, Nevada, Utah, Texas, Arizona, and New Mexico), Central America, and South America.

If the infection disseminates to other parts of the body, it could be several years after the initial lung symptoms before it causes other symptoms. Because of this, a history of living in the locations listed above during active duty service in the proper time-frame for this infection must be properly documented for the DoD to consider this condition service-connected.

Code 6836: Blastomycosis is caused by the fungus Blastomyces dermatitidis which is located in various areas of North America.

Code 6837: Cryptococcosis is either caused by Cryptococcus neoformans or Cryptococcus gattii. An increasing percentage of AIDS is often found in people with this infection because it allows AIDS to easily infiltrate the body’s immune system.

Code 6838: Aspergillosis is caused by the fungus Aspergillus, which everyone inhales every day. It only attacks people with a seriously decreased immune system, however. Because of this, it often infects people with cancer or other conditions that require therapy that suppresses the immune system.

Code 6839: Mucormycosis is caused by Mucorales fungi that grow in the blood vessels.

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Bacterial Infections of the Lung

Bacterial infections in the lungs are all rated the same. If the infection is active with symptoms like fever, night sweats, weight loss, and coughing up blood, it is rated 100%. If it does not qualify for this rating, it is rated based on any lasting symptoms like interstitial lung disease, restrictive lung disease or bronchitis.

Code 6822: Actinomycosis is a condition caused by the bacteria Actinomyces. It is very rare in humans, but when seen, causes puss-filled growths in the lungs.

Code 6823: Nocardiosis is caused by the bacteria Nocardia. It is very infectious, but occurs mostly in men with a decreased immune system. It is very hard to diagnose since the symptoms often look like other conditions.

Code 6824: Chronic lung abscess is and infection that causes the lung cells to die, creating cavities of pus in the tissues of the lungs.

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Sleep Apnea

Code 6847: Any sleep apnea syndrome is rated under this code. Sleep apnea is a disorder that occurs while asleep. There is either a pause when breathing that can last up to a few minutes or there is very shallow, low breathing. Central sleep apnea is caused by a decrease in the “action” of breathing—the body doesn’t try as hard to breathe properly. Obstructive sleep apnea is caused by a block in the airways, like a narrowing of the airway passages or an excess of mucus. This causes severe snoring. Mixed sleep apnea is a combination of both central and obstructive.

Sleep apnea can cause a significant impairment of the heart and respiratory system by limiting the amount of air that is taken in during the hours of sleep.

If the condition continues over a long period of time and causes respiratory failure with right heart ventricle failure or with too much carbon dioxide in the blood stream, or if it requires a tracheotomy, it is rated 100%.

If it requires the use of breathing machines like a continuous positive airway pressure (CPAP) machine during sleep, it is rated 50%.

If it causes serious sleepiness during the daytime or not feeling rested after sleeping, it is rated 30%.

If it is diagnosed by a sleep test, but it doesn’t cause any significant symptoms, it is rated 0%.

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Tuberculosis of the Respiratory System

Tuberculosis is an infectious disease that most commonly affects the lungs (pulmonary) but can also affect other organs (nonpulmonary). It is caused by an air-borne bacteria and causes symptoms like coughing, fever, sweating, and weight loss.

Code 6732: Tuberculous pleurisy is the swelling of the lungs due to liquid building up between the layers of the lining of the lungs with hard growths on the lining of the lungs. This condition is rated either under code 6730 if it is currently active or 6731 if it is inactive. The final code will look like this: 6732-6730. The first four-digit code defines the condition as tuberculous pleurisy, and the second four-digit code tells how it is rated.

Code 6730: All other pulmonary tuberculoses are rated under this code. If active, they are rated 100%.

As soon as the pulmonary tuberculosis becomes inactive, the VA will require another examination for rating purposes. This does not apply to the DoD. Most likely, the DoD will keep the service member on TDRL until the tuberculosis becomes inactive, at which point they will separate them with a permanent rating.

If the pulmonary tuberculosis is considered NOT service-connected, then it is not ratable UNLESS at least one of the following is also present or has occurred:

Active nonpulmonary tuberculosis
Severe symptoms
The tuberculosis was cured and then it came back
Lung lesions are continually getting worse despite treatment
If after being hospitalized for 6 months, the lesions and condition are not improving, or if after being hospitalized for 12 months, the condition is still active.

Code 6731: Inactive pulmonary tuberculosis is rated on the lasting symptoms or complications. If it causes restrictive heart disease or interstitial lung disease, then it will be rated on those conditions. Obstructive lung disease is rated as chronic bronchitis under code 6600, and a thoracoplasty is rated under code 5297.

Code 6515: Tuberculous laryngitis is a nonpulmonary tuberculosis that affects the larynx in the throat. If it is active, it is rated 100%. Once it is inactive, the 100% rating will continue for 1 year, after which the condition will be rated based on the lasting symptoms or complications. For example, if the condition causes an inability to speak, then it would be rated as aphonia, code 6519.

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Cancer and Tumors of the Respiratory System

Cancer and tumors are made up of the growth of abnormal cells. These cells can be benign—they do not attack the good cells around them (tumors)—or they can be malignant—they attack the cells around them (cancers). A “cancerous tumor” is just “cancer” under our definition.

Code 6819: Any malignant cancer of the respiratory system (this does not include skin cancers) is rated 100% while it is active. This 100% rating continues for 6 months following the last treatment. The condition is the re-evaluated and any left over symptoms or complications are rated separately.

Code 6820: Any tumor of the respiratory system is rated on any systems or functions that it affects. For example, if the tumor pushes on the larynx and makes it hard to speak, then it would be rated as aphonia, code 6519.

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Other Respiratory Conditions

All other digestive system conditions will be rated analogously (see the Analgous and Equivalent Codes page) with the above ratings. The bottom line rule is to rate any condition under the code that BEST describes it, even if it is not exact.

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DBQs for Respiratory Conditions

Here are the Disability Benefits Questionnaires (DBQs) used for respiratory conditions: Sleep Apnea DBQ, Nose and Throat DBQ, and Respiratory Conditions (other) DBQ.

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Principles that Apply

Pyramiding: A single condition can only be rated once! However, if another condition exists that is additional to the respiratory condition (not simply caused by it), then it can also be rated.

Special Monthly Compensation: If your condition makes it impossible to speak, you may qualify for the VA’s Special Monthly Compensation.

Probative Value: If two exams record the condition differently, the exam with the most thorough data and performed by the most qualified person in the area will be the exam the rating is based on.

A Tie Goes to the Veteran: If there are two equally strong exams with conflicting information, or if the condition can be equally rated under two different codes, then the one that gives the highest rating will be assigned. Every conflict should be resolved in favor of the higher rating.

Accurate Measurements: It is essential that the necessary information to rate your condition is recorded by the physician in your exam. With the information on this page, you should know what needs to be measured and recorded. Make sure this happens correctly to ensure that you receive a proper rating.

Hospital or Convalescent Ratings: Some conditions require periods of hospitalization or constant medical car (at-home nurse, etc.). Any condition that requires this is rated 100% during this intensive treatment. Once it ends, then the 100% rating will continue for a certain period. This period is 3 months unless another length (6 months, 1 year, etc.) is directly specified in the condition ratings. Some patients may need more time to recover than others, so the physician or Rating Authorities can lengthen this time period if they see fit.

Please see the VASRD Principles page for further guidance.

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