Rating Schedule for the Respiratory System
From the nose and sinuses to the lungs.
GENERAL PYRAMIDING NOTES:
Under this schedule the Veteran CANNOT receive multiple individual ratings for conditions besides in the following cases:
Diseases of the Nose & Sinuses
Diseases of the Throat
Lung cancers or tumors, CANNOT be given separate ratings if there is already a rating for respiratory condition (EXCEPT nose, sinuses, and throat conditions).
Otherwise the Veteran can only have one individual respiratory rating. I.E. either a rating for sleep apnea OR asthma - You CANNOT separate ratings for both!
If the secondary respiratory condition affects the Veteran's overall health significantly, then the rating for the dominant respiratory condition can be increased to the next higher rating in the schedule (not just with an added 10%).
HOWEVER, the rater CANNOT consider subjective symptoms or symptoms that overlap between the respiratory conditions.
Separate ratings for Sinusitis and Rhinitis ARE ALLOWED! You just can't get say 2 ratings for different types of sinusitis or rhinitis.
Evaluation Vocabulary to Know
Diffusion Capacity of the Lung for Carbon Monoxide by the Single Breath Method (DLCO (SB)). 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.
Results of this test would be a percentage of how you would compare to a healthy person. 80% and above is considered normal.
Exercise test - determines how much oxygen your body uses when functioning at its maximum capacity.
Results of this test look like: XX ml/kg/min.
Heart test - if the heart is involved in the respiratory condition a echocardiogram (ECG or EKG), cardiac catheterization, or other tests of the heart may be done.
Spirometry - determines the functioning of the lungs and the airways leading to the lungs. This test should be done BEFORE and AFTER you take medication!
IMPORTANT NOTE:
In terms of rating - if this test is used to evaluate conditions under diagnostic codes (DC) 6600, 6603, 6604, 6825-6833, and 6840-6845, then the results with the AFTER medication results will be used (if medication is used); UNLESS the medication made your results worse!
The following are results that are generated from spirometry tests:
Forced Vital Capacity (FVC) - the total maximum amount of air that you can exhale after taking a full breath.
Forced Expiratory Volume in 1 second (FEV-1) - the maximum amount of air that you can blow out in 1 second.
Results of this measurement would be a percentage of how you would compare to a healthy person. 70% and above is considered normal.
Ratio of FEV-1 to Forced Vital Capacity (FVC) - determined by dividing the FEV-1 by the FVC.
Results of this measurement would be a percentage of how you would compare to a healthy person. 75% and above is considered normal. However, if the Veteran's FEV-1 or FVC are valued at over 1 (better than what is considered normal) this measure CANNOT be used to assign a rating.
Flow-Volume Loop - Shows lung capacity and the ability to move air through the airways.
Results are presented as a graph. From which, an examiner can determine if there is an obstruction that is blocking airflow. Be it an upper airway, extrathoracic, or intrathoracic obstruction.
General Rating Schedule
A lot of respiratory conditions are rated under the general schedule.
IMPORTANT NOTES:
If the Veteran has results for multiple tests; The rater will base the rating on whichever test most closely resembles the extent of the Veteran's disability, as marked by the examiner. Which may not necessarily be the one that provides the highest rating!
EXCEPTION: Unless the Veteran meets the criteria for an evaluation under the Heart test or Miscellaneous sub-schedules. In which case the rater will assign an 100% evaluation.
Exercise Test
| Rating |
Description |
|---|---|
| 60% | 15-20 ml/kg/min with the limitation caused by a heart or respiratory condition. |
| 100% | Less than 15 ml/kg/min with the limitation caused by a heart or respiratory condition. |
Diffusing Capacity of the Lung - Single Breath (DLCO) (SB)
| Rating |
Description |
|---|---|
| 10% | 66-80%. |
| 30% | 56-65%. |
| 60% | 40-55%. |
| 100% | Less than 40%. |
FEV-1
| Rating |
Description |
|---|---|
| 10% | 71-80%. |
| 30% | 56-70%. |
| 60% | 40-55%. |
| 100% | Less than 40%. |
FEV-1/FVC
| Rating |
Description |
|---|---|
| 10% | 71-80%. |
| 30% | 56-70%. |
| 60% | 40-55%. |
| 100% | Less than 40%. |
Obstructive Lung Diseases
Diseases that block the airways.
6600 Chronic Bronchitis
Swelling of the bronchi in the lungs.
Rated under the General Rating Schedule.
6601 Bronchiectasis
When part of the bronchial tree becomes enlarged, obstructing airflow.
Rated under the General Rating Schedule or on incapacitating episodes*. Whichever gives the Veteran the highest rating.
Incapacitating Episodes
IMPORTANT NOTE:
Incapacitating episode is defined as: requiring bed rest and treatment by a physician.
| Rating |
Description |
|---|---|
| 10% | Intermittent productive cough with occasional infection requiring a course of antibiotics at least twice a year. |
| 30% | Episodes last 2-4 weeks, (combined) during a year, OR; daily coughing up mucus that contains pus or blood and that requires prolonged (lasting 4-6 weeks) antibiotic usage more than twice a year. |
| 60% | Episodes last 4-6 weeks, (combined) during a year, OR; near constant coughing up mucus containing pus or blood, with anorexia, weight loss, and requiring antibiotic usage almost continuously. |
| 100% | Episodes last at least 6 weeks, (combined) during a year. |
6602 Asthma
Swollen airways and bronchi.
Note:
In the absence of clinical findings of asthma at time of examination, a verified history of asthmatic attacks must be of record.
The Veteran will receive a singular rating, based upon the below tables - whichever is highest.
FEV-1
| Rating |
Description |
|---|---|
| 10% | 71-80%. |
| 30% | 56-70%. |
| 60% | 40-55%. |
| 100% | Less than 40%. |
FEV-1/FVC
| Rating |
Description |
|---|---|
| 10% | 71-80%. |
| 30% | 56-70%. |
| 60% | 40-55%. |
| 100% | Less than 40%. |
ER Visits
| Rating |
Description |
|---|---|
| 60% | At least once monthly ER visits. |
| 100% | 2 or more episodes a week resulting in respiratory failure that require ER visits. |
Medications
| Rating |
Description |
|---|---|
| 10% | Requires occasional use of a bronchodilator taken by mouth or inhaled. |
| 30% | Requires daily use of a bronchodilator taken by mouth or inhaled OR; Requires occasional use of inhaled anti-inflammatory medication. |
| 60% | Requires use of steroids or immunosuppressive medications taken by mouth or injection 3 or more times a year. |
| 100% | Requires daily HIGH doses of steroids or immunosuppressive medications taken by mouth or injection. |
Examples of Medications
Bronchodilators:
AccuNeb
Albuterol
Alupent
Bambuterol
Bitolterol mesylate
Bricanyl
Clenbuterol
Fenoterol
Foradil
Formoterol
Indacaterol
Levalbuteral
Levosalbutamol
Maxair
Metaproterenol
Pirbuteral
Procaterol
Proventil
Ritodrine
Salbutamol
Salmeterol
Sereveut
Symbicort
Terbutaline
Ventolin
Xopenex
Immunosuppressive Medications:
Decadron
Deltasone
Dexamethasone
Medrol
Orasone
Pediapred
Prednisone
Prednisolone
Prelone
Inhaled Anti-inflammatory Medications:
Advair (Fluticasone and Salmeterol)
Aerobid (Flunisolide)
Asmanex
Azmacort (triamcinolone)
Dulera
Flovent HFA (Flutocasone HFA)
Ipratropium Bromide (Atrovent)
Pulmicort
Qvar
Symbicort
6603 Pulmonary Emphysema
Disease that causes the tissues that maintain the shape of the lungs to die.
Rated under the General Rating Schedule.
6604 Chronic Obstructive Pulmonary Disease (COPD)
Having chronic bronchitis and/or emphysema.
Rated under the General Rating Schedule.
Restrictive Lung Diseases
Diseases that limit how much the lungs can expand.
6840 Diaphragm Paralysis (Diaphragm Paresis)
Rated under the General Rating Schedule.
6841 Injury of the Spinal Cord (Spinal Cord Injury with Respiratory Insufficiency)
Rated under the General Rating Schedule.
6842 Kyphoscoliosis, Pectus Excavatum, Pectus Carinatum
Kyphoscoliosis - abnormal curving of the spine both side-to-side & back-to-front.
Pectus excavatum - ribs and sternum grow inward, causing a caved-in chest.
Pectus carinatum - ribs and sternum grow outward in the middle of the chest.
These conditions limit the space in which the lungs can expand.
Rated under the General Rating Schedule.
6843 Collapsed Lung (Pneumothorax), Gunshot Wound to the Lungs (Traumatic Chest Wall Defect), Hernia, etc.
Conditions or defects of the chest wall that keep the lungs from inflating properly.
Hernia - when the lung pushes through the chest wall.
Collapsed lung (Pneumothorax)
PYRAMIDING NOTES:
If the muscles in Group XXI are affected (they control breathing). The Veteran will receive a respiratory rating OR a muscular rating - whichever is higher.
If other muscle groups are affected the Veteran can receive ratings for BOTH.
| Rating |
Description |
|---|---|
| ?% | General Rating Schedule. |
| 20% | Gunshot wound to the lung (minimum evaluation): If the bullet remains lodged in the lung; OR there is a crackly/wheezing sound in the lung; OR lower chest or the diaphragm CANNOT fully expand. |
| 100% | For 3 months after release from hospital. |
6844 Removal of a Lung (Lobectomy, Pneumonectomy, etc.)
Rated under the General Rating Schedule.
6845 Chronic Pleural Effusion, Fibrosis, or Pleurisy with Empyema
Effusion - excess fluid build up between the lung and the chest wall.
Fibrosis - excess connective tissues build up between the lung and the chest wall.
Pleurisy with empyema - pus builds up between the lung and the chest wall.
| Rating |
Description |
|---|---|
| ?% | General Rating Schedule. |
| 100% | While active. |
6846 Sarcoidosis
When lumps form on the tissues surrounding the air sacs, bronchi and small blood vessels in the lungs.
| Rating |
Description |
|---|---|
| ?% | General Rating Schedule. |
| 0% | Chronic hilar adenopathy or stable lung infiltrates without symptoms or physiologic impairment. |
| 30% | Pulmonary involvement with persistent symptoms requiring chronic low dose (maintenance) or intermittent corticosteroids. |
| 60% | Pulmonary involvement requiring systemic high dose (therapeutic) corticosteroids for control. |
| 100% | Right-sided heart failure (Cor pulmonale), OR; cardiac involvement with congestive heart failure, OR; progressive pulmonary disease with fever, night sweats, and weight loss despite treatment. |
Interstitial Lung Diseases
Conditions that affect the tissues surrounding the air sacs in the lungs:
6825 Diffuse Interstitial Fibrosis (Interstitial Pneumonitis, Fibrosing Alveolitis)
6826 Desquamative Interstitial Pneumonitis
6827 Pulmonary Alveolar Proteinosis
6828 Eosinophilic Granuloma of the Lung
6829 Drug-induced Pulmonary Pneumonitis and Fibrosis
6830 Radiation-induced Pulmonary Pneumonitis and Fibrosis
6831 Hypersensitivity Pneumonitis (Extrinsic Allergic Alveolitis)
6832 Pneumoconiosis (Silicosis, Anthracosis, etc.)
6833 Asbestosis
They are all rated under the following schedule:
Exercise Test
| Rating |
Description |
|---|---|
| 60% | 15-20 ml/kg/min with the limitation caused by a heart or respiratory condition. |
| 100% | Less than 15 ml/kg/min with the limitation caused by a heart or respiratory condition. |
DLCO (SB)
| Rating |
Description |
|---|---|
| 10% | 66-80%. |
| 30% | 56-65%. |
| 60% | 40-55%. |
| 100% | Less than 40%. |
FVC
| Rating |
Description |
|---|---|
| 10% | 75-80%. |
| 30% | 65-74%. |
| 60% | 50-64%. |
| 100% | Less than 50%. |
Heart Test
| Rating |
Description |
|---|---|
| 100% | Right-sided heart failure (Cor pulmonale). |
| 100% | High blood pressure that affects arteries in the lungs and in the heart (Pulmonary hypertension). |
Miscellaneous
| Rating |
Description |
|---|---|
| 100% | Requires use of oxygen therapy at home. |
Bacterial Infections of the Lungs
Bacterial infections of the lungs:
6515 Tuberculous Laryngitis
6730 All Other Active Pulmonary Tuberculoses
6731 Inactive Pulmonary Tuberculosis
6732 Tuberculous Pleurisy
6822 Actinomycosis
6823 Nocardiosis
6824 Chronic Lung Abscess
Rated under the following schedule:
| Rating |
Description |
|---|---|
| ?% | If not active, it is rated under General Rating Schedule or Interstitial Lung Schedule. Depending on whichever schedule is most appropriate. |
| 100% | While tuberculous is active and for 1 year after it goes inactive and treatment stops. |
| 100% | Active infection with persistent symptoms of fever, weight loss, night sweats, or coughing up large amounts of blood. |
Fungal Infections of the Lungs (Mycotic Lung Disease)
Caused by inhaling fungal spores:
6834 Histoplasmosis
6835 Coccidioidomycosis
It can take several years before this condition manifests. As such, if you are filing a claim for this condition it is important that your records show service in the Southwest US, Central America, or South America.
6836 Blastomycosis
6837 Cryptococcosis
6838 Aspergillosis
6839 Mucormycosis
They are all rated under the following schedule:
| Rating |
Description |
|---|---|
| 0% | Healed and inactive mycotic lesions, no symptoms. |
| 30% | Chronic pulmonary mycosis with minimal symptoms such as occasional minor coughing up blood or productive cough. |
| 50% | Chronic pulmonary mycosis requiring suppressive therapy with no more than minimal symptoms such as occasional minor coughing up blood or productive cough. |
| 100% | Active infection with persistent symptoms of fever, weight loss, night sweats, or coughing up large amounts of blood. |
The Nose and Sinuses
6502 Deviation of the Nasal Septum (Nasal Septum Deviation)
When your nasal septum is significantly displaced to one side, making one nasal air passage smaller than the other.
PYRAMIDING NOTE:
You CANNOT get separate evaluations for deviated septum and allergic or bacterial rhinitis.
IMPORTANT NOTE:
This condition can only be rated IF it is a result of a traumatic injury!
| Rating |
Description |
|---|---|
| 10% |
50% blockage of the nasal passage on both sides OR complete blockage on one side. |
6504 Loss of Part of the Nose/Significant Scarring
PYRAMIDING NOTE:
If the Veteran would rate higher under Disfiguring scars they will be rated under that schedule instead of this one.
| Rating |
Description |
|---|---|
| 10% | If one nasal passage is exposed or other obvious disfigurement. |
| 30% | Both nasal passages are exposed. |
6510-6514 Chronic Sinusitis (Various)
When the sinuses swell, often caused by an infection or allergy.
PYRAMIDING NOTES:
You CAN get separate evaluations for rhinitis and sinusitis!
Sinus headaches CANNOT be awarded a separate evaluation and/or be rated under the Migraine schedule, even if the migraine schedule would give a higher evaluation! Typically a grant would look like ‘chronic sinusitis with sinus headaches’.
The exception to being rated under the migraine schedule would require the rater to exercise an Extra scheduler evaluation or a BVA or higher judge exercising judicial judgement.
PRESUMPTIVE CONDITION:
Burn pit exposure.
NOTES:
Remember, the sinusitis must be chronic or it cannot be rated. So if you get a diagnosis of 'acute' that is NOT going to fly!
However, do know that a diagnosis of recurrent acute rhinosinusitis (RARS) IS a chronic condition, despite the name.
Incapacitating episode means the Veteran required bed rest and treatment by a physician.
All sinusitis conditions are rated the same. This includes:
Ethmoid sinusitis
Frontal sinusitis
Maxillary sinusitis
Pansinusitis
Sphenoid sinusitis
Common Secondary Condition:
| Rating |
Description |
|---|---|
| 0% | Detected by X-ray only. |
| 10% | 1 or 2 incapacitating episodes a year, requiring prolonged (lasting 4 to 6 weeks) antibiotic treatment, OR; 3 to 6 non-incapacitating episodes a year characterized by headaches, pain, and purulent discharge or crusting. |
| 30% | 3 or more incapacitating episodes a year requiring prolonged (lasting 4 to 6 weeks) antibiotic treatment, OR; more than 6 non-incapacitating episodes a year characterized by headaches, pain, and purulent discharge or crusting. |
| 50% | Following radical surgery with chronic osteomyelitis, OR; near constant sinusitis characterized by headaches, pain and tenderness of affected sinus, and purulent discharge or crusting after repeated surgeries. |
6522 Allergic or Vasomotor Rhinitis
Swelling of the tissues lining the nasal passage caused by allergies or other environmental triggers.
PYRAMIDING NOTE:
You CAN get separate evaluations for rhinitis and sinusitis!
PRESUMPTIVE CONDITION:
Burn pit exposure.
Common Secondary Condition:
| Rating |
Description |
|---|---|
| 10% | Without growths forming in the tissues (polyps), but with greater than 50% obstruction of nasal passage on both sides or complete obstruction on 1 side. |
| 30% | With polyps. |
6523 Bacterial Rhinitis
Swelling of the tissues lining the nasal passage caused by a bacterial infection.
PYRAMIDING NOTE:
You CAN get separate evaluations for rhinitis and sinusitis!
PRESUMPTIVE CONDITION:
Burn pit exposure.
| Rating |
Description |
|---|---|
| 10% | With permanent hypertrophy of turbinates AND having greater than 50% obstruction of nasal passage on both sides or complete obstruction on 1 side. |
| 50% | Rhinoscleroma. |
6524 Granulomatous Rhinitis
Swelling of the tissues lining the nasal passage with abnormal cell growths not caused by bacteria.
PRESUMPTIVE CONDITION:
Burn pit exposure.
| Rating |
Description |
|---|---|
| 20% | Granulomatous infection. |
| 100% | Wegener's granulomatosis (lethal midline granuloma). |
The Throat
Made up of the pharynx, larynx and trachea.
6516 Chronic Laryngitis
Swelling of the larynx (lasting at least 3 months at a time).
| Rating |
Description |
|---|---|
| 10% |
Hoarseness, with swelling of vocal cords or laynx walls. |
| 30% |
Hoarseness, with thickening or nodules of cords, polyps, submucous infiltration, or pre-cancerous tumors. |
6518 Removal of the Larynx (Laryngectomy)
| Rating |
Description |
|---|---|
| ?% | Partial: Rated on residuals such a Loss of speech, Laryngitis, Stenosis of the larynx, and/or Scarring. |
| 100% | Total. Veteran is also entitled to Special Monthly Compensation (SMC) for loss of use. |
6519 Loss of Organic Speech (Aphonia, Inability to Speak)
IMPORTANT NOTE:
If the inability to speak is due to a Mental disorder and not a physical (to include nerve based) reason it CANNOT be rated under this schedule!
NOTE:
If the Veteran's inability to speak comes and goes then they will be rated under Chronic laryngitis.
| Rating |
Description |
|---|---|
| 60% | Can speak, but not above a whisper. |
| 100% | Cannot speak at all. Veteran is also entitled to Special Monthly Compensation (SMC) for loss of use. |
6520 Stenosis of the Larynx
Narrowing of the larynx.
NOTE:
If the Veteran's condition results in the chronic inability to speak it can be rated under Aphonia instead - if it results in a higher rating.
| Rating |
Description |
|---|---|
| 10% | FEV-1 of 71-80%, with Flow-Volume Loop showing an upper airway obstruction. |
| 30% | FEV-1 of 56-70%, with Flow-Volume Loop showing an upper airway obstruction. |
| 60% | FEV-1 of 40-55%, with Flow-Volume Loop showing an upper airway obstruction. |
| 100% | FEV-1 less than 40%, with Flow-Volume Loop showing an upper airway obstruction, OR; requires a permanent tracheostomy. |
Miscellaneous Conditions
6817 Pulmonary Vascular Disease
Affects the blood vessels leading to and from the lungs.
| Rating |
Description |
|---|---|
| ?% | General Rating Schedule. |
| 0% | Asymptomatic, following resolution of pulmonary thromboembolism. |
| 30% | Symptomatic, following resolution of acute pulmonary embolism. |
| 60% | Chronic pulmonary thromboembolism requiring anticoagulant therapy, OR; following inferior vena cava surgery without evidence of pulmonary hypertension or right ventricular dysfunction. |
| 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. |
Upper Airway Resistance Syndrome (UARS)
Represents a progression toward the potential development of sleep apnea, caused by snoring.
However, UARS, in and of itself, does NOT meet the criteria of sleep-disordered breathing that defines sleep apnea and is NOT considered a ratable disability for compensation purposes.
If you have a diagnosis for UARS, you should wait on submitting a Claim till/if you get a diagnosis of sleep apnea.
6847 Sleep Apnea (SA, Obstructive, Central, Mixed)
When you stop breathing while you sleep or your breathing becomes insufficient leading to low blood oxygen levels.
IMPORTANT NOTES:
The VA MUST have a sleep study! Otherwise they CANNOT grant service-connection.
Home sleep studies are acceptable if:
It has been clinically determined that the Veteran can be appropriately evaluated by a home sleep study; and
A competent medical provider has evaluated the results.
The Veteran only needs to be prescribed a CPAP machine to rate 50%. While it would be a good idea to use it, for your health and all. It is NOT a requirement to use it to maintain this rating.
NOTES:
Other qualifying breathing assistance devices include:
Other positive airway pressure machines (automatic positive airway pressure device (APAP); bilevel positive airway pressure device (BiPAP));
Positive airway pressure machines may also be called non-invasive positive pressure ventilation (NIPPV) or non-invasive ventilation (NIV).
Nasopharyngeal appliances (nasal dilators; nasopharyngeal stents);
Oral appliances (mandibular advancement devices (MAD)); tongue-retaining mouthpieces); and
Implanted genioglossal nerve stimulation devices.
| Rating |
Description |
|---|---|
| 0% | No symptoms, but there is a diagnosis. |
| 30% | Persistent sleepiness during the daytime or not feeling rested after sleeping. |
| 50% | Requires use of breathing assistance device such as continuous airway pressure (CPAP) machine. |
| 100% | Chronic respiratory failure with carbon dioxide retention or cor pulmonale, OR; requires tracheostomy. |
6820 Tumor
Having a tumor itself is not a compensational condition.
However, if the tumor causes Secondary conditions such as Aphonia. Those issues may be rated. As well as any resulting scars that are the result of the removal of any tumor(s).
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