[Code of Federal Regulations] [Title 38, Volume 1] [Revised as of July 1, 2004] From the U.S. Government Printing Office via GPO Access [CITE: 38CFR4.97] [Page 414-418] TITLE 38--PENSIONS, BONUSES, AND VETERANS' RELIEF CHAPTER I--DEPARTMENT OF VETERANS AFFAIRS PART 4_SCHEDULE FOR RATING DISABILITIES--Table of Contents Subpart B_Disability Ratings Sec. 4.97 Schedule of ratings--respiratory system. ------------------------------------------------------------------------ Rating ------------------------------------------------------------------------ DISEASES OF THE NOSE AND THROAT ------------------------------------------------------------------------ 6502 Septum, nasal, deviation of: Traumatic only, With 50-percent obstruction of the nasal passage on 10 both sides or complete obstruction on one side........ 6504 Nose, loss of part of, or scars: Exposing both nasal passages............................... 30 Loss of part of one ala, or other obvious disfigurement.... 10 Note: Or evaluate as DC 7800, scars, disfiguring, head, face, or neck. 6510 Sinusitis, pansinusitis, chronic. 6511 Sinusitis, ethmoid, chronic. 6512 Sinusitis, frontal, chronic. 6513 Sinusitis, maxillary, chronic. 6514 Sinusitis, sphenoid, chronic. General Rating Formula for Sinusitis (DC's 6510 through 6514): Following radical surgery with chronic osteomyelitis, 50 or; near constant sinusitis characterized by headaches, pain and tenderness of affected sinus, and purulent discharge or crusting after repeated surgeries............................................. Three or more incapacitating episodes per year of 30 sinusitis requiring prolonged (lasting four to six weeks) antibiotic treatment, or; more than six non- incapacitating episodes per year of sinusitis characterized by headaches, pain, and purulent discharge or crusting................................. One or two incapacitating episodes per year of 10 sinusitis requiring prolonged (lasting four to six weeks) antibiotic treatment, or; three to six non- incapacitating episodes per year of sinusitis characterized by headaches, pain, and purulent discharge or crusting................................. Detected by X-ray only................................. 0 Note: An incapacitating episode of sinusitis means one that requires bed rest and treatment by a physician. 6515 Laryngitis, tuberculous, active or inactive. Rate under Sec. Sec. 4.88c or 4.89, whichever is appropriate. 6516 Laryngitis, chronic: Hoarseness, with thickening or nodules of cords, polyps, 30 submucous infiltration, or pre-malignant changes on biopsy Hoarseness, with inflammation of cords or mucous membrane.. 10 6518 Laryngectomy, total....................................... \1\ 100 Rate the residuals of partial laryngectomy as laryngitis (DC 6516), aphonia (DC 6519), or stenosis of larynx (DC 6520). 6519 Aphonia, complete organic: Constant inability to communicate by speech................ \1\ 100 Constant inability to speak above a whisper................ 60 Note: Evaluate incomplete aphonia as laryngitis, chronic (DC 6516). 6520 Larynx, stenosis of, including residuals of laryngeal trauma (unilateral or bilateral): Forced expiratory volume in one second (FEV-1) less than 40 100 percent of predicted value, with Flow-Volume Loop compatible with upper airway obstruction, or; permanent tracheostomy.............................................. FEV-1 of 40- to 55-percent predicted, with Flow-Volume Loop 60 compatible with upper airway obstruction.................. FEV-1 of 56- to 70-percent predicted, with Flow-Volume Loop 30 compatible with upper airway obstruction.................. FEV-1 of 71- to 80-percent predicted, with Flow-Volume Loop 10 compatible with upper airway obstruction.................. Note: Or evaluate as aphonia (DC 6519). 6521 Pharynx, injuries to: [[Page 415]] Stricture or obstruction of pharynx or nasopharynx, or; 50 absence of soft palate secondary to trauma, chemical burn, or granulomatous disease, or; paralysis of soft palate with swallowing difficulty (nasal regurgitation) and speech impairment......................................... 6522 Allergic or vasomotor rhinitis: With polyps................................................ 30 Without polyps, but with greater than 50-percent 10 obstruction of nasal passage on both sides or complete obstruction on one side................................... 6523 Bacterial rhinitis: Rhinoscleroma.............................................. 50 With permanent hypertrophy of turbinates and with greater 10 than 50-percent obstruction of nasal passage on both sides or complete obstruction on one side....................... 6524 Granulomatous rhinitis: Wegener's granulomatosis, lethal midline granuloma......... 100 Other types of granulomatous infection..................... 20 ---------------------------------------------------------------- DISEASES OF THE TRACHEA AND BRONCHI ------------------------------------------------------------------------ 6600 Bronchitis, chronic: FEV-1 less than 40 percent of predicted value, or; the 100 ratio of Forced Expiratory Volume in one second to Forced Vital Capacity (FEV-1/FVC) less than 40 percent, or; Diffusion Capacity of the Lung for Carbon Monoxide by the Single Breath Method (DLCO (SB)) less than 40-percent predicted, or; maximum exercise capacity less than 15 ml/ kg/min oxygen consumption (with cardiac or respiratory limitation), or; cor pulmonale (right heart failure), or; right ventricular hypertrophy, or; pulmonary hypertension (shown by Echo or cardiac catheterization), or; episode(s) of acute respiratory failure, or; requires outpatient oxygen therapy............................................ FEV-1 of 40- to 55-percent predicted, or; FEV-1/FVC of 40 60 to 55 percent, or; DLCO (SB) of 40- to 55-percent predicted, or; maximum oxygen consumption of 15 to 20 ml/ kg/min (with cardiorespiratory limit)..................... FEV-1 of 56- to 70-percent predicted, or; FEV-1/FVC of 56 30 to 70 percent, or; DLCO (SB) 56- to 65-percent predicted.. FEV-1 of 71- to 80-percent predicted, or; FEV-1/FVC of 71 10 to 80 percent, or; DLCO (SB) 66- to 80-percent predicted.. 6601 Bronchiectasis: With incapacitating episodes of infection of at least six 100 weeks total duration per year............................. With incapacitating episodes of infection of four to six 60 weeks total duration per year, or; near constant findings of cough with purulent sputum associated with anorexia, weight loss, and frank hemoptysis and requiring antibiotic usage almost continuously................................. With incapacitating episodes of infection of two to four 30 weeks total duration per year, or; daily productive cough with sputum that is at times purulent or blood-tinged and that requires prolonged (lasting four to six weeks) antibiotic usage more than twice a year................... Intermittent productive cough with acute infection 10 requiring a course of antibiotics at least twice a year... Or rate according to pulmonary impairment as for chronic bronchitis (DC 6600). Note: An incapacitating episode is one that requires bedrest and treatment by a physician. 6602 Asthma, bronchial: FEV-1 less than 40-percent predicted, or; FEV-1/FVC less 100 than 40 percent, or; more than one attack per week with episodes of respiratory failure, or; requires daily use of systemic (oral or parenteral) high dose corticosteroids or immuno-suppressive medications............................ FEV-1 of 40- to 55-percent predicted, or; FEV-1/FVC of 40 60 to 55 percent, or; at least monthly visits to a physician for required care of exacerbations, or; intermittent (at least three per year) courses of systemic (oral or parenteral) corticosteroids............................... FEV-1 of 56- to 70-percent predicted, or; FEV-1/FVC of 56 30 to 70 percent, or; daily inhalational or oral bronchodilator therapy, or; inhalational anti-inflammatory medication................................................ FEV-1 of 71- to 80-percent predicted, or; FEV-1/FVC of 71 10 to 80 percent, or; intermittent inhalational or oral bronchodilator therapy.................................... Note: In the absence of clinical findings of asthma at time of examination, a verified history of asthmatic attacks must be of record. 6603 Emphysema, pulmonary: FEV-1 less than 40 percent of predicted value, or; the 100 ratio of Forced Expiratory Volume in one second to Forced Vital Capacity (FEV-1/FVC) less than 40 percent, or; Diffusion Capacity of the Lung for Carbon Monoxide by the Single Breath Method (DLCO (SB)) less than 40-percent predicted, or; maximum exercise capacity less than 15 ml/ kg/min oxygen consumption (with cardiac or respiratory limitation), or; cor pulmonale (right heart failure), or; right ventricular hypertrophy, or; pulmonary hypertension (shown by Echo or cardiac catheterization), or; episode(s) of acute respiratory failure, or; requires outpatient oxygen therapy............................................ FEV-1 of 40- to 55-percent predicted, or; FEV-1/FVC of 40 60 to 55 percent, or; DLCO (SB) of 40- to 55-percent predicted, or; maximum oxygen consumption of 15 to 20 ml/ kg/min (with cardiorespiratory limit)..................... FEV-1 of 56- to 70-percent predicted, or; FEV-1/FVC of 56 30 to 70 percent, or; DLCO (SB) 56- to 65-percent predicted.. FEV-1 of 71- to 80-percent predicted, or; FEV-1/FVC of 71 10 to 80 percent, or; DLCO (SB) 66- to 80-percent predicted.. 6604 Chronic obstructive pulmonary disease: [[Page 416]] FEV-1 less than 40 percent of predicted value, or; the 100 ratio of Forced Expiratory Volume in one second to Forced Vital Capacity (FEV-1/FVC) less than 40 percent, or; Diffusion Capacity of the Lung for Carbon Monoxide by the Single Breath Method (DLCO (SB)) less than 40-percent predicted, or; maximum exercise capacity less than 15 ml/ kg/min oxygen consumption (with cardiac or respiratory limitation), or; cor pulmonale (right heart failure), or; right ventricular hypertrophy, or; pulmonary hypertension (shown by Echo or cardiac catheterization), or; episode(s) of acute respiratory failure, or; requires outpatient oxygen therapy............................................ FEV-1 of 40- to 55-percent predicted, or; FEV-1/FVC of 40 60 to 55 percent, or; DLCO (SB) of 40- to 55-percent predicted, or; maximum oxygen consumption of 15 to 20 ml/ kg/min (with cardiorespiratory limit)..................... FEV-1 of 56- to 70-percent predicted, or; FEV-1/FVC of 56 30 to 70 percent, or; DLCO (SB) 56- to 65-percent predicted.. FEV-1 of 71- to 80-percent predicted, or; FEV-1/FVC of 71 10 to 80 percent, or; DLCO (SB) 66- to 80-percent predicted.. ---------------------------------------------------------------- DISEASES OF THE LUNGS AND PLEURA--TUBERCULOSIS Ratings for Pulmonary Tuberculosis Entitled on August 19, 1968 ------------------------------------------------------------------------ 6701 Tuberculosis, pulmonary, chronic, far advanced, active.... 100 6702 Tuberculosis, pulmonary, chronic, moderately advanced, 100 active........................................................ 6703 Tuberculosis, pulmonary, chronic, minimal, active......... 100 6704 Tuberculosis, pulmonary, chronic, active, advancement 100 unspecified................................................... 6721 Tuberculosis, pulmonary, chronic, far advanced, inactive.. 6722 Tuberculosis, pulmonary, chronic, moderately advanced, inactive...................................................... 6723 Tuberculosis, pulmonary, chronic, minimal, inactive....... 6724 Tuberculosis, pulmonary, chronic, inactive, advancement unspecified................................................... General Rating Formula for Inactive Pulmonary Tuberculosis: 100 For two years after date of inactivity, following active tuberculosis, which was clinically identified during service or subsequently................................... Thereafter for four years, or in any event, to six years 50 after date of inactivity.................................. Thereafter, for five years, or to eleven years after date 30 of inactivity............................................. Following far advanced lesions diagnosed at any time while 30 the disease process was active, minimum................... Following moderately advanced lesions, provided there is 20 continued disability, emphysema, dyspnea on exertion, impairment of health, etc................................. Otherwise.................................................. 0 Note (1): The 100-percent rating under codes 6701 through 6724 is not subject to a requirement of precedent hospital treatment. It will be reduced to 50 percent for failure to submit to examination or to follow prescribed treatment upon report to that effect from the medical authorities. When a veteran is placed on the 100-percent rating for inactive tuberculosis, the medical authorities will be appropriately notified of the fact, and of the necessity, as given in footnote 1 to 38 U.S.C. 1156 (and formerly in 38 U.S.C. 356, which has been repealed by Public Law 90-493), to notify the Adjudication Division in the event of failure to submit to examination or to follow treatment. Note (2): The graduated 50-percent and 30-percent ratings and the permanent 30 percent and 20 percent ratings for inactive pulmonary tuberculosis are not to be combined with ratings for other respiratory disabilities. Following thoracoplasty the rating will be for removal of ribs combined with the rating for collapsed lung. Resection of the ribs incident to thoracoplasty will be rated as removal. ---------------------------------------------------------------- Ratings for Pulmonary Tuberculosis Initially Evaluated After August 19, 1968 ------------------------------------------------------------------------ 6730 Tuberculosis, pulmonary, chronic, active.................. 100 Note: Active pulmonary tuberculosis will be considered permanently and totally disabling for non-service- connected pension purposes in the following circumstances: (a) Associated with active tuberculosis involving other than the respiratory system. (b) With severe associated symptoms or with extensive cavity formation. (c) Reactivated cases, generally. (d) With advancement of lesions on successive examinations or while under treatment. (e) Without retrogression of lesions or other evidence of material improvement at the end of six months hospitalization or without change of diagnosis from ``active'' at the end of 12 months hospitalization. Material improvement means lessening or absence of clinical symptoms, and X-ray findings of a stationary or retrogressive lesion. 6731 Tuberculosis, pulmonary, chronic, inactive: Depending on the specific findings, rate residuals as interstitial lung disease, restrictive lung disease, or, when obstructive lung disease is the major residual, as chronic bronchitis (DC 6600). Rate thoracoplasty as removal of ribs under DC 5297. Note: A mandatory examination will be requested immediately following notification that active tuberculosis evaluated under DC 6730 has become inactive. Any change in evaluation will be carried out under the provisions of Sec. 3.105(e). 6732 Pleurisy, tuberculous, active or inactive: Rate under Sec. Sec. 4.88c or 4.89, whichever is appropriate. ---------------------------------------------------------------- NONTUBERCULOUS DISEASES ------------------------------------------------------------------------ 6817 Pulmonary Vascular Disease: Primary pulmonary hypertension, or; chronic pulmonary 100 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............ [[Page 417]] Chronic pulmonary thromboembolism requiring anticoagulant 60 therapy, or; following inferior vena cava surgery without evidence of pulmonary hypertension or right ventricular dysfunction............................................... Symptomatic, following resolution of acute pulmonary 30 embolism.................................................. Asymptomatic, following resolution of pulmonary 0 thromboembolism........................................... Note: Evaluate other residuals following pulmonary embolism under the most appropriate diagnostic code, such as chronic bronchitis (DC 6600) or chronic pleural effusion or fibrosis (DC 6844), but do not combine that evaluation with any of the above evaluations. 6819 Neoplasms, malignant, any specified part of 100 respiratory system exclusive of skin growths.............. Note: A rating of 100 percent shall continue beyond the cessation of any surgical, X-ray, antineoplastic chemotherapy or other therapeutic procedure. Six months after discontinuance of such treatment, the appropriate disability rating shall be determined by mandatory VA examination. Any change in evaluation based upon that or any subsequent examination shall be subject to the provisions of Sec. 3.105(e) of this chapter. If there has been no local recurrence or metastasis, rate on residuals. 6820 Neoplasms, benign, any specified part of respiratory system. Evaluate using an appropriate respiratory analogy. ---------------------------------------------------------------- Bacterial Infections of the Lung ------------------------------------------------------------------------ 6822 Actinomycosis. 6823 Nocardiosis. 6824 Chronic lung abscess. General Rating Formula for Bacterial Infections of the Lung (diagnostic codes 6822 through 6824): Active infection with systemic symptoms such as fever, 100 night sweats, weight loss, or hemoptysis.............. Depending on the specific findings, rate residuals as interstitial lung disease, restrictive lung disease, or, when obstructive lung disease is the major residual, as chronic bronchitis (DC 6600). ---------------------------------------------------------------- Interstitial Lung Disease ------------------------------------------------------------------------ 6825 Diffuse interstitial fibrosis (interstitial pneumonitis, fibrosing alveolitis). 6826 Desquamative interstitial pneumonitis. 6827 Pulmonary alveolar proteinosis. 6828 Eosinophilic granuloma of 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. General Rating Formula for Interstitial Lung Disease (diagnostic codes 6825 through 6833): Forced Vital Capacity (FVC) less than 50-percent 100 predicted, or; Diffusion Capacity of the Lung for Carbon Monoxide by the Single Breath Method (DLCO (SB)) less than 40-percent predicted, or; maximum exercise capacity less than 15 ml/kg/min oxygen consumption with cardiorespiratory limitation, or; cor pulmonale or pulmonary hypertension, or; requires outpatient oxygen therapy............................. FVC of 50- to 64-percent predicted, or; DLCO (SB) of 40- 60 to 55-percent predicted, or; maximum exercise capacity of 15 to 20 ml/kg/min oxygen consumption with cardiorespiratory limitation.......................... FVC of 65- to 74-percent predicted, or; DLCO (SB) of 56- 30 to 65-percent predicted.............................. FVC of 75- to 80-percent predicted, or; DLCO (SB) of 66- 10 to 80-percent predicted.............................. ---------------------------------------------------------------- Mycotic Lung Disease ------------------------------------------------------------------------ 6834 Histoplasmosis of lung. 6835 Coccidioidomycosis. 6836 Blastomycosis. 6837 Cryptococcosis. 6838 Aspergillosis. 6839 Mucormycosis. General Rating Formula for Mycotic Lung Disease (diagnostic codes 6834 through 6839): Chronic pulmonary mycosis with persistent fever, weight 100 loss, night sweats, or massive hemoptysis............. Chronic pulmonary mycosis requiring suppressive therapy 50 with no more than minimal symptoms such as occasional minor hemoptysis or productive cough.................. Chronic pulmonary mycosis with minimal symptoms such as 30 occasional minor hemoptysis or productive cough....... Healed and inactive mycotic lesions, asymptomatic...... 0 Note: Coccidioidomycosis has an incubation period up to 21 days, and the disseminated phase is ordinarily manifest within six months of the primary phase. However, there are instances of dissemination delayed up to many years after the initial infection which may have been unrecognized. Accordingly, when service connection is under consideration in the absence of record or other evidence of the disease in service, service in southwestern United States where the disease is endemic and absence of prolonged residence in this locality before or after service will be the deciding factor. ---------------------------------------------------------------- Restrictive Lung Disease ------------------------------------------------------------------------ 6840 Diaphragm paralysis or paresis. 6841 Spinal cord injury with respiratory insufficiency. 6842 Kyphoscoliosis, pectus excavatum, pectus carinatum. [[Page 418]] 6843 Traumatic chest wall defect, pneumothorax, hernia, etc. 6844 Post-surgical residual (lobectomy, pneumonectomy, etc.). 6845 Chronic pleural effusion or fibrosis. General Rating Formula for Restrictive Lung Disease (diagnostic codes 6840 through 6845): FEV-1 less than 40 percent of predicted value, or; the 100 ratio of Forced Expiratory Volume in one second to Forced Vital Capacity (FEV-1/FVC) less than 40 percent, or; Diffusion Capacity of the Lung for Carbon Monoxide by the Single Breath Method (DLCO (SB)) less than 40-percent predicted, or; maximum exercise capacity less than 15 ml/kg/min oxygen consumption (with cardiac or respiratory limitation), or; cor pulmonale (right heart failure), or; right ventricular hypertrophy, or; pulmonary hypertension (shown by Echo or cardiac catheterization), or; episode(s) of acute respiratory failure, or; requires outpatient oxygen therapy............................................... FEV-1 of 40- to 55-percent predicted, or; FEV-1/FVC of 60 40 to 55 percent, or; DLCO (SB) of 40- to 55-percent predicted, or; maximum oxygen consumption of 15 to 20 ml/kg/min (with cardiorespiratory limit).............. FEV-1 of 56- to 70-percent predicted, or; FEV-1/FVC of 30 56 to 70 percent, or; DLCO (SB) 56- to 65-percent predicted............................................. FEV-1 of 71- to 80-percent predicted, or; FEV-1/FVC of 10 71 to 80 percent, or; DLCO (SB) 66- to 80-percent predicted............................................. Or rate primary disorder. Note (1): A 100-percent rating shall be assigned for pleurisy with empyema, with or without pleurocutaneous fistula, until resolved. Note (2): Following episodes of total spontaneous pneumothorax, a rating of 100 percent shall be assigned as of the date of hospital admission and shall continue for three months from the first day of the month after hospital discharge. Note (3): Gunshot wounds of the pleural cavity with bullet or missile retained in lung, pain or discomfort on exertion, or with scattered rales or some limitation of excursion of diaphragm or of lower chest expansion shall be rated at least 20-percent disabling. Disabling injuries of shoulder girdle muscles (Groups I to IV) shall be separately rated and combined with ratings for respiratory involvement. Involvement of Muscle Group XXI (DC 5321), however, will not be separately rated. 6846 Sarcoidosis: Cor pulmonale, or; cardiac involvement with congestive 100 heart failure, or; progressive pulmonary disease with fever, night sweats, and weight loss despite treatment.... Pulmonary involvement requiring systemic high dose 60 (therapeutic) corticosteroids for control................. Pulmonary involvement with persistent symptoms requiring 30 chronic low dose (maintenance) or intermittent corticosteroids........................................... Chronic hilar adenopathy or stable lung infiltrates without 0 symptoms or physiologic impairment........................ Or rate active disease or residuals as chronic bronchitis (DC 6600) and extra-pulmonary involvement under specific body system involved...................................... 6847 Sleep Apnea Syndromes (Obstructive, Central, Mixed): Chronic respiratory failure with carbon dioxide retention 100 or cor pulmonale, or; requires tracheostomy............... Requires use of breathing assistance device such as 50 continuous airway pressure (CPAP) machine................. Persistent day-time hypersomnolence........................ 30 Asymptomatic but with documented sleep disorder breathing.. 0 ------------------------------------------------------------------------ \1\ Review for entitlement to special monthly compensation under Sec. 3.350 of this chapter. [61 FR 46728, Sept. 5, 1996] The Cardiovascular System