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TheRespiratorySystem
Topics:
RespiratoryRatingSystem
DiseasesoftheNoseandSinuses
DiseasesoftheThroat
RestrictiveLungDiseases
ObstructiveLungDiseases
InterstitialLungDiseases
PulmonaryVascularDiseases
FungalInfections(MycoticLungDisease)oftheLung
BacterialInfectionsoftheLung
SleepApnea
TuberculosisoftheRespiratorySystem
CancerandTumorsoftheRespiratorySystem
OtherRespiratoryConditions
DBQforRespiratoryConditions
PrinciplesthatApply
Reminder:TheVAwillgiveaMilitaryDisabilityRatingforeachserviceconnectedconditionaservicememberhas,but
theDoDwillonlyrateserviceconnectedconditionsthatmakeaservicememberUnfitforDuty.
Therespiratorysystemisanetworkoforgansthatbringsairintothebody,absorbstheoxygenintothebloodstream,and
thenexhalescarbondioxide.Therespiratorysystemismadeupofthenose,sinuses,pharynx,larynx,trachea,lungs,and
bronchi(bronchialtrees).

Airisbroughtintothebodythroughthenoseormouth.Itthenpassesdownthepharynxthroughthetracheatothebronchi
inthelungs.Thebronchithentransporttheairtotheareasofthelungswherethebloodabsorbstheoxygen.Afterthis
processiscomplete,theleftoverairisthenpushedbackupthetrachea.Whilepassingthroughthelarynx,itpassesover
thevocalcords,whichenablesspeech,beforeexitingthenoseormouth.
When rating conditions of the respiratory system, it is important to note that the following conditions cannot be rated
together(onlyoneofthemcanberated):66006847.Theonlyexceptiontothisisifoneoftheconditionsiseitheracancer
ortumor(codes6819and6820)andtheotherisaconditionthatdoesNOTaffectthelungsthemselves.Inthiscaseonly
canmorethanoneconditionwithacodebetweenthesenumbersberatedtogether.
Ifyouhavemorethanonerespiratoryconditionmakesuretocheckthattheyarentoneoftheselistedhere.Iftheyare,
onlyoneofthemcanberated.Youmustusetheconditionthatisthemostsevereordominant,notnecessarilytheonethat
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will give the highest rating. If the secondary conditions affect the overall health significantly, then the rating for the
dominantconditioncanbeincreasedtothenexthigherrating.
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RespiratoryRatingSystem
Notallrespiratoryconditionsareratedonthissystem,butthedefinitionsofthetestsfoundbelowwillcomeintoplaywith
manyconditionseveniftheydonotusetheexactsamesystem.
Ratings for the respiratory system are based on how well the lungs take in air, absorb oxygen into the blood, and then
exhaletheleftovergases.Pulmonaryfunctiontests(PFTs)areperformedtorecordtheproperfunctioningofthelungsand
theiraffectsontheentirebody.Becausetheoxygenthelungsintakegoesintothebloodstream,severelungconditionscan
affecttheheart.Iftheheartisaffected,itisessentialthatproperhearttestsarerunaspartofthePFTs.Belowisalistof
importanttestsandtestresultsthatarenecessaryforratings.
Spirometry: This is a set of tests that records the functioning of the lungs and the airways leading to the
lungs.Thesetestsshouldbedonebeforeandaftermedicationistaken,andsometimesnumeroustimesovera
longperiod,toproperlyreflecttheseverityofthecondition.Iftheyarenotperformedaftertakingmedication,
thenthephysicianmustexplainwhynotonthemedicalreport.Iftheresultsofthespirometryareusedtorate
thecondition,thenthetestresultsAFTERthemedicationistakenaretheonesthatmustbeusedunlessthetest
resultsfrombeforethemedicationareworse(thiswouldbeveryunusual).Thefollowingresultmeasurements
areusedforratingpurposes:
ForcedVitalCapacity(FVC)isthetotalmaximumamountofairthatyoucanexhaleaftertaking
afullbreath.Itisreportedasavolumeofairandalsoasapercentageoftheaverage,healthyperson
likeyou.
Forced Expiratory Volume in 1 second (FEV1) 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,healthypersonlikeyoucanexpel4.5litersofair,andyoucanexpel4.0litersofair,then
yourFEV1resultwouldbe89%(4.0/4.5=89%).70%andaboveisconsiderednormal.
The ratio of FEV1 to Forced Vital Capacity (FVC) is another measurement used for ratings.
TheratioisdeterminedbydividingtheFEV1bytheFVC,andwillbenotedasapercentage.Ifthe
FEV1measurementis3.5litersandtheFVCmeasurementis5.0liters,thentheFEV1/FVCwould
be 70% (3.5/5.0 = 70%). 75% and above is considered normal. If both the FEV1 and the FVCs
measurements arehigher than their predicted values, then this ratio cannot be used to rate the
condition.
AFlowVolumeLoopcanbecalculatedfromtheresultsofaspirometry.Itchartstheentirelung
capacityandtheabilitytomoveairthroughtheairwaysbyfirstinhalingcompletely,thenforcefully
exhalingcompletely,andthenquicklyinhalingagain.Theresultsofthistestareshownonagraph,
butthegraphsthemselvesareunimportantforrating.Theimportantinformationisthephysicians
analysisofthechart.Inthisanalysisitshouldbeclearlystatedwhetherornotthereisanobstruction
thatisblockingtheairflow.Thiscouldbeanupperairwayobstruction,extrathoracicobstructionor
intrathoracicobstruction.
TheDiffusionCapacityoftheLungforCarbonMonoxidebytheSingleBreathMethod(DLCO(SB))is
anothertestusedforrating.Inadditiontotestingthefunctionoftheairways,thistestalsomeasurestheability
ofthelungstoabsorbgasses.Afterinhalingacertainamountofcarbonmonoxide,thetestmeasureshowmuch
isabsorbedbythelungsintothebloodstreambymeasuringhowmuchisleftintheairthatisexhaled.The
resultofthistestthatisnecessaryforratingisagaingivenasthepercentageofanormal,healthypersonyour
age,height,ethnicity,andsex.Eightypercentandaboveisconsiderednormal.
Exercise testing: This test determines how much oxygen the body uses when functioning at its maximum
capacity.Maximumcapacityisdefinedasthemaximumamountofphysicalactivitythatcanberepeatedand
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sustainedbytheindividual.Sojustrunningatthemaximumspeedfor2secondsisnotthemaximumcapacity.
Instead,itwouldbethemaximumspeedthatcanbesustainedformorelike10minutes,etc.Eachpersonhasa
differentmaximumcapacity.Theratableresultofthistestistheamountofoxygen(inmilliliters,ml)usedby
yourbodyweight(inkilograms,kg)perminute(min).Itshouldlooklikethis:20ml/kg/min.
Heart tests: Because the lungs supply the blood and heart with oxygen, lung conditions often cause heart
problems.Iftheheartisinvolved,thenanechocardiogramoracardiaccatheterizationorothertestsoftheheart
maybenecessarytoproperlyratethecondition.
Notallofthesetestsmustbedoneineveryinstance.Obviously,iftheconditionisnotsevereenoughtoaffecttheheart,
thenthehearttestsarenotneeded.AcompletespirometryisalmostALWAYSneededunlesstheexercisetestresultsare
20ml/kg/min or less, the heart tests show pulmonary hypertension, there have been 1 or more episodes of respiratory
failure,orwhenregularoxygentherapyisneededathome.
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
highestratingcanbeused.Ifanyofthetestresultsarenotconsistentwiththeothertestsoroverallcondition,thenthe
examiningphysicianmustexplainwhythattestresultshouldnotbeusedtoratethecondition.
Theratings:
The following table has all the tests, conditions and their ratings. Remember that only one rating can be given for a
respiratorycondition.Theonethatbestreflectstheoverallconditionmustbeusedunlesstheyallrepresentitequally.Then
theonethatgivesthehighestratingisused.
Test
FEV1
FEV1
FEV1
FEV1
FEV1/FVC
FEV1/FVC
FEV1/FVC
FEV1/FVC
DLCO(SB)
DLCO(SB)
DLCO(SB)
DLCO(SB)
ExerciseTest
ExerciseTest
Heart
Test/Conditions
Heart
Test/Conditions
Heart
Test/Conditions
Other
Other

Result/Condition
Lessthan40%
4055%
5670%
7180%
Lessthan40%
4055%
5670%
7180%
Lessthan40%
4055%
5665%
6680%
Lessthan15ml/kg/minwiththelimitationcausedbyaheartor
respiratorycondition.
1520ml/kg/minwiththelimitationcausedbyaheartor
respiratorycondition.

Rating
100%
60%
30%
10%
100%
60%
30%
10%
100%
60%
30%
10%

Corpulmonale

100%

Rightventricularhypertrophy

100%

Pulmonaryhypertension

100%

1ormoreepisodesofrespiratoryfailure
Requiresoxygentreatmentsathome

100%
100%

100%
60%

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DiseasesoftheNoseandSinuses
Thenoseisconnectedtoagroupofhollowopeningsinthebonesoftheskullcalledthesinuses.Theethmoidsinusesare
locatedbetweentheeyesunderthebridgeofthenose.Thefrontalsinusesarelocatedabovetheeyebrows.Themaxillary
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sinusesarelocatedtoeithersideofthenoseinthecheekbones,andthesphenoidsinusesarelocatedbehindtheeyes.The
nasalpassageisdividedinhalfbytheseptum.

Code6502:Deviationofthenasalseptumisaconditionwheretheseptumblocksoneorbothofthenasalpassages.This
isonlyratableifitoccurredbecauseofatraumaticinjury.Ifitisblocking50%ofthenasalpassage,either50%onboth
sidesor100%ononeside,itisrated10%.
Code6504:Lossofpartofthenoseorsignificantscarringisrated30%ifbothnasalpassagesareexposedor10%if
thereisanobviousdisfigurement.Itcaneitherberatedunderthiscodeorundercode7800fordisfigurementifitwould
giveahigherrating.
Code6522:Allergicorvasomotorrhinitisistheswellingofthetissuesliningthenasalpassagebecauseofallergiesor
other inhaled triggers like smoke, fumes, etc. This causes the nose to become stuffy and runny. If the rhinitis is fairly
constantandtherearegrowthsforminginthetissues,itisrated30%.Iftherearenogrowthsinthetissues,but50%ofthe
nasalpassagesonbothsidesor100%ononesideisblocked,itisrated10%.
Code 6523: Bacterial rhinitis is the swelling of the tissues lining the nasal passage because of a bacterial infection,
causingcongestionandarunnynose.Iftheconditioncausesrhinoscleroma,itisrated50%.Ifthereisrhinitisandthenasal
conchagrowsabnormallyintothenasalpassagesandcauses50%ofbothor100%ofonetobeblocked,itisrated10%.
Code6524:Granulomatousrhinitisistheswellingofthetissuesliningthenasalpassagewithabnormalcellgrowthsthat
arenotcausedbybacteria.IftheconditionislethalmidlineWegenersgranulomatosis,itisrated100%.Thiscondition
causesthebloodvesselsinthenosetoswellandlumpstoformthatoftencausedeformitiestoformandtheairwaysto
become blocked. The condition is not curable, but it is treatable and not always lethal. Any other type of rhinitis that
causeslumpstoforminthenoseisrated20%.
SinusitisRatingSystem
Sinusitisoccurswhenthesinusesswellandismostoftencausedbyinfectionorallergy.Mostsinusitisiseasilyclearedup
within2weeks,andsoitisonlyratableifitischronic.Sinusitiscanoccurineachofthedifferentsinusesorinallatthe
sametime(pansinusitis).Treatmentsrangefrommedicationtosurgery.
Ifthesinusitisisconstantornearconstantwithheadaches,tendernesstothetouch,andpussydischargeorcrustingafter
repeatedsurgeries,orifaradicalsurgerywasperformedandthereisongoinginfectioninthefacialbones(osteomyelitis),
itisrated50%.
Ifthereare3ormore incapacitatingepisodeseachyearthatrequires4to6weeksofantibiotictreatment,orif there are
morethan6episodes(notincapacitating)eachyearofheadaches,tendernessandpussydischargeorcrusting,itisrated
30%.
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Ifthereare1or2incapacitatingepisodeseachyearthatrequires4to6weeksofantibiotictreatment,orifthereare3to6
episodeseachyearofheadaches,tenderness,andpussydischargeorcrusting,itisrated10%.
Anythinglessisrated0%.
Sinusitiscodes:
Code6510:Pansinusitis
Code6511:Ethmoidsinusitis
Code6512:Frontalsinusitis
Code6513:Maxillarysinusitis
Code6514:Sphenoidsinusitis
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DiseasesoftheThroat
The throat is comprised of the pharynx, larynx and trachea. The
pharynx is thepart of the throat that connects the nose, mouth, trachea,
andesophagus.Atthebottomofthepharynx,thetracheasplitsfromthe
esophagus and leads to the lungs (the esophagus leads to the stomach).
Nearthetopofthetracheaisthelarynxorvoicebox.Thisiswherethe
vocalcordsarelocated.
Code 6516: Chronic laryngitis is the swelling of the larynx that
regularlylastsmorethan3weeks.Ifitcauseshoarsenesswhenspeaking
and there are either growths in the larynx or on the vocal cords, or if
there are precancerous tumors, it is rated 30%. If it causes hoarseness
whenspeakingandthevocalcordsorlarynxwallsareswollen,itisrated
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,
breathingisdone through a hole in the throat. A total laryngectomy is rated 100%. A partial laryngectomy is not rated
underthiscode,butisratedonanylastingsymptomslikelaryngitis(code6516),theinabilitytospeak(code6519),ora
narrowedlarynx(code6520).
AdditionalcompensationmaybegivenbytheVAforthelossofthelarynx.SeetheSpecialMonthlyCompensationtoseeif
yourconditionqualifies.
Code 6519: Aphonia is the inability to speak that is caused by an infection, injury or disease. If it is caused by a
psychologicalcondition,itisnotratable.Ifyoucannotcommunicatethroughspeechatall,itisrated100%.Ifyoucan
speak,butnotlouderthanawhisper,itisrated60%.Ifyouhavebeendiagnosedwithincompleteaphonia,andyoucan
speak,buttherearetimeswhenyoucantoritisverydifficultto,thentheconditionisratedaslaryngitisundercode6516.
Your condition may also qualify for additional compensation by the VA. Please see the Special Monthly
Compensationpageformoreinformation.
Code6520:Stenosisofthelarynxiswhenthelarynxnarrowsandtheopeningtothetracheabecomesunusuallysmall,
causingdifficultyspeakingandbreathing.Ifthelarynxwasinjured,thenanyleftoversymptomsfromtheinjurycanalso
beratedunderthiscode.Theseconditionsareeitherratedonthefollowingsystem,orastheinabilitytospeak,code6519,
whicheverismostappropriatefortheconditionandprovidesthehigherrating.
IftheFEV1islessthan40%andtheFlowVolumeLoopshowsanupperairwayobstruction,or if there is a permanent
tracheostomy, then it is rated 100%. If the FEV1 is 4055% and the FlowVolume Loop shows an upper airway
obstruction,itisrated60%.IftheFEV1is5670%andtheFlowVolumeLoopshowsanupperairwayobstruction,itis
rated30%.IftheFEV1is7180%andtheFlowVolumeLoopshowsanupperairwayobstruction,itisrated10%.
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Code6521:Anyinjuriesofthepharynxareratedunderthiscode.Iftheinjuriescausedthepharynxatanypoint(upnear
thenasalpassagetodownnearthelarynx)tonarroworbecomecompletelyblocked,orifthesoftpalatehasbeenremoved
orismissingbecauseofinjury,chemicalburnsorgrowthsonit,orif the soft palate cannot move and causes difficulty
swallowingandspeaking,itisrated50%.
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RestrictiveLungDiseases
Restrictivelungdiseasesareallconditionsthatlimithowmuchthelungscanexpandwhenabreathistaken.Allrestrictive
lungdiseaseconditionsareratedontheRespiratoryRatingSystem.
Ifthemainsymptomsoftheconditionarenotproperlyratedbythissystem,thenitcanberatedunderthemostserious
symptom.Forexample,ifthebloodisnotgettingenoughoxygen,theheartcouldbedamage,buttheRespiratoryRating
Systemonlygivesratingsfortheheartifitisverysevere.If,however,theheartconditionisnotsoseverebutisthemain
symptomofthecondition,itcanberatedonthatheartconditionundertheappropriateheartcode.
Code6840:Ifthediaphragmisparalyzedormovesincorrectly,itcanlimittheexpansionofthelungs.
Code6841:Ifthereisaninjuryofthespinalcordthatlimitsthemovementofthelungs,itisratedunderthiscode.
Code6842:Threedifferentconditionsareratedunderthiscode.Kyphoscoliosisistheabnormalcurvingofthespineboth
sidetosideandbacktofront.Pectusexcavatumisaconditionwheretheribsandsternumgrowinward,causingacaved
inchest.Pectuscarinatumistheoppositeofpectusexcavatum.Itoccurswhentheribsandsternumgrowoutwardinthe
middleofthechest.Eachoftheseconditionslimitsthespacethelungsneedtoinflate.
Code6843:Afewdifferentthingsarealsoratedunderthiscode.Aherniaoccurswhenthelungpushesthroughthechest
wall.
Acollapsed 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
continuesfor3monthsafterdischargefromthehospital.Anyleftoversymptomswillthenberatedonthe Respiratory
RatingSystem.
Anyotherconditionsordefectsofthechestwallthatkeepsthelungfrominflatingproperlyisalsoratedunderthiscode.
Ifthereisagunshotwoundtothechestandeitherthebulletisstillinthelung,thereispainordiscomfortwithbreathing
or movement, there is a crackly/wheezing sound in the lungs,or the lower chest or diaphragm cannot expand fully, the
minimumratingfortheconditionis20%.
Inthecaseofagunshotwoundtothelungs,themusclesinGroupXXI,thenonesthatcontrolbreathing,cannotberated
also.Onlyamuscleratingoralungrating,whicheverprovidesthehigherrating.Ifshouldermusclesareaffectedaswell,
however,theycanberatedseparatelysincetheydonotdirectlyimpactbreathing.
Code6844:Ifanysurgery,likealobectomyorpneumonectomy,wasperformedonthelunganditishealed,butthelung
isstillunabletofullyinflate,itisratedunderthiscode.
Code6845:Ongoingpleuraleffusionoccurswhenexcessfluidbuildsupbetweenthelungandthechestwall,andfibrosis
occurs when excess connective tissues build up between the lung and the chest wall. These conditions are rated on
theRespiratoryRatingSystem.
Pleurisywithempyemawouldalsoberatedunderthiscode.Thisconditionoccurswhenpusbuildsupbetweenthelung
andthechestwallfromabacterialinfection.Thisconditionisrated100%whiletheinfectionisactive.Onceitisresolved,
anyleftoversymptomsareratedontheRespiratoryRatingSystem.
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ObstructiveLungDiseases
Obstructivelungdiseasescausetheairwaytothelungstobecomeblocked.Oftenthereissignificantswellingofthetissues
andtheairwayscollapseeasily.MostoftheseconditionsareratedontheRespiratoryRatingSystem,butsomehavesome
smalldifferences.
Code6600:Chronicbronchitisistheswellingofthebronchiinthelungs.Theswellingcausesthemtonarrowandblock
thepassageofair.
Code6603:Pulmonaryemphysemaisadiseasethatgetsworseovertimeandisnormallycausedbysmokingorbeing
exposedtopollutionforalongtime.Itcausesthetissuesthatholdtheshapeofthelungstodie,thuscausingthelungsto
collapseandloosetheirshape.
Code 6604: Chronic obstructive pulmonary disease (COPD) is simply the presence of chronic bronchitis and/or
emphysema.Itisratedexactlythesameasbothbronchitisandemphysema,andthecodecanbeusedinterchangeably.If
botharepresent,thenonlyoneratingcanbegivenunderthiscode.
Code6601:Bronchiectasisisaconditionwherepartofthebronchialtreebecomesenlargedandcausesobstructionofthe
airflow.Thisisapermanentconditionthatcannotbereversed.
Itiseither rated on the Respiratory Rating System or on incapacitating episodes below, whichever provides the highest
rating.Thedefinitionofanincapacitatingepisodeforratingthisconditionisaperiodwherethereisanactiveinfection
inthelungs,anditrequiresbedrestandtreatmentbyaphysician.
Ifthereareatotalofatleast6weeksofincapacitatingepisodeseachyear,itisrated100%.
If there are a total of 4 to 6 weeks of incapacitating episodes each year, or if there is constant coughing with pussy or
bloodymucousthatrequiresnearconstantantibiotictreatmentwithanorexiaandweightloss,itisrated60%.
Ifthereareatotalof2to4weeksofincapacitatingepisodeseachyear,orifthereisdailycoughingwithoccasionalpussy
orbloodymucousthatrequiresbetween4to6weeksofantibiotictreatment3ormoretimesayear,itisrated30%.
Ifthereisoccasionalcoughingwithinfectionsrequiringantibiotics2ormoretimesayear,itisrated10%.
Code6602:Asthmaisaconditionwheretheairwaysandbronchiswell,causingthemtocloseup.
This condition has slightly different rating requirements than the Respiratory Rating System. These are outlined in the
tablebelow.
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 FEV1 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,
medicationsaregiventotreattheasthmaattack.Ifspirometryisdonewithandwithoutmethacoline,theconditionisrated
onthemethacolineresults.
IfFEV1andFVCtestswithmethacolinearenotperformed,thenasthmacanberatedbasedonthekindofmedicationthat
isusedtotreattheconditionorontheseverityoftheconditionbasedonthenumberofERvisits.Inthesecases,however,
thephysicianmustclearlyrecordathoroughhistoryofasthmaattacks.
Test
FEV1
FEV1
FEV1
FEV1
FEV1/FVC
FEV1/FVC
FEV1/FVC
FEV1/FVC
ERvisits

Result/Condition
Lessthan40%
4055%
5670%
7180%
Lessthan40%
4055%
5670%
7180%
2ormoreattacksperweekwithrespiratoryfailurethatrequiresER
visitstosavelife

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Rating
100%
60%
30%
10%
100%
60%
30%
10%
100%
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ERvisits
Medication
Medication
Medication
Medication
Medication

RequiresmonthlyERvisitstosavelife
Requiresdailyhighdosesofsteroidsorimmunosuppressive
medicationstakenbymouthorbyinjection*
Requirestheuseofsteroidsorimmunosuppressivemedicationstaken
bymouthorbyinjection3ormoretimesayear*
Requiresoccasionaluseofinhaledantiinflammatorymedication*
Requiresdailybronchodilatortherapytakenbymouthorinhaled*
Requiresoccasionalbronchodilatortherapytakenbymouthor
inhaled*

60%
100%
60%
30%
30%
10%

*Adefinitionofthesemedicationsislistedbelow.

Swelling is the biggest problem with asthma, and so the majority of medications that treat asthma are for controlling
swelling.
Swellingisoftenareactionoftheimmunesystemtothingsitdoesntlike.Immunosuppressivemedicationssuppressthis
response,allowingtheairwaystoremainopeninanasthmaattack.Similarly,steroidstakenbymouthorinjection are
abletogreatlyreduceswelling.Bothofthesetreatmentsareonlyusedforthemostseverecasesofasthmaandonlywhen
alltheothermedicationslistedbelowdonotsatisfactorilytreatthecondition.Someofthemostcommonmedicationsin
these categories are Prednisone, Prednisolone, Decadron, Deltasone, Dexamethasone, Medrol, Orasone, Pediapred, and
Prelone.
Inhaled antiinflammatory medications are steroids, but a smaller dose than oral or injected steroids. These reduce
swellingandmucusproduction.Theyareusedtopreventasthmaattacks.Someofthemostcommonmedicationsinthis
category are Aerobid (Flunisolide), Flovent HFA (Flutocasone HFA), Azmacort (triamcinolone), Ipratropium Bromide
(Atrovent), Asmanex, Pulmicort, and Qvar. The following are a combination of an antiinflammatory medication and a
bronchodilator(discussednext),buttheyareratedasantiinflammatorymedication:Advair(FluticasoneandSalmeterol),
Duleva,andSymbicort.
Bronchodilatorsare used by pretty much anyone with asthma. These keep the bronchi from swelling and blocking the
airway.Theyareallinhaled,andthereareshortactingandlongactingbronchodilators.Shortactingonesaretherescue
inhalers that work very quickly and last between 1 hour and 4 hours. Common shortacting bronchodilators include
Proventil, Albuterol, Ventolin, Salbutamol, AccuNeb, Levosalbutamol, Levalbuteral, Xopenex, Terbutaline, Bricanyl,
Pirbuteral,Maxair,Procaterol,Metaproterenol,Alupent,Fenoterol,Bitolterolmesylate,andRitodrine.
Longacting bronchodilators are used to control asthma and prevent attacks. Common longacting bronchodilators
includeSereveut,Salmeterol,Formoterol,Foradil,Symbicort,Bambuterol,Clenbuterol,andIndacaterol.
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InterstitialLungDiseases
Interstitiallungdiseasesareconditionsthataffectthetissuessurroundingtheairsacsinthelungs.Allareratingonthe
sameratingsystemexceptSarcoidosis.
Code6846:Sarcoidosisisaconditionwherelumpsformonthetissuessurroundingtheairsacs,bronchiandsmallblood
vesselsinthelungs.
ThisconditioncaneitherberatedontheRespiratoryRatingSystemaschronicbronchitis(code6600)oronthefollowing
system,whicheverprovidesthehigherrating.IfitisratedontheRespiratoryRatingSystemaschronicbronchitis,thefinal
codewouldlooklikethis:68466600.Thefirstfourdigitcodedefinestheconditionassarcoidosis,andthesecondfour
digitcodetellshowitisrated.Ifitaffectsanyothersystembesidestheheartandrespiratorysystem,anadditionalrating
canbegivenforthosesymptoms.
Theratings:
Iftheconditioncausestherightventricleinthehearttoswellandfailbecauseofhighbloodpressurebetweentheheart
andlungs,orifthereiscongestiveheartfailure,orifitcauseslungdiseasethatcontinuallygetsworsedespitetreatment,
withfever,nightsweatsandweightloss,itisrated100%.
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Ifitrequireshighdosesoforalorinjectedsteroidstocontrolthecondition,itisrated60%.Ifitrequiresregularlowdoses
oroccasionalhighdosesoforalorinjectedsteroids,itisrated30%.
Ifitcausesthelymphnodestoswellinthelungsbutitcausesnosymptomsorimpairment,itisrated0%.
InterstitialLungDiseaseRatingSystem
All other interstitial lung conditions are rated on the following system. This system is similar to the Respiratory Rating
Systemandusesthesamespirometrytests,sofurtherinformationaboutthetestsandresultscanbefoundthere.
Test
FVC
FVC
FVC
FVC
DLCO(SB)
DLCO(SB)
DLCO(SB)
DLCO(SB)
ExerciseTest
ExerciseTest
Heart
Test/Conditions
Heart
Test/Conditions
Other

Result/Condition
Lessthan50%
5064%
6574%
7580%
Lessthan40%
4055%
5665%
6680%
Lessthan15ml/kg/minwiththelimitationcausedbyaheartor
respiratorycondition.
1520ml/kg/minwiththelimitationcausedbyaheartor
respiratorycondition.

Rating
100%
60%
30%
10%
100%
60%
30%
10%

Corpulmonale

100%

Pulmonaryhypertension

100%

Requiresoxygentreatmentsathome

100%

100%
60%

Code6825:Diffuseinterstitialfibrosisisagroupofconditionswherethetissuesinthelungswell,becomedamaged,and
thenturnintoscartissue.
Code 6826: Desquamative interstitial pneumonitis is a condition where lumps form in the tissues of the lungs. Most
oftenitiscausedbysmoking.
Code6827:Pulmonaryalveolarproteinosiscausesproteintobuildupintheairsacsofthelungs.
Code6828:Eosinophilicgranulomaofthelungisaconditionwherecellsfrombonemarrowaredepositedinthelungs.
Code 6829: Druginduced pulmonary pneumonitis and fibrosis is pneumonitis or fibrosis in the lungs caused by a
reactiontomedicationtakenforanothercondition.
Code6830:Radiationinducedpulmonarypneumonitisandfibrosisispneumonitisorfibrosisinthelungscausedbya
reactiontoradiationexposureortreatment.
Code6831:Hypersensitivitypneumonitis(extrinsicallergicalveolitis)istheswellingofthetissuesinthelungscaused
bybreathinginasubstancelikedustormildew.
Code6832:Pneumoconiosis(silicosis,anthracosis,etc.)isalungdiseasecausedbybreathingindustoveralongperiod
oftime.Thisismostcommonlyseenincoalminers.
Code6833:Asbestosisislungconditioncausedbybreathinginasbestosoveralongperiodoftime.
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PulmonaryVascularDiseases
Code6817:Allpulmonaryvasculardiseasesareratedunderthiscode.Theseconditionsaffectthebloodvesselsleading
toandfromthelungs.
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If the condition causes pulmonary hypertension, chronic pulmonary thromboembolism with pulmonary
hypertension,rightventricularhypertrophy,rightheartfailure,orpulmonaryhypertensionwithrightheartfailureorright
ventricularhypertrophycausedbytheblockageofarteriesorveinsinthelungs,itisrated100%.
Iftheconditioncausespulmonarythromboembolismthatrequiresanticoagulanttherapy,itisrated60%.A60%ratingis
alsogivenifsurgeryhasbeendoneonthe inferiorvenacavaandthereisnoevidenceofpulmonaryhypertensionorany
otherproblemswiththerightventricle.
Iftherehasbeenapulmonaryembolismandithasbeentreatedandcleared,buttheconditionsstillcausessymptoms,itis
eitherrated30%underthiscodeoritcanberatedunderthecodeofthesymptom(like6600for bronchitis or 6844 for
pleuraleffusionorfibrosis),whicheverprovidesthehighestrating.Onlyonecodecanbeused,however,evenifthereare
multiplesymptoms.Iftherearenosymptoms,itisrated0%.
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FungalInfections(MycoticLungDisease)oftheLung
Mycoticlungdiseasesarecausedbyinhalingfungalspores.Theseconditionsareratedonthefollowingsystem.
If the infection continues over a long period of time and causes fever, weight loss, night sweats, or coughing up large
amountsofblood,itisrated100%.
If it continues over a long period of time and requires treatment to keep it under control, and there are only minor
symptomslikeoccasionallycoughingupalittlebitofbloodormucous,itisrated50%.
Ifitcontinuesoveralongperiodoftimeandonlyhaveminorsymptomslikeoccasionallycoughingupalittlebitofblood
ormucous,itisrated30%.
Iftheconditionishealedandtherearenosymptoms,itisrated0%.
Theconditions:
Code6834:HistoplasmosisofthelungisafungalinfectioncausedbybreathinginthefungusHistoplasmacapsulatum.If
theinfectionremainsinthelungs,itisnormallyshortlivedandtreatable.If,however,itdisseminates,itcanbefatal.
Code6835:CoccidioidomycosisiscausedbythefungusCoccidioidesimmitisthatislocatedinthesoilinsouthwestern
UnitedStates(California,Nevada,Utah,Texas,Arizona,andNewMexico),CentralAmerica,andSouthAmerica.
Iftheinfectiondisseminatestootherpartsofthebody,itcouldbeseveralyearsaftertheinitiallungsymptomsbeforeit
causesothersymptoms.Becauseofthis,ahistoryoflivinginthelocationslistedaboveduringactivedutyserviceinthe
proper timeframe for this infection must be properly documented for the DoD to consider this condition service
connected.
Code6836:BlastomycosisiscausedbythefungusBlastomycesdermatitidiswhichislocatedinvariousareasofNorth
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 bodys
immunesystem.
Code6838:AspergillosisiscausedbythefungusAspergillus,whicheveryoneinhaleseveryday.Itonlyattackspeople
with a seriously decreased immune system, however. Because of this, it often infects people with cancer or other
conditionsthatrequiretherapythatsuppressestheimmunesystem.
Code6839:MucormycosisiscausedbyMucoralesfungithatgrowinthebloodvessels.
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BacterialInfectionsoftheLung
Bacterialinfectionsinthelungsareallratedthesame.Iftheinfectionisactivewithsymptomslikefever,nightsweats,
weightloss,andcoughingupblood,itisrated100%.Ifitdoesnotqualifyforthisrating,itisratedbasedonanylasting
symptomslikeinterstitiallungdisease,restrictivelungdiseaseorbronchitis.
Code6822:ActinomycosisisaconditioncausedbythebacteriaActinomyces.Itisveryrareinhumans,butwhenseen,
causespussygrowthsinthelungs.
Code 6823: Nocardiosis is caused by the bacteria Nocardia. It is very infectious, but occurs mostly in men with a
decreasedimmunesystem.Itisveryhardtodiagnosesincethesymptomsoftenlooklikeotherconditions.
Code6824:Chroniclungabscessisandinfectionthatcausesthelungcellstodie,creatingcavitiesofpusinthetissuesof
thelungs.
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SleepApnea
Code6847:Anysleepapneasyndromeisratedunderthiscode.Sleepapneaisadisorderthatoccurswhileasleep.There
iseitherapausewhenbreathingthatcanlastuptoafewminutesorthereisveryshallow,lowbreathing.Centralsleep
apneaiscausedbyadecreaseintheactionofbreathingthebodydoesnttryashardtobreatheproperly.Obstructive
sleepapneaiscausedbyablockintheairways,likeanarrowingoftheairwaypassagesoranexcessofmucus.Thiscauses
severesnoring.Mixedsleepapneaisacombinationofbothcentralandobstructive.
Sleepapneacancauseasignificantimpairmentoftheheartandrespiratorysystembylimitingtheamountofairthatis
takeninduringthehoursofsleep.
Iftheconditioncontinuesoveralongperiodoftimeandcausesrespiratoryfailurewithrightheartventriclefailureorwith
toomuchcarbondioxideinthebloodstream,orifitrequiresatracheotomy,itisrated100%.
Ifitrequirestheuseofbreathingmachineslikeacontinuouspositiveairwaypressure(CPAP)machineduringsleep,itis
rated50%.
Ifitcausesserioussleepinessduringthedaytimeornotfeelingrestedaftersleeping,itisrated30%.
Ifitisdiagnosedbyasleeptest,butitdoesntcauseanysignificantsymptoms,itisrated0%.
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TuberculosisoftheRespiratorySystem
Tuberculosisisaninfectiousdiseasethatmostcommonlyaffectsthelungs(pulmonary)butcanalsoaffectotherorgans
(nonpulmonary). It is caused by an airborne bacteria and causes symptoms like coughing, fever, sweating, and weight
loss.
Code6732:Tuberculouspleurisyistheswellingofthelungsduetoliquidbuildingupbetweenthelayersoftheliningof
the lungs with hard growths on the lining of the lungs. This condition is rated either under code 6730 if it is currently
activeor6731ifitisinactive.Thefinalcodewilllooklikethis:67326730.Thefirstfourdigitcodedefinesthecondition
astuberculouspleurisy,andthesecondfourdigitcodetellshowitisrated.
Code6730:Allotherpulmonarytuberculosesareratedunderthiscode.Ifactive,theyarerated100%.
Assoonasthepulmonarytuberculosisbecomesinactive,theVAwillrequireanotherexaminationforratingpurposes.This
doesnotapplytotheDoD.Mostlikely,theDoDwillkeeptheservicememberonTDRLuntilthetuberculosisbecomes
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inactive,atwhichpointtheywillseparatethemwithapermanentrating.
If the pulmonary tuberculosis is considered NOT serviceconnected, then it is not ratable UNLESS at least one of the
followingisalsopresentorhasoccurred:
Activenonpulmonarytuberculosis
Severesymptoms
Thetuberculosiswascuredandthenitcameback
Lunglesionsarecontinuallygettingworsedespitetreatment
If after being hospitalized for 6 months, the lesions and condition are not improving, or if after being
hospitalizedfor12months,theconditionisstillactive.
Code6731:Inactivepulmonarytuberculosisisratedonthelastingsymptomsorcomplications.Ifitcausesrestrictive
heart disease or interstitial lung disease, then it will be rated on those conditions. Obstructive lung disease is rated as
chronicbronchitisundercode6600,andathoracoplastyisratedundercode5297.
Code6515:Tuberculouslaryngitisisanonpulmonarytuberculosisthataffectsthelarynxinthethroat.Ifitisactive,itis
rated100%.Onceitisinactive,the100%ratingwillcontinuefor1year,afterwhichtheconditionwillberatedbasedon
thelastingsymptomsorcomplications.Forexample,iftheconditioncausesaninabilitytospeak,thenitwouldberatedas
aphonia,code6519.
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CancerandTumorsoftheRespiratorySystem
Cancerandtumorsaremadeupofthegrowthofabnormalcells.Thesecellscanbebenigntheydonotattackthegood
cellsaroundthem(tumors)ortheycanbemalignanttheyattackthecellsaroundthem(cancers).Acanceroustumor
isjustcancerunderourdefinition.
Code6819:Anymalignantcanceroftherespiratorysystem(thisdoesnotincludeskincancers)israted100%whileitis
active.This100%ratingcontinuesfor6monthsfollowingthelasttreatment.Theconditionisthereevaluatedandanyleft
oversymptomsorcomplicationsareratedseparately.
Code6820:Anytumoroftherespiratorysystemisratedonanysystemsorfunctionsthatitaffects.Forexample,ifthe
tumorpushesonthelarynxandmakesithardtospeak,thenitwouldberatedasaphonia,code6519.
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OtherRespiratoryConditions
All other digestive system conditions will be rated analogously(see the Analgous and Equivalent Codes page) with the
aboveratings.ThebottomlineruleistorateanyconditionunderthecodethatBESTdescribesit,evenifitisnotexact.
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DBQsforRespiratoryConditions
Here are the Disability Benefits Questionnaires (DBQs) used for respiratory conditions: Sleep Apnea DBQ, Nose and
ThroatDBQ,andRespiratoryConditions(other)DBQ.
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PrinciplesthatApply
Pyramiding: A single condition can only be rated once! However, if another condition exists that is additional to the
respiratorycondition(notsimplycausedbyit),thenitcanalsoberated.
Special Monthly Compensation: If your condition makes it impossible to speak, you may qualify for the VAs Special
MonthlyCompensation.
ProbativeValue:Iftwoexamsrecordtheconditiondifferently,theexamwiththemostthoroughdataandperformedbythe
mostqualifiedpersonintheareawillbetheexamtheratingisbasedon.
ATieGoestotheVeteran:Iftherearetwoequallystrongexamswithconflictinginformation,oriftheconditioncanbe
equallyratedundertwodifferentcodes,thentheonethatgivesthehighestratingwillbeassigned.Everyconflictshouldbe
resolvedinfavorofthehigherrating.
AccurateMeasurements:Itisessentialthatthenecessaryinformationtorateyourconditionisrecordedbythephysicianin
yourexam.Withtheinformationonthispage,youshouldknowwhatneedstobemeasuredandrecorded.Makesurethis
happenscorrectlytoensurethatyoureceiveaproperrating.
Hospital or Convalescent Ratings: Some conditions require periods of hospitalization or constant medical car (athome
nurse,etc.).Anyconditionthatrequiresthisisrated100%duringthisintensivetreatment.Onceitends,thenthe100%
ratingwillcontinueforacertainperiod.Thisperiodis3monthsunlessanotherlength(6months,1year,etc.)isdirectly
specifiedintheconditionratings.Somepatientsmayneedmoretimetorecoverthanothers,sothephysicianorRating
Authoritiescanlengthenthistimeperiodiftheyseefit.
PleaseseetheVASRDPrinciplespageforfurtherguidance.

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