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.. 106518 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:
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:
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.... 1006702 Tuberculosis, pulmonary, chronic, moderately advanced, 100
active........................................................6703 Tuberculosis, pulmonary, chronic, minimal, active......... 1006704 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
Veterans Service Center 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............
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.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, as amended at 71 FR 28586, May 17, 2006]
The Cardiovascular System