Body system: Respiratory SystemRegulation: 38 CFR § 4.97
Blastomycosis is a fungal infection caused by inhaling Blastomyces dermatitidis spores from moist soil and decaying organic matter, endemic to the central, southeastern, and midwestern United States (Mississippi, Ohio, and St. Lawrence River valleys). The VA rates this condition under the General Rating Formula for Mycotic Lung Disease (38 CFR § 4.97) from 0% to 100%: 100% with persistent fever, weight loss, night sweats, or massive hemoptysis; 50% requiring chronic suppressive antifungal therapy with no more than minimal symptoms; 30% with minimal symptoms but no need for suppressive therapy; 0% for healed inactive lesions.
Rating levels
- 100% — You qualify for 100% if your chronic pulmonary fungal infection (mycosis) causes persistent fever, weight loss, night sweats, or massive hemoptysis (coughing up large amounts of blood). Any one of these systemic findings is sufficient. The 100% rating recognizes the severe constitutional impact of a poorly controlled chronic pulmonary fungal infection.
- 50% — You qualify for 50% if your chronic pulmonary mycosis requires ONGOING SUPPRESSIVE ANTIFUNGAL THERAPY (typically long-term oral antifungals like itraconazole, voriconazole, or fluconazole) to keep the infection under control, with no more than minimal residual symptoms such as occasional minor hemoptysis or productive cough. The key distinguishing feature is the need for continued medication to prevent progression.
- 30% — You qualify for 30% if your chronic pulmonary mycosis causes minimal but ongoing symptoms such as occasional minor hemoptysis (small amounts of blood in sputum) or productive cough, but you do NOT require continuous suppressive antifungal therapy. The infection is stable enough that medication is not needed to prevent worsening.
- 0% — You qualify for 0% if your prior pulmonary mycosis has healed, the lesions are inactive, and you have no current symptoms. The 0% rating confirms service connection but does not pay compensation by itself; it preserves the basis for service connection if symptoms recur or new residual problems develop.