Diaphragm paralysis or paresis (DC 6840)

Rating levels

• 100% — Your diaphragm paralysis or weakness has severely damaged your breathing ability, shown by lung function tests that measure less than 40% of normal capacity or your body's ability to use oxygen during exercise drops below 15 ml/kg/min. You qualify if you've had episodes where you couldn't breathe on your own (respiratory failure), if your heart's right side has enlarged or failed from working too hard to pump blood through damaged lungs, if you have dangerously high blood pressure in your lungs, or if you need to use oxygen therapy at home.
• 60% — Your lung function tests must show that you're performing at only 40-55% of what would be expected for someone your age and size. This could be measured through breathing tests that check how much air you can blow out in one second (FEV-1), what percentage of your total lung capacity you can exhale quickly (FEV-1/FVC ratio), how well oxygen transfers from your lungs to your blood (DLCO), or how much oxygen your body can use during exercise (maximum oxygen consumption of 15-20 ml/kg/min).
• 30% — You qualify for this rating if breathing tests show your lung function is moderately reduced due to diaphragm problems. Specifically, you must have an FEV-1 test (measures how much air you can blow out in one second) showing 56-70% of what's normal for someone your age and size, or your FEV-1/FVC ratio (compares how much air you can blow out quickly versus your total lung capacity) is 56-70%, or your DLCO test (measures how well oxygen moves from your lungs into your blood) shows 56-65% of normal predicted values.
• 10% — You qualify for this rating if breathing tests show your lung function is reduced to 71-80% of what's expected for someone your age and size. The tests measure how much air you can forcefully blow out in one second (FEV-1), what percentage of your total lung capacity you can blow out quickly (FEV-1/FVC ratio), or how well your lungs transfer oxygen into your blood (DLCO). Your diaphragm weakness has caused a mild but measurable reduction in your breathing ability.
• -1% — If you have pleurisy with empyema (a collection of pus in the pleural space around the lung), with or without a pleurocutaneous fistula (an abnormal channel from the pleural space to the skin), you receive a MANDATORY 100% rating that continues UNTIL THE EMPYEMA IS RESOLVED. This applies regardless of where the pulmonary function tests place you on the regular ladder, the empyema rule overrides the standard tiers as long as the empyema is active.
• -1% — If you have a TOTAL SPONTANEOUS PNEUMOTHORAX (complete lung collapse not caused by trauma), the VA assigns 100% starting from the date of HOSPITAL ADMISSION for that episode. The 100% rating continues for THREE MONTHS from the first day of the month following hospital discharge. After that 3-month window, the rating shifts to whatever the regular pulmonary function tests warrant under the standard ladder tiers above. This rule applies to total spontaneous pneumothorax only; smaller pneumothoraces or traumatic pneumothoraces are rated on PFT findings under the regular ladder.