Body system: Respiratory SystemRegulation: 38 CFR § 4.97
Spinal cord injury with respiratory insufficiency is spinal cord damage at a level that impairs the muscles of respiration (especially cervical injuries affecting diaphragm or thoracic injuries affecting accessory respiratory muscles). The VA rates this condition under the General Rating Formula for Restrictive Lung Disease (38 CFR § 4.97) from 10% to 100% based on pulmonary function testing (FEV-1, FEV-1/FVC ratio, DLCO), maximum exercise capacity, and the presence of cor pulmonale, right ventricular hypertrophy, pulmonary hypertension, acute respiratory failure, or required outpatient oxygen. Per Note 1, pleurisy with empyema gets a mandatory 100% rating until resolved. Per Note 2, a total spontaneous pneumothorax gets 100% from hospital admission through three months after hospital discharge.
Rating levels
- 100% — You qualify for 100% if pulmonary function testing or related findings show any one of: FEV-1 less than 40% predicted; FEV-1/FVC ratio less than 40%; DLCO (single-breath method) less than 40% predicted; maximum exercise capacity less than 15 ml/kg/min oxygen consumption with cardiac or respiratory limitation; cor pulmonale (right-heart failure from chronic lung disease); right ventricular hypertrophy; pulmonary hypertension confirmed by echocardiogram or cardiac catheterization; episode(s) of acute respiratory failure; or requirement for outpatient oxygen therapy. Any one of these findings is sufficient for the 100% rating.
- 60% — You qualify for 60% if pulmonary function testing shows FEV-1 of 40% to 55% predicted, OR FEV-1/FVC ratio of 40% to 55%, OR DLCO (single-breath method) of 40% to 55% predicted, OR maximum oxygen consumption of 15 to 20 ml/kg/min with cardiorespiratory limitation. Any one of these findings is sufficient.
- 30% — You qualify for 30% if pulmonary function testing shows FEV-1 of 56% to 70% predicted, OR FEV-1/FVC ratio of 56% to 70%, OR DLCO (single-breath method) of 56% to 65% predicted. Any one of these findings is sufficient.
- 10% — You qualify for 10% if pulmonary function testing shows FEV-1 of 71% to 80% predicted, OR FEV-1/FVC ratio of 71% to 80%, OR DLCO (single-breath method) of 66% to 80% predicted. Any one of these findings is sufficient. This represents the mildest tier of the restrictive lung disease ladder. The VA may instead rate the primary disorder if that yields a higher evaluation.
- -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.