Body system: Respiratory SystemRegulation: 38 CFR § 4.97
Chronic pleural effusion or fibrosis is long-term fluid accumulation in the pleural space (effusion) or scarring of the pleura (fibrosis) that restricts lung expansion. 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 this rating if breathing tests show your lungs are working at less than 40% of what's expected for someone your age and size, or if you can only consume less than 15 ml/kg/min of oxygen during exercise due to heart or lung problems. You also qualify if you have serious heart complications from your lung condition like right heart failure (cor pulmonale), enlarged right heart chamber (right ventricular hypertrophy), or high blood pressure in your lungs (pulmonary hypertension), or if you've had episodes where you couldn't breathe well enough on your own (acute respiratory failure) or need to use oxygen at home.
- 60% — Your breathing tests must show that your lungs are working at only 40-55% of what they should be for someone your age and size. This includes tests that measure 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 moves from your lungs into your blood (DLCO), or how much oxygen your body can use during exercise (maximum oxygen consumption). At this level, your chronic bronchitis significantly limits your breathing capacity to about half of normal function.
- 30% — Your lung function tests must show that you're breathing at 56-70% of what's expected for someone your age and size. This is measured through breathing tests where you blow into a machine that checks how much air you can push out of your lungs in one second (FEV-1), what percentage of your total lung capacity you can exhale quickly (FEV-1/FVC ratio), or how well your lungs transfer oxygen into your blood (DLCO test). At this level, your chronic bronchitis significantly limits your breathing capacity but you still retain more than half of normal lung function.
- 10% — To qualify for this rating level, your lung function tests must show mild impairment in one of three key measurements. Either your FEV-1 (the amount of air you can forcefully exhale in one second) is 71-80% of what's expected for someone your age and size, or your FEV-1/FVC ratio (how much air you can blow out compared to your total lung capacity) is 71-80%, or your DLCO test (which measures how well oxygen moves from your lungs into your blood) shows 66-80% of normal function.
- -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.