Respiratory Conditions Rating Guide

Breathing problems are one of the fastest-growing categories of VA disability claims after burn-pit and airborne-hazard exposure. Almost every lung and airway condition is rated under the same schedule: 38 CFR § 4.97. A case of COPD, asthma, emphysema, or interstitial lung disease is scored by the same handful of rules, and most of them turn on a breathing test called the pulmonary function test, or PFT. Learn that shared pattern once and you understand your whole claim. This guide explains the rules that decide most respiratory ratings, then points you to the detailed guide for your specific condition.

The Rules That Decide Most Respiratory Claims

Most lung and airway conditions are rated on a single test: the pulmonary function test (PFT), a breathing test that measures how much air you can move and how fast. A few conditions, sinusitis, rhinitis, and sleep apnea, are the exceptions and are counted a different way. Here is the shared pattern.

1. The breathing test (PFT) drives most lung ratings

Most obstructive and restrictive lung diseases, including COPD, asthma, emphysema, chronic bronchitis, and interstitial lung disease, are rated on the numbers from a PFT. The three key readings are FEV-1 (the percent of predicted air you can force out in one second), the FEV-1/FVC ratio (how much of your total breath comes out in that first second), and DLCO (the percent of predicted for how well oxygen crosses from your lungs into your blood). The post-bronchodilator values (the readings taken after an inhaler) are generally the ones used, and the single test result that produces the correct rating level is the one that controls.

Which numbers count depends on your code, and asthma is the odd one out. Chronic bronchitis (DC 6600) and COPD (DC 6604) do read DLCO, and also maximum exercise capacity, cor pulmonale, right ventricular hypertrophy and pulmonary hypertension at their higher levels. Asthma (DC 6602) reads none of those. Its criteria are FEV-1, the FEV-1/FVC ratio, and a separate treatment path: bronchodilator or inhaled anti-inflammatory use, physician visits for exacerbations, and courses of systemic steroids. A DLCO figure will not raise an asthma rating, and expecting it to is a common way to be disappointed by an otherwise good exam. See the asthma claims guide.

2. When the breathing test does not fit, exercise capacity can be used

Sometimes the PFT numbers do not reflect how disabled a veteran actually is. In those cases, maximum exercise capacity measured in METs (metabolic equivalents, a measure of how much effort you can sustain) can be used to set the rating instead. This matters most for conditions where the lungs test better than the person feels.

3. Sinusitis and rhinitis are the exception (episodes, not breathing tests)

Chronic sinusitis and rhinitis are not rated on PFTs. Instead the VA counts incapacitating and non-incapacitating episodes over a year, along with findings like nasal polyps and blockage of the nasal passages. Because the method is completely different, a lung PFT does nothing for a sinus or nasal claim. See the sinusitis and rhinitis guide.

4. Sleep apnea turns on a breathing-assistance device

Sleep apnea is also not rated on a PFT. What matters is whether the condition requires a breathing-assistance device such as a CPAP machine. A sleep study documents the apnea, and the prescription for the device is what supports the rating. A CPAP is the common example, but VA's manual also counts other qualifying devices, including oral appliances such as mandibular advancement devices (MAD). See the sleep apnea guide.

5. Many respiratory conditions are PACT Act presumptives

A large share of lung and airway conditions are PACT Act burn-pit and airborne-hazard presumptives. For a covered veteran with a qualifying exposure, that often means you do not have to prove the medical link between service and the condition, the law presumes it. See the PACT Act guide and the burn-pit presumptive list.

Not every respiratory claim needs a breathing test, but most do. If your condition is a lung disease like COPD, asthma, or interstitial lung disease, the PFT is usually what the rating is built on, so a complete PFT report is the backbone of the claim. Sinus, nasal, and sleep-apnea claims are the exceptions and are proven a different way.

Find the Guide for Your Condition

The rules above apply across the board. For the exact rating table, the C&P exam, and the Board data for your specific condition, open the dedicated guide:

Area	Guide	DC codes
Chronic sinusitis and rhinitis	Sinusitis & Rhinitis Guide	6510-6514, 6522
COPD, bronchitis, emphysema	COPD Guide	6600, 6603, 6604
Asthma	Asthma Guide	6602
Sleep apnea	Sleep Apnea Guide	6847

For any code not listed, for example the interstitial lung diseases and respiratory cancers, open its condition lookup page for the rating levels and Board data.

Every Respiratory Diagnostic Code, With Board Outcomes

Every diagnostic code in this body system, ordered by how often it reaches the Board of Veterans' Appeals. Percentages are the share of each code's Board issues granted, denied, or remanded (sent back for more development); dismissed and other outcomes are not shown, so rows do not sum to 100%. Each code links to its full page: rating criteria, evidence notes, and secondary-condition data.

DC	Condition	Board appeals	Granted	Denied	Remanded
6847	Sleep Apnea Syndromes (Obstructive, Central, Mixed) Claims guide →	90,935	23.7%	23%	47.2%
6602	Asthma, bronchial Claims guide →	27,545	15.8%	32.5%	46.6%
6604	Chronic obstructive pulmonary disease Claims guide →	19,973	12.2%	33.1%	49%
6603	Emphysema, pulmonary Claims guide →	14,870	16%	40.2%	35.2%
6522	Allergic or vasomotor rhinitis Claims guide →	8,048	30.7%	12.1%	51%
6510	Sinusitis, pansinusitis, chronic Claims guide →	7,857	38.3%	22.7%	33.8%
6833	Asbestosis	6,673	14.8%	37.5%	42.4%
6819	Neoplasms, malignant, any specified part of respiratory system exclusive of skin growths	6,304	19.5%	29.6%	42.9%
6600	Bronchitis, chronic Claims guide →	5,787	9.2%	37.9%	47.7%
6502	Septum, nasal, deviation of	5,232	17.6%	35.8%	41.3%
6842	Kyphoscoliosis, pectus excavatum, pectus carinatum	4,553	18.2%	34.5%	42%
6846	Sarcoidosis	4,335	17.6%	33.7%	44.4%
6701	Tuberculosis, pulmonary, chronic, far advanced, active	3,732	7.8%	51.3%	34.2%
6513	Sinusitis, maxillary, chronic Claims guide →	2,876	9.6%	20.5%	64.5%
6825	Diffuse interstitial fibrosis (interstitial pneumonitis, fibrosing alveolitis)	2,289	23.5%	26.8%	42.9%
6817	Pulmonary Vascular Disease	1,404	15.3%	29.9%	47.8%
6843	Traumatic chest wall defect, pneumothorax, hernia, etc	1,064	9.9%	30.5%	57.2%
6601	Bronchiectasis	1,035	16.3%	35.1%	44.1%
6845	Chronic pleural effusion or fibrosis	972	15.1%	29%	50.8%
6820	Neoplasms, benign, any specified part of respiratory system	829	11.8%	29.9%	50.4%
6504	Nose, loss of part of, or scars	744	16.3%	28.8%	51.9%
6834	Histoplasmosis of lung	505	18.8%	38%	38.2%
6844	Post-surgical residual (lobectomy, pneumonectomy, etc.)	483	17.8%	21.5%	58%
6516	Laryngitis, chronic	381	14.7%	29.4%	52%
6835	Coccidioidomycosis	334	15.3%	33.2%	49.1%
6519	Aphonia, complete organic	271	19.6%	24%	51.7%
6520	Larynx, stenosis of, including residuals of laryngeal trauma (unilateral or bilateral)	207	11.1%	26.1%	56%
6832	Pneumoconiosis (silicosis, anthracosis, etc.)	199	9%	29.6%	56.3%
6823	Nocardiosis	98	12.2%	61.2%	19.4%
6730	Tuberculosis, pulmonary, chronic, active	1	100%

Show 31 more codes with too few Board appeals to report (expand)

DC	Condition	Board appeals
6511	Sinusitis, ethmoid, chronic Claims guide →	Too few Board appeals to report
6512	Sinusitis, frontal, chronic	Too few Board appeals to report
6514	Sinusitis, sphenoid, chronic Claims guide →	Too few Board appeals to report
6515	Laryngitis, tuberculous, active or inactive	Too few Board appeals to report
6518	Laryngectomy, total	Too few Board appeals to report
6521	Pharynx, injuries to	Too few Board appeals to report
6523	Bacterial rhinitis	Too few Board appeals to report
6524	Granulomatous rhinitis	Too few Board appeals to report
6702	Tuberculosis, pulmonary, chronic, moderately advanced, active	Too few Board appeals to report
6703	Tuberculosis, pulmonary, chronic, minimal, active	Too few Board appeals to report
6704	Tuberculosis, pulmonary, chronic, active, advancement unspecified	Too few Board appeals to report
6721	Tuberculosis, pulmonary, chronic, far advanced, inactive	Too few Board appeals to report
6722	Tuberculosis, pulmonary, chronic, moderately advanced, inactive	Too few Board appeals to report
6723	Tuberculosis, pulmonary, chronic, minimal, inactive	Too few Board appeals to report
6724	Tuberculosis, pulmonary, chronic, inactive, advancement unspecified	Too few Board appeals to report
6731	Tuberculosis, pulmonary, chronic, inactive	Too few Board appeals to report
6732	Pleurisy, tuberculous, active or inactive	Too few Board appeals to report
6822	Actinomycosis	Too few Board appeals to report
6824	Chronic lung abscess	Too few Board appeals to report
6826	Desquamative interstitial pneumonitis	Too few Board appeals to report
6827	Pulmonary alveolar proteinosis	Too few Board appeals to report
6828	Eosinophilic granuloma of lung	Too few Board appeals to report
6829	Drug-induced pulmonary pneumonitis and fibrosis	Too few Board appeals to report
6830	Radiation-induced pulmonary pneumonitis and fibrosis	Too few Board appeals to report
6831	Hypersensitivity pneumonitis (extrinsic allergic alveolitis)	Too few Board appeals to report
6836	Blastomycosis	Too few Board appeals to report
6837	Cryptococcosis	Too few Board appeals to report
6838	Aspergillosis	Too few Board appeals to report
6839	Mucormycosis	Too few Board appeals to report
6840	Diaphragm paralysis or paresis	Too few Board appeals to report
6841	Spinal cord injury with respiratory insufficiency	Too few Board appeals to report

Counts from RateMyVSO's index of published BVA decisions, refreshed weekly. A remand is not a loss; it means the Board needed more evidence before deciding. Descriptive of the published record, not a prediction for any claim.

Common Secondary Conditions

Respiratory conditions rarely stay in one place. Because breathing touches sleep, the heart, and mood, one service-connected condition often opens the door to several secondary claims:

Sleep apnea from a blocked airway or weight gain. Sleep apnea can be claimed as secondary to chronic sinus or nasal obstruction, or to weight gain caused by another service-connected condition that limits activity.
Cor pulmonale (right-heart strain). Severe, long-standing lung disease can strain the right side of the heart, a heart condition that can be claimed as secondary to the lung disease.
Depression and anxiety from chronic breathlessness. Long-term shortness of breath and lost activity drive depression and anxiety, which can be claimed as secondary to the physical condition. See secondary conditions.
GERD and asthma often travel together. Acid reflux and asthma frequently occur together and can aggravate each other, so one may support a secondary claim tied to the other.

Each dedicated guide above shows the live Board grant rates for that condition's most common secondary pairings.

Evidence That Wins

A pulmonary function test report that lists the post-bronchodilator FEV-1, FEV-1/FVC, and DLCO. These are the numbers the rating for most lung diseases is built on.
A sleep study plus the CPAP prescription for sleep apnea, since the rating turns on whether a breathing-assistance device is required.
An episode log for sinusitis, a dated record of how often the condition flares and how bad each episode gets, because sinus and nasal claims are rated by counting episodes.
Proof of a qualifying burn-pit or airborne-hazard exposure for the presumptive path, which can remove the need to separately prove the medical link.
The matching DBQ for the condition, which prompts the examiner to capture the right measurements. See the DBQ guide.

Evidence Cited in Published Asthma Decisions

We analyzed 20,326 published Board decisions involving asthma for condition-specific evidence, counting only case-specific mentions (boilerplate recitations excluded). "Favorable" is the share of decisions citing that evidence where every issue was granted or the outcome was mixed; the baseline across all these decisions is 52.5%. Evidence appearing in a decision does not mean it decided the case. Descriptive of the published record, not a prediction.

Inhalational therapy or bronchodilator usefavorable 60.7%

n = 6,808

Pulmonary function testing (FEV-1/FVC)favorable 57.1%

n = 6,799

Asthma attacks or urgent-care visits documentedfavorable 58.2%

n = 4,062

Asthma diagnosed or treated in servicefavorable 62.3%

n = 2,371

Systemic (oral) corticosteroid coursesfavorable 61.4%

n = 2,026

Evidence Cited in Published COPD and chronic lung disease Decisions

We analyzed 36,722 published Board decisions involving copd and chronic lung disease for condition-specific evidence, counting only case-specific mentions (boilerplate recitations excluded). "Favorable" is the share of decisions citing that evidence where every issue was granted or the outcome was mixed; the baseline across all these decisions is 43.8%, combining every diagnostic code below. Evidence appearing in a decision does not mean it decided the case. Descriptive of the published record, not a prediction.

Service exposure etiology discussed (asbestos, fumes, burn pits)favorable 46.3%

n = 12,268

Pulmonary function testing (FEV-1/FVC)favorable 46%

n = 11,357

Bronchodilator or inhalational therapyfavorable 50.8%

n = 8,243

Smoking history weighed as etiologyfavorable 42%

n = 7,039

Outpatient oxygen therapyfavorable 56%

n = 3,154

By diagnostic code

These codes are grouped together above. They do not perform the same, so find your own code here rather than reading the combined figure. Codes retired in the schedule rewrites are left out, because their old decisions were judged under criteria that no longer apply.

DC 6603 Emphysema, pulmonaryfavorable 49.8%

n = 14,587 decisions · 928 granted

DC 6604 Chronic obstructive pulmonary diseasefavorable 38%

n = 10,493 decisions · 448 granted

DC 6600 Bronchitis, chronicfavorable 44.4%

n = 9,062 decisions · 346 granted

DC 6833 Asbestosisfavorable 42.9%

n = 4,993 decisions · 422 granted

Detected by phrase-reading the decision text with condition-specific vocabularies. Source: Board of Veterans' Appeals decisions, RateMyVSO analysis.

Symptoms Recorded in Granted Asthma Decisions

We analyzed 1,407 granted Board decisions involving asthma for symptoms named in sentences about the condition (rating-criteria recitations excluded). Descriptive of the published record, what the Board wrote down, not a checklist of what to report.

Shortness of breathshare of granted 28.2%

n = 397

Wheezingshare of granted 17.4%

n = 245

Coughingshare of granted 14.1%

n = 198

Difficulty breathingshare of granted 4.6%

n = 65

Chest tightnessshare of granted 2.9%

n = 41

Symptoms Recorded in Granted COPD and chronic lung disease Decisions

We analyzed 2,038 granted Board decisions involving copd and chronic lung disease for symptoms named in sentences about the condition (rating-criteria recitations excluded). Descriptive of the published record, what the Board wrote down, not a checklist of what to report.

Shortness of breath (dyspnea)share of granted 10.5%

n = 215

Chronic coughshare of granted 5.8%

n = 119

Wheezingshare of granted 2.6%

n = 53

Sputum or mucus productionshare of granted 1.3%

n = 27

Detected by phrase-reading the decision text with condition-specific vocabularies. Source: Board of Veterans' Appeals decisions, RateMyVSO analysis.

Common Mistakes

Filing a lung claim with no PFT. If there is no breathing test in the file, there is often nothing for the rater to score the condition on. A complete PFT report is usually the backbone of the claim.
Using pre-bronchodilator numbers. Readings taken before the inhaler can overstate how well the lungs work. The post-bronchodilator values are generally the ones that control.
Skipping the presumptive path. If a qualifying burn-pit or airborne-hazard exposure already covers the condition under the PACT Act, do not overlook that route, it can remove the need to prove the medical link.
Not tying sleep apnea to its cause. Sleep apnea can be a secondary condition (for example, to sinus or nasal obstruction, or to weight gain from another condition). Claiming it in isolation can miss that link.
Forgetting that sinus and nasal conditions are rated separately. Sinusitis and rhinitis are counted by episodes, not by a PFT, so a lung claim does not cover them. Claim them on their own.

Frequently Asked Questions

How does the VA rate lung conditions?

Most lung diseases, including COPD, asthma, emphysema, chronic bronchitis, and interstitial lung disease, are rated under 38 CFR 4.97 on a breathing test called the pulmonary function test (PFT). For most of them the rating reads three numbers: FEV-1, the FEV-1/FVC ratio, and DLCO, usually measured after an inhaler (post-bronchodilator), and the single test result that produces the correct level is the one that controls. Asthma is the exception: DC 6602 uses FEV-1 and the FEV-1/FVC ratio but not DLCO, and it can also be rated on treatment alone. When the PFT does not reflect the disability, exercise capacity measured in METs can be used instead.

What does a PFT (breathing test) measure?

A pulmonary function test measures how much air you can move and how fast. The three readings that matter most for VA ratings are FEV-1 (the percent of predicted air you can force out in one second), the FEV-1/FVC ratio (how much of your total breath comes out in that first second), and DLCO (how well oxygen crosses from your lungs into your blood, as a percent of predicted). The post-bronchodilator values, taken after an inhaler, are generally the ones used.

How is sleep apnea rated?

Sleep apnea is not rated on a PFT. What matters is whether the condition requires a breathing-assistance device such as a CPAP machine. A sleep study documents the apnea, and the prescription for the device supports the rating. Sleep apnea can also be claimed as a secondary condition, for example to chronic sinus or nasal obstruction or to weight gain from another service-connected condition. See the sleep apnea guide for the details.

Are breathing conditions covered by the PACT Act?

Many are. A large share of respiratory conditions are PACT Act burn-pit and airborne-hazard presumptives. For a covered veteran with a qualifying exposure, that often means you do not have to separately prove the medical link between service and the condition, because the law presumes it. See the PACT Act guide and the burn-pit presumptive list to check whether your condition and service qualify.

Is sinusitis rated the same way as COPD?

No. COPD and most lung diseases are rated on the numbers from a breathing test (the PFT). Chronic sinusitis and rhinitis are rated a completely different way: by counting incapacitating and non-incapacitating episodes over a year, along with findings like nasal polyps and blockage. Because the methods differ, a lung PFT does nothing for a sinus or nasal claim, and those conditions should be claimed on their own.

Related Tools and Guides

COPD Guide

How COPD, bronchitis, and emphysema rate on the breathing test.

Asthma Guide

The PFT numbers and medication rules behind an asthma rating.

Sleep Apnea Guide

Why the CPAP device, not a PFT, drives the rating.

Sinusitis & Rhinitis Guide

Counting episodes, polyps, and nasal blockage instead of a PFT.

PACT Act Guide

Burn-pit and airborne-hazard presumptives for the lungs.

DBQ Guide

The exam forms that capture the breathing measurements.

Asbestos Exposure

How the Board has tied asbestos to lung conditions, by outcome.

Silica Exposure

Crystalline-silica lung claims in published BVA decisions.

Diesel Exhaust

Diesel fuel and exhaust as a claimed respiratory cause.

Sources: 38 CFR 4.97, respiratory ratings · VA airborne hazards and burn-pit exposures. Educational only, not legal advice, and not a prediction of any individual claim. Rating criteria and the presumptive lists change; confirm current details in 38 CFR Part 4 and on VA.gov. For help with your claim, find a VA-accredited representative.