Respiratory Conditions Rating Guide

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.

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. 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.

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:

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.

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.

Common Mistakes

Frequently Asked Questions