Respiratory Conditions
Respiratory Conditions
Overview of VA Respiratory Ratings
Respiratory conditions affect the lungs and airways, impacting your ability to breathe properly. Military service can lead to respiratory conditions through exposure to environmental hazards (burn pits, sand/dust, chemicals), physical exertion, or infectious diseases. This section explains how the VA rates respiratory conditions and provides detailed guidance for the most common conditions.
General Rating Principles for Respiratory Conditions
The VA rates most respiratory conditions based on several factors:
- Pulmonary Function Tests (PFTs): Objective measurements of lung function
- Frequency and severity of symptoms: How often symptoms occur and how severe they are
- Required treatments: Medications, oxygen therapy, or other interventions needed
- Impact on daily activities: How the condition affects your ability to work and perform daily tasks
Pulmonary Function Tests
Many respiratory conditions are rated based on the results of Pulmonary Function Tests (PFTs), which include:
- FEV-1 (Forced Expiratory Volume in 1 second): How much air you can forcefully exhale in one second
- FVC (Forced Vital Capacity): The total amount of air you can forcefully exhale after taking a deep breath
- FEV-1/FVC: The ratio of these two measurements
- DLCO (SB) (Diffusion Capacity of the Lung for Carbon Monoxide, Single Breath): How well oxygen passes from your lungs into your blood
The VA will use the test result that reflects the most severe level of disability.
Presumptive Service Connection for Respiratory Conditions
Certain respiratory conditions may qualify for presumptive service connection based on specific exposures:
Presumptive Conditions by Exposure
Burn Pit Exposure (PACT Act)
For veterans who served in Southwest Asia, Afghanistan, or Djibouti during specified periods:
- Asthma (if it developed within 10 years of service)
- Chronic bronchitis
- Chronic obstructive pulmonary disease (COPD)
- Chronic rhinitis
- Chronic sinusitis
- Constrictive bronchiolitis or obliterative bronchiolitis
- Emphysema
- Granulomatous disease
- Interstitial lung disease
- Pleuritis
- Pulmonary fibrosis
- Sarcoidosis
Gulf War Illness
For veterans who served in the Southwest Asia theater of operations:
- Chronic multi-symptom illness with respiratory symptoms
- Undiagnosed respiratory illnesses
Agent Orange Exposure
For veterans who served in Vietnam, certain areas of Thailand, or other specified locations:
- Respiratory cancers (lung, bronchus, larynx, trachea)
Asthma
On this page:
Overview of Asthma
Asthma is a chronic respiratory condition characterized by inflammation and narrowing of the airways, leading to breathing difficulties. Symptoms typically include wheezing, shortness of breath, chest tightness, and coughing, particularly at night or early morning.
Military service can cause or aggravate asthma through various factors:
- Exposure to environmental irritants (dust, smoke, fumes, chemicals)
- Exposure to burn pits or other airborne hazards
- Extreme weather conditions
- Physical exertion
- Respiratory infections
Service Connection for Asthma
There are several ways to establish service connection for asthma:
Direct Service Connection
If your asthma began during service or was directly caused by an in-service event, you may qualify for direct service connection. This requires:
- Current diagnosis of asthma
- Evidence of an in-service event, injury, or illness that could cause or aggravate asthma
- Medical nexus linking your current asthma to the in-service event
Aggravation
If you had asthma before joining the military (including childhood asthma that resolved) and it was permanently worsened beyond its natural progression by your service, you may qualify for service connection based on aggravation.
Presumptive Service Connection (PACT Act)
Under the PACT Act, asthma is presumptively service-connected if:
- You served in Southwest Asia, Afghanistan, or Djibouti during specified periods
- Your asthma manifested within 10 years of your last date of service in these locations
With presumptive service connection, you don’t need to prove that your asthma was caused by a specific in-service event.
VA Disability Ratings for Asthma
Asthma is rated under 38 CFR § 4.97, Diagnostic Code 6602. Ratings are based on pulmonary function test results, frequency of asthma attacks, and required treatments.
| Rating | Criteria |
|---|---|
| 100% | FEV-1 less than 40% predicted, or FEV-1/FVC less than 40%; OR More than one attack per week with episodes of respiratory failure; OR Requires daily use of systemic (oral or parenteral) high-dose corticosteroids or immunosuppressive medications |
| 60% | FEV-1 of 40-55% predicted, or FEV-1/FVC of 40-55%; OR At least monthly visits to a physician for required care of exacerbations; OR Intermittent (at least three per year) courses of systemic (oral or parenteral) corticosteroids |
| 30% | FEV-1 of 56-70% predicted, or FEV-1/FVC of 56-70%; OR Daily inhalational or oral bronchodilator therapy; OR Inhalational anti-inflammatory medication |
| 10% | FEV-1 of 71-80% predicted, or FEV-1/FVC of 71-80%; OR Intermittent inhalational or oral bronchodilator therapy |
Important Rating Notes
In the absence of pulmonary function tests, the VA will rate based on the frequency of asthma attacks and required treatments.
The term “systemic corticosteroids” refers to medications like prednisone that affect the entire body, not inhaled corticosteroids like Flovent or Qvar.
Evidence Needed for Asthma Claims
To support your asthma claim, gather the following evidence:
Medical Evidence
- Diagnosis of asthma from a medical provider
- Pulmonary function test results
- Treatment records showing medications prescribed
- Documentation of asthma attacks and emergency room visits
- Medical opinions linking your asthma to service
Service Records
- Service treatment records showing respiratory complaints
- Documentation of exposure to environmental hazards
- Deployment records (for presumptive claims)
Lay Evidence
- Personal statements describing when and how your asthma began or worsened during service
- Statements from fellow service members who witnessed your symptoms
- Statements from family members about changes in your respiratory health before and after service
Tips for Successful Asthma Claims
- Document All Treatments: Keep records of all medications (including inhalers), doctor visits, and emergency treatments.
- Get Pulmonary Function Tests: These objective measurements are crucial for determining your rating.
- Track Asthma Attacks: Document the frequency, severity, and treatment of asthma attacks.
- Consider Presumptive Connection: If you served in qualifying locations, highlight your eligibility for presumptive service connection under the PACT Act.
- Address Pre-existing Asthma: If you had asthma before service, gather evidence showing how it worsened during service beyond its natural progression.
Sleep Apnea
On this page:
Overview of Sleep Apnea
Sleep apnea is a serious sleep disorder characterized by repeated interruptions in breathing during sleep. These interruptions, called apneas, can last from a few seconds to minutes and may occur 30 or more times per hour. The most common type is obstructive sleep apnea (OSA), where the throat muscles relax and block the airway during sleep.
Symptoms of sleep apnea include:
- Loud snoring
- Episodes of stopped breathing during sleep (observed by others)
- Gasping for air during sleep
- Awakening with a dry mouth or sore throat
- Morning headaches
- Difficulty staying asleep (insomnia)
- Excessive daytime sleepiness
- Difficulty concentrating during the day
- Irritability
Military service can contribute to sleep apnea through various factors:
- Weight gain during or after service
- Nasal or throat injuries
- Exposure to environmental hazards
- Irregular sleep schedules
- PTSD or other mental health conditions
- Use of sleep medications
Service Connection for Sleep Apnea
There are several ways to establish service connection for sleep apnea:
Direct Service Connection
If your sleep apnea began during service or was directly caused by an in-service event, you may qualify for direct service connection. This requires:
- Current diagnosis of sleep apnea (confirmed by a sleep study)
- Evidence of an in-service event, injury, or illness that could cause sleep apnea
- Medical nexus linking your current sleep apnea to the in-service event
Secondary Service Connection
Sleep apnea is often connected to other service-connected conditions, including:
- PTSD and other mental health conditions
- Rhinitis or sinusitis
- Asthma
- Deviated septum
- Traumatic brain injury (TBI)
- Diabetes
- Heart conditions
If your sleep apnea was caused or aggravated by another service-connected condition, you may qualify for secondary service connection.
VA Disability Ratings for Sleep Apnea
Sleep apnea is rated under 38 CFR § 4.97, Diagnostic Code 6847. Ratings are based on the severity of the condition and the treatment required.
| Rating | Criteria |
|---|---|
| 100% | Chronic respiratory failure with carbon dioxide retention or cor pulmonale; OR Requires tracheostomy |
| 50% | Requires use of breathing assistance device such as continuous positive airway pressure (CPAP) machine |
| 30% | Persistent day-time hypersomnolence |
| 0% | Asymptomatic but with documented sleep disorder breathing |
Important Rating Notes
The most common rating for sleep apnea is 50%, which is assigned when a CPAP machine or similar device is required.
Even if you don’t use your CPAP machine regularly, you may still qualify for the 50% rating if it was prescribed by your doctor.
“Persistent day-time hypersomnolence” means excessive daytime sleepiness that significantly impacts your daily functioning.
Evidence Needed for Sleep Apnea Claims
To support your sleep apnea claim, gather the following evidence:
Medical Evidence
- Diagnosis of sleep apnea confirmed by a sleep study
- Sleep study results showing the severity of your condition
- Prescription for CPAP or other breathing assistance device
- Treatment records
- Medical opinions linking your sleep apnea to service or to a service-connected condition
Service Records
- Service treatment records showing sleep problems, snoring, or daytime fatigue
- Documentation of weight changes during service
- Records of related conditions (nasal injuries, respiratory issues, etc.)
Lay Evidence
- Personal statements describing when your symptoms began and how they’ve affected you
- Statements from spouses, roommates, or fellow service members who witnessed your snoring, breathing interruptions during sleep, or daytime fatigue
- Sleep logs documenting your symptoms
Tips for Successful Sleep Apnea Claims
- Get a Sleep Study: A formal sleep study is essential for diagnosing sleep apnea and determining its severity.
- Obtain Buddy Statements: Since you’re asleep when most symptoms occur, statements from people who have observed your sleep patterns are particularly valuable.
- Consider Secondary Connection: If you have service-connected PTSD, sinusitis, or other conditions that could cause or aggravate sleep apnea, pursue secondary service connection.
- Document CPAP Use: If you’ve been prescribed a CPAP machine, ensure this is well-documented in your medical records.
- Address In-Service Symptoms: Even if you weren’t diagnosed during service, document any in-service symptoms that could indicate early signs of sleep apnea (snoring, daytime fatigue, morning headaches).
Sinusitis
On this page:
Overview of Sinusitis
Sinusitis is inflammation of the sinuses, the air-filled cavities in the skull around the nose and eyes. This inflammation can cause a range of symptoms and can be acute (short-term) or chronic (long-lasting).
Symptoms of sinusitis include:
- Facial pain or pressure
- Nasal congestion
- Thick nasal discharge
- Reduced sense of smell
- Headaches
- Post-nasal drip
- Sore throat
- Cough
- Fatigue
Military service can cause or aggravate sinusitis through various factors:
- Exposure to environmental irritants (dust, smoke, fumes)
- Exposure to burn pits
- Extreme climate conditions
- Barotrauma (pressure injuries) from flying or diving
- Facial or nasal injuries
- Respiratory infections
Service Connection for Sinusitis
There are several ways to establish service connection for sinusitis:
Direct Service Connection
If your sinusitis began during service or was directly caused by an in-service event, you may qualify for direct service connection. This requires:
- Current diagnosis of sinusitis
- Evidence of an in-service event, injury, or illness that could cause sinusitis
- Medical nexus linking your current sinusitis to the in-service event
Presumptive Service Connection (PACT Act)
Under the PACT Act, chronic sinusitis is presumptively service-connected if you served in Southwest Asia, Afghanistan, or Djibouti during specified periods.
With presumptive service connection, you don’t need to prove that your sinusitis was caused by a specific in-service event.
Secondary Service Connection
Sinusitis can be secondary to other service-connected conditions, such as:
- Rhinitis
- Deviated septum
- Nasal or facial injuries
- Dental conditions
VA Disability Ratings for Sinusitis
Sinusitis is rated under 38 CFR § 4.97, Diagnostic Codes 6510-6514, depending on which sinuses are affected. However, the rating criteria are the same for all types of sinusitis.
| Rating | Criteria |
|---|---|
| 50% | Following radical surgery with chronic osteomyelitis; OR Near constant sinusitis characterized by headaches, pain and tenderness of affected sinus, and purulent discharge or crusting after repeated surgeries |
| 30% | Three or more incapacitating episodes per year of sinusitis requiring prolonged (lasting four to six weeks) antibiotic treatment; OR More than six non-incapacitating episodes per year of sinusitis characterized by headaches, pain, and purulent discharge or crusting |
| 10% | One or two incapacitating episodes per year of sinusitis requiring prolonged (lasting four to six weeks) antibiotic treatment; OR Three to six non-incapacitating episodes per year of sinusitis characterized by headaches, pain, and purulent discharge or crusting |
| 0% | Detected by X-ray only |
Important Rating Notes
An “incapacitating episode” is defined as one requiring bed rest and treatment by a physician.
“Repeated surgeries” generally means two or more surgeries.
Evidence Needed for Sinusitis Claims
To support your sinusitis claim, gather the following evidence:
Medical Evidence
- Diagnosis of sinusitis
- Imaging studies (CT scans, X-rays) showing sinus inflammation
- Treatment records showing frequency of episodes
- Documentation of antibiotic treatments and their duration
- Records of any sinus surgeries
- Medical opinions linking your sinusitis to service
Service Records
- Service treatment records showing sinus complaints
- Documentation of exposure to environmental hazards
- Deployment records (for presumptive claims)
Lay Evidence
- Personal statements describing the frequency and severity of your sinusitis episodes
- Symptom log tracking headaches, pain, discharge, and other symptoms
- Statements from family members or coworkers about how sinusitis affects your daily life
Tips for Successful Sinusitis Claims
- Document All Episodes: Keep a detailed log of all sinusitis episodes, including symptoms, duration, and treatments.
- Track Antibiotic Use: Document all courses of antibiotics, especially those lasting 4-6 weeks.
- Consider Presumptive Connection: If you served in qualifying locations, highlight your eligibility for presumptive service connection under the PACT Act.
- Get Imaging Studies: CT scans or other imaging can provide objective evidence of sinusitis.
- Address Secondary Connections: If you have service-connected rhinitis or other related conditions, pursue secondary service connection.
Rhinitis
On this page:
Overview of Rhinitis
Rhinitis is inflammation of the nasal passages, causing symptoms such as runny nose, nasal congestion, sneezing, and post-nasal drip. There are two main types:
- Allergic Rhinitis: Triggered by allergens like pollen, dust, or pet dander
- Non-allergic Rhinitis: Caused by irritants, weather changes, certain medications, or other factors
Military service can cause or aggravate rhinitis through various factors:
- Exposure to environmental irritants (dust, smoke, fumes)
- Exposure to burn pits
- Extreme climate conditions
- Exposure to allergens in different geographic locations
- Nasal injuries
Service Connection for Rhinitis
There are several ways to establish service connection for rhinitis:
Direct Service Connection
If your rhinitis began during service or was directly caused by an in-service event, you may qualify for direct service connection. This requires:
- Current diagnosis of rhinitis
- Evidence of an in-service event, injury, or illness that could cause rhinitis
- Medical nexus linking your current rhinitis to the in-service event
Presumptive Service Connection (PACT Act)
Under the PACT Act, chronic rhinitis is presumptively service-connected if you served in Southwest Asia, Afghanistan, or Djibouti during specified periods.
With presumptive service connection, you don’t need to prove that your rhinitis was caused by a specific in-service event.
Secondary Service Connection
Rhinitis can be secondary to other service-connected conditions, or it can cause other conditions:
- Rhinitis can be secondary to sinusitis or nasal injuries
- Rhinitis can cause or aggravate sinusitis, sleep apnea, or other conditions
VA Disability Ratings for Rhinitis
Rhinitis is rated under 38 CFR § 4.97, Diagnostic Code 6522 for allergic or vasomotor rhinitis.
| Rating | Criteria |
|---|---|
| 30% | With polyps |
| 10% | Without polyps, but with greater than 50% obstruction of nasal passage on both sides or complete obstruction on one side |
Important Rating Notes
Nasal polyps are soft, painless, noncancerous growths on the lining of your nasal passages or sinuses.
The degree of nasal obstruction is typically determined by a medical examination.
Evidence Needed for Rhinitis Claims
To support your rhinitis claim, gather the following evidence:
Medical Evidence
- Diagnosis of rhinitis
- Documentation of nasal polyps (if present)
- Medical examination showing degree of nasal obstruction
- Allergy testing results (for allergic rhinitis)
- Treatment records
- Medical opinions linking your rhinitis to service
Service Records
- Service treatment records showing nasal or allergy complaints
- Documentation of exposure to environmental hazards
- Deployment records (for presumptive claims)
Lay Evidence
- Personal statements describing when your symptoms began and how they’ve affected you
- Statements from others who have observed your symptoms
Tips for Successful Rhinitis Claims
- Get Medical Examination: A thorough ENT examination can document the degree of nasal obstruction.
- Document Polyps: If you have nasal polyps, ensure they’re well-documented for a higher rating.
- Consider Presumptive Connection: If you served in qualifying locations, highlight your eligibility under the PACT Act.
- Address Secondary Connections: Consider how rhinitis might relate to other service-connected conditions.