An infectious disease of the lung in which the lesion or lesions become fibrosed, calcify, and heal through treatment. Following this course, the disease becomes inactive.

Mycobacterium tuberculosis is the causative agent. The use of specific medications and the treatments, listed in Diagnostic Code: 6730 Tuberculosis, pulmonary, chronic, active, are the underlying bases for the disease becoming inactive.

When primary lesions heal, the chest x-ray may show localized calcifications, but otherwise show normal findings. Active disease symptoms should not be evident.

The following tests are used to determine activity of the disease: chest x-ray, sputum tests, computed tomography (CT) scan, and monitoring for extrapulmonary tuberculosis (TB) in the kidneys, long bones and vertebra. A positive tuberculin skin test never reverts to negative, and is never repeated.

To assist in the prevention of reactivation, the patient is counseled to obtain sufficient rest, to eat a nutritious diet, to maintain regular follow-up examinations, and to learn the signs and symptoms of disease reactivation.

Patients who have had a thoracoplasty will have a skeletal chest deformity on the side of the surgery. Those who have had a lung resection for removal of a cavity may have adhesions postoperatively with symptoms of pleurisy. Reactivation of TB is possible, especially in the elderly, those who are frail and weak, human immunodeficiency virus (HIV) infected persons, and those who live in crowded, inner city dwellings.

• Review 38 CFR 3.343 for continuance of disability ratings relating to tuberculosis compensation.”

• Review rating considerations relative to inactive tuberculosis found in 38 CFR 3.370 – Pulmonary tuberculosis shown by X-ray in active service

• Review rating considerations relative to inactive tuberculosis found in 38 CFR 3.371 – Presumptive service connection for tuberculosis disease; wartime and service on or after January 1, 1947”

•  Review rating considerations relative to inactive tuberculosis found in 38 CFR 3.372 – Initial grant following inactivity of tuberculosis

•  Review rating considerations relative to inactive tuberculosis found in 38 CFR 3.375 – Determination of inactivity (complete arrest) in tuberculosis

•  Review rating considerations relative to inactive tuberculosis found in 38 CFR 3.378 – Changes from activity in pulmonary tuberculosis pension cases.”

• Review rating considerations relative to tuberculosis found in 38 CFR 3.959

• Review 38 CFR 3.401(g) relating to the effective date of special compensation for arrested tuberculosis

• May be entitled to special monthly compensation where the Veteran has a single service-connected disability rated as 100% with additional service-connected disability or disabilities independently ratable at 60% or more, which are separate and distinct from the 100% service-connected disability and involves different anatomical segments or bodily systems. See  38 CFR 3.350(i)(1) – Special Monthly Compensation (SMC).

• Review special provisions regarding the evaluation of specific respiratory conditions under 38 CFR 4.96(a) - Rating co-existing respiratory conditions; and (b) – Rating ‘protected’ tuberculosis cases

• A mandatory examination will be requested immediately following notification that active tuberculosis evaluated under DC 6730 has become inactive. Any change in evaluation will be carried out under the provisions of 38 CFR 3.105(e).

Obtain familiarity with the following classification standards adopted by the American Lung Association under the Diagnostic Standards and Classification of Tuberculosis and other Mycobacterial Diseases, 1974:

1. Tuberculosis Suspect. An individual may be so classified until diagnostic procedures are complete. The classification should not be used for more than 3 months.

2. Other Mycobacterial Diseases. In general, disease caused by other mycobacteria is indistinguishable clinically, radiologically and histologically from M. tuberculosis.

3. A definite diagnosis requires (1) evidence of disease, such as an infiltrate visible on a chest x-ray, with no other cause established by careful clinical and laboratory studies and (2) either (a) isolation of the same strain of mycobacteria repeatedly or (b) isolation of the mycobacteria from a closed lesion from which the specimen has been collected and handled under sterile conditions.

   1. Mycobacteria that may commonly be involved as pathogens are M. kansasii, M. intracellulare, and M. scrofulaceum. M. bovis is rarely responsible for disease where there is effective control of tuberculosis in cattle and pasteurization of milk and milk products; this species is undistinguishable from M. tuberculosis except by culture. With certain modifications, the classification for tuberculosis is adaptable for classifying other mycobacterial diseases. There is no need to use the first three categories used for tuberculosis--that is, no exposure, not infected; exposure, no evidence of infection; and infection, without disease.

   2. Diagnosis of mycobacterial infection by skin test is not possible. The current antigens for these mycobacteria have high cross-reactivity (low specificity)