Blastomycosis is a fungal infection caused by inhalation of mold spores.

The disease is caused by the inhalation of dust (conidia) containing mold spores of Blastomyces dermatitidis. The mold spores grow at room temperature and in soil that contains animal excreta and acidic organic material, which converts to yeast, and ultimately invades the lungs. The condition may be increased in persons who are immunocompromised. It is also referred to as North America blastomycosis.

The onset of the infection is insidious and chronic. Symptoms are usually non-specific, but may include a productive or dry, hacking cough, chest pain, dyspnea, fever, chills, profuse sweating, and adult respiratory distress syndrome. X-rays may reveal focal or diffuse infiltrates as patchy bronchopneumonia, resembling a tumor or growth, and pleural effusion.

Tests may include histopathology, cultures, x-rays and other tests to differentiate the condition from other diseases caused by fungus, mycoses, tuberculosis (TB) (see Diagnostic Code: 6730 Tuberculosis, pulmonary, chronic, active), and tumors.

The treatment of choice for the condition is drug therapy with oral itraconazole, and amphotericin B intravenous (IV) therapy. Alternative drugs used are ketoconazole and fluconazole.

Amphotericin B is highly toxic. Renal functional impairment is the main toxic risk. Creatinine and BUN levels should be monitored during treatment. If untreated, the condition progresses slowly and is ultimately fatal.

• 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).

• Coccidioidomycosis has an incubation period up to 21 days, and the disseminated phase is ordinarily manifest within six months of the primary phase. However, there are instances of dissemination delayed up to many years after the initial infection which may have been unrecognized. Accordingly, when service connection is under consideration in the absence of record or other evidence of the disease in service, service in southwestern United States where the disease is endemic and absence of prolonged residence in this locality before or after service will be the deciding factor.  

• Review special provisions regarding the evaluation of specific respiratory conditions under 38 CFR 4.96(a) - Rating co-existing respiratory conditions.