Respiratory Overview

The respiratory system has as a primary purpose, the exchange of oxygen and carbon dioxide in the lungs and tissues. Changes in the functional capacity of the respiratory system affect the functioning of other body systems, and changes in the functioning of other body systems affect the primary purpose of the respiratory system by altering the need for and rate of exchange of oxygen and carbon dioxide.

The respiratory tract consists of upper and lower airways. Structures of the upper airway include: the nose, pharynx, adenoids, tonsils, epiglottis, and larynx. Structures of the lower airway include: the trachea, bronchi, bronchioles, and lungs.

The three specialized functions of the nose are to: (1) warm, moisten and filter inhaled air; (2) receive stimuli related to smell; and (3) provide a resonating chamber for speech sounds. The throat, consisting of the nasopharynx, oropharynx, laryngopharynx, and larynx, serves as a passageway for air and assists with resonance for speech sounds. The trachea, a cylinder-shaped tube, extends from the larynx to the primary bronchi. The main bronchi subdivide to form segmental and sub-segmental bronchi. These sub-segmental divisions further divide to form bronchioles.

The exchange of oxygen or carbon dioxide cannot take place until air reaches the most distant bronchioles called respiratory bronchioles. The gaseous exchange of oxygen and carbon dioxide occurs in the alveoli, which are small sacs considered to be the functional areas of the lungs because of their particular role in the respiratory process.

General Considerations for Rating

  • Rating coexisting respiratory conditions.

    M21-1 Part III, Subpart iv, Chapter 4, Section D.1.g Ratings under diagnostic codes 6600 through 6817 and 6822 through 6847 will not be combined with each other. Where there is lung or pleural involvement, ratings under diagnostic codes 6819 and 6820 will not be combined with each other or with diagnostic codes 6600 through 6817 or 6822 through 6847. A single rating will be assigned under the diagnostic code which reflects the predominant disability with elevation to the next higher evaluation where the severity of the overall disability warrants such elevation. However, in cases protected by the provisions of Pub. L. 90-493, the graduated ratings of 50 and 30 percent for inactive tuberculosis will not be elevated. 38CFR ยง4.96 [Special provisions regarding evaluation of respiratory conditions]. [M21-1 Part III, Subpart iv, Chapter 4, Section D]

    When the results of pre-bronchodilator pulmonary function tests are normal, post-bronchodilator studies are ordinarily not done and are not required for VA evaluation purposes. In all other cases, post-bronchodilator studies should be done unless contradicated (because of allergy to medication, etc.) or if a patient was on bronchodilators before the test and had taken his or her medication within a few hours of the study. An examiner who determines that a post-bronchodilator study should not be done in a given case should provide an explanation. You should request this explanation if it is not provided (unless the pre-bronchodilator results are normal). [M21-1 Part III, Subpart iv, Chapter 4, Section D]

  • Post-bronchodilator results.

    When available, the post-bronchodilator results should always be used in applying the evaluation criteria in the rating schedule. There is, however, a small group of patients (5% or less), in whom for unknown reasons there may be a paradoxical reaction to bronchodilators, i.e., the post-bronchodilator results will be poorer than the pre-bronchodilator results. When there is a paradoxical response, you should use the better (pre-bronchodilator) values.

    When there is disparity between the results of different tests (FEV-1, FVC, etc.), so that the level of evaluation would differ depending on which test result you use, the examiner should tell you which test result most accurately reflects the level of disability. Request this information from the examiner if he or she has not provided it.

    When the FEV-1 is greater than 100% , an Fev-1/FVC ratio that is below normal should be considered a physiologic variant rather than an abnormal value.

Nose & Throat

Diagnostic Code Name VA Exam Acronym
6502 Septum, nasal, deviation of Nose, Sinus, Larynx & Pharynx ---
6504 Nose, loss of part of, or scars Nose, Sinus, Larynx & Pharynx or Scars ---
6510 Sinusitis, pansinusitis, chronic Nose, Sinus, Larynx & Pharynx PAN SI
6511 Sinusitis, ethmoid, chronic Nose, Sinus, Larynx & Pharynx ---
6512 Sinusitis, frontal, chronic Nose, Sinus, Larynx & Pharynx ---
6513 Sinusitis, maxillary, chronic Nose, Sinus, Larynx & Pharynx AMS
6514 Sinusitis, sphenoid, chronic Nose, Sinus, Larynx & Pharynx ---
6515 Laryngitis, tuberculous, active or inactive Nose, Sinus, Larynx & Pharynx ---
6516 Laryngitis, chronic Nose, Sinus, Larynx & Pharynx ---
6518 Laryngectomy, total Nose, Sinus, Larynx & Pharynx ---
6519 Aphonia, complete organic Nose, Sinus, Larynx & Pharynx ---
6520 Larynx, stenosis of, including residuals of laryngeal trauma (unilateral or bilateral) Nose, Sinus, Larynx & Pharynx ---
6521 Pharynx, injuries to Nose, Sinus, Larynx & Pharynx ---
6522 Allergic or vasomotor rhinitis Nose, Sinus, Larynx & Pharynx AR
6523 Bacterial rhinitis Nose, Sinus, Larynx & Pharynx ---
6524 Granulomatous rhinitis Nose, Sinus, Larynx & Pharynx ---

Trachea & Bronchi

Diagnostic Code Name VA Exam Acronym
6600 Bronchitis, chronic Respiratory (Obstructive, Restrictive, Interstitial) CHB
6601 Bronchiectasis Respiratory (Obstructive, Restrictive, Interstitial) BRCHTS
6602 Asthma, bronchial Respiratory (Obstructive, Restrictive, Interstitial) BA
6603 Emphysema, pulmonary Respiratory (Obstructive, Restrictive, Interstitial) ---
6604 Chronic obstructive pulmonary disease Respiratory (Obstructive, Restrictive, Interstitial) COPD

Pulmonary Tuberculosis

Diagnostic Code Name VA Exam Acronym
6730 Tuberculosis, pulmonary, chronic, active (including DC 6701, 6702, 6703, and 6704) Pulmonary Tuberculosis TB
6731 Tuberculosis, pulmonary, chronic, inactive (including DC 6721, 6722, 6723, and 6724) Pulmonary Tuberculosis TB
6732 Pleurisy, tuberculous, active or inactive Pulmonary Tuberculosis ---

Nontuberculous Diseases

Diagnostic Code Name VA Exam Acronym
6817 Pulmonary vascular disease Respiratory Disease, miscellaneous PVD
6819 Neoplasms, malignant, any specified part of respiratory system exclusive of skin growths Respiratory Disease, miscellaneous ---
6820 Neoplasms, benign, any specified part of the respiratory system. Evaluate using an appropriate respiratory analogy Respiratory Disease, miscellaneous ---

Bacterial Infections

Diagnostic Code Name VA Exam Acronym
6822 Actinomycosis Respiratory Disease, miscellaneous ACMYS
6823 Nocardiosis Respiratory Disease, miscellaneous ---
6824 Chronic lung abscess Respiratory Disease, miscellaneous ---

Interstitial Lung Disease

Diagnostic Code Name VA Exam Acronym
6825 Diffuse interstitial fibrosis (interstitial pneumonitis, fibrosing alveolitis) Respiratory Disease, miscellaneous DIF
6826 Desquamative intersititial pneumonitis Respiratory Disease, miscellaneous DIP
6827 Pulmonary alveolar proteinosis Respiratory Disease, miscellaneous PAP
6828 Eosinophilic granuloma of the lung Respiratory Disease, miscellaneous EGL
6829 Drug induced pulmonary pneumonitis and fibrosis Respiratory Disease, miscellaneous ---
6830 Radiation-induced pulmonary pneumonitis and fibrosis Respiratory Disease, miscellaneous ---
6831 Hypersensitivity pneumonitis (extrinsic allergic alveolitis) Respiratory Disease, miscellaneous HP
6832 Pneumoconiosis (silicosis, anthracosis, etc) Respiratory Disease, miscellaneous ---
6833 Asbestosis Respiratory (Obstructive, Restrictive, Interstitial) ASTOS

Mycotic Lung Disease

Diagnostic Code Name VA Exam Acronym
6834 Histoplasmosis of lung Respiratory Disease, miscellaneous ---
6835 Coccidioidomycosis Respiratory Disease, miscellaneous COCCI
6836 Cryptococcosis Respiratory Disease, miscellaneous APB
6837 Blastomycosis Respiratory Disease, miscellaneous CRCOS
6838 Asperigillosis Respiratory Disease, miscellaneous ---
6839 Mucormycosis Respiratory Disease, miscellaneous ---

Restrictive Lung Disease

Diagnostic Code Name VA Exam Acronym
6840 Diaphragm paralysis or paresis Respiratory Disease, miscellaneous ---
6841 Spinal cord injury with respiratory insufficiency Respiratory (Obstructive, Restrictive & Interstitial) ---
6842 Kyphoscoliosis, pectus excavatum, pectus carinatum Respiratory (Obstructive, Restrictive & Interstitial) ---
6843 Traumatic chest wall defect, pneumothorax, hernia, etc. Respiratory (Obstructive, Restrictive & Interstitial) ---
6844 Post-surgical residual (lobectomy, pneumonectomy, etc.) Respiratory (Obstructive, Restrictive & Interstitial) ---
6845 Chronic pleural effusion or fibrosis Respiratory (Obstructive, Restrictive & Interstitial) ---
6846 Sarcoidosis Respiratory Disease, miscellaneous SARC
6847 Sleep apnea syndromes (Obstructive, central, mixed) Respiratory Disease, miscellaneous OSA

Analogous

Diagnostic Code Name
6599-6502 Fracture, nose
6599-6512 Antritis, chronic
6599-6516 Tonsillitis/Tonsillectomy
6599-6520 Diphtheria
6599-6522 Hay fever
6699-6600 Gas inhalation, res
6699-6600 Inflammatory lung disease
6699-6602 Reactive airway disease
6899-6817 Pulmonary embolus
6899-6822 Pneumonia, pneumocystis carinii
6899-6825 Fibrosis, pulmonary/Peribronchial fibrosis
6899-6834 Lung, mycosis unspecified
6899-6845 Pneumonia

Historical

Old Diagnostic Code Name New Diagnostic Code
6517 Larynx, injuries of, healed Deleted
6800 Anthracosis (Black Lung Disease) 6832 - Rating Critera Changed
6801 Silicosis 6832 - Rating Critera Changed
6802 Pneumoconiosis, unspecified 6832 - Rating Critera Changed
6815 Pneumonectomy 6844 - Rating Critera Changed
6816 Lobectomy 6845 - Rating Critera Changed
6818 Pleural cavity, injuries, residuals of, including gunshot wounds 6845 - Rating Critera Changed