§ 4.97 Schedule of ratings—respiratory system.

Traumatic chest wall defect or collapsed lung

Damage to the chest wall or lung collapse from injury that may cause breathing difficulty.

What the rating means

Traumatic chest wall defect, pneumothorax, hernia, and related conditions (diagnostic code 6843) are rated under the General Rating Formula for Restrictive Lung Disease, which covers diagnostic codes 6840 through 6845. VA may also rate your primary disorder instead, whichever produces the higher rating.

The formula has four levels based on breathing test results and other clinical findings. A 10% rating applies when FEV-1 is 71 to 80 percent of the predicted value, FEV-1/FVC ratio is 71 to 80 percent, or DLCO (SB) is 66 to 80 percent predicted. A 30% rating applies when FEV-1 is 56 to 70 percent predicted, FEV-1/FVC is 56 to 70 percent, or DLCO (SB) is 56 to 65 percent predicted. A 60% rating applies when FEV-1 is 40 to 55 percent predicted, FEV-1/FVC is 40 to 55 percent, DLCO (SB) is 40 to 55 percent predicted, or maximum oxygen consumption is 15 to 20 ml/kg/min with cardiorespiratory limitation. A 100% rating applies when FEV-1 or FEV-1/FVC is below 40 percent, DLCO (SB) is below 40 percent predicted, maximum exercise capacity is below 15 ml/kg/min, cor pulmonale is present, right ventricular hypertrophy or pulmonary hypertension is documented, there has been an episode of acute respiratory failure, or you require outpatient oxygen therapy.

Two special rules also apply. Following total spontaneous pneumothorax requiring hospitalization, a 100% rating is assigned from the date of admission and continues for three months from the first day of the month after discharge. For gunshot wounds of the pleural cavity where a bullet or missile is retained in the lung, or where there is pain on exertion, scattered rales, or limited diaphragm or lower chest expansion, the rating is at least 20%. If you also have disabling injuries to shoulder girdle muscles (Groups I through IV), those are rated separately and combined with the respiratory rating, except that Muscle Group XXI is not separately rated.

Evidence that helps

Because ratings under this formula turn largely on pulmonary function test results, the most directly useful records are spirometry reports showing FEV-1, FVC, and the FEV-1/FVC ratio, along with a DLCO (SB) test result. Each of these values should be expressed as a percentage of the predicted normal so they can be compared against the thresholds in the formula.

For the 60% and 100% levels, an exercise tolerance test recording maximum oxygen consumption in ml/kg/min with a noted cardiorespiratory limitation becomes relevant. At the 100% level, records showing cor pulmonale, right ventricular hypertrophy, or pulmonary hypertension documented by echocardiogram or cardiac catheterization are important, as are hospital records of acute respiratory failure or a prescription and records of use for outpatient oxygen therapy.

For the special pneumothorax rule, hospital admission and discharge records that document total spontaneous pneumothorax and the exact dates of admission and discharge are needed to establish the period covered by the 100% rating.

For gunshot wound cases, imaging or operative reports confirming a retained bullet or missile in the lung, along with examination findings noting pain on exertion, rales, or reduced chest expansion, support the minimum 20% rating. Your own statements describing how breathing difficulties and chest pain affect your work and daily activities can help show the functional impact of your symptoms.

Secondary conditions

Conditions that are often caused or made worse by this one. If you have any of these, they may be claimable as secondary service connection.

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What the rating means

Evidence that helps

Secondary conditions

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