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RESPIRATORY SECTION
Current Section: Respiratory Conditions
Table of Contents

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
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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
Agent Orange Exposure

For veterans who served in Vietnam, certain areas of Thailand, or other specified locations:

  • Respiratory cancers (lung, bronchus, larynx, trachea)
Gulf War Illness

For veterans who served in Southwest Asia during the Gulf War:

  • Undiagnosed respiratory symptoms
  • Medically unexplained chronic multisymptom illness with respiratory symptoms

Asthma

Asthma is a chronic respiratory condition characterized by inflammation and narrowing of the airways, leading to breathing difficulties, wheezing, coughing, and chest tightness. Military service can trigger or worsen asthma due to environmental exposures, physical exertion, or stress.

Establishing Service Connection for Asthma

To establish service connection for asthma, you need:

  1. Diagnosis of asthma by a qualified medical professional
  2. Evidence of onset or worsening during service or evidence of exposure to environmental hazards that caused or aggravated your asthma
  3. Medical nexus linking your current asthma to service or to environmental exposures during service
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PACT Act Presumption

Under the PACT Act, asthma is presumptively service-connected if:

  • You served in Southwest Asia, Afghanistan, or Djibouti during specified periods, and
  • Your asthma developed within 10 years of your service in these locations

With this presumption, you don't need to prove that your asthma was caused by your service—only that it developed within the specified timeframe after your qualifying service.

VA Rating Criteria for Asthma

Asthma is rated under Diagnostic Code 6602 based on pulmonary function test results, frequency of attacks, and required treatments:

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 immuno-suppressive medications

Evidence for 100% Rating:

  • Pulmonary function tests showing FEV-1 less than 40% predicted, or FEV-1/FVC less than 40%
  • Medical records documenting more than one asthma attack per week with episodes of respiratory failure
  • Prescription records showing daily use of systemic corticosteroids (oral or injectable) or immuno-suppressive medications
  • Documentation of hospitalizations for asthma attacks
  • Evidence of severe impact on daily activities and inability to work
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

Evidence for 60% Rating:

  • Pulmonary function tests showing FEV-1 of 40-55% predicted, or FEV-1/FVC of 40-55%
  • Medical records documenting at least monthly visits to a physician for required care of exacerbations
  • Prescription records showing at least three courses per year of systemic corticosteroids (oral or injectable)
  • Documentation of frequent asthma attacks requiring medical intervention
  • Evidence of significant impact on daily activities and work
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

Evidence for 30% Rating:

  • Pulmonary function tests showing FEV-1 of 56-70% predicted, or FEV-1/FVC of 56-70%
  • Prescription records showing daily use of inhalational or oral bronchodilator therapy
  • Prescription records showing use of inhalational anti-inflammatory medication (such as inhaled corticosteroids)
  • Documentation of regular asthma symptoms requiring daily medication
  • Evidence of moderate impact on daily activities and work
10%
FEV-1 of 71-80% predicted, or; FEV-1/FVC of 71-80%, or; intermittent inhalational or oral bronchodilator therapy

Evidence for 10% Rating:

  • Pulmonary function tests showing FEV-1 of 71-80% predicted, or FEV-1/FVC of 71-80%
  • Prescription records showing intermittent use of inhalational or oral bronchodilator therapy
  • Documentation of occasional asthma symptoms requiring intermittent medication
  • Evidence of mild impact on daily activities and work
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Key Terms

Systemic corticosteroids: Medications like prednisone, methylprednisolone, or dexamethasone that are taken orally or by injection and affect the entire body.

Inhalational anti-inflammatory medication: Medications like fluticasone, budesonide, or beclomethasone that are inhaled directly into the lungs to reduce inflammation.

Bronchodilator therapy: Medications like albuterol, levalbuterol, or formoterol that open the airways by relaxing the muscles around them.

Building a Strong Asthma Claim

Evidence Checklist for Asthma Claims

Required Medical Evidence
Military Records
Supporting Statements
Additional Evidence (if applicable)
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Asthma Claim Tip

Keep all your medication packaging and prescription records. The VA rating criteria for asthma are heavily based on the types and frequency of medications required to control your symptoms. Prescription records provide objective evidence of your treatment needs.

Sleep Apnea

Sleep apnea is a sleep disorder characterized by pauses in breathing or periods of shallow breathing during sleep. The most common type is obstructive sleep apnea (OSA), where the airway becomes partially or completely blocked during sleep. Military service can contribute to sleep apnea through weight gain, sleep disruption, PTSD, or physical changes to the airway.

Establishing Service Connection for Sleep Apnea

To establish service connection for sleep apnea, you need:

  1. Diagnosis of sleep apnea by a qualified medical professional, typically based on a sleep study
  2. Evidence of onset during service or evidence of a service-connected condition that caused or aggravated your sleep apnea
  3. Medical nexus linking your current sleep apnea to service or to another service-connected condition
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Secondary Service Connection

Sleep apnea is often secondary to other service-connected conditions, including:

  • PTSD or other mental health conditions
  • Rhinitis or sinusitis
  • Asthma
  • Diabetes
  • Medication side effects (weight gain from psychiatric medications)

If you have one of these service-connected conditions, you may be able to establish service connection for sleep apnea as secondary to that condition.

VA Rating Criteria for Sleep Apnea

Sleep apnea is rated under Diagnostic Code 6847 based on the severity of symptoms and required treatments:

100%
Chronic respiratory failure with carbon dioxide retention or cor pulmonale, or; requires tracheostomy

Evidence for 100% Rating:

  • Medical documentation of chronic respiratory failure with carbon dioxide retention
  • Medical documentation of cor pulmonale (right heart failure due to lung disease)
  • Evidence of requiring a tracheostomy (surgical opening in the neck to place a tube into the windpipe)
  • Medical records showing severe complications from sleep apnea
  • Documentation of significant impact on health and daily functioning
50%
Requires use of breathing assistance device such as continuous airway pressure (CPAP) machine

Evidence for 50% Rating:

  • Prescription for CPAP machine or other breathing assistance device
  • Medical records documenting the need for a breathing assistance device
  • Sleep study results showing moderate to severe sleep apnea requiring CPAP
  • CPAP compliance records showing regular use
  • Documentation of improvement with CPAP use
30%
Persistent day-time hypersomnolence

Evidence for 30% Rating:

  • Medical documentation of persistent daytime sleepiness
  • Sleep study results showing sleep apnea with daytime symptoms
  • Personal statements describing daytime fatigue and its impact
  • Statements from others observing your daytime sleepiness
  • Documentation of impact on work and daily activities due to fatigue
0%
Asymptomatic but with documented sleep disorder breathing

Evidence for 0% Rating:

  • Sleep study confirming diagnosis of sleep apnea
  • Medical documentation showing minimal or no symptoms
  • No requirement for treatment
  • No significant impact on daily functioning
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Key Term

Persistent day-time hypersomnolence: Excessive daytime sleepiness that occurs despite adequate nighttime sleep, causing significant impairment in daily functioning.

Building a Strong Sleep Apnea Claim

Evidence Checklist for Sleep Apnea Claims

Required Medical Evidence
Military Records
Supporting Statements
Additional Evidence (if applicable)
💡

Sleep Apnea Claim Tip

For secondary service connection claims, obtain a strong medical opinion that clearly explains the physiological mechanism by which your service-connected condition (like PTSD or sinusitis) causes or aggravates your sleep apnea. Generic statements are often insufficient; the opinion should cite medical literature and explain your specific case.

Case Study: Successful Sleep Apnea Claim

Veteran Profile

Army veteran with 6 years of service including deployment to Iraq. Service-connected for PTSD (50%) and lumbar strain (20%).

Condition

Obstructive Sleep Apnea diagnosed 3 years after separation from service.

Symptoms & Presentation
  • Loud snoring and witnessed breathing pauses during sleep
  • Excessive daytime sleepiness affecting work performance
  • Morning headaches and irritability
  • Sleep study showing moderate OSA with AHI of 22
  • Prescribed CPAP machine with good compliance
  • Significant improvement in symptoms with CPAP use
Evidence Submitted
  • Sleep study report confirming OSA diagnosis
  • CPAP prescription and compliance records
  • Medical opinion from pulmonologist linking OSA to service-connected PTSD
  • Medical literature on the relationship between PTSD and sleep apnea
  • Statement from spouse describing observed sleep symptoms during and after service
  • Personal statement detailing progression of sleep problems
  • Statement from supervisor about observed daytime fatigue affecting work
Outcome

The veteran was awarded service connection for sleep apnea as secondary to PTSD with a 50% rating based on the required use of a CPAP machine. The medical opinion was crucial, as it explained how PTSD affects sleep architecture, increases stress hormones, and contributes to upper airway muscle dysfunction, all of which can cause or aggravate sleep apnea.

Key Takeaways
  1. A strong medical opinion with specific physiological explanations was essential for secondary service connection
  2. CPAP compliance records provided objective evidence of treatment requirements
  3. Lay statements from spouse and supervisor corroborated the symptoms and their impact
  4. Medical literature strengthened the connection between PTSD and sleep apnea
  5. The 50% rating significantly increased the veteran's combined disability rating

See Also

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