Asthma, COPD and lungs: breathing tests and the exam

How VA rates lung conditions

38 CFR 4.97, 4.96

Lung conditions are rated in 38 CFR 4.97, mostly from breathing tests, called pulmonary function tests (PFTs). The numbers on the test are compared with what is predicted for a person your size and age:

• FEV-1: how much air you can force out in the first second, as a percent of predicted.
• FEV-1/FVC: that amount compared with your total forced breath, as a percent.
• DLCO (SB): how well the lungs pass oxygen into the blood, as a percent of predicted.
• Maximum exercise capacity in ml/kg/min of oxygen.

Asthma is the exception. It can also be rated from attacks, doctor visits and medicines.

COPD, chronic bronchitis and emphysema

38 CFR 4.97, DC 6604, 6600, 6603

All three codes use the same levels. At each level, any one listed item is enough:

• 100%: FEV-1 under 40% of predicted; or FEV-1/FVC under 40%; or DLCO (SB) under 40%; or maximum exercise capacity under 15 ml/kg/min; or cor pulmonale (right heart failure); or right ventricular hypertrophy; or pulmonary hypertension shown by echo or cardiac catheterization; or an episode of acute respiratory failure; or outpatient oxygen therapy.
• 60%: FEV-1 40 to 55%; or FEV-1/FVC 40 to 55%; or DLCO (SB) 40 to 55%; or maximum oxygen consumption 15 to 20 ml/kg/min.
• 30%: FEV-1 56 to 70%; or FEV-1/FVC 56 to 70%; or DLCO (SB) 56 to 65%.
• 10%: FEV-1 71 to 80%; or FEV-1/FVC 71 to 80%; or DLCO (SB) 66 to 80%.

Asthma

38 CFR 4.97, DC 6602

• 100%: FEV-1 under 40%, or FEV-1/FVC under 40%, or more than one attack a week with episodes of respiratory failure, or daily use of high-dose systemic (oral or injected) corticosteroids or immunosuppressive medicines.
• 60%: FEV-1 40 to 55%, or FEV-1/FVC 40 to 55%, or at least monthly doctor visits for required care of exacerbations, or intermittent courses of systemic corticosteroids, at least three a year.
• 30%: FEV-1 56 to 70%, or FEV-1/FVC 56 to 70%, or daily inhaled or oral bronchodilator therapy, or inhaled anti-inflammatory medicine.
• 10%: FEV-1 71 to 80%, or FEV-1/FVC 71 to 80%, or intermittent inhaled or oral bronchodilator therapy.

The note says that if there are no clinical findings of asthma at the exam, a verified history of asthmatic attacks must be of record.

How the breathing tests are used

38 CFR 4.96(d)

• PFTs are required for COPD, bronchitis, emphysema, interstitial lung disease and restrictive conditions, with exceptions: a maximum exercise capacity test of record at 20 ml/kg/min or less; pulmonary hypertension, cor pulmonale or right ventricular hypertrophy; one or more episodes of acute respiratory failure; or outpatient oxygen therapy.
• Post-bronchodilator studies are required, unless the pre-bronchodilator results are normal or the examiner says why they should not be done. VA uses the post-bronchodilator results, unless they were poorer than the pre-bronchodilator ones, in which case it uses the pre-bronchodilator values.
• If the DLCO test is not of record, VA can use other criteria if the examiner states why the test would not be useful or valid.
• When tests do not match clinical findings, VA evaluates on the PFTs unless the examiner states why they are not valid.
• When different test results would give different levels, VA uses the result the examiner says most accurately reflects the level of disability.
• If FEV-1 and FVC are both over 100% of predicted, a decreased FEV-1/FVC ratio does not support a compensable rating.

Bronchiectasis

38 CFR 4.97, DC 6601

• 100%: incapacitating episodes of infection totaling at least six weeks a year.
• 60%: four to six weeks a year, or near-constant cough with purulent sputum plus anorexia, weight loss and frank hemoptysis, needing antibiotics almost continuously.
• 30%: two to four weeks a year, or daily productive cough with sputum, at times purulent or blood-tinged, needing prolonged (four to six weeks) antibiotics more than twice a year.
• 10%: intermittent productive cough with acute infection needing antibiotics at least twice a year.

It can instead be rated on lung function as chronic bronchitis (DC 6600). An incapacitating episode requires bed rest and treatment by a physician.

Interstitial lung disease, asbestosis and sarcoidosis

38 CFR 4.97, DC 6825 to 6833, 6846

The interstitial lung disease codes include pulmonary fibrosis, hypersensitivity pneumonitis, pneumoconiosis (silicosis) and asbestosis (6833). They use a different formula, built on FVC:

• 100%: FVC under 50%, or DLCO (SB) under 40%, or maximum exercise capacity under 15 ml/kg/min, or cor pulmonale or pulmonary hypertension, or outpatient oxygen therapy.
• 60%: FVC 50 to 64%, or DLCO (SB) 40 to 55%, or exercise capacity 15 to 20 ml/kg/min.
• 30%: FVC 65 to 74%, or DLCO (SB) 56 to 65%.
• 10%: FVC 75 to 80%, or DLCO (SB) 66 to 80%.

Sarcoidosis (6846) is rated differently: 100% for cor pulmonale, cardiac involvement with heart failure, or progressive disease with fever, night sweats and weight loss despite treatment; 60% if high-dose corticosteroids are needed for control; 30% for persistent symptoms needing low-dose or intermittent corticosteroids; 0% for chronic hilar adenopathy or stable infiltrates without symptoms.

Lung cancer and collapsed lung

38 CFR 4.97, DC 6819, 6820, 6844, 6845

Malignant lung neoplasm (6819): 100%, continuing after surgery, radiation or chemotherapy ends. A mandatory VA exam follows six months after treatment stops, and if there is no local recurrence or spread, it is rated on residuals. Benign neoplasms (6820) are rated by an appropriate respiratory analogy.

For restrictive conditions such as lung surgery residuals or pleural effusion (6840 to 6845), a total spontaneous pneumothorax is rated 100% from the date of hospital admission for three months after the first day of the month following discharge.

Why lung ratings are not combined

38 CFR 4.96(a)

Ratings under diagnostic codes 6600 through 6817 and 6822 through 6847 will not be combined with each other. A single rating is assigned under the code that reflects the predominant disability, with elevation to the next higher evaluation where the severity of the overall disability warrants it.

That range includes sleep apnea (6847). See sleep apnea rating changes. The sinusitis and rhinitis codes (6510 to 6524) fall outside that range. See sinusitis and rhinitis.

Burn pits, Gulf War and lung conditions

Presumptive conditions

Some lung conditions are on VA’s presumptive lists for burn pit and Gulf War service. The lists and their rules are on presumptive conditions by era and burn pit registry and toxic exposure screening. Once a condition is service connected, it is rated with the levels on this page.

What VA’s respiratory exam form covers

VA Respiratory Conditions DBQ (updated 2024-08-27)

• Diagnosis checklist: asthma, emphysema, COPD, chronic bronchitis, interstitial lung disease, sarcoidosis, restrictive lung disease and others.
• Medicines: oral or injected corticosteroids (including how many bursts in the past 12 months), inhaled and oral bronchodilators and anti-inflammatories (intermittent or daily), antibiotics, and outpatient oxygen therapy.
• Asthma: attacks with respiratory failure in the past 12 months, and physician visits for exacerbations (less than monthly or at least monthly).
• Bronchiectasis: cough, sputum, infections, antibiotic courses and incapacitating episodes.
• Cardiopulmonary complications: cor pulmonale, right ventricular hypertrophy and pulmonary hypertension.
• Pulmonary function tests: pre- and post-bronchodilator FVC, FEV-1, FEV-1/FVC and DLCO, which result the examiner thinks best reflects disability, why any test was not done, and exercise capacity.
• Functional impact on work.

See Preparing for Your C&P Exam.

What I could not verify

• The rating levels come from the eCFR text of 38 CFR 4.96 and 4.97 (current as of October 16, 2026). eCFR is unofficial, and the official text wins over me. The respiratory schedule was last amended in 2006.
• I checked the respiratory exam form through a text reader of VA’s PDF, not line by line. The form itself is the authority.
• I did not check which lung conditions are on the burn pit, Gulf War or other presumptive lists beyond what your presumptive page already says.
• I did not research medical causes of lung conditions, or whether one condition leads to another.
• I did not check how VA handles a veteran who cannot do a breathing test for medical reasons beyond the exceptions in 4.96(d).