Chronic obstructive pulmonary disease — VA Diagnostic Code 6604

FEV-1, FEV-1/FVC, and DLCO (SB)

The lines use those abbreviations. Section 4.97 spells out Forced Expiratory Volume in one second, Forced Vital Capacity, and Diffusion Capacity of the Lung for Carbon Monoxide by the Single Breath Method on the 100 percent line. Later lines use the short forms. The 60 percent line says “DLCO (SB) of 40- to 55-percent predicted.” The 30 and 10 percent lines omit the word “of” before the DLCO range.

15 ml/kg/min and 20 ml/kg/min

The 100 percent line uses maximum exercise capacity less than 15 ml/kg/min oxygen consumption (with cardiac or respiratory limitation). The 60 percent line uses maximum oxygen consumption of 15 to 20 ml/kg/min (with cardiorespiratory limit). Section 4.96(d)(1)(i) is a different sentence: PFT's are not required when a maximum exercise capacity test of record is 20 ml/kg/min or less. If that test is not of record, the same paragraph says to evaluate based on alternative criteria.

Post-bronchodilator results

38 CFR § 4.96(d) applies to diagnostic codes 6600, 6603, 6604, 6825-6833, and 6840-6845. Paragraph (d)(1) says pulmonary function tests (PFT's) are required to evaluate these conditions except: (i) when the results of a maximum exercise capacity test are of record and are 20 ml/kg/min or less (if a maximum exercise capacity test is not of record, evaluate based on alternative criteria); (ii) when pulmonary hypertension (documented by an echocardiogram or cardiac catheterization), cor pulmonale, or right ventricular hypertrophy has been diagnosed; (iii) when there have been one or more episodes of acute respiratory failure; or (iv) when outpatient oxygen therapy is required. Paragraph (d)(2) says that if the DLCO (SB) test is not of record, evaluate based on alternative criteria as long as the examiner states why the test would not be useful or valid in a particular case. Paragraph (d)(3) says that when the PFT's are not consistent with clinical findings, evaluate based on the PFT's unless the examiner states why they are not a valid indication of respiratory functional impairment in a particular case. Paragraph (d)(4) says post-bronchodilator studies are required when PFT's are done for disability evaluation purposes except when the results of pre-bronchodilator pulmonary function tests are normal or when the examiner determines that post-bronchodilator studies should not be done and states why. Paragraph (d)(5) says that when evaluating based on PFT's, use post-bronchodilator results unless the post-bronchodilator results were poorer than the pre-bronchodilator results, in which case use the pre-bronchodilator values. Paragraph (d)(6) says that when different PFT's would produce different evaluation levels, use the test result that the examiner states most accurately reflects the level of disability. Paragraph (d)(7) says: if the FEV-1 and the FVC are both greater than 100 percent, do not assign a compensable evaluation based on a decreased FEV-1/FVC ratio.

When two lines are close

38 CFR § 4.7 (Higher of two evaluations) assigns the higher rating when the disability picture more nearly approximates the criteria required for that rating. Otherwise, the lower rating will be assigned. 38 CFR § 4.6 (Evaluation of evidence) requires each element affecting the evidence to be studied so that decisions will be equitable and just.

Codes that print these same measurements

What is the VA rating for Chronic obstructive pulmonary disease?

Under 38 CFR § 4.97, Diagnostic Code 6604 prints 100, 60, 30, and 10. There is no printed 0 percent line. Section 4.31 assigns a zero percent evaluation when the requirements for a compensable evaluation are not met. Section 4.96(d) is the rule for pulmonary function tests. Education only. VA decides on the evidence.

Can this code be combined with another respiratory code?

Section 4.96(a) says ratings under diagnostic codes 6600 through 6817 and 6822 through 6847 will not be combined with each other. One rating is 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.

How does VA rate Chronic obstructive pulmonary disease under DC 6604?

Under 38 CFR § 4.97, DC 6604 prints 100, 60, 30, and 10. The 100 line includes the FEV-1, FEV-1/FVC, and DLCO (SB) thresholds, and it also includes maximum exercise capacity less than 15 ml/kg/min oxygen consumption (with cardiac or respiratory limitation), cor pulmonale, right ventricular hypertrophy, pulmonary hypertension shown by Echo or cardiac catheterization, episode(s) of acute respiratory failure, or outpatient oxygen therapy. Education only.

Which spirometry result is used?

Section 4.96(d)(5) says to use post-bronchodilator results unless the post-bronchodilator results were poorer than the pre-bronchodilator results. In those cases, use the pre-bronchodilator values. Paragraph (d)(6) says that when different tests would produce different levels, use the test result the examiner states most accurately reflects the level of disability. Paragraph (d)(7) says not to assign a compensable evaluation based on a decreased FEV-1/FVC ratio when both FEV-1 and FVC are greater than 100 percent.

Is chronic obstructive pulmonary disease on the herbicide list or in § 3.320?

No. The herbicide-agent list in § 3.309(e) does not name chronic obstructive pulmonary disease. Section 3.320(a)(2) and (a)(3) do not name it either. The statute at 38 U.S.C. § 1120(b) lists “Chronic obstructive pulmonary disease,” and VA’s PACT Act page lists “Chronic obstructive pulmonary disease (COPD).” Those are different authorities from § 3.309(e) and § 3.320.