Chronic pleural effusion or fibrosis — VA Diagnostic Code 6845

Pleuritis, pleural effusion, and pleurisy with empyema

DC 6845’s title is chronic pleural effusion or fibrosis. The statute and the VA PACT Act page say pleuritis. Note (1) assigns 100 percent for pleurisy with empyema, with or without pleurocutaneous fistula, until resolved. Those are three different phrases in the sources. This page does not treat them as the same sentence.

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.

The restrictive formula and the obstructive codes

What is the VA rating for DC 6845?

Under 38 CFR § 4.97, DC 6845 uses the General Rating Formula for Restrictive Lung Disease: 100, 60, 30, and 10, or rate the primary disorder. Note (1) is a separate 100 percent for pleurisy with empyema until resolved. Education only. VA decides on the evidence.

What does Note (2) say about pneumothorax?

Following episodes of total spontaneous pneumothorax, a rating of 100 percent shall be assigned as of the date of hospital admission and shall continue for three months from the first day of the month after hospital discharge.

How does VA rate chronic pleural effusion or fibrosis under DC 6845?

DC 6845 uses the General Rating Formula for Restrictive Lung Disease. The measurement lines are 100, 60, 30, and 10. The schedule also says “Or rate primary disorder.” Note (1) assigns 100 percent for pleurisy with empyema, with or without pleurocutaneous fistula, until resolved. Education only.

Is pleuritis the title of DC 6845?

No. The schedule title is “Chronic pleural effusion or fibrosis.” Pleuritis is the word in 38 U.S.C. § 1120(b) and on VA’s PACT Act page. Note (1) uses “pleurisy with empyema.”

Does the herbicide list name pleuritis?

No. Section 3.309(e) does not name pleuritis, pleurisy, or chronic pleural effusion or fibrosis.