How VA Rates COPD: DC 6604 Pulmonary Function Criteria

COPD, chronic bronchitis, and emphysema are rated under 38 CFR 4.97 using the General Rating Formula for Respiratory Conditions: 10% for FEV-1 of 71% to 80% predicted, or DLCO of 66% to 80%; 30% for FEV-1 of 56% to 70% predicted, or DLCO of 56% to 65%; 60% for FEV-1 of 40% to 55% predicted, or DLCO of 40% to 55%; and 100% for FEV-1 or DLCO of less than 40% predicted, or requiring continuous outpatient oxygen therapy.

Pulmonary function testing (PFT) is mandatory for rating COPD. Spirometry measures forced expiratory volume in one second (FEV-1) and forced vital capacity (FVC). In addition, diffusing capacity of the lung for carbon monoxide (DLCO) measures how efficiently oxygen moves from alveoli into the blood. The VA evaluates based on the most severe finding.

If a medical provider prescribes continuous, ambulatory, or nocturnal outpatient oxygen therapy based on documented hypoxemia, the 38 CFR 4.97 formulas that list "Requires outpatient oxygen therapy" list 100 percent for it, regardless of whether spirometric numbers are higher.

COPD, emphysema, and chronic bronchitis are listed in 38 U.S.C. 1120(b) among the diseases specified for a covered veteran, as 38 U.S.C. 1119(c)(1) defines that term. Under 38 U.S.C. 1119(b)(1), the Secretary presumes that a covered veteran was exposed to the listed hazards during that service, "unless there is affirmative evidence to establish that the covered veteran was not exposed to any such substances, chemicals, or hazards in connection with such service".

Under 38 CFR 4.96(a), ratings for respiratory conditions spanning Diagnostic Codes 6600 through 6817 and 6822 through 6847 generally may not be combined with each other. When a veteran is diagnosed with both COPD (DC 6604) and asthma (DC 6602), the VA does not combine the ratings. Instead, the VA assigns a single disability rating under the diagnostic code reflecting the predominant disability, with elevation to the next higher evaluation if the overall severity justifies it. While 38 CFR 4.14 prohibits pyramiding broadly, 38 CFR 4.96(a) is the specific regulation controlling coexisting respiratory diagnoses.