Pulmonary Function Tests in VA Disability Claims: PFT and Spirometry Guide

38 CFR 4.96(d)(1) says pulmonary function tests (PFTs) "are required to evaluate" diagnostic codes 6600, 6603, 6604, 6825-6833, and 6840-6845, except in the circumstances it lists. The criteria in 38 CFR 4.97 use FEV-1, FEV-1/FVC, FVC, and DLCO (SB) percentages, depending on the diagnostic code. The rating schedule assigns percentage evaluations based on the degree of deficit demonstrated on testing.

For DC 6604 (chronic obstructive pulmonary disease) and the General Rating Formula for Restrictive Lung Disease (DCs 6840-6845), 38 CFR 4.97 lists 10 percent for FEV-1 of 71 to 80 percent predicted, FEV-1/FVC of 71 to 80 percent, or DLCO (SB) of 66 to 80 percent predicted; 30 percent for 56 to 70 percent (DLCO 56 to 65); 60 percent for 40 to 55 percent, or maximum oxygen consumption of 15 to 20 ml/kg/min; and 100 percent for less than 40 percent, or maximum exercise capacity less than 15 ml/kg/min, cor pulmonale, right ventricular hypertrophy, pulmonary hypertension, episodes of acute respiratory failure, or outpatient oxygen therapy. The Interstitial Lung Disease formula (DCs 6825-6833) uses FVC and DLCO (SB) bands instead.

Under 38 CFR 4.96(d), post-bronchodilator studies are generally required when PFTs are performed for VA disability evaluations, and post-bronchodilator results are generally used for rating. However, important regulatory exceptions apply: post-bronchodilator testing is not required if pre-bronchodilator values are normal or the examiner explains why it should not be done; if post-bronchodilator results are poorer than pre-bronchodilator results, the pre-bronchodilator values are used; and when different test results produce different rating levels, the VA uses the value the examiner states most accurately reflects disability.

Diffusing Capacity of the Lung for Carbon Monoxide (DLCO) measures how efficiently oxygen transfers across alveolar capillary membranes into the bloodstream. 38 CFR 4.96(d)(6) says that when different PFT results would lead to different levels of evaluation, "use the test result that the examiner states most accurately reflects the level of disability."

38 CFR 4.96(d)(1) lists these exceptions: (i) results of a maximum exercise capacity test of record are 20 ml/kg/min or less (if no such test is of record, "evaluate based on alternative criteria"); (ii) pulmonary hypertension (documented by an echocardiogram or cardiac catheterization), cor pulmonale, or right ventricular hypertrophy has been diagnosed; (iii) one or more episodes of acute respiratory failure; (iv) outpatient oxygen therapy is required.