Pulmonary Tuberculosis: How VA Rates Active & Inactive TB Under 38 CFR 4.97

Active tuberculosis of the respiratory system is evaluated under Diagnostic Code 6731 in 38 CFR 4.97. When active disease is confirmed by positive sputum culture, molecular testing, or clinical diagnosis requiring intensive anti-mycobacterial drug therapy, the VA assigns a mandatory 100% disability rating under 38 CFR 4.88b. This total disability rating continues for the entire duration of active infection and clinical treatment.

38 CFR 4.88c lists a 100 percent level for the first year after the date of inactivity.

Following the expiration of the one-year post-inactivity window, the veteran is re-evaluated under Diagnostic Code 6730 (chronic pulmonary tuberculosis, inactive). The evaluation is based on permanent structural and functional pulmonary residuals: severe lung volume loss, extensive fibrocalcific scarring, cavitary lesions, thoracoplasty surgical collapse, or lobectomy. Residuals are rated using the objective pulmonary function test criteria for restrictive or obstructive disease in 38 CFR 4.97.

38 CFR 4.89 lists 100 "For 2 years after date of inactivity", then 50 for the following 4 years and 30 for the next 5 years. The section applies to the category it titles "in effect on August 19, 1968".

Tuberculosis possesses special presumptive status under 38 CFR 3.309(a). Active tuberculosis that manifests to a compensable degree (10% or greater) within three years from the date of military separation is presumed to be service-connected, even if no symptoms were noted in military service treatment records. This extended three-year presumptive window recognizes the slow incubation and latent reactivation of Mycobacterium tuberculosis infections contracted during military service.