**4.96-1** §4.96---Special provisions regarding evaluation of
respiratory conditions **4.96-1**

# The Respiratory System

4.96 Special provisions regarding evaluation of respiratory conditions
4.96-1

4.97 Schedule of ratings---respiratory system 4.97-1

**§4.96 Special provisions regarding evaluation of respiratory
conditions.**

\(a\) *Rating coexisting respiratory conditions*. Ratings under
diagnostic codes 6600 through 6817 and 6822 through 6847 will not be
combined with each other. Where there is lung or pleural involvement,
ratings under diagnostic codes 6819 and 6820 will not be combined with
each other or with diagnostic codes 6600 through 6817 or 6822 through
6847. A single rating will be 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. However, in cases protected by the provisions of Pub. L.
90-493, the graduated ratings of 50 and 30 percent for inactive
tuberculosis will not be elevated.

\(b\) *Rating "protected" tuberculosis cases.* Public Law 90-493
repealed section 1156 of title 38, United States Code which had provided
graduated ratings for inactive tuberculosis. The repealed section,
however, still applies to the case of any veteran who on August 19,
1968, was receiving or entitled to receive compensation for
tuberculosis. The use of the protective provisions of Pub. L. 90-493
should be mentioned in the discussion portion of all ratings in which
these provisions are applied. For application in rating cases in which
the protective provisions of Pub. L. 90-493 apply the former evaluations
pertaining to pulmonary tuberculosis are retained in §4.97.

\(c\) *Special monthly compensation*. When evaluating any claim
involving complete organic aphonia, refer to §3.350 of this chapter to
determine whether the veteran may be entitled to special monthly
compensation. Footnotes in the schedule indicate conditions which
potentially establish entitlement to special monthly compensation;
however, there are other conditions in this section which under certain
circumstances also establish entitlement to special monthly
compensation. (Authority: 38 U.S.C. 1155)

\(d\) *Special provisions for the application of evaluation criteria for
diagnostic codes 6600, 6603, 6604, 6825--6833, and 6840--6845*.

\(1\) 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.

(No. 41 9/25/06)

**4.96-2** §4.96---Special provisions regarding evaluation of
respiratory conditions **4.96-2**

> \(ii\) 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.
>
> \(iv\) When outpatient oxygen therapy is required.

\(2\) If the DLCO (SB) (Diffusion Capacity of the Lung for Carbon
Monoxide by the Single Breath Method) 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.

\(3\) 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.

\(4\) 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.

\(5\) When evaluating based on PFT's, use post-bronchodilator results in
applying the evaluation criteria in the rating schedule unless the
post-bronchodilator results were poorer than the pre-bronchodilator
results. In those cases, use the pre-bronchodilator values for rating
purposes.

\(6\) When there is a disparity between the results of different PFT's
(FEV-1 (Forced Expiratory Volume in one second), FVC (Forced Vital
Capacity), etc.), so that the level of evaluation would differ depending
on which test result is used, use the test result that the examiner
states most accurately reflects the level of disability.

\(7\) 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.

\[34 FR 5062, Mar. 11, 1969, as amended at 61 FR 46727, Sept. 5, 1996;
71 FR 52459, Sept. 6, 2006\]

**Supplement *Highlights* references**: 18(1), 41(1).

(No. 41 9/25/06)