Respiratory System§ 4.97Updated
Rating criteria

VA Diagnostic Code 6603Emphysema, pulmonary:

Rated from 10% to 100% under § 4.97. Here is what the VA requires at each level.

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What each rating requires

The VA assigns the highest level your evidence actually supports. Read up the stack until your records stop matching.

  1. 100%

    FEV-1 less than 40 percent of predicted value, or; the ratio of Forced Expiratory Volume in one second to Forced Vital Capacity (FEV-1/FVC) less than 40 percent, or; Diffusion Capacity of the Lung for Carbon Monoxide by the Single Breath Method (DLCO (SB)) less than 40-percent predicted, or; maximum exercise capacity less than 15 ml/kg/min oxygen consumption (with cardiac or respiratory limitation), or; cor pulmonale (right heart failure), or; right ventricular hypertrophy, or; pulmonary hypertension (shown by Echo or cardiac catheterization), or; episode(s) of acute respiratory failure, or; requires outpatient oxygen therapy.

  2. 60%

    FEV-1 of 40- to 55-percent predicted, or; FEV-1/FVC of 40 to 55 percent, or; DLCO (SB) of 40- to 55-percent predicted, or; maximum oxygen consumption of 15 to 20 ml/kg/min (with cardiorespiratory limit)

  3. 30%

    FEV-1 of 56- to 70-percent predicted, or; FEV-1/FVC of 56 to 70 percent, or; DLCO (SB) 56- to 65-percent predicted

  4. 10%

    FEV-1 of 71- to 80-percent predicted, or; FEV-1/FVC of 71 to 80 percent, or; DLCO (SB) 66- to 80-percent predicted

Pulmonary Emphysema (VA Diagnostic Code 6603)

Respiratory System — 38 CFR § 4.97

Understanding Pulmonary Emphysema and How the VA Rates It

Pulmonary emphysema is a condition affecting the respiratory system. Under the VA rating schedule, it is evaluated using Diagnostic Code 6603, found in § 4.97 of the Code of Federal Regulations.

The VA assigns a disability rating based largely on the results of pulmonary function tests (PFTs) and related clinical findings. Key measurements the VA considers include:

  • FEV-1 — Forced Expiratory Volume in one second, measured as a percentage of the predicted value
  • FEV-1/FVC — the ratio of Forced Expiratory Volume in one second to Forced Vital Capacity
  • DLCO (SB) — Diffusion Capacity of the Lung for Carbon Monoxide by the Single Breath Method, as a percentage of predicted
  • Maximum exercise capacity — measured by oxygen consumption (ml/kg/min)
  • Other serious findings such as cor pulmonale, right ventricular hypertrophy, pulmonary hypertension, episodes of acute respiratory failure, or the need for oxygen therapy

Available Rating Levels

The VA can assign the following disability ratings for pulmonary emphysema:

100%

Assigned when any of the following are present:

  • FEV-1 less than 40 percent of predicted value, or
  • FEV-1/FVC less than 40 percent, or
  • DLCO (SB) less than 40-percent predicted, or
  • Maximum exercise capacity less than 15 ml/kg/min oxygen consumption (with cardiac or respiratory limitation), or
  • Cor pulmonale (right heart failure), or
  • Right ventricular hypertrophy, or
  • Pulmonary hypertension (shown by Echo or cardiac catheterization), or
  • Episode(s) of acute respiratory failure, or
  • Requires outpatient oxygen therapy

60%

Assigned when any of the following are present:

  • FEV-1 of 40- to 55-percent predicted, or
  • FEV-1/FVC of 40 to 55 percent, or
  • DLCO (SB) of 40- to 55-percent predicted, or
  • Maximum oxygen consumption of 15 to 20 ml/kg/min (with cardiorespiratory limit)

30%

Assigned when any of the following are present:

  • FEV-1 of 56- to 70-percent predicted, or
  • FEV-1/FVC of 56 to 70 percent, or
  • DLCO (SB) 56- to 65-percent predicted

10%

Assigned when any of the following are present:

  • FEV-1 of 71- to 80-percent predicted, or
  • FEV-1/FVC of 71 to 80 percent, or
  • DLCO (SB) 66- to 80-percent predicted

What the VA Looks For

When rating pulmonary emphysema, the VA reviews objective test results — most commonly pulmonary function tests measuring FEV-1, the FEV-1/FVC ratio, and DLCO (SB) — along with measures of exercise capacity and evidence of related cardiac or respiratory complications. The more significant the reduction in lung function or the presence of serious findings like acute respiratory failure or the need for oxygen therapy, the higher the potential rating.

This information is provided for general educational purposes and reflects the VA rating criteria under Diagnostic Code 6603. Individual ratings depend on your specific medical evidence and examination results.

These criteria are a rendering of § 4.97, diagnostic code 6603. The official version is the one that governs your rating.

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What next

How to claim this

Knowing the criteria is the first half. Getting your file to show them is the second.

  1. Find your level in the stack

    Read each rung against what your medical records already say. The level your records document today is the one the VA can support today.

  2. Name the gap

    Look at the rung above yours and write down exactly what it asks for that your file does not show yet — a diagnosis, a measurement, a prescribed brace, a doctor’s opinion linking it to service.

  3. Claim it by code

    File under diagnostic code 6603 and attach the evidence for the level you are asking for. Other Respiratory System codes may cover your secondary conditions.

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