Respiratory System§ 4.97Updated
Rating criteria

VA Diagnostic Code 6840Diaphragm paralysis or paresis

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

How it is applied

General rating formula

General Rating Formula for Restrictive Lung Disease (diagnostic codes 6840 through 6845)

From the schedule

Notes on this code

These notes are part of the regulation. They change how the levels above are applied.

  • Note (1): A 100-percent rating shall be assigned for pleurisy with empyema, with or without pleurocutaneous fistula, until resolved.
  • Note (2): Following episodes of total spontaneous pneumothorax, a rating of 100 percent shall be assigned as of the date of hospital admission and shall continue for three months from the first day of the month after hospital discharge.
  • Note (3): Gunshot wounds of the pleural cavity with bullet or missile retained in lung, pain or discomfort on exertion, or with scattered rales or some limitation of excursion of diaphragm or of lower chest expansion shall be rated at least 20-percent disabling. Disabling injuries of shoulder girdle muscles (Groups I to IV) shall be separately rated and combined with ratings for respiratory involvement. Involvement of Muscle Group XXI (DC 5321), however, will not be separately rated.

Diaphragm Paralysis or Paresis (VA Diagnostic Code 6840)

Respiratory System · 38 CFR § 4.97

Understanding This Condition

Diaphragm paralysis or paresis affects the primary muscle involved in breathing. Because it limits how fully the lungs can expand, the VA evaluates it under the General Rating Formula for Restrictive Lung Disease (diagnostic codes 6840 through 6845).

Under this formula, your disability rating is based largely on objective measures of lung function—such as breathing tests and, in some cases, exercise capacity or evidence of related heart and lung complications.

Available Rating Levels

The VA assigns one of the following ratings based on the measured severity of the condition:

100%

Assigned when any of the following are present:

  • FEV-1 less than 40 percent of predicted value, or
  • FEV-1/FVC ratio 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) of 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) of 66- to 80-percent predicted

What the VA Looks For

The VA relies on the following types of evidence when rating this condition:

  • FEV-1 — Forced Expiratory Volume in one second, measured as a percentage of 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, measured as a percentage of predicted value.
  • Maximum exercise / oxygen consumption capacity — measured in ml/kg/min, with cardiac or respiratory limitation.
  • Related complications — such as cor pulmonale (right heart failure), right ventricular hypertrophy, pulmonary hypertension, episodes of acute respiratory failure, or a need for outpatient oxygen therapy.

Important Notes

  • Note (1): A 100-percent rating shall be assigned for pleurisy with empyema, with or without pleurocutaneous fistula, until resolved.
  • Note (2): Following episodes of total spontaneous pneumothorax, a rating of 100 percent shall be assigned as of the date of hospital admission and shall continue for three months from the first day of the month after hospital discharge.
  • Note (3): Gunshot wounds of the pleural cavity with bullet or missile retained in the lung, pain or discomfort on exertion, or with scattered rales or some limitation of excursion of the diaphragm or of lower chest expansion shall be rated at least 20-percent disabling. Disabling injuries of shoulder girdle muscles (Groups I to IV) shall be separately rated and combined with ratings for respiratory involvement. Involvement of Muscle Group XXI (DC 5321), however, will not be separately rated.

This information is drawn directly from the VA rating schedule under 38 CFR § 4.97. It is provided for general educational purposes and does not guarantee any particular rating or outcome.

These criteria are a rendering of § 4.97, diagnostic code 6840. 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 6840 and attach the evidence for the level you are asking for. Other Respiratory System codes may cover your secondary conditions.

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