VA Diagnostic Code 6841Spinal cord injury with respiratory insufficiency

Spinal Cord Injury with Respiratory Insufficiency (VA Diagnostic Code 6841)

Respiratory System · 38 CFR § 4.97

Understanding This Condition

Spinal cord injury with respiratory insufficiency is rated under VA Diagnostic Code 6841, part of the Respiratory System section of the rating schedule. When a spinal cord injury affects the muscles and nerves involved in breathing, it can reduce lung function and the body's ability to move air effectively.

The VA rates this condition using the General Rating Formula for Restrictive Lung Disease, which applies to diagnostic codes 6840 through 6845. Under this formula, disability levels are largely based on objective breathing tests and other measurable indicators of respiratory and cardiac function.

Available Rating Levels

The VA assigns one of four rating levels based on your test results and clinical findings:

100%

Assigned when any of the following are present:

• FEV-1 less than 40% of predicted value, or
• FEV-1/FVC ratio less than 40%, or
• DLCO (SB) less than 40% 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
• A requirement for outpatient oxygen therapy

60%

Assigned when any of the following are present:

• FEV-1 of 40% to 55% predicted, or
• FEV-1/FVC of 40% to 55%, or
• DLCO (SB) of 40% to 55% 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% predicted, or
• FEV-1/FVC of 56% to 70%, or
• DLCO (SB) of 56% to 65% predicted

10%

Assigned when any of the following are present:

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

What the VA Looks For

The VA relies primarily on pulmonary function test (PFT) measurements to determine the appropriate rating level, including:

• FEV-1 — Forced Expiratory Volume in one second, expressed 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, expressed as a percentage of predicted value
• Maximum exercise / oxygen consumption capacity, measured in ml/kg/min

Beyond breathing test numbers, the VA also considers specific clinical findings that can support a 100% rating, such as cor pulmonale (right heart failure), right ventricular hypertrophy, pulmonary hypertension confirmed by echocardiogram or cardiac catheterization, episodes of acute respiratory failure, or a need for outpatient oxygen therapy.

Additional Notes That May Apply

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