VA Diagnostic Code 6845Chronic pleural effusion or fibrosis

Chronic Pleural Effusion or Fibrosis (VA Diagnostic Code 6845)

Respiratory System — 38 CFR § 4.97

Understanding This Condition

Chronic pleural effusion or fibrosis affects the lungs and the tissues surrounding them, and it falls under the VA's evaluation of the Respiratory System. Because it is a restrictive lung condition, the VA rates it using the General Rating Formula for Restrictive Lung Disease, which applies to diagnostic codes 6840 through 6845.

Under this formula, the severity of the condition is measured largely through pulmonary function testing and related clinical findings, rather than by symptoms alone.

Available Rating Levels

The VA assigns one of the following disability ratings based on the results of your pulmonary function tests and other findings:

What the VA Looks For When Rating This Condition

The VA relies heavily on objective measurements from pulmonary function tests, including:

• FEV-1 — Forced Expiratory Volume in one second, compared to 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, compared to the predicted value
• Maximum exercise / oxygen consumption capacity (measured in ml/kg/min)

At the higher levels, the VA also considers serious clinical findings such as cor pulmonale (right heart failure), right ventricular hypertrophy, pulmonary hypertension confirmed by echocardiogram or cardiac catheterization, episodes of acute respiratory failure, or the need for outpatient oxygen therapy.

Important Notes

Several special situations carry their own rating rules:

• 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 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 — are rated at least 20% disabling. Disabling injuries of shoulder girdle muscles (Groups I to IV) are separately rated and combined with ratings for respiratory involvement. Involvement of Muscle Group XXI (DC 5321), however, will not be separately rated.