Revised July 29, 2021
VIII.iv.9.B.1.aDiving Techniques and Associated Risks
Diving techniques include the following:
- free (breath-hold)
- snorkeling
- SCUBA (self-contained underwater breathing apparatus)
- surface supplied air and mixed-gas bounce diving, and
- saturation diving.
Saturation diving is essentially defined as a diver having been at a depth long enough (typically 24 hours or longer) for tissues to have absorbed the maximum amount of gas possible for that particular depth, so that gas equilibrium has been achieved. Saturation divers live for long periods of time in a chamber pressured to the desired depth, and work in an extremely harsh, physically demanding environment. Bounce diving commonly refers to any non-saturation dive. Typically, multiple bounce dives of different depths and duration are conducted in a single day with repeated decompressions. Under certain circumstances, any type of diving may result in
- decompression illness, historically referred to as Caisson disease
- barotraumas (tissue damage due to increased pressure), or
- pulmonary overinflation syndromes (trapping of gases in lungs, with potential for rupture of alveoli leading to arterial gas emboli).
Note: Long-term effects resulting in chronic disabilities are more likely to result from saturation, rather than non-saturation, diving.
VIII.iv.9.B.1.bDecompression Illness and AGE
In decompression illness, nearly all symptoms are present within 24 hours after the dive while some may occur within 3 hours. While many signs and symptoms resolve rapidly if treated within minutes of onset, permanent injury or disability may result even with treatment. Arterial gas emboli (AGE) are inert gas bubbles that form in the venous blood during decompression and can lodge in coronary, cerebral, or other arteries in the body with potentially catastrophic results. DCS is divided into two types, depending on the symptoms involved, and some divers experience both types. The table below describes some, but not all, of the symptoms and potential chronic effects of decompression illness and AGE.
| Diving-Related Disability | Symptoms | Potential Long-Term Effects |
|---|---|---|
Type I decompression illness | Musculoskeletal and skin symptoms constituted by pain mainly in the arm and leg joints, and/or itching, mottling, and rashes of the skin. |
|
Type II decompression illness | Symptoms involving the brain, spinal cord, and organs of special sense. Other symptoms include visual disturbances, altered mental status, respiratory symptoms, thrombus formations, or hypovolemic shock. Coma and death occur in the most extreme cases. |
|
AGE | Rupture of pulmonary alveoli, which allows gas from the lungs to enter into arterial circulation. This may result in stroke, seizure, central nervous system effects, or myocardial infarction. | Residuals such as stroke or myocardial infarction will result in chronic residuals. |
VIII.iv.9.B.1.cToxic Effects of Gases in Diving
The table below describes the conditions and associated symptoms that may be due to the toxic effects of gases when diving. Chronic disabilities may result from these responses to diving.
| Condition | Symptoms |
|---|---|
High pressure nervous/neurological syndrome (HPNS) | Dizziness, nausea, vomiting, tremors, incoordination, fatigue, somnolence, myoclonic jerking, stomach cramps, decreased intellectual performance, and disturbed sleep. |
Nitrogen narcosis (also called “narcs” or “rapture of the deep") | Resembles alcohol intoxication, with euphoria, confusion, irrational behavior, paranoia, and hallucinations. May result in coma. |
Oxygen toxicity | Muscle twitching, seizures, vision and hearing problems, and pulmonary problems such as cough or substernal burning. |
Carbon dioxide toxicity | Respiratory impairment, headaches, unconsciousness, or other neurological impairment |
Atmospheric contaminants | Acute toxic effects or subtle, unrecognized long-term toxicity |
VIII.iv.9.B.1.dPotential Long-Term Effects of Diving
Many other long-term effects may result from diving, with or without incurrence of decompression illness. The table below lists some, but not all, of the disabilities that may be associated with a history of diving.
| Body System | Possible Disabilities |
|---|---|
Musculoskeletal | Bone infarcts (dysbaric osteochondrosis), osteoarthritis |
Skin | Eczema, infection |
Ear | Chronic otitis externa, hearing loss, perforated eardrum, vestibular problems, tinnitus |
Neurological | Stroke, seizures, paralysis, weakness, peripheral neuropathy, autonomic symptoms, cognitive deficits |
Visual | Scotomas, diplopia, vision loss |
Respiratory | Airflow obstruction |
Cardiovascular | Myocardial infarction, arrhythmia, cold and heat injuries |
Psychiatric | posttraumatic stress disorder |
2Adjudication Considerations for Diving-Related Disabilities
This topic contains information on disabilities that may be related to diving, including
- examinations and medical opinions for diving-related disabilities, and
- rating residuals of diving injuries.
Revised July 29, 2021
VIII.iv.9.B.2.aExaminations and Medical Opinions for Diving-Related Disabilities
An examination with medical opinion is needed for a claim for service connection for residuals of diving if there is not sufficient competent medical evidence to decide the claim, but the record contains
- competent lay or medical evidence of a current diagnosed disability or persistent or recurrent symptoms of disability
- evidence that the Veteran has a history of diving in service or incurred a diving-related injury in service, and
- an indication that the claimed disability or symptoms may be associated with in-service diving or a diving-related injury.
Submit complex or unusual questions related to a claim for disability compensation on the basis of diving or a diving-related injury to Compensation Service for an advisory opinion. References: For more information on
- requesting medical opinions, see
- 38 CFR 3.159(c)(4)
- M21-1, Part IV, Subpart i, 2.A.7, and
- McLendon v. Nicholson, 20 Vet.App. 79 (2006), and
- requesting an advisory opinion, see M21-1, Part X, Subpart v, 1.A.2.
VIII.iv.9.B.2.bRating Residuals of Diving Injuries
In rating residuals of a diving injury, 38 CFR 4.71a, diagnostic code (DC) 5011, decompression illness, is used as it is the only DC specific to diving-related residuals. 38 CFR 4.71a, DC 5011, directs that manifestations of decompression illness should be rated under the DC appropriate to the affected body system. In service connecting any disability due to diving, use DC 5011 hyphenated with the appropriate code used for the disability evaluation. For example, eczema due to a diving injury would be rated as DC 5011-7806.Important:
- Many conditions will be reported in the service treatment records; however, some, such as bone infarcts or arthritis, do not appear immediately and may not have been reported in service.
- If there is a history of in-service diving, a diving etiology should be considered for such conditions as a bone infarct or arthritis (especially of the hip or shoulder), hearing loss, other ear or labyrinthine abnormalities, neurological conditions, and skin disorders.
- Veterans who did saturation diving during the approximate time frame of the 1960s – 1980s were at greater risk for long-term health effects as they worked under different circumstances than current military divers, who have improved techniques and safety measures.
End of Part VIII, Subpart iv, Chapter 9, Section B