Chronic Bronchitis is a respiratory condition characterized by persistent inflammation and irritation of the bronchial tubes, resulting in a daily, productive cough lasting at least three months per year for two consecutive years. For Veterans, service connection for this condition has been significantly impacted by recent legislation.
This detailed guide outlines the criteria used by the Department of Veterans Affairs (VA) to evaluate and rate Chronic Bronchitis, including its status as a presumptive condition under the PACT Act and the required medical evidence.
Establishing Service Connection for Chronic Bronchitis
To receive VA disability compensation, a Veteran must establish service connection. This is achieved through one of three pathways: Direct Connection, Secondary Connection, or Presumptive Connection.
The PACT Act: Presumptive Service Connection
The Sergeant First Class Heath Robinson Honoring Our PACT Act of 2022 designated Chronic Bronchitis as a presumptive service-connected condition for Veterans who meet specific criteria related to toxic exposure.
To qualify for presumption, a Veteran must have:
- A current diagnosis of Chronic Bronchitis.
- Service in a qualifying area during a designated time period, generally including deployment to:
- Southwest Asia (including Iraq, Afghanistan, the Persian Gulf, and surrounding waters) on or after August 2, 1990.
If these criteria are met, the VA automatically presumes that the Veteran’s military service caused the Chronic Bronchitis, eliminating the need for the Veteran to provide a complex medical nexus opinion.
1. Direct Service Connection (Non-Presumptive)
For Veterans whose service location or time frame does not fall under the PACT Act presumption, service connection is established by providing:
- A current medical diagnosis of Chronic Bronchitis.
- Evidence of an in-service event, injury, or exposure (e.g., documented exposure to airborne irritants, industrial solvents, or heavy dust) that caused or aggravated the condition.
- A medical nexus opinion linking the current disability to the in-service event.
2. VA Rating Criteria: Diagnostic Code 6600
Chronic Bronchitis is evaluated under 38 CFR § 4.97, Diagnostic Code (DC) 6600 for Respiratory Conditions (Bronchitis, chronic). Ratings are assigned at 10%, 30%, 60%, or 100% and are based primarily on objective evidence from Pulmonary Function Tests (PFTs).
Evaluation Based on Pulmonary Function Tests (PFTs)
PFTs, such as spirometry, measure the flow and volume of air that passes through the lungs. The key values used for rating Chronic Bronchitis are:
- FEV-1: Forced Expiratory Volume in 1 second (the volume of air exhaled in the first second of forced exhalation).
- FEV-1/FVC: The ratio of FEV-1 to Forced Vital Capacity (FVC is the total volume of air exhaled during a forced breath).
| VA Disability Rating | PFT Criteria (FEV-1 or FEV-1/FVC % Predicted Value) | Other Clinical Criteria |
| 100% | Less than 40% of predicted value | Requires continuous use of outpatient oxygen therapy, or is characterized by one or more episodes of acute respiratory failure per year. |
| 60% | 40% to 55% of predicted value | Requires the use of systemic (oral or injected) corticosteroids or immunosuppressive medications 3 or more times per year. |
| 30% | 56% to 70% of predicted value | Requires daily use of an inhaled or oral bronchodilator, or inhaled anti-inflammatory medication. |
| 10% | 71% to 80% of predicted value | Requires intermittent use of an inhaled or oral bronchodilator. |
Note on Incapacitating Episodes (IEs): In some cases, DC 6600 allows for an alternative rating based on the total duration of incapacitating episodes per year. An IE is defined as a period that requires bed rest and treatment by a physician.
3. Secondary Service Connection Pathways and Rating Criteria
Claiming conditions as secondary disabilities (meaning they are caused or aggravated by the service-connected Chronic Bronchitis) is a possible legal pathway.
A. Gastroesophageal Reflux Disease (GERD)
Chronic, forceful coughing caused by Chronic Bronchitis significantly increases intra-abdominal pressure, which can force stomach acid up the esophagus, leading to or aggravating GERD. This acid aspiration, in turn, can further irritate the bronchial airways, creating a cycle of symptoms.
- Nexus Theory: The chronic physical strain of the bronchitis-related cough is the proximate cause for the development or aggravation of GERD.
- VA Diagnostic Code (DC): GERD is rated under the current standard, DC 7206 (Gastroesophageal Reflux Disease), with the rating based on the severity of symptoms and the presence of esophageal stricture (narrowing of the esophagus).
VA Disability Rating GERD Rating Criteria
| 80% | Documented history of recurrent or refractory esophageal stricture(s) causing dysphagia (difficulty swallowing) with aspiration, undernutrition, or substantial weight loss requiring surgical correction or feeding tube placement. |
| 50% | Recurrent or refractory esophageal stricture(s) causing dysphagia which requires: dilation 3 or more times per year, dilation using steroids at least once per year, or esophageal stent placement. |
| 30% | Recurrent esophageal stricture(s) causing dysphagia which requires dilation no more than 2 times per year. |
| 10% | Documented history of esophageal stricture(s) that requires daily medication to control dysphagia, otherwise asymptomatic. |
| 0% | Documented history without daily symptoms or requirement for daily medications. |
B. Obstructive Sleep Apnea (OSA)
The underlying lung inflammation, decreased lung volume, and poor oxygen saturation associated with Chronic Bronchitis can worsen breathing patterns, contributing to the severity of Obstructive Sleep Apnea (OSA).
- Nexus Theory: The respiratory impairment from service-connected Chronic Bronchitis is a pathological mechanism that contributes to the severity or onset of OSA.
- VA Diagnostic Code (DC): OSA is rated under DC 6847 (Sleep Apnea Syndromes), with the rating primarily determined by the treatment required.
VA Disability Rating Obstructive Sleep Apnea Rating Criteria
| 100% | Requires a tracheostomy; OR chronic respiratory failure with carbon dioxide retention; OR cor pulmonale (right-sided heart failure). |
| 50% | Requires the use of a breathing assistance device such as a Continuous Positive Airway Pressure (CPAP) machine. |
| 30% | Characterized by persistent daytime hypersomnolence (excessive daytime sleepiness) that is medically documented but does not require a breathing assistance device. |
| 0% | Documented sleep disorder breathing that is asymptomatic (no symptoms). |
Required Documentation for a Complete Claim
A thoroughly documented claim is essential for a proper VA evaluation:
- Medical Records: All physician and specialist notes detailing the diagnosis, severity, frequency of exacerbations, and required treatment (e.g., inhalers, oxygen).
- C&P Examination: The Veteran must attend the Compensation and Pension (C&P) exam scheduled by the VA, which will include the mandated PFTs for rating purposes.
- Nexus Opinion (if non-presumptive or for secondary claims): A statement from a qualified physician asserting that the Chronic Bronchitis or the secondary condition is “at least as likely as not” related to service or to an existing service-connected condition.
- Lay Evidence (Veteran’s Statement): A detailed account of how the symptoms (coughing, shortness of breath, fatigue, chest pain) limit the Veteran’s occupational and social functioning. This evidence provides context for the objective PFT scores.
Ready to Take the Next Step?
If you’re ready to pursue the benefits you are medically, legally, and ethically eligible for, or if you have questions about building your medical evidence, schedule a free consultation with our team. There’s no upfront cost, and you remain in complete control of your benefits journey.
