Understanding Respiratory Conditions Among Veterans
Breathing conditions significantly impact your quality of life, independence, and ability to pursue daily activities. Military service, particularly exposure to chemical agents, burn pits, asbestos, toxins, or particulate matter, may result in respiratory diseases, such as asthma and sleep apnea.
Medical evidence is key to reflecting your condition accurately. Thorough documentation by respiratory specialists supports Department of Veterans Affairs (VA) evaluations, clearly demonstrating your health conditions and their severity.
Common Respiratory Conditions & How to Document Them
The VA rates respiratory conditions under Diagnostic Codes 6600–6847 (38 CFR Part 4). Common conditions include:
Asthma (Diagnostic Code 6602)
Medical Evidence Needed:
- Pulmonary Function Tests (PFTs): Pre- and post-bronchodilator Forced Expiratory Volume in 1 second (FEV1), Forced Vital Capacity (FVC), and FEV1/FVC results.
- Documentation of severity, frequency, and duration of attacks.
- Records showing use of inhaled or oral corticosteroids, emergency visits, or hospitalizations.
- Allergy or pulmonology specialist notes regarding medication effectiveness.
Chronic Obstructive Pulmonary Disease: COPD, Emphysema, Chronic Bronchitis (Diagnostic Codes 6600, 6603, 6604)
Medical Evidence Needed:
- Complete PFT results, including FEV1, FVC, FEV1/FVC ratio, and DLCO (Diffusion capacity for carbon monoxide).
- Chest imaging (X-ray, CT scan) showing structural lung changes.
- Records documenting oxygen therapy, severity of breathing difficulty, and frequency of hospitalizations or exacerbations.
- Evaluation notes from pulmonologist detailing medication regimen and effectiveness.
Sleep Apnea (Diagnostic Code 6847)
Medical Evidence Needed:
- Polysomnography (sleep study) documenting apnea-hypopnea index (AHI), oxygen desaturation, and arousal indices.
- Documentation of prescribed treatments (CPAP/BiPAP), compliance data, and physician notes indicating residual daytime symptoms.
- Specialist (ENT or sleep specialist) evaluations highlighting associated symptoms and functional impairment.
Related Guide: Sleep Apnea VA Rating: A Comprehensive Guide for Veterans
Restrictive Lung Diseases—Pulmonary Fibrosis, Asbestosis, Pneumoconiosis (Diagnostic Codes 6830-6833)
Medical Evidence Needed:
- PFTs indicating reduced Total Lung Capacity (TLC), FVC, and impaired DLCO.
- High-resolution CT imaging showing fibrosis, scarring, or nodules.
- History clearly documenting exposure to asbestos or harmful particles during service.
- Pulmonologist’s opinion detailing severity, progression, and functional limitations.
Respiratory Cancers (Diagnostic Code 6819)
Medical Evidence Needed:
- Pathology reports diagnosing malignancy.
- Imaging studies indicating extent of disease.
- Documented treatments such as surgery, chemotherapy, and radiation therapy, including ongoing or completed treatments.
- Notes from oncologist or pulmonologist outlining prognosis and impact on lung function.
Essential Medical Evidence Checklist
Your documentation forms the cornerstone of accurate evaluations:
- Formal Diagnoses: Clearly stated with ICD-10 codes.
- Pulmonary Function Testing: Complete and current PFT results (FEV1, FVC, DLCO, TLC).
- Bronchodilator Response Testing: Pre- and post-bronchodilator readings.
- Oxygen Saturation: At rest and after exertion, clearly documented.
- Specialist Evaluations: Pulmonary, allergy, or sleep medicine specialists.
- Detailed Medications: List doses, frequencies, and response for inhalers, oral steroids, and oxygen therapy.
- Exacerbation Records: Evidence from hospitalizations, ER visits, urgent care, or clinical visits.
- Imaging Studies: X-rays, CT scans, MRIs with clear interpretations.
- Functional Assessments: Documentation highlighting daily activities, exertional limitations, sleep impacts, and occupational restrictions.
- Historical Documentation: Service exposure history clearly outlining chemicals, particulates, or environmental inhalants encountered during military service
Common Secondary Conditions Linked to Respiratory Conditions
Respiratory disorders often affect other body systems, potentially generating secondary health issues including:
- Cardiovascular Conditions: Increased lung strain can lead to right-sided heart enlargement (cor pulmonale), pulmonary hypertension, and heart failure. Document cardiology workups, echocardiograms, and specialist assessments clearly.
- Mental Health Disorders: Chronic respiratory illness contributes significantly to depression and anxiety due to activity limitations and constant fear of breathing emergencies. Include mental health evaluations clearly linking respiratory symptoms to these psychological impacts.
- Fatigue & Sleep Quality: Disrupted oxygenation and poor sleep lead to fatigue and reduced daily functioning. Clearly document sleep studies and functional limitation impacts.
- Gastroesophageal Reflux Disease (GERD): Increased coughing severity may exacerbate or derive from GERD. Document GI evaluations indicating symptom relationships.
Examples of Documentation Quality
Weak Asthma Example:
“Patient has asthma. Uses inhaler occasionally. Recommend follow-up.”
Strong Asthma Example:
“Definitive asthma diagnosis (J45.40). Recent PFT (April 2024): FEV1 pre-bronchodilator 62%, improves post-bronchodilator to 78%. Maintenance medication includes daily fluticasone/salmeterol (250/50mcg) and montelukast 10mg nightly. Albuterol required for rescue 4–5 times weekly. Documented exacerbation requiring ER treatment and systemic steroids (prednisone 50mg), most recent Nov 2023. Pulmonary consult notes ongoing limitation: difficulty performing simple activities like stair climbing or prolonged walking.”
Understanding Pulmonary Function Test (PFT) Values
| PFT Measurement | Normal | Mild impairment | Moderate impairment | Severe impairment |
| FEV1 (% predicted) | ≥80% | 70–79% | 50–69% | <50% |
| FEV1/FVC Ratio | ≥70% | 60–69% | 50–59% | <50% |
| DLCO (% predicted) | ≥80% | 66–79% | 56–65% | <56% |
| TLC (% predicted) | ≥80% | 70–79% | 60–69% | <60% |
Respiratory Symptom Tracking Template
Date: _______________
Symptoms:
- Shortness of Breath (severity 0–10): Morning __ Afternoon __ Evening __
- Cough (frequency/severity): _______________
- Activities that Triggered Breathing Issues: _______________
- Oxygen Usage (flow rate and duration): _______________
- Rescue Inhaler Usage: _______________
Functional Impacts:
- Walking Distance Before Breathlessness: _______________
- Tasks Limited by Breathing: _______________
- Nighttime Sleep Disruption: _______________
- Medications Taken Today: _______________
Secondary Symptoms:
- Anxiety (severity 0–10): _______________
- Fatigue (severity 0–10): _______________
- Chest Tightness: _______________
- Other Notes: _______________
Questions to Ask Your Healthcare Provider
Consider asking your medical specialist to include:
- “Could you clearly document my pulmonary function test results pre- and post-bronchodilator?”
- “Please document how often and severely my respiratory exacerbations impact daily tasks.”
- “Clearly note how my breathing impacts my daily activities, sleep, and work responsibilities.”
- “Would you include clear documentation of medication usage, doses, and effectiveness in managing my symptoms?”
Medical Terminology Quick Reference
- Dyspnea: Shortness or difficulty breathing.
- Hypoxemia: Low oxygen levels in blood.
- Paroxysmal Nocturnal Dyspnea (PND): Sudden nighttime breathlessness.
- Cor Pulmonale: Right-sided heart enlargement due to lung disease.
- Apnea-Hypopnea Index (AHI): Number of sleep apnea events per hour during sleep.
- Bronchodilator: Medication expanding airways to ease breathing.
- Corticosteroids: Anti-inflammatory medications commonly used in respiratory diseases.
- DLCO: Test measuring oxygen transfer from lungs to blood.
- FEV1: Forced Expiratory Volume in 1 second, a key airflow measurement.
Documenting Your Health Accurately
Your medical documentation reflects your health condition accurately, enabling proper VA evaluations. You always retain control over your documentation process. Consult appropriate medical and legal professionals regarding your health needs.
Disclaimer:
This information is educational only and does not constitute legal advice. We do not prepare or prosecute VA claims. Each individual’s case may differ, and you should consult qualified professionals for personalized advice and support.
