Asthma & COPD: VA Rating Criteria

Plain-language guide

What this rating actually turns on

For asthma, the controller inhaler in your medicine cabinet can outrank your breathing test. Bronchial asthma (DC 6602) and COPD (DC 6604) both sit under 38 CFR 4.97 and both run the ladder 10 / 30 / 60 / 100, but they turn on different things. COPD is purely a numbers game: pulmonary function. Asthma has two independent axes, pulmonary function and medication, and the criteria at each level are joined by “or,” so you qualify for a level by meeting any single listed criterion. VA assigns whichever level your worst-qualifying fact reaches, which means the medication prong alone can carry the rating even when your spirometry looks good.

Asthma (6602): 10 percent for FEV-1 of 71–80 percent predicted, or FEV-1/FVC of 71–80 percent, or intermittent inhalational or oral bronchodilator therapy; 30 percent for FEV-1 of 56–70 percent, or FEV-1/FVC of 56–70 percent, or daily inhalational or oral bronchodilator therapy, or inhalational anti-inflammatory medication; 60 percent for FEV-1 of 40–55 percent, or FEV-1/FVC of 40–55 percent, or at least monthly visits to a physician for required care of exacerbations, or intermittent (at least three per year) courses of systemic (oral or parenteral) corticosteroids; 100 percent for FEV-1 less than 40 percent, or FEV-1/FVC less than 40 percent, or more than one attack per week with episodes of respiratory failure, or daily use of systemic high-dose corticosteroids or immuno-suppressive medications. The most-missed line is the 30 percent medication prong: a daily inhaled anti-inflammatory (an inhaled corticosteroid like fluticasone or budesonide, the standard controller inhaler) meets 30 percent outright, no matter what your PFTs say.

COPD (6604) has no medication prong. It is 10 percent for FEV-1 of 71–80 percent predicted, FEV-1/FVC of 71–80 percent, or DLCO(SB) of 66–80 percent; 30 percent for FEV-1 of 56–70 percent, FEV-1/FVC of 56–70 percent, or DLCO of 56–65 percent; 60 percent for FEV-1 of 40–55 percent, FEV-1/FVC of 40–55 percent, DLCO of 40–55 percent, or maximum oxygen consumption of 15–20 ml/kg/min; and 100 percent for FEV-1 less than 40 percent, FEV-1/FVC less than 40 percent, DLCO less than 40 percent, maximum exercise capacity less than 15 ml/kg/min, cor pulmonale, right ventricular hypertrophy, pulmonary hypertension, an episode of acute respiratory failure, or a requirement for outpatient oxygen therapy.

A worked example

A veteran with qualifying PACT Act service files for asthma that set in after a year around the burn pits at Balad. Her C&P spirometry actually looks respectable: post-bronchodilator FEV-1 comes back at 78 percent predicted, which on the numbers alone sits in the 10 percent band. But the examiner also records what keeps her that stable, a daily dose of fluticasone, an inhaled corticosteroid controller she has taken every morning for three years, backed by her pharmacy refill history. Under DC 6602 the criteria at each level are joined by “or,” and daily inhalational anti-inflammatory medication is its own 30 percent criterion, independent of any breathing test. So VA assigns the level her worst-qualifying fact reaches: not the 10 percent her spirometry suggests, but 30 percent on the medication prong. Had the DBQ listed only her FEV-1 and left the controller inhaler off, she would have been rated at a third of what the regulation actually owes her. See the pay table on this page for what 30 percent pays once it combines with your other ratings.

What the C&P exam measures

The examiner completes the Respiratory Conditions (other than Tuberculosis and Sleep Apnea) DBQ (VA Form 21-0960L-1) and orders spirometry. How the numbers get read is set by 38 CFR 4.96(d): post-bronchodilator studies are required for disability PFTs, except when the pre-bronchodilator results are normal or the examiner documents why post-bronchodilator testing was not done. If the post-bronchodilator numbers come out worse than the pre-bronchodilator numbers, VA uses the pre-bronchodilator values, whichever is worse for you governs. When FEV-1, FEV-1/FVC, and DLCO point to different levels, the rater uses the test result the examiner states most accurately reflects your disability. One nuance that cuts in your favor: that post-bronchodilator mandate in 4.96(d) is written for codes 6600, 6603, 6604, 6825–6833, and 6840–6845, and 6602 asthma is not on that list, so for asthma pre-bronchodilator values can be argued. For asthma the DBQ also records your medication regimen, exacerbation visits, and systemic steroid history, which map straight onto the medication prongs above.

What to have in your file

Per VA’s evidence requirements:

• The pharmacy and prescription record proving your inhaler regimen and whether it is daily or intermittent, this is the line between 10 and 30 percent for asthma, so a daily controller inhaler needs to be unambiguous in the notes.
• PFT reports with both pre- and post-bronchodilator values, so the rater can apply the 4.96(d) worse-of rule correctly, and DLCO for COPD.
• Dated records of systemic corticosteroid courses (prednisone bursts): three or more in a year is an express 60 percent pathway for asthma, and monthly physician visits for exacerbations is another.
• For asthma diagnosed after service, evidence of qualifying service for the PACT Act presumption, otherwise a nexus opinion; plus lay statements (VA Form 21-10210) on attack frequency, rescue-inhaler use, and missed work.

Common mistakes

• Rating asthma on PFTs alone. A veteran on a daily inhaled corticosteroid is a 30 percent claim by the medication prong even with near-normal spirometry. Many settle for 10 because their numbers “looked fine,” make sure the controller regimen is in the DBQ.
• Not documenting steroid bursts. Three or more systemic (oral or parenteral) corticosteroid courses per year is a stated 60 percent pathway that gets left out because the bursts happened at urgent care, not the VA.
• Expecting separate asthma and COPD ratings. Under 38 CFR 4.96(a), ratings within DCs 6600–6817 and 6822–6847 are not combined with each other; coexisting asthma and COPD get a single rating under the predominant disability, with possible elevation to the next level, not two stacked ratings.
• Missing the pre-bronchodilator reading. If the bronchodilator improved your numbers, the better post-bronchodilator figure is what governs unless the pre-bronchodilator figure is worse and on file. Make sure both are recorded.

Worth knowing

Asthma (diagnosed after service), chronic rhinitis, and chronic sinusitis are PACT Act presumptive conditions for Gulf War era veterans who served on or after August 2, 1990 in the covered Southwest Asia locations and for post-9/11 veterans who served on or after September 11, 2001 in the covered locations. If that fits your service, VA presumes the burn-pit or toxic exposure and the connection, so you need only a current diagnosis and proof of qualifying service. Our PACT Act guide covers the locations and the filing path. Note the asthma note in the schedule: in the absence of clinical findings of asthma at the exam, a verified history of asthmatic attacks must be of record, so if your asthma is well-controlled the day of the C&P, the documented history is what saves the claim. The calculator on this site combines whatever percentage you land on with your other ratings.

If your rating came back lower than this

A decision that ignores the criteria above is a frequent reason veterans are underpaid. Line your decision up against the levels on this page. If the evidence supports a higher level than VA assigned, you have three ways to challenge it, and the right one depends on why it went wrong:

• Something was missing from the record (an exam finding, a prescription, a flare-up statement, a nexus letter): add it with a Supplemental Claim.
• The evidence was already there and VA misread it: ask for a Higher-Level Review by a more senior rater, with no new evidence needed.
• A legal or judgment error: take it to the Board of Veterans' Appeals.

Before you file, recombine this rating with your others (VA math does not add ratings), check how long each lane is taking right now, and remember a VA-accredited representative or VSO will help you for free. You can also browse every other condition's criteria to make sure you are claiming everything you are owed.