Pulmonary Function Tests for VA Disability: Ratings and Exceptions

The VA rates most lung conditions using pulmonary function tests for VA disability claims, and the numbers those tests produce (FEV-1, FEV-1/FVC ratio, DLCO, and in some cases FVC) place a veteran at a 10%, 30%, 60%, or 100% rating. The criteria are joined by “or,” so whichever qualifying value is worst usually controls the rating. A handful of regulatory rules decide which number the VA actually applies, and knowing them is often the difference between a low rating and an accurate one.

The Numbers the VA Cares About

A pulmonary function test is a non-invasive breathing exam, typically 45 to 90 minutes, repeated at least three times to capture the veteran’s best effort.1Veterans Health Library. Pulmonary Function Tests Three measurements do the work in a VA rating:

  • FEV-1 (Forced Expiratory Volume in one second): how much air you can force out in the first second of exhaling. The primary indicator of airway obstruction.
  • FEV-1/FVC ratio: the share of your total exhaled air (FVC, Forced Vital Capacity) that comes out in that first second. A low ratio signals obstructive disease.
  • DLCO (Diffusing Capacity of the Lung for Carbon Monoxide): how efficiently oxygen crosses from your lungs into your bloodstream. Especially important for restrictive diseases like pulmonary fibrosis.

Each result is reported as a percentage of the predicted value for someone of your age, sex, height, and ethnicity, currently calculated using the Global Lung Function Initiative 2012 reference equations.2U.S. Medicine. Removing Race From Lung Function Equations Shifts Disease Classifications

Ratings for COPD, Chronic Bronchitis, and Emphysema

Chronic bronchitis (DC 6600), pulmonary emphysema (DC 6603), and COPD (DC 6604) share one rating table under 38 CFR § 4.97. Restrictive lung diseases under DCs 6840–6845 use the same FEV-1, FEV-1/FVC, and DLCO thresholds.3eCFR. 38 CFR 4.97 – Schedule of Ratings, Respiratory System

  • 10%: FEV-1 71–80% predicted, or FEV-1/FVC 71–80%, or DLCO (SB) 66–80% predicted.
  • 30%: FEV-1 56–70% predicted, or FEV-1/FVC 56–70%, or DLCO (SB) 56–65% predicted.
  • 60%: FEV-1 40–55% predicted, or FEV-1/FVC 40–55%, or DLCO (SB) 40–55% predicted, or maximum oxygen consumption of 15–20 ml/kg/min with cardiorespiratory limitation.
  • 100%: FEV-1 less than 40% predicted, or FEV-1/FVC less than 40%, or DLCO (SB) less than 40% predicted, or maximum exercise capacity less than 15 ml/kg/min, or cor pulmonale, right ventricular hypertrophy, pulmonary hypertension shown by echocardiogram or catheterization, episodes of acute respiratory failure, or a requirement for outpatient oxygen therapy.

Ratings for Interstitial Lung Disease

Interstitial fibrosis, pneumoconiosis, asbestosis, and related conditions (DCs 6825–6833) drop FEV-1 and rely on FVC and DLCO:3eCFR. 38 CFR 4.97 – Schedule of Ratings, Respiratory System

  • 10%: FVC 75–80% predicted, or DLCO (SB) 66–80% predicted.
  • 30%: FVC 65–74% predicted, or DLCO (SB) 56–65% predicted.
  • 60%: FVC 50–64% predicted, or DLCO (SB) 40–55% predicted, or maximum exercise capacity 15–20 ml/kg/min.
  • 100%: FVC less than 50% predicted, or DLCO (SB) less than 40% predicted, or maximum exercise capacity less than 15 ml/kg/min, or cor pulmonale, pulmonary hypertension, or a requirement for outpatient oxygen therapy.

Ratings for Asthma

Bronchial asthma (DC 6602) is rated on PFT results or treatment requirements, whichever yields the higher evaluation:4Cornell Law Institute. 38 CFR 4.97 – Schedule of Ratings, Respiratory System

  • 10%: FEV-1 71–80% predicted, or FEV-1/FVC 71–80%, or intermittent use of an inhaled or oral bronchodilator.
  • 30%: FEV-1 56–70% predicted, or FEV-1/FVC 56–70%, or daily inhalational or oral bronchodilator therapy, or daily inhalational anti-inflammatory medication.
  • 60%: FEV-1 40–55% predicted, or FEV-1/FVC 40–55%, or at least monthly physician visits for exacerbations, or at least three courses of systemic corticosteroids per year.
  • 100%: FEV-1 less than 40% predicted, or FEV-1/FVC less than 40%, or more than one attack per week with episodes of respiratory failure, or daily use of systemic high-dose corticosteroids or immunosuppressive medications.

Asthma also gets special treatment on bronchodilator testing. The post-bronchodilator rule at 38 CFR § 4.96(d)(4) does not explicitly cover DC 6602, so the Board of Veterans’ Appeals uses whichever PFT result, pre- or post-bronchodilator, produces the more favorable rating.5VA Board of Veterans’ Appeals. Citation Nr: 20077818

How the VA Decides Which Number Controls

The tables above look straightforward until multiple values point to different ratings. Several rules in 38 CFR § 4.96 decide what happens then.6eCFR. 38 CFR 4.96 – Special Provisions Regarding Evaluation of Respiratory Conditions

Post-Bronchodilator Results Usually Win

For DCs 6600, 6603, 6604, 6825–6833, and 6840–6845, the VA uses post-bronchodilator results, meaning the values recorded after you inhale a medication that opens the airways. If pre-bronchodilator results are actually worse than post-bronchodilator results, the VA uses the pre-bronchodilator values instead.

When PFT Results Disagree With Each Other

FEV-1, FVC, and DLCO often point to different rating levels on the same test. When that happens, 38 CFR § 4.96(d)(6) requires the examiner to identify which result “most accurately reflects the level of disability.”7Cornell Law Institute. 38 CFR 4.96 – Special Provisions Regarding Evaluation of Respiratory Conditions The Board of Veterans’ Appeals looks at whether the chosen result matches the veteran’s clinical picture, including documented symptoms, treatment requirements, and whether conditions like pulmonary hypertension or oxygen dependence are present.8VA Board of Veterans’ Appeals. Citation Nr: 1544668 Where two examiners have picked different metrics, the Board has remanded the claim for an addendum opinion reconciling them with explicit reasoning.9VA Board of Veterans’ Appeals. Citation Nr: A22001689

The FEV-1/FVC Ratio Floor

If both your FEV-1 and FVC are above 100% of predicted, the VA will not assign a compensable rating based only on a low FEV-1/FVC ratio. That one is easy to miss.

When PFTs Are Not Required at All

Certain findings skip PFTs entirely and support a 100% rating under most respiratory codes: a maximum exercise capacity of 20 ml/kg/min or less, a diagnosis of pulmonary hypertension or cor pulmonale or right ventricular hypertrophy, one or more episodes of acute respiratory failure, or a requirement for outpatient oxygen therapy.6eCFR. 38 CFR 4.96 – Special Provisions Regarding Evaluation of Respiratory Conditions If any of those is documented, PFT numbers no longer drive the outcome.

Exercise Capacity When PFTs Understate the Impairment

Maximum oxygen consumption (VO2 max) provides an alternative route to 60% or 100%. A VO2 max of 15–20 ml/kg/min with cardiorespiratory limitation supports 60%; less than 15 ml/kg/min supports 100%.3eCFR. 38 CFR 4.97 – Schedule of Ratings, Respiratory System Direct measurement needs specialized equipment most VA facilities lack, so examiners sometimes convert from metabolic equivalents using VO2 max = METs × 3.5. In one Board decision, a veteran received a 100% rating based on a calculated VO2 max of 14.35 ml/kg/min derived from 4.1 METs on an exercise tolerance test.10VA Board of Veterans’ Appeals. Citation Nr: 0303277

Only One Respiratory Rating, Even With Multiple Conditions

Veterans with more than one lung condition often expect stacked ratings. The VA does not allow that. Under 38 CFR § 4.96(a), ratings for DCs 6600–6817 and 6822–6847 cannot be combined. The VA assigns a single rating based on the predominant disability, elevated to the next higher level if the overall severity warrants it. A veteran with both COPD and interstitial lung disease receives one respiratory rating, not two.

What the C&P Examiner Has to Document

When you file a respiratory claim, the VA schedules a Compensation and Pension exam. The examiner records findings on a standardized Disability Benefits Questionnaire that requires pre- and post-bronchodilator results for FVC, FEV-1, FEV-1/FVC, and DLCO, and requires the examiner to identify which of those results most accurately reflects your disability.11VA Benefits Administration. Respiratory Conditions DBQ The examiner also has to log your medication history (corticosteroids, bronchodilators, antibiotics, immunosuppressives, oxygen), record clinical indicators tied to the diagnosis, and describe how the condition affects your ability to work. If the DLCO test is skipped, the examiner must explain why it would not be useful or valid, and if PFT results do not accurately reflect functional impairment, the examiner must say so.

The 2026 Medication Rule

An interim final rule took effect on February 17, 2026, amending 38 CFR § 4.10 to say that examiners “will not estimate or discount improvements to the disability due to the effects of medication or treatment.”12Federal Register. Evaluative Rating Impact of Medication The rule responded to the U.S. Court of Appeals for Veterans Claims decision in Ingram v. Collins, 38 Vet. App. 130 (2025), which held that examiners should estimate how a disability would present without medication. The VA called that standard impractical “prognostication” and moved to overrule it.

For respiratory claims, the effect is straightforward: if bronchodilators improve your PFT results, the improved numbers are what the VA uses. There is no attempt to imagine what the untreated lung would look like. Public comments were accepted through April 20, 2026.

If the Rating Comes Out Too Low

Three formal decision review paths are available. A Supplemental Claim lets you submit new and relevant evidence, such as updated PFT results or a fresh medical opinion. A Higher-Level Review asks a senior reviewer to reexamine the existing record without new evidence. An appeal to the Board of Veterans’ Appeals sends the case to a Veterans Law Judge.13VA. VA Decision Reviews and Appeals Accredited attorneys, claims agents, and Veterans Service Organization representatives can help with any of them. When PFT values are borderline, or when the examiner picked a metric that doesn’t match your clinical picture, one of these routes is usually where the rating gets corrected.