VA Disability Ratings for Pleuritis

Pleuritis is a condition that affects the tissue surrounding the lungs.  If a veteran faces toxic exposure during their military service, such as exposure to burn pits, they may develop pleurisy as a result of their service.  Veterans with pleuritis may be eligible for VA disability compensation.

What is Pleuritis?

Pleuritis, or pleurisy, refers to inflammation of the tissue that lines the outside of the lungs and inside of the chest cavity.  Usually, fluid lubricates the layers of the pleura, or the tissue, so they can slide alongside each other as a person breathes.  However, when the pleura are inflamed, they can rub against each other painfully.

When a person experiences pleurisy, they may feel sharp chest pain or shortness of breath.

Causes of Pleuritis

Pleuritis can have a number of causes, and doctors are still studying to fully understand what can cause pleuritis.  Viral or bacterial infections can cause pleuritis.  Additionally, other conditions can cause pleuritis, such as:

• Lung disease
• Autoimmune disorders
• Pulmonary embolism
• Inflammatory bowel disease (IBD)
• Cancers of the respiratory system

Common Symptoms

Symptoms of pleuritis can include:

• Shortness of breath
• Extreme weight loss
• Fatigue
• Fever
• Coughing

How is Pleuritis Diagnosed?

Certain tests usually need to be performed in order for a doctor to diagnose a person with pleurisy.  These tests could include:

• A physical exam
• Imaging tests
• Blood tests
• Biopsy
• Fluid extraction of the pleural space

VA Service Connection for Pleuritis

To establish service connection for any condition, veterans usually need to submit:

• A current diagnosis;
• An in-service event, illness, injury or stressor which caused or contributed to the veteran’s condition;
• A nexus which links the veteran’s condition to their in-service stressor

Another way veterans may establish service connection for pleuritis is through secondary service connection.  Secondary service connection is a form of service connection for veterans who have a condition caused or aggravated by another service-connected condition.

For example, a veteran may develop pleuritis as the result of service-connected lupus.  The veteran can then apply for secondary service connection with pleuritis rated as secondary to lupus.

Honoring Our PACT Act and Pleuritis

The recently passed Honoring Our PACT Act has added pleuritis to the presumptive list of disabilities for “covered veterans.”  Covered veterans are typically those who were exposed to toxins, such as military burn pits, during their military service.  Under the Honoring Our PACT Act, a covered veteran is defined as one who served:

• On or after August 2, 1990, with active military, naval, air, or space service while assigned to a duty station, including the airspace above:
  • Bahrain
  • Iraq
  • Kuwait
  • Oman
  • Qatar
  • Saudi Arabia
  • Somalia
  • United States Emirates

• On or after September 11, 2001, with active military, naval, air, or space service while assigned to a duty station, including the airspace above:
  • Afghanistan
  • Djibouti
  • Eqypt
  • Jordan
  • Lebanon
  • Syria
  • Yemen
  • Uzbekistan

Pleuritis is a covered condition for veterans who meet the service requirements listed above.  This means that if a veteran has a diagnosis of pleuritis, and meet the criteria, their pleuritis should be presumed to have been caused or aggravated by burn pit exposure.

Compensation & Pension Exams for Veterans with Pleurisy

Sometimes, VA may request that a veteran seeking VA disability benefits for pleurisy undergo a Compensation & Pension (C&P) exam.  C&P exams are typically performed for two reasons: to determine if service connection is warranted and to gather evidence to establish a rating if service connection is granted.

During a C&P exam, the examiner may ask the veteran questions about their condition and physically examine them.  Since pleurisy is a respiratory condition, the examiner may also use VA Form 21-09690L-1.

This form is a Disability Benefits Questionnaire (DBQ) for respiratory conditions.  The form can be used by a veteran’s treating doctor to provide more information about the impact of their disability, or by a C&P examiner to gather more evidence about the condition.

For example, the respiratory conditions DBQ includes sections to provide information about the veteran’s diagnosis, treatment, medical history, symptoms, and more.

How Does VA Rate the Condition?

Although pleuritis is listed under Diagnostic Code 6732 under 38 CFR § 4.97, Schedule of ratings for respiratory system, the rating instruction is for VA raters to use § 4.88c or 4.89, whichever is appropriate.

Specifically, § 4.88c instructs VA’s raters to assign a 100 percent for one year following the date of inactivity after active tuberculosis.  It also instructs the raters to rate the residuals under the specific body system or systems affected.  This rating is specifically for inactive nonpulmonary tuberculosis initially entitled after August 19, 1968.

VA uses § 4.89 to rate inactive nonpulmonary tuberculosis in effect on August 19, 1968.  The ratings under this diagnostic code are as follows:

• 100% – This rating is assigned for two years after the date of inactivity, following active tuberculosis, which was clinically identified during service or subsequently
• 50% – The 50 percent rating is assigned for four years thereafter, or in any event, to 6 years after the date of inactivity
• 30% – This rating is assigned thereafter, for five years, or to 11 years after the date of inactivity
• 0% – The 0 percent rating is assigned thereafter, in the absence of a schedular compensable permanent residual.

After the two-year rating, VA rates based on the residuals of non-pulmonary tuberculosis with the appropriate diagnostic code.

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VA may also rate pleurisy using Diagnostic Code 6845 in 38 CFR § 4.97.  This code is for chronic pleural effusion or fibrosis.  For this code, VA uses the General Rating for Restrictive Lung Disease, which is as follows:

• 100%
  • FEV-1 less than 40 percent of predicted value; OR
  • The ratio of Forced Expiratory Volume in one second to Forced Vital Capacity (FEV-1/FVC) less than 40 percent; OR
  • Diffusion Capacity of the Lung for Carbon Monoxide by the Single Breath Method (DLCO(SB)) less than 40 percent predicted; OR
  • Maximum exercise capacity less than 15 ml/kg/min oxygen consumption (with cardiac or respiratory limitation); OR
  • Cor pulmonale (right heart failure); OR right ventricular hypertrophy; OR
  • Pulmonary hypertension (shown by Echo or cardiac catheterization); OR
  • Episode(s) of acute respiratory failure; OR
  • Requires outpatient oxygen therapy
• 60%
  • FEV-1 of 40 to 55 percent predicted; OR
  • FEV-1/FVC of 40 to 55 percent; OR
  • DLCO (SB) or 40 to 55 percent predicted; OR
  • Maximum oxygen consumption of 15 to 20 ml/kg/min (with cardiorespiratory limit)
• 30%
  • FEV-1 of 56 to 70 percent predicted; OR
  • FEV-1/FVC of 56 to 70 percent; OR
  • DLCO (SB) 56 to 65 percent predicted
• 10%
  • FEV-1 of 71 to 80 percent predicted; OR
  • FEV-1/FVC of 71 to 80 percent; OR
  • DLCO (SB) 66 to 80 percent predicted

Importantly, under this rating criteria, a 100 percent rating is instructed to be assigned to veterans for pleurisy with empyema, with or without pleurocutaneous fistula, until resolved.

How to Get Help with VA Disability Benefits

If you are a veteran fighting for VA disability benefits, the experienced veterans’ advocates at Chisholm Chisholm & Kilpatrick may be able to help.  Our talented team members can help write persuasive arguments, gather evidence, and even submit documentation to VA on your behalf, easing the stress of the appeal process.  Call our office today for a free case evaluation.