Veteran (VA) Disability Ratings for Sarcoidosis
What is Sarcoidosis?
Sarcoidosis is a disease that causes inflammation of the body tissues and leads to small lumps called granulomas. This condition can affect any organ in the body, but often starts in the lungs and lymph nodes. Between 10 and 40 in every 100,000 people in the United States have sarcoidosis. While this condition can affect people of all ages, it most commonly occurs in those who are between 20 and 40 years old. Symptoms of sarcoidosis include the following:
- General feeling of discomfort, fatigue, and ill health
- Night sweats and fever
- Weight loss and decreased appetite
- Small, red bumps that appear on the arms, buttocks, or face
- Eyes that are watery and red
- Arthritis in various joints, including the elbows, ankles, hands, and wrists
- Dry cough and wheezing
- Tightness in chest and shortness of breath
Treatment can be done to help relieve symptoms, reduce inflammation, and prevent damage. Such treatment typically includes medications that can either be inhaled or taken in pill form (e.g. Prednisone, Azathioprine, Cyclophosphamide).
Research on Sarcoidosis in the Military Population
Research conducted by the United States Navy and Centers for Disease Control and Prevention (CDC) found that there was an unexpectedly higher number of sarcoidosis cases in military employees who served aboard aircraft carriers. This prompted further studies, which were performed by the Naval Health Resource Center (NHRC) and the Armed Forces Institute of Pathology (AFIP). The NHRC and AFIP examined reported cases among enlisted Navy employees between 1975 and 2001. Specifically, the groups looked at the relationship between duties performed onboard naval ships and employees hospitalized for sarcoidosis. Results of the studies indicated the following:
- There was an increased rate of sarcoidosis in certain groups of enlisted employees who worked on aircraft carriers, including aviation structural mechanics, barbers, those who operated dry cleaning and laundry equipment, and mess management specialists.
- There was a possible association between exposure to deck-grinding abrasives and the occurrence of sarcoidosis.
- There was a decline in the number of diagnosed sarcoidosis cases in the Navy since the mid-1970s.
Additional research is needed to further assess military occupational and work environments in a more detailed manner in order to gain a better understanding and identify preventable measures for future servicemembers.
Service Connection for Sarcoidosis
Generally speaking, veterans need to meet three requirements in order to establish service connection. First, they must have a current, diagnosed condition, in this case sarcoidosis. Second, they must have experienced an in-service event, injury or illness. Finally, they must provide a medical nexus (i.e. link) between the in-service event and their sarcoidosis. However, there are certain cases in which VA will presume service connection for sarcoidosis, meaning veterans do not have to provide a nexus. Here, veterans must prove that their sarcoidosis was diagnosed within one year of separation from service to a degree of at least 10 percent disabling and that they served on active duty for at least 90 continuous days. If so, VA should presume their sarcoidosis is related to their time in service and award service connection.
How VA Rates Sarcoidosis
Once service connection is established, VA will assign a disability rating for the veteran’s sarcoidosis based on severity. VA rates sarcoidosis under 38 CFR § 4.97, Respiratory System, Diagnostic Code 6846 as follows:
- “100% – cor pulmonale, or; cardiac involvement with congestive heart failure, or; progressive pulmonary disease with fever, night sweats, and weight loss despite treatment
- 60% – pulmonary involvement requiring systemic high dose (therapeutic) corticosteroids for control
- 30% – pulmonary involvement with persistent symptoms requiring chronic low dose (maintenance) or intermittent corticosteroids
- 0% – chronic hilar adenopathy or stable lung infiltrates without symptoms or physiologic impairment”
If the veteran’s service-connected sarcoidosis does not fit the rating criteria outlined above, VA will rate it along with any residuals as chronic bronchitis (Diagnostic Code 6600) and extra-pulmonary involvement under the specific body system involved.
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