Asthma VA Ratings and the C&P Exam (Diagnostic Code 6602)

Asthma is one of the few conditions in the VA rating schedule where the medication a veteran takes can establish the evaluation independently of test results. That structure matters, because many veterans with well-controlled asthma produce near-normal pulmonary function numbers on the day of the examination.

This guide explains both pathways under Diagnostic Code 6602 and what the examination has to capture.

The rating criteria

Bronchial asthma is evaluated at 10, 30, 60, or 100 percent. Each level can be met by pulmonary function testing or by the treatment required:

• 10 percent - FEV-1 of 71 to 80 percent predicted, or FEV-1/FVC of 71 to 80 percent, or intermittent inhalational or oral bronchodilator therapy
• 30 percent - FEV-1 of 56 to 70 percent predicted, or FEV-1/FVC of 56 to 70 percent, or daily inhalational or oral bronchodilator therapy, or inhalational anti-inflammatory medication
• 60 percent - FEV-1 of 40 to 55 percent predicted, or FEV-1/FVC of 40 to 55 percent, or at least monthly visits to a physician for required care of exacerbations, or intermittent courses of systemic corticosteroids at least three times per year
• 100 percent - FEV-1 less than 40 percent predicted, 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 immunosuppressive medications

The medication pathway is not a lesser route

The criteria are written in the alternative. A veteran on a daily inhaled corticosteroid meets the 30 percent criteria on that basis alone, regardless of what the spirometry shows. This is one of the most frequently overlooked provisions in the respiratory schedule, and it is the reason the examination should record the full medication list with dosing frequency.

The same logic runs at 60 percent: three or more courses of systemic corticosteroids in a year satisfies the criteria whether or not the numbers do.

Post-bronchodilator testing

Under 38 CFR 4.96(d), post-bronchodilator results are generally used for rating purposes unless they are poorer than pre-bronchodilator results or the examiner determines testing is not indicated. Where only pre-bronchodilator values appear in the file, the rating may be based on an incomplete study.

Only one respiratory rating at a time

38 CFR 4.96(a) provides that ratings under the restrictive and obstructive lung disease codes are not combined with each other. Where a veteran has more than one qualifying condition, a single evaluation is assigned under the diagnostic code reflecting the predominant disability, with elevation to the next higher evaluation where the severity of the overall disability warrants it.

This is distinct from the upper airway codes. Rhinitis and sinusitis evaluations are handled separately - see rhinitis and sinusitis ratings explained.

What happens at the examination

An asthma examination normally includes a history, a physical examination, and pulmonary function testing. The examiner completes the respiratory conditions questionnaire, which asks about the frequency of attacks, exacerbations requiring physician visits, courses of oral or parenteral corticosteroids, and whether treatment is intermittent, daily, or continuous.

Attacks are episodic by nature, so a veteran examined on a symptom-free day may present normally. A dated log of attacks, urgent care visits, and rescue inhaler use gives the examiner something to report other than the appearance of that single morning.

Asthma, exposure, and the PACT Act

Asthma diagnosed after service is a presumptive condition for veterans with qualifying burn pit and airborne hazards exposure. Where the presumption applies, the nexus element does not have to be separately proven. See burn pits, airborne hazards, and the PACT Act.

Where it does not apply - service outside the covered locations or periods - the claim returns to a direct theory requiring a medical opinion.

Related conditions

Asthma commonly coexists with allergic rhinitis, and upper airway inflammation is a recognized contributor to lower airway symptoms. Sleep-disordered breathing is also common in this population; our sleep apnea series covers those claims.

When the evidence in a file has never been assessed against the criteria above, a paid medical records review is where veterans typically start.

Documenting exacerbations between exams

Because pulmonary function testing on a single day may not reflect the full pattern of a veteran's asthma, records that document exacerbations over time carry real weight. Emergency room visits, urgent care records, pharmacy refill history for rescue inhalers, and a veteran's own symptom journal can all show a pattern that a single spirometry reading cannot.

Where treating physicians, physician assistants, or nurse practitioners have documented frequency of attacks and the medications prescribed to control them, that longitudinal record often does more to establish the correct evaluation level than the C&P exam alone.

Common reasons asthma claims are underrated

A frequent error is rating asthma using only the pulmonary function numbers from the C&P exam while overlooking the medication-based criteria in Diagnostic Code 6602. If the file documents daily inhaled corticosteroid use or multiple courses of systemic corticosteroids in a year, that alone can support a higher evaluation regardless of spirometry results.

Another common issue is reliance on pre-bronchodilator test values when 38 CFR 4.96(d) generally calls for post-bronchodilator results. Reviewing the exam report for which values were used, and requesting correction if the wrong values were applied, is a reasonable step before appealing a rating decision.