May 30, 2024 Lunch & Learn - https://kaileyking.substack.com/p/rating-respiratory-conditions?r=2f4jof&utm_campaign=post&utm_medium=web&triedRedirect=true

“Pyramiding”

Respiratory Conditions:

DC 6602 Asthma
DC 6522 Rhinitis
**Constrictive Bronchiolitis (CB)**
DC 6510-6514 Sinusitis
DC 6847 Sleep Apnea

Conditions with Overlapping Symptoms (you get one or the other):

§ 4.96(a) Rating Coexisting Respiratory Conditions.

When combining respiratory ratings, VA guidelines direct raters to first assess which individual condition currently meets the highest severity percentage based on documented measurements like reduced airflow or necessary oxygen therapy. That diagnosis forms the baseline rating, but raters still must judge if other issues like sleep apnea then exacerbate predominant condition effects, which could warrant rating elevation.

DCs 6600 through 6817 = NOT combined

DC 6819 and 6820 = NOT combined

DCs 6822 through 6847 = NOT combined

A single rating will be assigned under the diagnostic code which reflects the predominant disability with elevation to the next higher evaluation where the severity of the overall disability warrants such elevation.

Asthma & Sinusitis = one rating

Conditions with Distinct Symptoms (you can get separate ratings for each):

I. Insomnia (analogously rated under DC 9413) & Sleep Apnea (DC 6847)

II.

Because many respiratory conditions overlap in symptoms and anatomical location, VA generally does not assign separate ratings for each unless specific criteria are met. But when conditions affect different anatomical systems or function independently, separate ratings may be warranted.

Here’s a breakdown:

✅ **Respiratory Conditions That Can Be Rated Separately**

To be rated separately, conditions must:

Involve distinct anatomical locations, and
Have non-overlapping symptoms or impairment, and
Not be explicitly barred from pyramiding by 38 C.F.R. § 4.96(a)

Here are some examples where separate ratings MAY be permitted:

Condition #1	Condition #2	Notes
Sleep Apnea (DC 6847)	Asthma (DC 6602)	Can be rated separately if symptoms (e.g., CPAP use vs. inhaler use) are clearly distinguishable
Chronic Rhinitis (DC 6522)	Deviated Septum (DC 6502)	If both are symptomatic and cause different impairments
Pulmonary Embolism (DC 6817)	Asthma or COPD (DC 6602)	If embolism caused vascular damage distinct from bronchial conditions
Tuberculosis (DC 6730)	Bronchiectasis (DC 6601)	Can be separately rated if post-TB residuals affect different areas
Interstitial Lung Disease (DC 6835, etc.)	Obstructive conditions	If PFTs show separate impairment from both diseases (rare)
Insomnia (analogously rated under DC 9413)	Sleep Apnea (DC 6847)

✅ Conditions You Can Combine with Respiratory Ratings

These affect different body systems and can be rated separately:

Sinusitis (6510–6514)
Rhinitis (6522)
Deviated septum (6502)
Sleep disorders (if rated as mental health)

🚫 **Respiratory Conditions That Cannot Be Rated Separately**

Under 38 C.F.R. § 4.96(a), the following DCs cannot be rated together: “Ratings under diagnostic codes 6600 through 6817 and 6822 through 6847 will not be combined with each other. A single rating will be assigned under the diagnostic code which reflects the predominant disability...”

This includes:

Asthma (6602)
Bronchitis (6600/6601)
Emphysema (6603/6604)
COPD
Pulmonary fibrosis (6825–6833)
Sleep Apnea (6847)
Restrictive lung disease (6840–6846)

📌 You must pick one primary DC for rating based on predominant symptoms if a veteran has multiple overlapping conditions (e.g., asthma + COPD).

🧠 Pro Tip for Advocacy:

To argue for separate ratings:

Get a clear medical opinion that identifies distinct functional impairment for each condition.
Provide Pulmonary Function Test (PFT) results showing separate respiratory deficits (if available).
Use language from 38 C.F.R. § 4.14 (Avoidance of pyramiding) and VAOPGCPREC 36-97 when arguing separate manifestations.

Let me know if you want help drafting an argument for a specific case!