Respiratory conditions are one of the fastest-growing categories of VA claims since the PACT Act was signed in 2022. If you served near burn pits, open-air waste fires, or toxic industrial areas in Iraq, Afghanistan, or other PACT Act locations, you may have a presumptive claim requiring no nexus proof at all. This page covers both the standard rating pathway and the PACT Act burn pit presumptive.
1. What This Condition Is
Respiratory conditions rated by the VA include asthma, chronic bronchitis, chronic obstructive pulmonary disease (COPD), constrictive or obliterative bronchiolitis, pulmonary fibrosis, interstitial lung disease, sarcoidosis, and others. These conditions affect your ability to breathe, exercise, work, and perform daily activities.
Military service creates unique respiratory exposures: burn pits in Iraq and Afghanistan that burned chemicals, plastics, medical waste, and ammunition; oil well fire smoke in Southwest Asia; industrial air pollutants near military bases; chemical exposure at Camp Lejeune; airborne hazards from Agent Orange era operations; and occupational exposures in military occupational specialties involving vehicle exhaust, chemicals, and confined spaces.
The PACT Act (Sergeant First Class Heath Robinson Honoring our Promise to Address Comprehensive Toxics Act), signed August 10, 2022, expanded presumptive service connection to cover many respiratory conditions for veterans who served in covered locations after August 2, 1990.
2. VA Rating Criteria
Diagnostic Code: 6602 (Bronchial Asthma) under 38 CFR 4.97 (Schedule of Ratings -- Respiratory System)
Asthma is rated primarily through objective pulmonary function testing (PFT), specifically Forced Expiratory Volume in one second (FEV-1) and the ratio of FEV-1 to Forced Vital Capacity (FEV-1/FVC). Treatment requirements also drive ratings.
| Rating | Criteria |
|---|---|
| 100% | FEV-1 less than 40% of predicted; OR FEV-1/FVC less than 40%; OR more than one attack per week with episodes of respiratory failure; OR requires daily use of systemic (oral or parenteral) high-dose corticosteroids or immunosuppressive medications |
| 60% | FEV-1 of 40-55% of predicted; OR FEV-1/FVC of 40-55%; OR at least monthly visits to a physician for required care of exacerbations; OR intermittent (at least three times per year) course of systemic corticosteroids |
| 30% | FEV-1 of 56-70% of predicted; OR FEV-1/FVC of 56-70%; OR daily inhalational or oral bronchodilator therapy |
| 10% | FEV-1 of 71-80% of predicted; OR FEV-1/FVC of 71-80%; OR intermittent inhalational or oral bronchodilator therapy |
Other respiratory conditions (COPD, bronchitis, emphysema, pulmonary fibrosis, etc.) are rated under their own diagnostic codes within 38 CFR 4.97, many also using PFT-based criteria.
PACT Act Presumptive Conditions (as of 2022)
Under the PACT Act, veterans who served on active duty, active duty for training, or inactive duty training in a covered location on or after August 2, 1990, may receive presumptive service connection for the following respiratory conditions without a nexus letter:
- Asthma (if not diagnosed before discharge)
- Chronic bronchitis
- Chronic obstructive pulmonary disease (COPD)
- Constrictive or obliterative bronchiolitis
- Emphysema
- Granulomatous disease
- Interstitial lung diseases
- Pleuritis
- Pulmonary fibrosis
- Sarcoidosis
- Chronic sinusitis
- Chronic rhinitis
Covered locations include Iraq, Afghanistan, Syria, Djibouti, Jordan, Egypt, Turkey, Somalia, Saudi Arabia, Kuwait, Bahrain, Qatar, UAE, Oman, Yemen, and other Southwest Asia locations, as well as certain Philippines and other service locations. Check the current VA PACT Act location list at va.gov for the most current covered areas.
3. What to Expect at Your C&P Exam
The C&P exam for respiratory conditions almost always includes pulmonary function testing. The examiner will review your spirometry results and assess your symptom history, treatment history, and functional limitations.
The examiner will ask: When did your breathing problems start? What triggers symptoms? What medications do you use (inhalers, corticosteroids, bronchodilators) and how often? Have you had emergency visits or hospitalizations for respiratory symptoms? How does the condition affect your work and physical activity?
Bring all records of your respiratory treatment, any spirometry or PFT reports, and documentation of any military occupational specialty or deployment location that involved toxic exposure. If you are filing under PACT Act presumptive, bring your deployment orders or DD-214 showing covered service locations.
4. Evidence You Need to Win
Diagnosis: A current diagnosis from a pulmonologist, allergist, or VA provider with supporting objective testing (PFT, spirometry, chest imaging).
Service Connection -- Standard Route: Medical records or service treatment records documenting onset during service; buddy statements from fellow service members describing exposure; a nexus letter from a physician connecting your respiratory condition to service exposures.
Service Connection -- PACT Act Presumptive Route: DD-214 or deployment orders showing service in a covered location on or after August 2, 1990. No nexus letter required. The VA must grant service connection based on the presumption.
DBQ Form: VA Disability Benefits Questionnaire for Respiratory Conditions (other than tuberculosis and sleep apnea).
Treatment Records: Emergency department visits, pulmonology notes, prescription history for inhalers and corticosteroids, and any hospitalization records for respiratory exacerbations.
Personal Statement: Describe when symptoms started, what triggers them, how often you use medication, and how the condition limits your daily activities and work capacity.
Buddy Statement (VA Form 21-10210): A fellow service member who served alongside you in a burn pit or toxic exposure location can document the shared exposure environment.
5. Secondary Conditions to Consider
Sleep Apnea: Respiratory conditions frequently co-exist with and worsen sleep apnea. Service-connected asthma or COPD contributing to obstructive sleep apnea supports a secondary connection under DC 6847.
Sinusitis and Rhinitis: Burn pit and toxic exposure often affect the upper and lower respiratory tract simultaneously. Chronic sinusitis and rhinitis can be rated separately (DC 6510-6522) and frequently accompany asthma claims.
GERD (Gastroesophageal Reflux Disease): Asthma and GERD have a bidirectional relationship. GERD can trigger or worsen asthma, and asthma medications can worsen GERD. Each can be rated as secondary to the other.
Anxiety and PTSD: Breathing difficulty and the fear of respiratory attacks cause documented anxiety. Service-connected respiratory conditions that contribute to an anxiety disorder or worsen PTSD support a secondary mental health claim.
Cardiovascular Conditions: Chronic hypoxia from severe respiratory disease can lead to right-heart complications (cor pulmonale) and hypertension. These can be rated as secondary if the respiratory condition is service-connected.
Rhinitis and Allergic Conditions: PACT Act veterans frequently develop concurrent upper respiratory allergic conditions from the same toxic exposures. File these alongside the lower respiratory claim.
6. Common Mistakes That Kill Claims
Not knowing about PACT Act presumptive status. Thousands of veterans with service in Southwest Asia after August 2, 1990 are still filing standard direct-connection claims and writing nexus letters when the presumptive route requires only proof of service in a covered location. Check PACT Act eligibility before spending money on private medical evidence.
Getting low PFT results because of improper effort at the exam. Pulmonary function testing requires maximal effort. If you are not coached or coached poorly, your numbers will look better than your actual condition. Request a repeat if your results do not match your symptoms.
Only filing for asthma when you have multiple respiratory conditions. Burn pit exposure often causes sarcoidosis, constrictive bronchiolitis, or interstitial lung disease alongside asthma. Get a full pulmonary workup and file for every diagnosed condition.
Filing only under PACT Act without documenting current severity. The presumptive establishes service connection but your rating is still based on current severity. You need documented PFT results, treatment history, and functional limitations to get a compensable rating.
Not claiming sinusitis, rhinitis, or sleep apnea as secondaries. Veterans routinely get service connection for asthma and stop there. Upper respiratory and sleep conditions tied to the same exposure or the same physiology are left unfiled.
7. FWD Assist Resources
These FWD Assist titles are most relevant for veterans building respiratory and PACT Act claims:
- PACT Act Veterans Guide -- Covers the full PACT Act presumptive list, covered locations, and how to file PACT Act claims correctly.
- C&P Exam Prep Guide -- Explains what pulmonary function testing is, how to prepare for it, and how to document your worst-day symptoms rather than your best-day performance.
- Secondary Conditions: How to Build a Cascading Claim -- Covers sleep apnea, GERD, sinusitis, and cardiovascular conditions as respiratory secondaries.
- Sleep Apnea VA Claims Guide -- Detailed guidance on the sleep apnea claim, which is often filed alongside respiratory conditions.
- Nexus Letters: How to Get the Medical Evidence You Need -- For veterans filing under the standard (non-presumptive) route who need a private medical opinion.
- Appeals Guide -- For veterans who filed respiratory claims before the PACT Act and received denials that can now be reopened under presumptive rules.
All titles are available at fwdassisthq.com.
8. Get Help Without a Claim Shark
Free, accredited help is available through VSOs including the DAV, American Legion, VFW, and AMVETS. County Veterans Service Officers provide free claims assistance. VA-accredited claims agents and attorneys can represent you after an initial decision.
Charging upfront fees to assist with a VA claim is illegal under 38 USC 5905. After an initial decision, accredited representatives may charge a fee capped at 20% of past-due benefits only. Do not pay anyone who asks for money before a decision is issued.
Verify accreditation at: va.gov/ogc/accreditation.asp