VA disability ratings for pleuritis do not just point to one diagnostic code. They have two entirely different rating pathways, and each diagnostic pathway has its own criteria and ceiling.
It is good to help you classify and isolate your condition in a more thorough manner, but it is easy to get lost in the cross-referencing process.
And this is not just applicable to a pleurisy VA rating; it can be a universal problem when you are filing a VA claim or applying for VA benefits.
At Just4Veterans Enterprise, we can develop a strategy to pursue your claim and conduct a thorough and HIPAA-compliant review of your medical records to further strengthen your knowledge in determining the best course of action for your VA disability claim.
For this article, we will explore what pleurisy is, the entire nuance of VA ratings for pleuritis, and how you can establish service a connection with it.
What is Pleurisy? Understanding The Pleura and its Functions
The pleura consists of two large, thin layers of tissue separating the lung from the chest wall. It provides lubrication (a small amount of fluid) that prevents friction and allows you to breathe normally.
When these layers of tissue become inflamed, this smooth motion turns into painful friction, making breathing difficult, otherwise known as pleurisy or pleuritis.
Common symptoms include:
- Chest pains: worsens when you breathe deeply, cough, or sneeze
- Shortness of breath
- Coughing (in some cases)
- Fever (in some cases)
Pain often radiates to the shoulder or back and tends to ease when holding the breath still.
What Causes Pleurisy?
Pleurisy can stem from different sources; there are some medical conditions that may aggravate pleurisy or circumstances that cause them to contract it. Some of these are:
- Viral infection (e.g., influenza)
- Bacterial infection (e.g., pneumonia)
- Fungal infection
- Autoimmune disorder (rheumatoid arthritis or lupus)
- Lung cancer (if the cancer is near the pleural surface)
- Pulmonary embolism
- Tuberculosis
- Rib fracture or trauma
- Selected inherited disease
- Certain medications (sometimes recreational drugs)
Some common causes for veterans are:
- Combat injuries (rib fracture or trauma)
- Shrapnel wounds
- Bullet injuries
- Heavy blunt objects
- Exposure to certain chemicals
- Burn pits
- Other harsh conditions, such as Prisoner of War
What is the VA rating for Pleurisy?
It depends on the pathway. If your pleurisy is tuberculosis-linked, it’s rated under DC 6732 via §4.88c or §4.89, starting at 100% and stepping down over time. If it’s unrelated to tuberculosis, it’s rated under DC 6845 based on pulmonary function test results, ranging from 10% to 100%. The first step is to understand which pathway applies to your case, so let’s break down how the VA arrives at each one.
Two Ways VA Rates Pleurisy: Tuberculosis and Chronic Pleuritis
VA ratings for pleuritis can go two ways, and it depends on the findings of the VA. The result can either be tuberculosis-linked or without it. Here is a more thorough explanation.
Pathway 1: Tuberculosis-linked pleuritis (DC 6732, via §4.88c or §4.89)
This condition is when pleurisy develops as a result of tuberculosis. The VA rates this condition under Diagnostic Code 6732. VA raters will then apply 38 C.F.R. §4.88c or §4.89, whichever fits the facts.
About §4.88c
A section specifically for inactive non-pulmonary tuberculosis initially authorized after August 19, 1968.
It contains instructions for VA raters to assign a 100% schedular disability rating for one year, accompanying the date of inactivity after active tuberculosis. Once that year passes, raters are to rate the residuals under the specific body systems or those affected. For example, respiratory, pleural, and musculoskeletal, rather than continuing the 100% TB rating.
About §4.89
This section consists of an older, graduated rating schedule with the application to inactive non-pulmonary tuberculosis cases in effect on August 19, 1968. It preserves former evaluations for veterans who are already entitled to compensation for tuberculosis VA rating.
| Level | Condition | Typical Rating | Notes |
|---|---|---|---|
| Primary | Tuberculous Pleurisy (DC 6732) | Active; TB rules; Inactive; residuals | Rated by activity and residual impairment |
| Secondary | Restrictive Lung Disease / Pleural Fibrosis | 10-100% | From pleural scarring |
| Secondary | Chronic Chest Pain (Pleuritic) | 10-40% | Functional limitation evidence required |
| Secondary | Pulmonary TB Residuals | 10-100% | When pleurisy followed pulmonary TB |
| Tertiary | Respiratory Insufficiency | 30-100% | Severe restrictive impairment |
| Tertiary | Reduced Work Capacity / Fatigue | 10-60% | Impact on daily functioning |
Pathway 2: Chronic pleuritis or pleural effusion without tuberculosis (DC 6845)
Diagnostic Code 6845 — Chronic Pleural Effusion or Fibrosis is for pleurisy that is unrelated to tuberculosis. So, the condition can range from combat injuries, chemical exposure, and other infections veterans may have experienced during their service.
This code falls under the General Rating Formula for Restrictive Lung Disease, which relies on pulmonary function test (PFT) results rather than a fixed set of symptoms.
A simple way to tell which pathway applies to your case
Does your medical record connect your pleurisy to a tuberculosis diagnosis, active or inactive?
If the answer is yes, then the DC 6732 and its tuberculosis-specific rules will likely govern your evaluation.
However, if your pleurisy is caused entirely by a different circumstance: a burn pit, a respiratory infection, lung cancer, or other combat injuries, DC 6845 is almost certainly the applicable pathway, and your rating will hinge on your pulmonary function testing.
Can pleurisy be rated at 100%?
Yes. Under DC 6845, a 100% rating applies if any single criterion is met, such as FEV-1 below 40% of the predicted value, DLCO (SB) below 40% predicted, cor pulmonale, pulmonary hypertension, or a requirement for outpatient oxygen therapy. A 100% rating also applies automatically for pleurisy with empyema until the condition resolves.
VA Rating Percentages for Pleurisy at a Glance
VA disability ratings for pleurisy under the DC 6845 are based on three primary measurements:
- FEV-1 (Forced Expiratory Volume in one second) — measures how much air can be forcibly exhaled in one second, just like gauging your VA rating for Asthma
- FEV-1/FVC ratio — compares the FEV-1 to the total forced vital capacity to assess airflow obstruction
- DLCO (SB) (Diffusing Capacity of the Lungs for Carbon Monoxide, Single Breath) — measures how efficiently gas transfers across the lung membrane
Here is the table that you can use for your reference.
| Rating | Criteria (any of these qualifies per 38 C.F.R. § 4.97) |
|---|---|
| 100% | – FEV-1 less than 40% predicted – FEV-1/FVC less than 40% – DLCO (SB) less than 40% predicted – Maximum exercise capacity less than 15 ml/kg/min oxygen consumption (with cardiac or respiratory limitation); – Cor pulmonale (right heart failure) – Right ventricular hypertrophy – Pulmonary hypertension (shown by echo or cardiac catheterization) – Episode(s) of acute respiratory failure – Requires outpatient oxygen therapy |
| 60% | – FEV-1 of 40–55% predicted – FEV-1/FVC of 40–55% – DLCO (SB) of 40–55% predicted – Maximum oxygen consumption of 15–20 ml/kg/min (with cardiorespiratory limit) |
| 30% | – FEV-1 of 56–70% predicted – FEV-1/FVC of 56–70% – DLCO (SB) 56–65% predicted |
| 10% | – FEV-1 of 71–80% predicted – FEV-1/FVC of 71–80% – DLCO (SB) 66–80% predicted |
During the C&P (Compensation and Pension) exam, the VA will take a calculated estimate of what your lung capacity should be. They would take your age, gender, height, and other physical evaluation factors to reach a conclusion.
When a test indicates “FEV-1 less than 40% of predicted value”, it means that the VA is taking what a healthy person under your statistics would be expected to produce, then comparing those results to that number.
Establishing Service Connection for Pleurisy
You can either account your VA disability for pleurisy with a direct service connection, aggravation of a pre-existing condition, or a secondary condition. Here is how it goes.
Direct Service Connection
Establishing a direct service connection requires three things:
- Current diagnosis of pleurisy or its residuals
- An in-service event
- Injury
- Exposure
- Medical nexus opinion that links your current diagnosis and in-service event.
Your service treatment records should show chest pain and respiratory complaints. You can also secure a documented pleurisy episode during your service to make a direct service connection more potent.
You can ask your trusted physician to create a nexus letter that clarifies the relationship between your conditions to strengthen your case, or you can obtain a buddy statement to document how your condition is affecting your life; the buddy statement should be considered secondary.
Nexus Letter Caution: A nexus letter alone is not always sufficient for approval. In a 2025 BVA case (Citation No. A25020399), a nexus letter was submitted in support of a pleuritis claim but was found insufficient due to a lack of supporting treatment records. A strong claim requires the nexus letter to be supported by contemporaneous medical documentation — treatment records, imaging, and PFT results — not a nexus letter standing alone.
Aggravation of a pre-existing condition
If pleurisy existed before service but worsened beyond its natural progression because of military duties or exposures.
The VA can grant service connection for the degree of aggravation, provided that medical evidence distinguishes the baseline condition from the service-caused worsening.
Related Reading: Pre-existing Conditions Aggravated by Military Service
Secondary service condition
Pleurisy can also be rated as secondary to an already service-connected disability when medical evidence shows the existing condition caused or aggravated the pleurisy.
See Also: What are VA Secondary Conditions?
Secondary conditions often linked to Pleurisy
Some well-known secondary conditions linked to pleurisy are:
- Lupus
- Rheumatoid Arthritis
- Chronic bronchitis
- Pneumonia residuals
- Certain autoimmune or connective tissue disorders
These are often the secondary conditions cited when pleurisy is claimed on a secondary basis.
Is pleurisy a PACT Act presumptive condition?
Yes. The PACT Act includes pleuritis as a condition that is automatically considered related to burn pit and airborne hazard exposure for veterans who served in certain places and times, so they don’t have to prove a link to their service exposure.
The PACT Act expanded on the list of conditions that are presumptively connected to the following, as from the official document from VA:
- Burn pit
- Airborne hazard exposure
- Gulf War
- Post 9-11 veterans
For veterans who served in qualifying locations and time periods, this presumption removes the burden of separately proving a nexus between service exposure and the current diagnosis, which can meaningfully simplify the claims process.
The C&P Exam for Pleurisy
At the Compensation & Pension exam, you need to expect the following:
- Review of your medical history
- A physical examination
- Pulmonary function testing (PFT)
The PFT results drive the DC 6845 rating in most non-tuberculosis cases; this is where the examiner completes a Respiratory Conditions Disability Benefits Questionnaire, documenting the following:
- Your diagnosis
- Treatment history
- Symptom severity
- Functional limitations
Bringing a clear symptom history and any private treatment records to the exam helps ensure the findings reflect your actual condition.
What if Pleurisy Rating Doesn’t Reflect Your Current Condition?
Respiratory conditions can fluctuate, and a rating assigned years ago may no longer match your present-day breathing capacity or symptom severity. If your condition has worsened, you can pursue an increased rating claim supported by updated pulmonary function testing and current medical records.
But we understand that the process can be challenging, especially if you do not know where to start.
Here at Just 4 Veterans Enterprise, we can provide you with the education to support your understanding of your VA rating .
We can:
- Organize and review necessary evidence with you
- Connect with medical professionals for nexus letters
- Develop strategies to pursue your claim
Don’t let a simple miscalculation get in your way of an appropriate VA rating. Take action today by contacting us to discuss your next steps.