Some deployed personnel with biopsy-confirmed constrictive bronchiolitis had relatively unrevealing noninvasive tests. Normal routine testing does not automatically exclude every small-airway disease.
A “normal chest X-ray and breathing test” does not automatically rule out deployment lung disease. Some soldiers with biopsy-proven small-airway disease had relatively unremarkable routine testing — so a negative screen is not the end of the analysis.
Exposure routes
Interactive pathway
Burn-pit smoke, fine sand and particulate matter, diesel exhaust, Mishraq sulfur dioxide, Qarmat Ali hexavalent chromium, and oil-well fire smoke.
Each row shows how strong the cited evidence is for that specific statement, using the National Academies scale.
Constrictive bronchiolitis in symptomatic deployed personnel
Limited or suggestiveBiopsy-confirmed New England Journal of Medicine case series; invasive to confirm and not a universal cause of all symptoms.
“Normal noninvasive testing rules out small-airway disease”
Inadequate or insufficientSome biopsy-confirmed cases had relatively unrevealing routine tests — a normal screen does not exclude disease.
Categories follow the National Academies framework and reflect the general evidence for each statement — not a determination about any individual veteran’s claim.
The examiner shortcut this rebuts
“Normal imaging and pulmonary testing rule out deployment-related lung disease.”
Tap the signs that sound like you. This is a private learning tool — nothing is saved or sent. Bring what you mark to a clinician and to a free review.
Nothing marked yet.
General education about Respiratory & Small-Airway Disease — not a diagnosis or medical advice.
Each source is paired with an honest limitation. A study establishes biological plausibility; a qualified clinician still has to apply it to your specific service and medical facts.
New England Journal of Medicine
What it supports: Described biopsy-confirmed constrictive bronchiolitis in symptomatic deployed soldiers.
Limit / honest caveat: Biopsy is invasive and cohorts do not establish a universal cause for all respiratory symptoms.
Verify at New England Journal of Medicine
American Journal of Epidemiology (Millennium Cohort Study), PMID 19850627
What it supports: In a prospective cohort of 46,077 service members, 14% of deployers reported new persistent or recurring cough or shortness of breath, compared with 10% of non-deployers. The association held for Army (adjusted odds ratio 1.73) and Marine Corps (1.49) personnel independent of smoking, and land-based deployment carried higher odds than sea-based deployment.
Limit / honest caveat: Symptoms were self-reported, and at that follow-up the rates of physician-diagnosed chronic bronchitis, emphysema, and asthma were similar between deployers and non-deployers — so this establishes a symptom excess tied to in-theater exposure, not a diagnosis rate.
Published in American Journal of Epidemiology (Millennium Cohort Study), PMID 19850627 — indexed in PubMed under the citation above.
National Academies of Sciences, Engineering, and Medicine (2020)
What it supports: Reviewed 27 respiratory outcomes and found limited or suggestive evidence of an association between deployment and chronic persistent cough, shortness of breath, and wheezing for both 1990–1991 Gulf War and post-9/11 veterans. The committee also faulted the underlying research for using bare “deployment” as a stand-in for exposure and recommended VA convene an expert panel on the diagnosis of constrictive bronchiolitis.
Limit / honest caveat: For named diseases — including asthma, chronic bronchitis, COPD, emphysema, constrictive bronchiolitis, interstitial lung disease, and respiratory cancers — the committee classified the evidence as inadequate or insufficient. Read the report’s own words on that: inadequate or insufficient evidence does not mean there is no association, only that existing studies cannot settle the question. Examiners cite this category as if it were a finding of no link.
Verify at National Academies of Sciences, Engineering, and Medicine (2020)
CHEST / U.S. Army Medical Center of Excellence, PMID 32017933
What it supports: Evaluated 450 active-duty and retired personnel with chronic post-deployment shortness of breath or reduced exercise tolerance using full pulmonary function testing, chest CT, methacholine challenge, laryngoscopy, exercise testing, and bronchoscopy. Asthma was diagnosed in roughly 20%, upper-airway and laryngeal disorders in others, roughly 30% had no specific pulmonary abnormality, and diffuse lung diseases including constrictive bronchiolitis were rarely found. The investigators cautioned against routine lung biopsy.
Limit / honest caveat: This is the study examiners quote to deny deployment lung claims — so know what it does and does not say. It enrolled a symptomatic clinical population, its own authors describe post-deployment symptoms as multifactorial, and it makes no finding about any individual veteran. Note also what it did find: asthma in about one in five, which is itself a PACT Act presumptive respiratory condition.
Published in CHEST / U.S. Army Medical Center of Excellence, PMID 32017933 — indexed in PubMed under the citation above.
Environmental Health (2025) — Providence VA / Brown / UMass Lowell
What it supports: The largest objective test of burn-pit exposure yet: 459,381 Army and Air Force veterans deployed between 2005 and 2011, with exposure built from Department of Defense deployment histories rather than memory. The 109 most populated bases in Iraq and Afghanistan were classified year by year as unsegregated burning, segregated waste, incineration, or no burning at all. Asthma and hypertension risk were elevated among veterans deployed to bases that burned unsegregated waste — and were not elevated among veterans at bases that separated waste or used incinerators. For hypertension there was a clear duration-response: more than 240 days at an unsegregated-burning base carried a 16% higher risk (adjusted odds ratio 1.16, 95% confidence interval 1.13 to 1.19). Outcomes came from VA healthcare records.
Limit / honest caveat: The duration-response held for hypertension but not for asthma, so this does not show that longer time at a burn pit produced proportionally more asthma. Exposure is still measured by where and how long you were stationed rather than by what you personally breathed, and the cohort covers Army and Air Force veterans who later used VA health care. Its power for a claim is the base-and-year detail — it identifies which installations were burning unsegregated waste, and in which years.
Verify at Environmental Health (2025) — Providence VA / Brown / UMass Lowell
Journal of Occupational and Environmental Medicine (National Jewish Health / VA Eastern Colorado)
What it supports: 127 consecutive deployers with new-onset respiratory symptoms received a full evaluation between 2009 and 2017. Deployment-related distal lung disease — injury in the small airways — was identified in 68.5%, asthma in 31.5%, rhinosinusitis in 15%, and intermittent laryngeal obstruction in 14.2%. Reduced diffusion capacity was the one lung-function measure significantly associated with distal lung disease (odds ratio 4.6, 95% confidence interval 1.4 to 15.1). The authors’ conclusion is that a comprehensive workup, not resting spirometry alone, is what finds these diseases.
Limit / honest caveat: This is a referral series at a specialty center rather than a random sample, so the percentages describe symptomatic referred deployers, not every veteran. What it does establish is that small-airway disease is being missed by ordinary testing — which is precisely the assumption behind the examiner shortcut at the top of this page.
Verify at Journal of Occupational and Environmental Medicine (National Jewish Health / VA Eastern Colorado)A plain-English overview from the U.S. Department of Veterans Affairs on toxic-exposure benefits and how the PACT Act expanded them — useful background before you take an examiner’s opinion apart.
This is the actual language the VA uses to rate respiratory disease — the whole of 38 CFR § 4.97, reproduced here in plain terms so you never have to go hunting for it. Every diagnostic code in that section is below. Six shared formulas do most of the work; everything else carries criteria of its own. Read it, and you will know more than most veterans ever do walking into a claim.
38 CFR § 4.97 — Schedule of ratings, respiratory system
Chronic bronchitis, emphysema and COPD are rated on one identical scale. The name on the diagnosis barely matters — what matters is what your pulmonary function test measures, or whether your heart and your oxygen needs have already started to fail.
100%
FEV-1, FEV-1/FVC or DLCO under 40% predicted — or cor pulmonale, right ventricular hypertrophy, pulmonary hypertension, acute respiratory failure, or outpatient oxygen therapy.
60%
FEV-1 or FEV-1/FVC of 40 to 55%, DLCO of 40 to 55% predicted, or maximum oxygen consumption of 15 to 20 ml/kg/min.
30%
FEV-1 or FEV-1/FVC of 56 to 70%, or DLCO of 56 to 65% predicted.
10%
FEV-1 or FEV-1/FVC of 71 to 80%, or DLCO of 66 to 80% predicted.
CONDITIONS RATED ON THIS FORMULA (DIAGNOSTIC CODES 6600, 6603, 6604)
Asthma is the one respiratory code where the treatment you take can outrank the number on your breathing test. It is PACT Act presumptive when it is diagnosed after service — and the 30% step is the door most veterans walk through without knowing it exists.
FEV-1 or FEV-1/FVC under 40% predicted, or more than one attack per week with episodes of respiratory failure, or daily use of systemic (oral or injected) high-dose corticosteroids or immunosuppressive medication.
FEV-1 or FEV-1/FVC of 40 to 55% predicted, or at least monthly visits to a physician for required care of exacerbations, or intermittent courses — at least three per year — of systemic corticosteroids.
FEV-1 or FEV-1/FVC of 56 to 70% predicted, or daily inhaled or oral bronchodilator therapy, or inhaled anti-inflammatory medication.
Read that last clause again. A daily inhaler meets this criterion on its own — your breathing test does not have to be abnormal at all.
FEV-1 or FEV-1/FVC of 71 to 80% predicted, or intermittent inhaled or oral bronchodilator therapy.
THE NOTE THAT FOLLOWS DIAGNOSTIC CODE 6602
Scarring diseases of the lung tissue are not rated on airflow. They are rated on forced vital capacity and on how well oxygen crosses into your blood, which is why a veteran with fibrosis can breathe out normally and still be badly impaired.
100%
FVC under 50% predicted, DLCO under 40% predicted, maximum exercise capacity under 15 ml/kg/min, cor pulmonale or pulmonary hypertension, or outpatient oxygen therapy.
60%
FVC of 50 to 64% predicted, DLCO of 40 to 55% predicted, or maximum exercise capacity of 15 to 20 ml/kg/min.
30%
FVC of 65 to 74% predicted, or DLCO of 56 to 65% predicted.
10%
FVC of 75 to 80% predicted, or DLCO of 66 to 80% predicted.
CONDITIONS RATED ON THIS FORMULA (DIAGNOSTIC CODES 6825–6833)
When the chest wall, the diaphragm, the pleura or a surgical scar is what limits your breathing, the VA uses the obstructive numbers over again — or rates the underlying disorder instead, whichever gives you more.
100%
FEV-1, FEV-1/FVC or DLCO under 40% predicted — or cor pulmonale, right ventricular hypertrophy, pulmonary hypertension, acute respiratory failure, or outpatient oxygen therapy.
60%
FEV-1 or FEV-1/FVC of 40 to 55%, DLCO of 40 to 55% predicted, or maximum oxygen consumption of 15 to 20 ml/kg/min.
30%
FEV-1 or FEV-1/FVC of 56 to 70%, or DLCO of 56 to 65% predicted.
10%
FEV-1 or FEV-1/FVC of 71 to 80%, or DLCO of 66 to 80% predicted.
CONDITIONS RATED ON THIS FORMULA (DIAGNOSTIC CODES 6840–6845)
Chronic sinusitis is PACT Act presumptive, and it is rated on episodes rather than imaging. The schedule counts how many times a year it flattens you and how long the antibiotics run — which is why the treatment record matters more than the CT scan.
50%
Following radical surgery with chronic osteomyelitis, or near-constant sinusitis with headaches, pain and tenderness of the affected sinus, and purulent discharge or crusting after repeated surgeries.
30%
Three or more incapacitating episodes a year requiring four-to-six-week antibiotic treatment, or more than six non-incapacitating episodes a year with headaches, pain, and purulent discharge or crusting.
10%
One or two incapacitating episodes a year requiring four-to-six-week antibiotic treatment, or three to six non-incapacitating episodes a year.
0%
Detected by X-ray only.
CONDITIONS RATED ON THIS FORMULA (DIAGNOSTIC CODES 6510–6514)
Fungal lung infections have their own four-step ladder. Note the second step: staying on suppressive antifungal therapy is worth 50% even when your symptoms are close to nothing.
100%
Chronic pulmonary mycosis with persistent fever, weight loss, night sweats, or massive hemoptysis.
50%
Chronic pulmonary mycosis requiring suppressive therapy, with no more than minimal symptoms such as occasional minor hemoptysis or productive cough.
30%
Chronic pulmonary mycosis with minimal symptoms such as occasional minor hemoptysis or productive cough.
0%
Healed and inactive mycotic lesions, asymptomatic.
CONDITIONS RATED ON THIS FORMULA (DIAGNOSTIC CODES 6834–6839)
Three bacterial lung diseases share one rule: total while the infection is running, then re-rated on whatever it leaves behind. The re-rating is where claims get lost, because the residual has to be pushed onto the right formula.
100%
Active infection with systemic symptoms such as fever, night sweats, weight loss, or hemoptysis.
CONDITIONS RATED ON THIS FORMULA (DIAGNOSTIC CODES 6822–6824)
These codes are not on any shared formula. The schedule writes their criteria out one at a time, and if any of them describes you, this is what the law already says you are owed.
Upper airway damage is rated separately from the lungs, and it is routinely under-claimed. Chronic rhinitis is PACT Act presumptive, and several of these codes stack with a lung rating rather than replacing it.
Source, reproduced above in plain terms: 38 CFR § 4.97 — Schedule of ratings, respiratory system. Every diagnostic code in that section appears on this page. Each percentage is a starting point, not a prediction — an accredited representative should confirm which diagnostic code and evaluation truly fit your record before you file.
Have this condition and a denial or low rating?
Send the examiner’s exact wording. An accredited claims agent will tell you honestly whether the opinion answered the real question — and what evidence rebuts it. General information, not legal or medical advice.
Knowing the criteria is half the job. The other half is whether the law already concedes your exposure, and which form actually puts the claim in front of a rater. Here is both, in the order that protects your money.
If you served on active duty, active duty for training, or inactive duty training in a covered location and you carry one of the listed diagnoses, exposure is conceded by law. You do not have to prove you breathed burn-pit smoke. Covered service is: on or after August 2, 1990 in Bahrain, Iraq, Kuwait, Oman, Qatar, Saudi Arabia, Somalia, or the United Arab Emirates; or on or after September 11, 2001 in Afghanistan, Djibouti, Egypt, Jordan, Lebanon, Syria, Yemen, or Uzbekistan — including the airspace above those locations.
Respiratory conditions on the presumptive list
Fort McClellan. Camp Lejeune. A stateside engine room, a paint locker, an aircraft hangar. Naval Air Facility Atsugi, Al-Mishraq, Qarmat Ali. None of those are burn-pit presumption locations, and plenty of serious lung disease is not on the list. Direct service connection under 38 CFR § 3.303 still works, and it needs three things: a current diagnosis, an in-service exposure or event established by the facts found, and a medical opinion tying the two together at “at least as likely as not.” Personnel records, unit location, actual duty tasks, exposure-record material, and buddy statements do the work the presumption would otherwise have done for you.
A service-connected airway or sinus condition that causes or worsens something else — sleep apnea, sinusitis, right heart strain — can be service connected as secondary under 38 CFR § 3.310. A breathing condition you had before you enlisted that service permanently worsened is compensable for the degree of worsening under § 3.306. And for Southwest Asia service, chronic respiratory symptoms that no clinician can pin to a diagnosis may qualify as an undiagnosed illness under 38 CFR § 3.317 — that pathway carries a presumptive period VA has extended by rulemaking more than once, so confirm the current end date before you rely on it.
An Intent to File preserves your effective date for up to one year while you gather evidence. Back pay runs from that date — not from the day you finally submit the claim. It costs nothing and takes minutes, and it is the single most commonly skipped step in the entire process.
Application for Disability Compensation and Related Compensation Benefits. Name the diagnosis — chronic bronchitis, asthma, constrictive bronchiolitis, asbestosis — not “breathing problems.” List every qualifying location with dates. If the diagnosis is on the presumptive list, say so and name the service that makes you a covered veteran.
Your percentage is set by FEV-1, the FEV-1/FVC ratio, FVC, DLCO, or oxygen need. Ask that post-bronchodilator values be reported, that DLCO be run, and that the examiner state which test most accurately reflects your impairment. Bring documentation of daily inhaler use, steroid courses, and flare-up visits — under DC 6602 that evidence alone can carry 30% or 60%.
A Supplemental Claim reopens a decided claim on new and relevant evidence, and a change in law counts as a reason to look again. Veterans denied before the PACT Act for conditions that are now presumptive are exactly who this route is for. Effective-date consequences differ between a Supplemental Claim, a Higher-Level Review, and a Board appeal — get that choice analyzed before you file, because picking the wrong lane can cost you years of back pay.
Enrolled veterans are offered a VA toxic exposure screening. It puts a dated, VA-held record of the exposures and symptoms you reported into your own file — contemporaneous evidence a later examiner has to weigh, rather than a memory you are asked to prove years afterward.
VA-accredited claims agents, attorneys, and recognized veterans service organization representatives are the only people permitted to represent you before VA. No one is allowed to charge you a fee to prepare and file an initial claim. If someone is asking for money up front to submit your claim, that is your warning sign.
General information, not legal or medical advice. Presumptive lists, form numbers, and presumptive periods change — confirm the current requirements with VA or an accredited representative before you file.
Registries and screening
VA's registries are keyed to where and when you served, not to your diagnosis. There is no registry for respiratory & small-airway disease — there is a registry for the exposure that may have caused it. Which one fits you depends on the theater, the base and the years on your discharge papers, so the six programs below are organized by exposure rather than by illness. For most veterans on this page, at least one of them covers their service.
None of these is a claim, and none of them is required in order to file one. If anyone tells you your claim depends on being in a registry, they are wrong. What a registry evaluation actually does is put a dated exposure history and a clinician's findings into VA's own record, in VA's own words — and years later, that entry is what shows your concern predated the diagnosis. That is far harder for an examiner to wave away than a memory.
The PACT Act requires VA to offer this to every veteran enrolled in VA health care. It takes about five to ten minutes, and it is the cheapest way to get your exposure history into VA's own record in VA's own words.
What it is
A short set of questions asking whether you believe you were exposed to open burn pits and other airborne hazards, Agent Orange, radiation, Gulf War-related hazards, or contaminated water at Camp Lejeune.
Who can get it
Every veteran enrolled in VA health care. If you are not enrolled yet, enrollment comes first — call 877-222-8387.
How often
An initial screening, then at least once every five years. If you answer that you do not know whether you were exposed, VA schedules you again a year later.
How to get one
It is often done during a primary care or specialty visit — but you can ask for it sooner. Ask your primary care team directly, or ask your facility for its Toxic Exposure Screening Navigator by name.
What it is not
It is not an exam for any specific illness, and it is not part of the disability claims process. It is optional, and declining it does not affect your health care or your benefits.
Why bother
It creates a dated VA record that you raised military exposure. Years later, that entry is evidence that the concern predated the diagnosis.
A civilian or community provider cannot perform this screening — it lives inside VA's own health record. If you only see a private doctor, that is a reason to enroll in VA health care as well.
Read the eligibility line first. If it describes your service, the program is open to you whether or not you have ever filed a claim, and whether or not anyone has connected your illness to the exposure yet.
Who it covers
Veterans who may have been exposed to herbicides, including Agent Orange, during service.
What happens
A free, exposure-focused health examination by a VA clinician, with your exposure history documented and a written summary of the findings.
It is not a disability exam, it is not a claim, and taking part does not commit you to filing anything.
Agent Orange Registry on VA Public Health
Who it covers
Veterans and service members who served in the listed operations and locations. Since August 1, 2024, VA and the Defense Department enroll eligible people automatically, from deployment records, for service between August 2, 1990 and August 31, 2021.
What happens
Nothing to sign up for, in most cases. If you enrolled yourself before the redesign, your enrollment carried over. To check your status, ask the environmental health coordinator at your facility.
The registry holds deployment and demographic data only — no medical information. It is optional, it is not required to file a claim, and it is not evidence of exposure on its own.
Open the burn pit registry
Who it covers
Veterans who served in the Gulf War and the Southwest Asia theater of operations.
What happens
A free registry examination and a documented exposure history, with a written summary of what was found and what to follow up on.
It is not the same thing as a claim, and it does not replace filing one. It also does not affect your eligibility for care or benefits either way.
Gulf War Registry on VA Public Health
Who it covers
Veterans who took part in a radiation-risk activity during service.
What happens
A free registry examination with your radiation exposure history documented in VA’s own record, plus a written summary.
It is not a claim and it is not a rating decision. It is a clinical assessment and a research record.
Radiation registry exam on VA Public Health
Who it covers
Veterans who were in or on a vehicle struck by depleted uranium rounds, who were near a fire or an explosion involving depleted uranium munitions or armor, or who were deployed to Karshi-Khanabad Air Base in Uzbekistan.
What happens
Urine testing for uranium plus a clinical evaluation. Call VET-HOME at 833-633-8846 and ask to speak with a nurse about depleted uranium urine testing.
A normal result does not erase the exposure from your history, and it does not decide a claim.
Depleted uranium program on VA Public Health
Who it covers
Veterans carrying retained fragments from a blast injury — metal that was never removed.
What happens
Long-term surveillance and evaluation through VA’s Toxic Embedded Fragment Surveillance Center, because embedded metal can keep releasing into the body for decades.
It is a surveillance and evaluation program, not a claim, and not a substitute for treatment of the injury itself.
Embedded fragment center on VA Public HealthVET-HOME — the VA exposure team
The Veterans Exposure Team — Health Outcomes Military Exposures runs the registry evaluations, and a registry evaluation does not require you to be enrolled in VA health care. Call and say you want an exposure evaluation and the registry exam that fits your service. Monday to Friday, 9:00 a.m. to 7:30 p.m. Eastern. They do not prescribe medication and they do not complete claim forms.
The doctor page has the direct phone number and VA email of the environmental health coordinator at your own VA medical center, state by state.
Bring this condition to a clinician and get the exposure written into your record. Our doctor page has the words to use, the direct phone number and VA email of the exposure coordinator at your own VA medical center, and every VA registry you can sign up for.
VA-Accredited Claims Agent #45147
Tell an accredited agent what happened. We review your situation first and tell you honestly whether we can help — before anyone signs anything.
An accredited agent personally reviews every request — we’ll reach out within 48 hours.