VA Rating Guide for Granulomatous Disease

Granulomatous disease is one of the presumptive conditions the VA automatically recognizes as connected to burn pits exposure, but veterans also have other ways to establish service connection and obtain VA disability benefits. Find out how to prove your case and how to get up to 100% disability for granulomatous disease, depending on how severe your condition is and which body systems are affected. 

Granulomatous Diseases in Veterans

Granulomatous diseases cause chronic inflammation and the formation of granulomas, which are tight clusters of immune cells that form when the body attempts to contain infections or irritants it cannot eliminate. These conditions may be infectious, such as tuberculosis, or non-infectious, such as sarcoidosis. 

Among U.S. service members, sarcoidosis represents one of the most frequently identified non-infectious granulomatous diseases. According to a large VA cohort study covering more than 13 million veterans, the annual prevalence of sarcoidosis was 54.9 per 100,000 veterans, compared to 27.1 per 100,000 in the general population. The annual incidence was also four to five times higher in veterans, particularly among those with prior deployment or exposure to particulate matter. 

Service in ship repair and Southwest Asia conflicts increased exposure to fine particulates, solvents, and burn-pit smoke. These findings support growing evidence that environmental exposure during military service contributes to long-term lung injury and immune dysregulation, setting the stage for granuloma formation and chronic disease. 

VA Rating Criteria

The Department of Veterans Affairs (VA) rates granulomatous diseases under 38 C.F.R. § 4.97, which covers conditions that affect the respiratory system. Because these diseases vary widely in severity and may affect multiple organs, the VA assigns disability ratings from 0% to 100% based on how much the illness limits a veteran’s ability to function. 

When determining the proper rating, the VA looks for objective medical evidence that shows how the disease affects breathing and daily activity. This includes results from pulmonary function tests (PFTs) and any ongoing medical treatments, such as steroid therapy or supplemental oxygen. The VA also considers whether the condition involves only the lungs or has spread to other body systems. Granulomatous disease is evaluated based on:

• Pulmonary Function Tests (PFTs) – The VA uses measurements like Forced Vital Capacity (FVC) and Diffusion Capacity of Carbon Monoxide (DLCO) to assess lung strength and oxygen exchange. 
• Treatment Requirements – Long-term use of corticosteroids, immunosuppressive therapy, or oxygen usually supports a higher rating. 
• Functional Impairment – Limitations in walking, exercising, or performing daily tasks show how the condition impacts work and quality of life. 
• Extent of Organ Involvement – Granulomatous diseases that spread beyond the lungs, such as to the heart, kidneys, or nervous system, can justify higher evaluations. 
• Frequency and Duration of Flare-Ups – Recurrent or chronic symptoms that require ongoing care weigh heavily in favor of higher compensation. 

Each case is rated individually, taking into account the combined effect of symptoms and any secondary conditions caused by the disease. Veterans with multiple granulomatous disorders or complications may qualify for separate ratings under related diagnostic codes, as long as the symptoms do not overlap (per the VA’s rule against pyramiding). 

VA Ratings for Granulomatous Diseases

The VA recognizes several granulomatous diseases that may qualify for disability compensation. Each condition is rated under a specific Diagnostic Code (DC) based on symptoms, severity, and how the illness affects different parts of the body, with ratings ranging from 0% to 100%. Below are the main types of granulomatous diseases the VA rates, starting with those affecting the upper respiratory system. 

Granulomatous Rhinitis

Granulomatous rhinitis is a rare form of chronic nasal inflammation caused by either infection or autoimmune reaction. It leads to nasal obstruction, sinus pain, discharge, and tissue destruction, which can interfere with breathing and sense of smell. The VA evaluates this condition under Diagnostic Code (DC) 6524 within the Schedule of Ratings for the Respiratory System, with ratings of 20% or 100%. 

• 100% – Assigned to veterans with Wegener’s granulomatosis (also known as granulomatosis with polyangiitis) or lethal midline granuloma, both severe systemic diseases that can destroy blood vessels and tissue in the nose, lungs, and kidneys. 
• 20% – Given to other types of granulomatous infection involving the nasal passages. 

Granulomatous Disease Affecting the Throat 

Granulomatous diseases can also affect the pharynx or nasopharynx, the parts of the throat responsible for swallowing and airflow. When granulomas form in these areas, they can cause obstruction, narrowing (stricture), or tissue destruction, leading to serious complications. 

Veterans with this condition may have difficulty swallowing (dysphagia), speaking, or breathing normally. In more advanced cases, tissue loss can cause nasal regurgitation of food or fluid and alter speech quality. Under Diagnostic Code (DC) 6521, granulomatous disease is assigned a 50% rating when the disease causes a complete obstruction or absence of the soft palate, or when it results in the inability to swallow or severe impairment of speech. 

Because granulomatous inflammation in the throat often stems from systemic conditions such as Wegener’s granulomatosis, sarcoidosis, or tuberculosis, the VA evaluates each case individually to avoid double-counting overlapping symptoms already rated under another body system. 

Eosinophilic Granuloma of the Lung 

Eosinophilic granuloma of the lung is a rare interstitial lung disease caused by the abnormal buildup of Langerhans cells, a type of white blood cell that helps regulate immune response. When these cells multiply excessively, they form granulomas and cysts that damage lung tissue. This condition is known by several names: 

• Pulmonary Langerhans Cell Histiocytosis (PLCH) 
• Histiocytosis X (lung form) 
• Eosinophilic Granulomatosis (lung form) 

Veterans with eosinophilic granuloma may experience: 

• Chronic cough and shortness of breath 
• Chest pain or tightness 
• Recurrent pneumothorax (collapsed lung) 
• Fatigue and reduced exercise tolerance 

The VA relies on factors such as PFT results, types of treatment and the way the condition affects the veteran’s life: 

• Pulmonary Function Test (PFT) results – Ratings depend on measurements such as Forced Vital Capacity (FVC) and Diffusion Capacity of Carbon Monoxide (DLCO). 
• Treatment requirements – The need for steroids, immunosuppressive drugs, or supplemental oxygen supports a higher evaluation. 
• Functional impact – The VA considers how symptoms limit daily activities, including walking, climbing stairs, or performing work duties. 

The VA rates eosinophilic granuloma under Diagnostic Code (DC) 6828, which covers interstitial lung diseases, with ratings of 10%, 30%, 60% or 100%: 

• 10% rating for FVC of 75- to 80-percent predicted, or; DLCO (SB) of 66- to 80-percent predicted  
• 30% rating for FVC of 65- to 74-percent predicted, or; DLCO (SB) of 56- to 65-percent predicted  
• 60% rating for FVC of 50- to 64-percent predicted, or; DLCO (SB) of 40- to 55-percent predicted, or; maximum exercise capacity of 15 to 20 ml/kg/min oxygen consumption with cardiorespiratory limitation  
• 100% rating for FVC less than 50-percent predicted, or; Diffusion Capacity of the Lung for Carbon Monoxide by the Single Breath Method (DLCO (SB)) less than 40-percent predicted, or; maximum exercise capacity less than 15 ml/kg/min oxygen consumption with cardiorespiratory limitation, or; cor pulmonale or pulmonary hypertension, or; requires outpatient oxygen therapy 

Because eosinophilic granuloma can lead to progressive lung scarring and recurrent lung collapse, veterans may qualify for higher ratings or secondary conditions such as chronic respiratory failure if the disease becomes severe. 

Sarcoidosis 

Sarcoidosis is a non-infectious granulomatous disease in which clusters of inflammatory cells form in different organs. It most commonly affects the lungs, but it can also involve the skin, eyes, heart, liver, and nervous system. The condition is unpredictable; some veterans experience only mild symptoms, while others develop chronic or multi-organ sarcoidosis that causes significant disability. Research has shown the veteran population has twice the annual prevalence of sarcoidosis compared with the nonveteran population.

Common Symptoms 

• Shortness of breath or chronic dry cough 
• Chest pain or tightness 
• Fatigue and weakness 
• Joint pain 
• Skin lesions or eye inflammation 

The VA rates sarcoidosis based on both objective medical findings and the extent of systemic involvement, and assigns ratings from 0% to 100% according to diagnostic code 6846. Learn more about how the VA evaluates this condition in the Sarcoidosis VA Rating Guide.

Rating Criteria 

• 0% – Diagnosed but inactive disease with no symptoms. 
• 30% – Evidence of persistent symptoms with abnormal chest X-rays or mild functional limitation. 
• 60% – Requires systemic corticosteroid therapy or shows moderate pulmonary limitation on testing. 
• 100% – For chronic, progressive disease with severe respiratory or multi-organ involvement despite treatment. 

Sarcoidosis may also cause cardiac, ocular, or neurological complications, which can result in separate or secondary VA ratings if they produce distinct functional impairments. Because symptoms can overlap with other respiratory diseases, obtaining a clear medical nexus opinion is essential when filing a claim. 

Tuberculosis 

Tuberculosis is an infectious granulomatous disease caused by the bacterium Mycobacterium tuberculosis. It primarily affects the lungs but can also spread to other organs such as the lymph nodes, bones, kidneys, or spine. When TB becomes active, the body forms granulomas to wall off the infection. However, even after the infection becomes inactive, many veterans are left with scarring, fibrosis, or chronic breathing difficulties that continue to affect their health. 

The VA recognizes several forms of tuberculosis and assigns disability ratings under specific Diagnostic Codes (DCs) depending on whether the disease is active or inactive.

• DC 6730: Active pulmonary tuberculosis 
• DC 6731: Inactive (chronic) pulmonary tuberculosis 
• DC 6311: Non-pulmonary tuberculosis (such as lymph node or bone TB, per § 4.88b) 

Rating Criteria: 

• Active TB: Automatically rated 100% during the active phase and for one year following inactivity. 
• Inactive TB: Rated based on residual damage such as fibrosis, shortness of breath, or reduced pulmonary function. 

Residual COPD or bronchiectasis may be rated separately when symptoms don’t overlap. 

Tuberculosis can also occur outside the lungs, affecting the larynx, kidneys, or spine. These cases are evaluated under their respective body system codes and can result in higher ratings when significant functional loss occurs. Early treatment records and laboratory results are key evidence for proving service connection, especially for veterans exposed to crowded living conditions or burn pits during deployment, which can increase TB risk. 

Is Granulomatous Disease a Presumptive Condition? 

Yes! Veterans exposed to airborne hazards during service may qualify for presumptive service connection if later diagnosed with a granulomatous disease. This rule means the VA assumes the illness is service-related, reducing the burden of proof when in-service exposure records are limited. 

Exposures Linked to Granulomatous Diseases 

• Burn pits used in Iraq and Afghanistan, releasing toxic smoke and metals 
• Dust storms and desert sand, containing silica and microbial particles 
• Oil well fires and fuel combustion, producing respiratory irritants 
• Construction and maintenance work, involving asbestos or welding fumes 

These exposures can lead to chronic inflammation and the formation of granulomas in the lungs. The VA’s Airborne Hazards Presumptive List includes several respiratory and inflammatory conditions related to such exposures. 

Service Connection Requirements 

To qualify for VA disability compensation for a granulomatous disease, veterans must establish a link between their condition and their military service. Both direct and secondary service connection are possible, depending on how the disease developed or worsened. 

Direct Service Connection 

A direct service connection applies when evidence shows the granulomatous disease began during or was caused by military service. Veterans must prove three key elements: 

• Current diagnosis of a granulomatous disease (confirmed through medical testing or biopsy) 
• In-service event, exposure, or injury, such as burn pit fumes, dust, or infection 
• Medical nexus (a doctor’s opinion linking the current diagnosis to that in-service exposure) 

Direct service connection often relies on deployment history, occupational specialty, and documented exposures. For example, ship repairers, engineers, and personnel stationed near burn pits or chemical sites are at higher risk for exposure-related granulomatous conditions. 

Secondary Service Connection 

A secondary service connection can be established when a veteran’s granulomatous disease results from or is aggravated by another service-connected condition, such as: 

• Chronic infections that develop after exposure-related lung damage 
• Autoimmune diseases that trigger granuloma formation 
• Medication side effects from treatment of another service-connected condition 

For instance, a veteran with service-connected asthma who later develops sarcoidosis or eosinophilic granuloma as a complication may qualify for secondary benefits. 

What Documentation Do You Need for Service Connection? 

• Service treatment records (STRs) showing exposure, respiratory issues, or early symptoms 
• Private and VA medical records documenting diagnosis and ongoing treatment 
• Nexus letters from physicians explaining how service exposures likely caused or worsened the disease 
• Lay statements from fellow service members describing conditions or exposures 

How to File a Granulomatous Disease VA Disability Claim 

1. Begin by gathering medical documentation, including imaging scans, biopsy results, and pulmonary function tests that confirm your diagnosis and show the disease’s severity. Records from both VA and private providers give the VA a clearer picture of your symptoms over time. 

2. Next, collect service-related evidence that proves exposure to harmful environments. Deployment orders, duty assignments, or unit records can show your presence in areas with burn pits, dust, or other toxins. 

3. Obtain a nexus letter from a qualified healthcare provider stating it is “at least as likely as not” that your disease relates to service. 

4. Submit VA Form 21-526EZ online through VA.gov, by mail, or with help from a Veterans Service Officer (VSO). After submission, the VA may schedule a Compensation & Pension (C&P) exam to verify your diagnosis and assess how the condition affects your daily life and work. 

5. Stay proactive. Track your claim through VA.gov and respond quickly to any VA requests. A VA-accredited representative can help ensure your evidence is complete and presented correctly. 

C&P Exam Preparation

The Compensation & Pension exam is a crucial part of your VA claim. It confirms your diagnosis, measures how severe the condition is, and shows how it limits your daily life. 

During the exam, a VA clinician reviews your medical history and symptoms. They may order pulmonary function tests (PFTs) or imaging scans to check for lung damage or inflammation. Be specific about your symptoms, explain how often they occur, how they affect your breathing, and what treatments you use, such as steroids or oxygen therapy. You should also bring any recent records and tests (VA and private) you may have.  

The examiner records everything in a Disability Benefits Questionnaire (DBQ), which becomes part of your claim file. Accurate and detailed responses during this exam can strongly influence your final VA rating. 

Extra Compensation for Granulomatous Diseases 

Veterans with severe or multi-system granulomatous diseases may qualify for extra compensation beyond the standard disability rating. The VA provides two major forms of additional benefits; Total Disability based on Individual Unemployability (TDIU) and Special Monthly Compensation (SMC) for veterans whose conditions cause substantial functional loss or prevent them from working. 

TDIU: the Alternative Path to a 100% Rating 

TDIU allows veterans to receive 100% disability pay even if their combined rating is below 100%, as long as their service-connected conditions prevent them from maintaining gainful employment. Veterans with advanced sarcoidosis, Wegener’s granulomatosis, or tuberculosis may qualify if chronic respiratory failure, organ impairment, or severe fatigue limits their ability to perform regular work tasks. Get a free case evaluation to see if you qualify.

Special Monthly Compensation 

SMC for Wegener’s Granulomatosis 

Wegener’s granulomatosis, now known as granulomatosis with polyangiitis, is a systemic autoimmune granulomatous disease that often affects the lungs, kidneys, and upper airways. It can lead to renal failure, respiratory impairment, hearing loss, and neuropathy or paralysis, depending on the extent of vascular and nerve involvement. Because of its multi-organ impact, veterans with this condition may qualify for several levels of SMC depending on severity: 

• SMC-K: Awarded for complete deafness in both ears or loss of use of a hand or foot due to neuropathy or paralysis. 
• SMC-S: Can be obtained if the veteran receives TDIU solely for Wegener’s disease and has  additional 60% service-connected ratings for other conditions. 
• SMC-L: Applied when the veteran requires regular aid and attendance due to the disease’s progression, such as assistance with mobility or personal care. 

Veterans whose kidney or respiratory function severely declines may also qualify for permanent and total disability, resulting in continued 100% benefits without reexamination. 

SMC for Sarcoidosis 

Sarcoidosis is a systemic granulomatous disease that can affect nearly every organ, including the lungs, heart, skin, liver, spleen, eyes, and lymph nodes. The severity and range of organ involvement determine eligibility for additional VA compensation. Possible complications include: 

• Respiratory failure or chronic hypoxia 
• Cardiac sarcoid, leading to arrhythmia or heart block 
• Ocular sarcoidosis, which may cause blindness or severe vision loss 
• Neurological sarcoidosis, which affects the brain or spinal cord 

Because of its potential to cause both physical and neurological disability, sarcoidosis can meet the criteria for multiple levels of SMC: 

• SMC-K: For blindness in at least one eye, loss of use of a reproductive organ, or other isolated impairments. 
• SMC-S: If the veteran receives TDIU based solely on sarcoidosis and has additional disabilities rated at 60% or higher. 
• SMC-L to SMC-O: For veterans who require aid and attendance or whose disease affects multiple major organs or limbs. 

These higher levels of compensation recognize that sarcoidosis can be progressive and disabling, even with ongoing corticosteroid or immunosuppressive treatment. 

SMC for Tuberculosis with Granulomas 

Tuberculosis (TB) in its granulomatous form can lead to lasting and sometimes irreversible complications when it affects the larynx, lungs, or spine. Veterans who experience these effects may qualify for additional benefits depending on the resulting impairment. Potential complications include: 

• Loss of voice (aphonia) when the larynx is damaged 
• Lung cavitation or chronic respiratory failure 
• Spinal tuberculosis (Pott’s disease) causing deformity or paralysis 

Because these residuals often limit a veteran’s independence, the VA recognizes several forms of special compensation: 

• SMC-K: For loss of voice or loss of function in an affected organ. 
• SMC levels L to O: For veterans with paraplegia or those who require aid and attendance. 
• SMC-S: When TDIU is awarded for tuberculosis and the veteran holds additional 60% ratings from other  service-connected disabilities. 

Chronic tuberculosis can also qualify for permanent and total disability if respiratory failure or paralysis prevents full self-care. 

Because granulomatous diseases can affect multiple body systems, each affected organ or residual complication must be properly documented. Veterans should ensure their medical providers include clear language about loss of function, need for assistance, or unemployability when completing Disability Benefits Questionnaires or medical opinions. This level of documentation helps ensure the VA evaluates the full scope of disability and assigns the highest rating and compensation possible. 

Has the VA Given You a Lower Rating Than You Deserve? 

At Hill & Ponton, we specialize in assisting underrated veterans receive the full benefits they’re entitled to. Contact us for a free evaluation of your case and let us maximize your compensation!