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C&P Exam Prep: Tuberculosis (Pulmonary / Non-Pulmonary)

DC 6730 respiratory 38 CFR 4.97 / 4.88

DBQ Overview

Interview + Physical
Form Name
Tuberculosis
Form Code
Tuberculosis
Page Count
7
Examiner Type
Pulmonologist or Infectious Disease Physician
Estimated Duration
30-45 minutes
Exam Format
Interview + Physical

What to Expect During Your Exam

Exam Overview

To establish the current diagnosis, activity status (active vs. inactive), extent of pulmonary lesions, residual pulmonary and non-pulmonary complications, and overall functional impairment attributable to Tuberculosis (TB) for disability rating purposes under 38 CFR 4.97 and 4.88.

What the examiner evaluates:

  • Confirmation of TB diagnosis (pulmonary or non-pulmonary) and ICD code
  • Active vs. inactive status of the disease and date of inactivity
  • Extent of pulmonary lesions: minimal, moderately advanced, or far advanced
  • Presence of respiratory symptoms: dyspnea on exertion, chronic cough, hemoptysis
  • Pulmonary function test (PFT) results: FEV1, FVC, FEV1/FVC ratio, DLCO
  • Imaging findings: chest X-ray, CT scan, high-resolution CT (HRCT)
  • Pulmonary complications: emphysema, pulmonary hypertension, right ventricular hypertrophy, cor pulmonale
  • Episodes of acute respiratory failure and oxygen therapy requirement
  • Non-pulmonary TB manifestations: skeletal, genitourinary, gastrointestinal, meningitis, laryngeal, pleural, peritoneal, lymphadenitis, cutaneous, ocular TB
  • Treatment history, current medications, dates of treatment initiation and completion
  • Impact on daily activities, work capacity, and overall health
  • Nexus between current condition and military service

Exam will be conducted by a Pulmonologist or Infectious Disease Physician at a VA facility or contracted exam site (e.g., LHI, VES, QTC). Pulmonary function testing may occur on the same day or be scheduled separately. Bring all prior TB treatment records, sputum culture results, AFB smear results, chest imaging reports, and medication lists. Veterans in most states have the right to record the examination - verify your state law before the appointment.

Typical duration: 30-45 minutes

Spirometry - FEV1 (Forced Expiratory Volume in 1 second)

The volume of air forcibly exhaled in the first second; primary marker of obstructive airflow limitation caused by TB-related lung damage.

What to expect:

You will breathe into a mouthpiece connected to a spirometer and exhale as hard and fast as possible. Multiple attempts are made. Results are expressed as absolute value (liters) and percentage of predicted normal for your age, sex, and height.

Key thresholds:

  • FEV1 > 70% predicted — May support lower respiratory rating; residual impairment evaluated under separate respiratory DCs post-inactivity
  • FEV1 56-70% predicted — Mild obstruction; may support 30% under analogous respiratory DC
  • FEV1 40-55% predicted — Moderate obstruction; may support 60% under analogous respiratory DC
  • FEV1 < 40% predicted — Severe obstruction; may support 100% under analogous respiratory DC

Tips:

  • Do NOT use a bronchodilator on the day of testing unless medically required - testing should reflect your baseline condition.
  • Perform the test when you are experiencing your typical level of symptoms, not on an unusually good day.
  • If you feel your effort was not maximal due to coughing or fatigue, tell the technician immediately so the test can be repeated.
  • Bring your rescue inhaler to the exam in case it is needed post-testing.

Pain considerations: If forceful exhalation triggers chest pain, pleuritic pain, or significant coughing episodes, inform the technician immediately. Document that the effort was limited by symptoms.

Spirometry - FVC (Forced Vital Capacity)

The total volume of air exhaled after maximal inhalation; reduced FVC indicates restrictive lung disease, common in fibrotic TB sequelae.

What to expect:

Performed simultaneously with FEV1 during spirometry. A low FVC with a normal or elevated FEV1/FVC ratio indicates restriction rather than obstruction.

Key thresholds:

  • FVC > 70% predicted — Minimal restriction; functional impairment may still exist from TB sequelae
  • FVC 56-70% predicted — Mild restriction; supports meaningful respiratory impairment
  • FVC 40-55% predicted — Moderate restriction; supports higher-level respiratory ratings
  • FVC < 40% predicted — Severe restriction; supports 100% rating under analogous respiratory DC

Tips:

  • Ensure a full maximum inhalation before each exhalation effort.
  • TB-related fibrosis and pleural scarring frequently produce a restrictive pattern - make sure the examiner notes this distinction.
  • Report any history of pleuritis or pleural effusion as this can cause falsely improved FVC on a single test day.

Pain considerations: Pleural scarring from TB pleurisy may cause sharp chest pain with deep inhalation during FVC testing. Report this to the technician.

FEV1/FVC Ratio

The ratio of FEV1 to FVC; distinguishes obstructive (ratio < 0.70) from restrictive (ratio normal or high with low FVC) patterns.

What to expect:

Calculated automatically from spirometry data. The examiner will use this to characterize the type and degree of pulmonary impairment from TB.

Key thresholds:

  • FEV1/FVC < 0.70 — Obstructive pattern - indicates airway damage such as bronchiectasis or emphysema from TB
  • FEV1/FVC - 0.70 with low FVC — Restrictive pattern - indicates fibrosis or pleural disease from TB; still ratable

Tips:

  • Understand that TB can cause both obstructive and restrictive patterns - your impairment is valid regardless of pattern type.
  • Ask the examiner to document which pattern is present and to link it to your TB diagnosis.

Pain considerations: Not directly applicable; see FEV1 and FVC entries.

DLCO (Diffusing Capacity of the Lungs for Carbon Monoxide)

The efficiency of gas exchange across the alveolar-capillary membrane; reduced in TB-related fibrosis, emphysema, and pulmonary hypertension.

What to expect:

You inhale a small amount of carbon monoxide and hold your breath for 10 seconds, then exhale. Results are expressed as a percentage of predicted normal.

Key thresholds:

  • DLCO > 70% predicted — Mild impairment of gas exchange
  • DLCO 56-70% predicted — Moderate impairment; supports higher disability ratings
  • DLCO < 40% predicted — Severe impairment; supports 100% rating under analogous respiratory DC

Tips:

  • DLCO is particularly important if you have significant fibrosis, emphysema, or pulmonary hypertension from TB.
  • Do not smoke for at least 24 hours before the test as smoking artificially elevates DLCO.
  • Ensure this test is performed and documented - it may be the single most important objective indicator of your functional impairment.

Pain considerations: Breath-holding may be difficult if you experience pleuritic chest pain. Inform the technician if breath-holding is limited by pain or dyspnea.

Chest X-Ray (CXR)

Extent and distribution of pulmonary TB lesions; used to classify as minimal, moderately advanced, or far advanced; detects cavitation, calcification, fibrosis, pleural disease.

What to expect:

Standard posteroanterior (PA) and lateral chest X-rays. The radiologist or examiner will classify lesion extent and note any cavities, infiltrates, calcification, pleural thickening, or effusion.

Key thresholds:

  • Minimal lesions (no cavitation, small non-dense lesions, total extent - 1 lung volume) — Active minimal: DC 6703 at 100% while active; Inactive minimal: DC 6723, rated on residuals
  • Moderately advanced lesions — Active: DC 6702 at 100% while active; Inactive: rated on residuals
  • Far advanced lesions (cavitation, extensive infiltration, or total volume > moderately advanced) — Active: 100% while active; Inactive DC 6721: rated on residuals with staged reduction schedule

Tips:

  • Request that all prior chest X-rays be compared for lesion progression or regression.
  • Ensure the radiologist specifies lesion classification (minimal/moderately advanced/far advanced) - this directly drives the rating level.
  • Cavity formation is a marker of far advanced disease - confirm this is documented if present.

Pain considerations: Not directly applicable; imaging is non-invasive.

CT Scan / High-Resolution CT (HRCT)

Detailed lung parenchymal assessment; detects bronchiectasis, fibrosis, miliary disease, cavitation, and lymphadenopathy not visible on plain X-ray.

What to expect:

You will lie in a CT scanner for approximately 10-15 minutes. No contrast is typically required for pulmonary TB evaluation unless vascular complications are suspected.

Key thresholds:

  • Evidence of bronchiectasis — Supports separately ratable condition under DC 6600 series
  • Evidence of pulmonary fibrosis — Supports restrictive pattern on PFTs; may be rated under DC 6825
  • Miliary pattern or disseminated disease — Supports far advanced classification and highest rating level

Tips:

  • If CT has been performed by your treating physician, bring the radiology report and CD/disc to the exam.
  • HRCT is particularly valuable for documenting bronchiectasis as a TB residual - ensure this finding is linked to TB by the examiner.

Pain considerations: Not directly applicable; imaging is non-invasive.

Estimate

Rating Criteria Breakdown

100% Active pulmonary TB - any degree of activity (minimal, moder ...

Active pulmonary TB - any degree of activity (minimal, moderately advanced, or far advanced). Under DCs 6703 and 6702, active TB is rated at 100% for the duration of active disease. Under DC 6721 (inactive, far advanced), a 100% rating applies from the date of inactivity for an initial period per 38 CFR 3.376 and M21-1 V.iii.4.B, with staged reductions thereafter. Active non-pulmonary TB manifestations may also support 100% while active.

Key Symptoms

  • Positive sputum culture or AFB smear for Mycobacterium tuberculosis
  • Active cavitary or infiltrative lesions on imaging
  • Constitutional symptoms: fever, night sweats, weight loss, fatigue
  • Productive cough, hemoptysis
  • Currently on anti-TB medication regimen (RIPE therapy or equivalent)
  • Far advanced inactive lesions within the mandatory 100% period post-inactivity

CFR: 38 CFR DC 6703: Tuberculosis, pulmonary, chronic, minimal, active - 100%. 38 CFR DC 6702: Tuberculosis, pulmonary, chronic, moderately advanced, active - 100%. M21-1 V.iii.4.B: Far advanced inactive TB (DC 6721) receives 100% from date of inactivity, reducing to 50% two years later and 30% four years after that per the statutory schedule.

50% Inactive far advanced pulmonary TB (DC 6721) - two years aft ...

Inactive far advanced pulmonary TB (DC 6721) - two years after the date of inactivity, the rating reduces from 100% to 50% per M21-1 staged reduction schedule (38 CFR 3.376). May also apply to inactive TB rated on pulmonary residuals under an analogous respiratory DC where FEV1 or FVC is 40-55% predicted.

Key Symptoms

  • Confirmed inactive TB with prior far advanced lesion classification
  • Significant residual dyspnea on exertion limiting daily activities
  • Moderate obstruction or restriction on PFTs (FEV1 40-55% or FVC 40-55%)
  • Bronchiectasis with recurrent infections
  • Moderate functional impairment at work or in daily life

CFR: M21-1 V.iii.4.B.3: Inactive far advanced TB (DC 6721) rated at 100% from date of inactivity, 50% two years later, 30% four years after that. Separately, analogous respiratory DCs (e.g., DC 6600 bronchiectasis) may provide 50% if FEV1 or FVC is 40-55% predicted.

30% Inactive far advanced pulmonary TB (DC 6721) - four years af ...

Inactive far advanced pulmonary TB (DC 6721) - four years after the date of inactivity (six years total from inactivity), the rating reduces to 30% per M21-1 staged reduction. May also apply to inactive TB rated on residuals under an analogous respiratory DC where FEV1 or FVC is 56-70% predicted or mild impairment is present.

Key Symptoms

  • Longstanding inactive TB with prior far advanced classification
  • Mild to moderate residual dyspnea
  • Mild obstruction or restriction on PFTs (FEV1 or FVC 56-70% predicted)
  • Residual pleural thickening, fibrosis, or calcification on imaging
  • Occasional exacerbations or respiratory infections

CFR: M21-1 V.iii.4.B.3: Inactive far advanced TB (DC 6721) rated at 30% from four years after inactivity. Analogous respiratory DCs may independently support 30% if FEV1 or FVC is 56-70% predicted.

0% Inactive TB with minimal lesions (DC 6723) or inactive TB wi ...

Inactive TB with minimal lesions (DC 6723) or inactive TB with minimal/no residual impairment. A 0% rating means the condition is service-connected but does not currently produce compensable disability. However, residual complications (emphysema, bronchiectasis, pulmonary hypertension) may be separately rated under appropriate DCs.

Key Symptoms

  • Inactive TB with minimal lesion classification
  • Normal or near-normal PFTs
  • No significant residual pulmonary or non-pulmonary complications
  • No current symptoms attributable to TB

CFR: 38 CFR DC 6723: Tuberculosis, pulmonary, chronic, minimal, inactive - rated on residuals only. If no ratable residuals exist, a 0% non-compensable service-connected rating is assigned, preserving future claims for worsening.

How to Describe Your Symptoms

Dyspnea (Shortness of Breath)

How to describe:

Describe exactly what activities trigger shortness of breath and how it limits you. Quantify: Can you climb one flight of stairs? Walk one block on flat ground? Get dressed without stopping to catch your breath? Use MRC dyspnea scale language if possible.

Worst-day example:

“On my worst days, I become severely short of breath just walking from my bedroom to the bathroom - about 20 feet. I have to stop and sit down after minimal exertion. I sometimes wake at night gasping for air.”

What the examiner listens for:

Specific activity-related triggers, quantified exertional tolerance, nocturnal dyspnea, positional worsening, and whether oxygen is needed.

Understatements to avoid:

Do not say 'I get a little winded sometimes.' Say exactly at what level of exertion breathlessness occurs and how it impacts your life.

Chronic Cough and Hemoptysis

How to describe:

Describe frequency, character (dry vs. productive), volume and color of sputum, presence of blood. Note whether coughing causes chest pain, disrupts sleep, or prevents you from speaking in long sentences.

Worst-day example:

“On bad days I cough continuously for 30-45 minutes in the morning producing thick, sometimes blood-tinged sputum. The coughing causes sharp chest pain and leaves me exhausted for hours.”

What the examiner listens for:

Chronicity, sputum production, hemoptysis episodes, relationship to posture or activity, and impact on sleep and daily function.

Understatements to avoid:

Do not minimize blood in sputum as 'just a little bit.' Even intermittent hemoptysis is a significant symptom that must be accurately reported.

Fatigue and Constitutional Symptoms

How to describe:

Describe daily energy levels, how quickly you fatigue with normal activities, whether fatigue improves with rest, and any ongoing constitutional symptoms (night sweats, weight loss, fever) even if TB is labeled inactive.

Worst-day example:

“I wake up exhausted despite 8-9 hours of sleep. After light activity like cooking a meal or doing laundry, I need to rest for 1-2 hours. I have lost 15 pounds over the past year without trying.”

What the examiner listens for:

Functional impact of fatigue on work and self-care, persistence of constitutional symptoms suggesting ongoing or reactivated disease, and whether fatigue is respiratory or systemic in origin.

Understatements to avoid:

Do not say 'I'm just a little tired.' Describe specific tasks you can no longer complete and how long recovery takes after minimal exertion.

Chest Pain and Pleuritic Pain

How to describe:

Describe location, character (sharp, stabbing, pressure), whether it is worse with deep breathing or coughing (pleuritic), and whether it limits your ability to breathe deeply, exercise, or sleep.

Worst-day example:

“When I breathe deeply or cough, I feel a stabbing pain in my right lower chest that scores 7 out of 10. It forces me to breathe shallowly, which makes me feel more short of breath. It wakes me up at night when I roll onto that side.”

What the examiner listens for:

Pleuritic character (worsens with breathing), location correlating with known TB lesion sites, and functional impact on respiratory effort.

Understatements to avoid:

Do not describe chest pain as 'soreness.' Use specific language about how breathing mechanics are affected.

Non-Pulmonary TB Manifestations

How to describe:

For each non-pulmonary site affected (skeletal, genitourinary, gastrointestinal, meningitis, laryngeal, etc.), describe the specific symptoms and functional limitations at that site. Note whether symptoms are ongoing, episodic, or permanent sequelae.

Worst-day example:

“My spinal TB (Pott's disease) causes constant back pain rated 8/10 that prevents me from standing for more than 10 minutes. On bad days the pain radiates into both legs with numbness and weakness.”

What the examiner listens for:

Confirmation of non-pulmonary TB site, specific organ-system symptoms, whether the condition is active or has left permanent residuals, and whether a separate DBQ is needed.

Understatements to avoid:

Do not assume non-pulmonary TB is automatically captured in the pulmonary evaluation. Each affected organ system must be separately described and documented.

Impact on Work and Daily Life

How to describe:

Describe specifically which work tasks or daily activities you cannot perform due to TB and its complications. Note any lost employment, reduced hours, job changes, or accommodations required.

Worst-day example:

“I had to leave my job as a warehouse supervisor because I cannot walk the floor without stopping to catch my breath every 50 feet. I now work part-time in a seated administrative role, which still requires me to leave early 1-2 days per week due to respiratory symptoms.”

What the examiner listens for:

Occupational impact, frequency of medical appointments, hospitalizations, and whether symptoms prevent sustained full-time employment.

Understatements to avoid:

Do not say 'I manage okay.' Describe every specific limitation and accommodation honestly and in detail.

Common Mistakes to Avoid

Prep Checklist

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Before Your Exam

Day Of

During the Exam

After the Exam

Your Rights During a C&P Exam

  • You have the right to request a copy of the completed DBQ and C&P examination report through your VA records portal or by written request to your VARO.
  • You have the right to record your C&P examination in most U.S. states - verify one-party vs. two-party consent requirements in your state before recording.
  • You have the right to bring a representative (VSO, accredited attorney, claims agent, or supportive person) to your C&P examination.
  • You have the right to request a new or supplemental examination if the initial exam is inadequate, incorrect, or fails to address all claimed conditions.
  • You have the right to submit a private medical opinion (nexus letter or IME) to rebut or supplement the C&P examiner's findings.
  • You have the right to full consideration of all submitted evidence, including lay statements, buddy statements, and personal statements about your symptoms and their impact.
  • You have the right to the benefit of the doubt under 38 CFR 3.102 - when evidence is in approximate balance, the decision must be resolved in your favor.
  • You have the right to submit a Notice of Disagreement (NOD) if you disagree with the rating decision, and to request a Higher-Level Review (HLR) or Board of Veterans' Appeals (BVA) hearing.
  • Under 38 CFR 3.370 and 3.371, chest X-ray evidence must be properly interpreted by VA-authorized personnel - you have the right to ensure this standard is met for your claim.
  • You have the right to request the examination be rescheduled if you are acutely ill on the exam date and your condition would not accurately reflect your typical level of impairment.
  • For inactive far advanced TB (DC 6721), you have the right to the mandatory 100% rating from the date of inactivity, with reductions only after 2 and 6 years per 38 CFR 3.376 - premature reductions must be contested.

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This C&P exam preparation guide is for educational purposes only and does not constitute legal, medical, or claims advice. Always consult with a qualified Veterans Service Organization (VSO) representative or VA-accredited attorney for guidance specific to your claim. Never exaggerate, minimize, or fabricate symptoms during a C&P examination.