For years, veterans who live with a debilitating lung ailment after being exposed to toxic air and burning trash during their service have reported they’ve struggled to get disability benefits through the Department of Veterans Affairs.
The VA’s system for awarding these benefits does not have a diagnostic code for constrictive bronchiolitis, or CB, which has been linked to post-9/11 military installations in Southwest Asia, Afghanistan and Djibouti.
For nearly all medical conditions a veteran may have, the VA’s Schedule for Rating Disabilities assigns a four-digit code, along with a percentage rating that attempts to reflect the degree of a veteran’s disability. The ratings help determine the monthly payment a veteran will receive for their service-related injuries and diseases to make up for the “loss of working time from exacerbations or illnesses proportionate to the severity” of their condition.
Because the VA does not have a specific diagnostic code and corollary rating schedule for this condition, the majority of veterans with constrictive bronchiolitis receive a zero disability rating, and are not awarded disability compensation. But a new revision to the system could create such a code, making it easier for veterans to receive payments.
In an interview with the PBS NewsHour, Under Secretary for Benefits Joshua Jacobs said the VA was “actively working to update” its Schedule for Rating Disabilities “as quickly as possible” and that it will address constrictive bronchiolitis. “It is a very high priority.”
In an email to the NewsHour, the department’s spokesman went one step further, saying the “VA is considering the addition of a diagnostic code for constrictive bronchiolitis.”
Under Secretary of Veterans Affairs for Health Dr. Shereef Elnahal shared more details about options officials were considering at a Society for Federal Health Professionals conference in February, according to two participants who say they spoke to him on the sidelines. Elnahal indicated that lawyers at the VA were trying to decide whether a newly created diagnostic code and rating schedule should be focused exclusively around constrictive bronchiolitis, or an umbrella medical term called “Deployment-Related Respiratory Disease,” which includes constrictive bronchiolitis and other respiratory conditions.
The VA aims to publish the revised changes in the Federal Register by Sept. 30, 2024, which is the end of the current fiscal year, according to a Capitol Hill staffer and a health professional with knowledge of discussions on this issue.
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There are an estimated 300 to 400 veterans who have been diagnosed with constrictive bronchiolitis or other small airway injuries after receiving lung biopsies, according to a VA staffer who has worked extensively on this issue. That estimate pales in comparison to the number of veterans with other more common respiratory conditions. For example, as of Jan. 1, 2024 more than 7,000 veterans had claims approved for Chronic Obstructive Pulmonary Disease. More than 30,000 claims for asthma were approved.
But unlike asthma and other pulmonary conditions, CB cannot be diagnosed with traditional lung tests such as X-rays, CT scans or pulmonary function tests (PFT). A confirmed diagnosis requires an invasive lung biopsy, a test that can present significant costs and risks to the patient.
The NewsHour has requested updated VA data on how many veterans have been diagnosed with CB but has not received it.
Former VA doctor Allyn Harris says that the 300 to 400 number is “a huge…
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