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

Spirometry - FEV1 (Forced Expiratory Volume in 1 second)

What it measures: 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.

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)

What it measures: 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.

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

What it measures: 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.

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

DLCO (Diffusing Capacity of the Lungs for Carbon Monoxide)

What it measures: 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.

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)

What it measures: 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.

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

CT Scan / High-Resolution CT (HRCT)

What it measures: 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.

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

100%

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.

From 38 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 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.

From 38 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 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.

From 38 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 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.

From 38 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.

Dyspnea (Shortness of Breath)

How to describe it: 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.

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.

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

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 it: 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.

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.

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

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 it: 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.

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.

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.

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 it: 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.

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.

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

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

Non-Pulmonary TB Manifestations

How to describe it: 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.

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.

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.

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 it: 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.

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.

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

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