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VA Rating Assistant

DC 7710 · 38 CFR 4.97 / 4.88

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

To document the current severity, activity status, extent of pulmonary or non-pulmonary involvement, residual functional impairment, and service connection nexus for tuberculosis under 38 CFR 4.97 and 4.88. The examiner will determine whether TB is active or inactive, the degree of lesion advancement, presence of complications, and impact on daily functioning and employability.

Format:
Interview + Physical
Typical duration:
30-45 minutes
DBQ form:
Tuberculosis (Tuberculosis)
Examiner:
Pulmonologist or Infectious Disease Physician

What the examiner evaluates

  • Whether tuberculosis is currently active or inactive (arrested)
  • Degree of lesion advancement: minimal, moderately advanced, or far advanced
  • Pulmonary function test results (FEV1, FVC, FEV1/FVC ratio, DLCO)
  • Presence and severity of respiratory symptoms: dyspnea on exertion, chronic cough, hemoptysis, wheezing
  • Pulmonary complications: emphysema, pulmonary hypertension, right ventricular hypertrophy, cor pulmonale, acute respiratory failure
  • Non-pulmonary TB manifestations: skeletal TB, genitourinary TB, gastrointestinal TB, tuberculous meningitis, tuberculous pleurisy, tuberculous peritonitis, tuberculous laryngitis, tuberculous lymphadenitis, cutaneous TB, ocular TB
  • Treatment history: medications used, dates of treatment initiation and completion
  • Imaging findings: chest X-ray, CT scan, high-resolution CT (HRCT), MRI results
  • Scar tissue, cavitation, fibrosis, or calcification visible on imaging
  • Whether the condition causes impairment of health or functional limitations
  • Any secondary or associated conditions caused or aggravated by TB
  • Impact of the condition on occupational and daily activities

The examination typically occurs at a VA medical center, VAMC affiliate, or contracted QTC/LHI/Optum Serve clinic. Bring all prior imaging CDs or reports, pulmonary function test records, treatment records, and any private physician statements. You have the right to record the exam in most states - check your state law and notify the examiner beforehand. The examiner will review medical records, conduct a respiratory-focused physical exam, and may order or review spirometry results.

Measurements and tests

FEV1 (Forced Expiratory Volume in 1 Second)

What it measures: The volume of air you can forcefully exhale in the first second of a breath. A primary indicator of obstructive lung disease and overall respiratory capacity. Used directly to assign rating percentages under 38 CFR 4.97.

What to expect: You will be asked to breathe in deeply and then blow out as hard and fast as possible into a mouthpiece connected to a spirometer. At least three acceptable efforts are required. Pre- and post-bronchodilator measurements may be taken. The test takes approximately 15-20 minutes.

Critical thresholds

  • FEV1 > 70% of predicted Supports lower severity ratings; may result in 0% if asymptomatic residuals
  • FEV1 56-70% of predicted Supports 30% rating range for chronic pulmonary residuals
  • FEV1 40-55% of predicted Supports 60% rating range for chronic pulmonary residuals
  • FEV1 < 40% of predicted Supports 100% rating for severe chronic pulmonary residuals
  • Active TB (any severity) Automatic 100% while active under DC 6702, 6703, or 6704

Tips

  • Do NOT use bronchodilators, inhalers, or caffeine for the specified period before testing - follow your provider's instructions
  • Wear loose clothing; do not eat a heavy meal within 2 hours of testing
  • If you experience significant shortness of breath, dizziness, or chest tightness during the test, stop and notify the technician immediately
  • Give maximum effort on every attempt - inconsistent effort can result in artificially low or high readings
  • If your condition is worse on some days due to weather, allergens, or exertion, mention this to the examiner so the single-day result is contextualized
  • Ask the examiner to document if you were symptomatic or fatigued during testing

Pain considerations: Forceful exhalation may trigger coughing episodes, chest discomfort, or pain in veterans with pleuritic involvement or post-surgical scarring. Notify the examiner if forceful exhalation causes pain or coughing that limits your best effort - this functional limitation itself is relevant evidence.

FVC (Forced Vital Capacity)

What it measures: Total volume of air exhaled during a forced breath. Reduction in FVC indicates restrictive lung disease, which is common in TB-related fibrosis, pleural scarring, and post-cavitary lesions.

What to expect: Measured during the same spirometry session as FEV1. Results are expressed as a raw volume (liters) and as a percentage of predicted value based on age, height, sex, and ethnicity.

Critical thresholds

  • FVC - 80% predicted Normal range; supports lower severity unless other indicators present
  • FVC 51-79% predicted Mild to moderate restriction; supports intermediate rating levels
  • FVC - 50% predicted Severe restriction; supports higher rating levels

Tips

  • FVC reduction combined with FEV1 reduction strengthens the case for higher severity ratings
  • Mention if your breathing capacity varies day to day or worsens with exertion, cold air, or illness
  • TB-related pleural scarring and fibrosis often cause restriction even after the infection is resolved - make sure the examiner understands this connection

Pain considerations: Pleuritic chest pain or musculoskeletal pain from past thoracic surgery or rib involvement may limit maximum inhalation and exhalation effort. Clearly communicate any pain that prevents you from inhaling fully.

FEV1/FVC Ratio

What it measures: The ratio of FEV1 to FVC. Used to distinguish obstructive (e.g., emphysema, COPD) from restrictive (e.g., fibrosis) patterns. TB can cause both patterns depending on extent of destruction and scarring.

What to expect: Automatically calculated from spirometry data. A ratio below 0.70 suggests obstruction; a preserved or elevated ratio with reduced FVC suggests restriction.

Critical thresholds

  • FEV1/FVC < 0.70 Obstructive pattern; consistent with TB-related emphysema or bronchiectasis
  • FEV1/FVC - 0.70 with reduced FVC Restrictive pattern; consistent with TB-related fibrosis or pleural disease

Tips

  • Ensure the examiner documents both the pre- and post-bronchodilator values if available
  • TB-related obstructive patterns are ratable as respiratory residuals under 38 CFR 4.97

Pain considerations: Not typically painful; however, forceful breathing maneuvers may exacerbate pleuritic or chest wall discomfort.

DLCO (Diffusing Capacity of the Lungs for Carbon Monoxide)

What it measures: Measures how efficiently the lungs transfer gas from inhaled air to the bloodstream. Reduced DLCO indicates damage to the alveolar-capillary membrane, common in TB-related fibrosis and emphysema.

What to expect: You will inhale a small amount of carbon monoxide mixed with other gases, hold your breath for 10 seconds, then exhale. The exhaled gas is analyzed. Results expressed as percent predicted.

Critical thresholds

  • DLCO - 70% predicted Near normal gas exchange; lower severity
  • DLCO 41-69% predicted Moderate impairment; supports intermediate to higher ratings
  • DLCO - 40% predicted Severe impairment; supports 100% rating range

Tips

  • Do not smoke for at least 4 hours before the DLCO test as carbon monoxide from smoking artificially lowers the result
  • DLCO reduction documents the real-world functional impact of lung tissue destruction even when spirometry appears near-normal
  • Ask the examiner to include DLCO results in the DBQ even if only spirometry was ordered

Pain considerations: Breath-holding is required; if chest pain or coughing prevents adequate breath-holding, inform the technician.

Rating criteria by percentage

100%

Active tuberculosis of any variety - pulmonary or non-pulmonary - regardless of degree of advancement. Under DC 6702 (moderately advanced active), DC 6703 (minimal active), and DC 6704 (advancement unspecified active), active TB is rated at 100% for the duration of activity. Additionally, per 38 CFR 4.88b, inactive pulmonary TB that was far advanced at any time is initially rated 100% for two years following inactivity, then reduced to 50% and again to 30% per the staged reduction schedule. Non-pulmonary TB forms such as meningitis, skeletal TB, genitourinary TB, and others are rated at 100% while active.

Key symptoms

  • Bacteriologically confirmed active TB (sputum culture, AFB smear, NAAT positive)
  • Constitutional symptoms: fever, night sweats, significant weight loss, fatigue
  • Hemoptysis
  • Progressive cough with productive sputum
  • Radiographic evidence of active cavitation, consolidation, or miliary pattern
  • Currently on anti-TB treatment regimen (RIPE therapy or equivalent)
  • Failure to complete treatment or drug-resistant TB requiring extended therapy
  • Non-pulmonary active TB: meningitis, skeletal, genitourinary, GI, pleural involvement

From 38 CFR: 38 CFR 4.97 DC 6702: Tuberculosis, pulmonary, chronic, moderately advanced, active - 100%. DC 6703: Tuberculosis, pulmonary, chronic, minimal, active - 100%. DC 6704: Tuberculosis, pulmonary, chronic, active, advancement unspecified - 100%. M21-1 V.iii.4.B: Active TB is rated 100% for the duration of active disease regardless of advancement level.

100%

Inactive (arrested) pulmonary TB that was far advanced at any time during the disease course. Under 38 CFR 4.88b and M21-1 V.iii.4.B.2, the veteran receives a 100% rating for two full years from the date of inactivity. This is the initial stage of the staged reduction schedule even after bacteriological cure.

Key symptoms

  • Prior documentation of far-advanced lesions on imaging
  • Bilateral or extensive pulmonary involvement
  • Severe respiratory impairment even after completing treatment
  • Requirement for oxygen therapy
  • Cor pulmonale or right ventricular hypertrophy
  • Episodes of acute respiratory failure
  • Severe restriction in activities of daily living

From 38 CFR: DC 6721: Tuberculosis, pulmonary, chronic, far advanced, inactive. M21-1 Example: Far advanced inactive TB rated 100% from date of inactivity, 50% two years later, 30% four years after inactivity date per staged reduction schedule.

50%

Inactive (arrested) pulmonary TB with far-advanced lesion history, two years after the date of inactivity under the staged reduction schedule per 38 CFR 4.88b. Also applicable to inactive TB with moderately advanced residual damage that produces significant but not total functional impairment as rated under the residual respiratory conditions framework.

Key symptoms

  • FEV1 in the 40-55% of predicted range
  • Persistent dyspnea on moderate exertion
  • Requirement for bronchodilators or other respiratory medications
  • Chronic productive cough with significant sputum production
  • Moderate restriction in daily activities due to breathlessness
  • Ongoing pulmonary hypertension without cor pulmonale
  • Moderate radiographic residuals: scarring, fibrosis, calcification

From 38 CFR: M21-1 V.iii.4.B.3: Far advanced inactive TB reduced to 50% two years after date of inactivity. M21-1 Example 3: Reduction to 50% effective date of last payment at expiration of due process period.

30%

Inactive (arrested) pulmonary TB with far-advanced lesion history, four years after the date of inactivity under the staged reduction schedule per 38 CFR 4.88b. Also applicable to inactive TB residuals with mild-to-moderate functional impairment rated under associated respiratory diagnostic codes.

Key symptoms

  • FEV1 in the 56-70% of predicted range
  • Dyspnea on significant exertion but not at rest or with mild activity
  • Mild chronic cough
  • Residual pleural thickening or scarring on imaging
  • Mild limitation in physical activities
  • Occasional use of rescue inhalers

From 38 CFR: M21-1 V.iii.4.B.3: Far advanced inactive TB reduced to 30% four years after date of inactivity. M21-1 Example 4: Staged reduction to 30% four years after date of reinstatement following reexamination.

0%

Inactive TB with minimal or no residual functional impairment. Spirometry near normal, no significant respiratory symptoms, no complications, and no ongoing treatment requirement. However, a 0% rating still establishes service connection, preserving eligibility for future increases if condition worsens or complications develop.

Key symptoms

  • FEV1 and FVC greater than 70% of predicted
  • No dyspnea at rest or with normal activity
  • No requirement for respiratory medications
  • Stable imaging with only minor calcifications or scarring
  • No constitutional symptoms
  • No complications such as pulmonary hypertension or cor pulmonale

From 38 CFR: Residual respiratory ratings under 38 CFR 4.97; 0% rating applies when TB is inactive with no compensable residuals. Service connection should still be established.

Describing your symptoms accurately

Dyspnea (Shortness of Breath)

How to describe it: Quantify your breathlessness in concrete functional terms. Describe specific activities you can no longer perform or that require you to stop and rest. Use the MRC Dyspnea Scale as a framework: Can you walk on level ground without stopping? Do you need to stop after 100 yards? Are you breathless getting dressed? Specify whether breathlessness is worse in cold weather, humidity, or after respiratory infections.

Example: On my worst days, I cannot walk from my bedroom to the kitchen without stopping to catch my breath. I have to sit on the edge of the bed for several minutes after getting dressed before I can continue. I canceled a family outing last month because I knew I could not keep up with walking across a parking lot.

Examiner listens for: The examiner is assessing whether dyspnea limits occupational activities, whether it occurs at rest versus only with exertion, and whether it correlates with spirometry findings. Specific functional limitations are more persuasive than general statements of 'shortness of breath.'

Avoid: Avoid saying 'I get a little winded' - instead say 'I become significantly short of breath and must rest after [specific distance or activity].' Do not minimize symptoms to appear stoic.

Chronic Cough and Sputum Production

How to describe it: Describe the frequency (times per day, times per week), character (dry vs. productive), color and amount of sputum, and whether coughing is worse at certain times of day or triggered by specific factors. Note any episodes of hemoptysis (coughing up blood) with dates and amount.

Example: On my worst days, I cough for extended periods in the morning - sometimes for 30 to 45 minutes - bringing up thick yellow-green sputum. The coughing wakes me from sleep at least three nights per week. I have had two episodes this year where I coughed up blood, which required urgent care visits.

Examiner listens for: Frequency, severity, impact on sleep and daily activities, any hemoptysis, and whether the cough is productive versus dry. Hemoptysis is particularly significant and should be documented with specific dates and amounts.

Avoid: Do not omit hemoptysis even if it seems minor - any episode of blood in sputum is clinically significant for TB residuals. Do not say 'I just have a normal cough' without quantifying its impact on your sleep, work, and daily life.

Fatigue and Constitutional Symptoms

How to describe it: Describe fatigue in terms of its impact on your ability to complete daily tasks, work, or maintain social activities. Distinguish fatigue from ordinary tiredness - explain that it does not resolve with rest. Note any persistent low-grade fevers, night sweats, or unintentional weight loss if active or recently active.

Example: On my worst days, I wake up exhausted after 8 to 9 hours of sleep, often with soaking night sweats. By noon I have no energy to complete basic household tasks. I have lost 15 pounds in the past six months without trying. I had to stop working my part-time job because I could not sustain even light activity for a full shift.

Examiner listens for: Whether fatigue is severe enough to impact occupational functioning, whether night sweats and weight loss suggest ongoing or partially treated disease, and the overall impairment of health caused by the condition.

Avoid: Do not attribute fatigue solely to age or unrelated factors during the exam. Accurately connect fatigue to your TB condition and its treatment course.

Chest Pain and Pleuritic Symptoms

How to describe it: Describe whether chest pain is sharp, dull, or pressure-like, whether it is pleuritic (worsens with deep breathing or coughing), and its location. Note whether pain limits your ability to take deep breaths, exercise, or sleep comfortably. Describe any history of pleural effusion, pleuritis, or empyema.

Example: On my worst days, any deep breath causes a sharp stabbing pain on my left side that makes me afraid to breathe deeply. I have to sleep sitting up because lying flat increases the pain. I cannot exercise at all because the combination of breathing harder and chest pain is unbearable.

Examiner listens for: Evidence of pleural involvement (rated separately as tuberculous pleurisy), whether chest pain limits respiratory effort during pulmonary function testing, and the overall functional impact on daily living.

Avoid: Do not minimize chest pain - it has both direct rating implications (tuberculous pleurisy) and impacts how accurately spirometry results capture your true limitations.

Non-Pulmonary TB Manifestations

How to describe it: If you have had or currently have non-pulmonary TB involvement (skeletal, genitourinary, gastrointestinal, meningitis, lymphadenitis, ocular, cutaneous, or laryngeal), describe each manifestation separately with specific symptoms, functional limitations, and treatment history. These are rated separately from pulmonary TB.

Example: For skeletal TB: On my worst days my back pain from spinal TB is an 8 out of 10. I cannot stand for more than 10 minutes, I cannot lift anything over 5 pounds, and I need a cane to walk. For genitourinary TB: I experience severe pelvic pain on my worst days, urinary frequency every 30 minutes, and I have had multiple procedures for ureteral strictures.

Examiner listens for: Each non-pulmonary site of involvement may result in a separate rating. The examiner will check specific DBQ fields for each type. Accurate and detailed reporting of each site's symptoms maximizes the completeness of the DBQ.

Avoid: Do not fail to mention non-pulmonary involvement just because the exam is labeled 'pulmonary.' The DBQ covers all TB manifestations. Each system affected should be described in detail.

Treatment Burden and Medication Side Effects

How to describe it: Describe the full anti-TB treatment regimen you were placed on, how long it lasted, any adverse effects (hepatotoxicity from isoniazid, optic neuritis from ethambutol, peripheral neuropathy from isoniazid, hearing loss from streptomycin), and whether you required drug modifications. Treatment burden itself informs the severity narrative.

Example: During my 9-month RIPE therapy course I developed peripheral neuropathy in both feet that persists today. I also had an episode of drug-induced hepatitis that required me to stop all medications for three weeks. The neuropathy remains severe enough that I cannot stand on hard floors for more than 20 minutes.

Examiner listens for: Completeness of treatment, drug resistance requiring second-line agents, treatment complications that resulted in additional diagnoses, and ongoing effects of medications that are ratable as secondary conditions.

Avoid: Do not dismiss medication side effects as 'already over' if they caused permanent damage. Peripheral neuropathy from isoniazid, for example, may be separately ratable as a secondary service-connected condition.

Common mistakes to avoid

Reporting only current symptoms without describing worst-day functioning

Why: VA ratings are based on the overall picture of disability including worst-day severity, not just how you feel on exam day. M21-1 guidance and case law support using the full range of your symptom experience.

Do this instead: Explicitly state when the examiner asks about symptoms: 'On my average day I experience X, but on my worst days - which occur about [frequency] - I experience Y.' Bring a written symptom diary documenting bad days.

Impact: All levels - critical for distinguishing 30% vs. 50% vs. 100%

Failing to disclose non-pulmonary TB manifestations during a pulmonary-focused exam

Why: The Tuberculosis DBQ covers all sites of TB involvement. Each non-pulmonary manifestation may result in a separate, additional rating. Failing to report them means the DBQ remains incomplete and those conditions may go unrated.

Do this instead: Before the exam, prepare a written list of all past and current TB manifestations by body site. Hand it to the examiner and ask that each site be documented in the appropriate DBQ section.

Impact: Affects total combined disability rating - potentially significant

Stopping short of maximum effort during spirometry to 'be safe' or avoid discomfort

Why: Submaximal effort produces artificially elevated spirometry values that do not reflect true functional impairment, potentially resulting in a lower rating that does not accurately capture disability.

Do this instead: Give your honest maximum effort. If discomfort or coughing limits your effort, tell the technician and examiner - this limitation is itself important clinical information that should be documented.

Impact: Critical for 30% vs. 60% vs. 100% under residual respiratory ratings

Not mentioning that far-advanced lesions were documented at any point during the disease

Why: Under 38 CFR 4.88b, a history of far-advanced lesions triggers the staged reduction schedule (100% - 50% - 30%) even after the disease becomes inactive. If the examiner is unaware of prior far-advanced disease, this protection may be missed.

Do this instead: Bring copies of all prior chest imaging reports or radiology reads that documented far-advanced, extensive, or bilateral involvement. Specifically point out these findings to the examiner.

Impact: Directly determines eligibility for 100% (inactive) vs. lower ratings

Describing functional limitations in vague terms without specific examples

Why: The examiner must document concrete functional impairment in the DBQ narrative fields. Vague statements like 'I feel bad' or 'it affects my life' do not give the examiner sufficient detail to accurately populate functional limitation fields.

Do this instead: Prepare specific examples: distances walked before stopping, household tasks you can no longer complete, lost employment, missed appointments, inability to perform hobbies. Quantify everything possible.

Impact: Critical for occupational and industrial impairment determinations

Assuming TB is automatically service-connected without providing nexus information

Why: Service connection requires a nexus between active duty service and the TB diagnosis. This may be direct SC, presumptive SC under 38 CFR 3.309, or secondary SC from another service-connected condition. Providing this information helps the examiner document it correctly.

Do this instead: Be prepared to explain exactly when, where, and how TB was contracted or diagnosed in relation to military service. Bring any relevant service treatment records, separation documents, or buddy statements.

Impact: Foundational - affects initial grant of service connection

Not requesting a copy of the completed DBQ before leaving the exam

Why: You have the right to request a copy of the DBQ. Reviewing it allows you to identify any factual errors, omissions, or mischaracterizations that could negatively impact your rating decision.

Do this instead: At the end of the exam, politely ask the examiner for a copy of the completed DBQ or ask how you can obtain one through VA. You can also request it through your VSO or via a FOIA/Privacy Act request.

Impact: All levels

Prep checklist

  • critical

    Gather all TB-related medical records

    Collect all records documenting your TB diagnosis, including: military service treatment records (STRs) showing TB exposure or treatment, VA medical center records, private physician records, hospital discharge summaries, bacteriology reports (sputum cultures, AFB smears, NAAT results), and all imaging reports (chest X-rays, CT scans, HRCT, MRI). Organize chronologically.

    before exam

  • critical

    Obtain all prior pulmonary function test records

    Collect any prior spirometry results (FEV1, FVC, FEV1/FVC, DLCO) from any treating provider. These provide a longitudinal record of respiratory function decline and are directly relevant to the rating decision. If records are at the VA, ensure they are in your file before the exam.

    before exam

  • critical

    Compile all chest imaging results with radiologist reports

    Collect actual radiology reports (not just images) for every chest X-ray and CT scan related to TB. Pay special attention to any report that documented 'far advanced,' 'moderately advanced,' bilateral involvement, cavitation, or extensive fibrosis - these findings trigger specific rating protections under 38 CFR 4.88b.

    before exam

  • critical

    Document all TB treatments with dates

    Create a written timeline of: date TB was diagnosed, date treatment began, all medications prescribed (isoniazid, rifampin, pyrazinamide, ethambutol, streptomycin, or second-line agents for drug-resistant TB), date treatment was completed or if it was discontinued and why, any treatment interruptions, and any treatment-related side effects that caused lasting harm (neuropathy, hepatotoxicity, hearing loss, vision changes).

    before exam

  • critical

    Write a symptom diary covering the past 30-90 days

    Document daily symptoms including: breathlessness during specific activities, cough frequency and character, sputum production, night sweats, fatigue levels, chest pain, hemoptysis episodes, and their impact on work, household activities, and social functioning. Note both average days and worst days. Bring this written record to the exam.

    before exam

  • critical

    Identify and document all non-pulmonary TB manifestations

    List every site of the body where TB has affected you: lungs, lymph nodes, spine or joints (skeletal), kidneys or genitourinary system, brain or meninges, gastrointestinal tract, pleura, peritoneum, larynx, skin, or eyes. For each affected site, note the diagnosis date, treatment received, and current symptoms or residuals. Each site can generate a separate rating.

    before exam

  • recommended

    Request exam recording authorization if applicable

    Check your state's recording laws. In most states, at least one-party consent applies and you may record your C&P exam. Notify the examiner at the start of the exam. Recording provides an objective record if the examiner's report mischaracterizes your statements.

    before exam

  • recommended

    Obtain a private medical opinion (nexus letter) if service connection is not yet established

    If TB occurred during service or as a result of service-connected activities (e.g., deployment to endemic regions, occupational exposure), consider obtaining a written nexus opinion from a private pulmonologist or infectious disease physician linking your TB to service. This is especially important if there is a gap between service and first diagnosis.

    before exam

  • recommended

    Prepare a written impact statement describing occupational and daily life limitations

    Write a one to two page statement describing: specific jobs or duties you can no longer perform, activities of daily living that are limited or impossible, social and recreational activities given up, relationships affected, and any emergency room visits or hospitalizations related to TB or its residuals. Give this to the examiner at the start of the appointment.

    before exam

  • recommended

    Identify and contact any buddy statement witnesses

    Ask fellow service members, supervisors, family members, or close friends who witnessed your TB diagnosis, treatment, or ongoing limitations to submit written buddy statements (VA Form 21-10210). These lay statements corroborate your reported functional limitations.

    before exam

  • critical

    Do not use bronchodilators before pulmonary function testing unless medically necessary

    Unless your doctor has instructed otherwise for safety reasons, avoid using short-acting bronchodilators (albuterol/salbutamol) for at least 4 hours before spirometry, and long-acting bronchodilators for 12-24 hours. Using them may artificially improve your results and underrepresent your baseline impairment. If you must use them for breathing safety, document this clearly and tell the examiner.

    day of

  • critical

    Avoid caffeine, heavy meals, and smoking before pulmonary function tests

    Do not smoke for at least 4 hours before testing (affects DLCO). Avoid caffeine for 4 hours (may act as mild bronchodilator). Do not eat a heavy meal within 2 hours as it can restrict diaphragm movement. Wear loose, non-restrictive clothing.

    day of

  • critical

    Bring all physical documents in an organized folder

    Bring hard copies of: treatment records, imaging reports, prior PFT results, your symptom diary, your written impact statement, and a list of all current medications with dosages. Bring the documents even if you believe they are in the VA file - examiners do not always have access to all records at the time of examination.

    day of

  • recommended

    Dress comfortably but reflect your functional status accurately

    Dress as you typically do on an average day - do not dress up in a way that masks your actual functional limitations. If you normally use a cane, walker, or supplemental oxygen, bring and use these aids. If you arrive having pushed yourself beyond your normal capacity to get there, explain this to the examiner.

    day of

  • recommended

    Arrive early and note your symptoms at arrival

    Arrive 15-20 minutes early. Before entering, note how you feel physically - breathlessness after parking and walking, fatigue, coughing. These observations are relevant and can be shared with the examiner as a description of your typical functional capacity for ordinary outings.

    day of

  • critical

    Report symptoms on your worst days, not your best days

    When the examiner asks how you are doing, describe the full range of your experience. Per M21-1 guidance, ratings should reflect the overall disability picture including worst-day severity. Explicitly state: 'On my worst days, which happen [frequency], I experience [specific symptoms and limitations].' Do not let the examiner assume your current presentation represents your typical status.

    during exam

  • critical

    Clearly communicate all non-pulmonary TB manifestations

    Actively bring up every non-pulmonary site of TB involvement. Do not wait to be asked. Say: 'In addition to my pulmonary TB, I also had [skeletal/genitourinary/meningitis/etc.] TB diagnosed on [date], treated with [treatment], and I currently have [current symptoms/residuals].'

    during exam

  • critical

    Give maximum effort during spirometry and report any pain or difficulty

    Provide your honest best effort on each spirometry attempt. If coughing, chest pain, dizziness, or air trapping prevents you from giving maximum effort, immediately tell the technician and examiner. Document that these factors limited the test - functional limitations during testing are themselves evidence of disability.

    during exam

  • recommended

    Confirm with the examiner that all relevant body systems are being documented

    Before the exam concludes, ask the examiner to confirm that they have documented all sites of TB involvement, all treatment history, all pulmonary function results, all complications, and all functional limitations. This ensures the DBQ is as complete as possible.

    during exam

  • critical

    Ask the examiner to document the nexus between your TB and military service

    Explicitly state how and when you believe TB was contracted or diagnosed in relation to your military service. Provide the examiner with any supporting documentation. The nexus opinion in the DBQ is critical for establishing or maintaining service connection.

    during exam

  • critical

    Request a copy of the completed DBQ

    Ask the examiner for a copy of the completed DBQ before leaving, or ask how to obtain one. Review it carefully for accuracy. If you identify errors - misquoted symptoms, missing conditions, incorrect dates, or conclusions not supported by your statements - document them and contact your VSO immediately to submit a supplemental statement correcting the record.

    after exam

  • recommended

    Write down everything you recall from the exam within 24 hours

    While memory is fresh, write a detailed account of what was asked, what you said, what tests were performed, what the examiner's tone and thoroughness were, and anything you wish you had said differently. This record is invaluable if you need to appeal or request a new examination.

    after exam

  • recommended

    Follow up with your VSO or accredited claims agent about the exam report

    Share your notes and any copy of the DBQ with your Veterans Service Organization representative, accredited claims agent, or VA-accredited attorney. They can advise whether the exam was adequate or whether a request for a new examination or an independent medical opinion is warranted.

    after exam

  • recommended

    Monitor your eFolder in VA.gov for the uploaded DBQ

    Log into VA.gov and check your eFolder (Blue Button records and documents) within 1-2 weeks of the exam to confirm the DBQ was uploaded. If you identify discrepancies between the report and your recollection, discuss options with your VSO.

    after exam

Your rights during a C&P exam

  • You have the right to be examined by a qualified physician - for tuberculosis, this should be a Pulmonologist or Infectious Disease Physician. If the examiner lacks appropriate expertise, you may request a more qualified examiner through your VSO.
  • You have the right to request a copy of the completed DBQ and all examination reports associated with your claim.
  • In most states, you have the right to record your C&P examination. Check your specific state's recording consent laws. Notify the examiner at the start of the appointment that you will be recording.
  • You have the right to submit a personal statement, buddy statements (VA Form 21-10210), and private medical opinions to supplement or rebut the C&P examination findings.
  • You have the right to request a new C&P examination if the original examination was inadequate, the examiner failed to review relevant records, or the DBQ contains factual errors. This request should be submitted through your VSO or directly to the VA Regional Office handling your claim.
  • You have the right to a Duty to Assist - VA is obligated to assist you in obtaining relevant records, scheduling examinations, and developing your claim. If VA failed to obtain records you identified, this may constitute a Duty to Assist error.
  • You have the right to appeal an unfavorable rating decision through the Supplemental Claim, Higher-Level Review, or Board of Veterans' Appeals lanes under the Appeals Modernization Act (AMA).
  • You have the right to bring a VSO representative, accredited claims agent, or VA-accredited attorney with you to the C&P examination as a witness and advocate.
  • Under 38 CFR 4.88b, if your pulmonary TB was ever far advanced, you have the right to the staged reduction schedule (100% for two years after inactivity, then 50%, then 30%). VA cannot reduce your rating below this schedule without documented clinical improvement.
  • You have the right to a rating that reflects your worst-day symptoms, not just your status on the day of the examination. If the examiner only documents your presentation on exam day, you have the right to submit evidence of your typical worst-day functioning.
  • You have the right to separate ratings for each distinct non-pulmonary manifestation of tuberculosis (skeletal, genitourinary, meningitis, etc.) in addition to the pulmonary rating. Do not accept a single rating if multiple body systems were affected.
  • You have the right to have all relevant VA records, service treatment records, and private medical evidence reviewed by the examiner before or during the examination. If the examiner states they did not review your records, document this and report it to your VSO.

Related conditions

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This guide covers what to expect for any veteran with this condition. If you have already uploaded your medical records, sign in to generate a packet that maps your specific symptoms to the DBQ fields your examiner will fill out.

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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.