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Updated Dec 27, 2021

In This Section

  
This section contains the following topics:
 
Topic
Topic Name
1
2
 

 
 

1.  General Information on Diving-Related Disabilities

 

Introduction

  
This topic contains general information on diving-related disabilities, including

Change Date

  
July 29, 2021

VIII.iv.9.B.1.a.  Diving Techniques and Associated Risks

  
Diving techniques include the following:
  • free (breath-hold)
  • snorkeling
  • SCUBA (self-contained underwater breathing apparatus)
  • surface supplied air and mixed-gas bounce diving, and
  • saturation diving. 
Saturation diving is essentially defined as a diver having been at a depth long enough (typically 24 hours or longer) for tissues to have absorbed the maximum amount of gas possible for that particular depth, so that gas equilibrium has been achieved.  Saturation divers live for long periods of time in a chamber pressured to the desired depth, and work in an extremely harsh, physically demanding environment. 
 
Bounce diving commonly refers to any non-saturation dive.  Typically, multiple bounce dives of different depths and duration are conducted in a single day with repeated decompressions. 
 
Under certain circumstances, any type of diving may result in
  • decompression illness, historically referred to as Caisson disease
  • barotraumas (tissue damage due to increased pressure), or
  • pulmonary overinflation syndromes (trapping of gases in lungs, with potential for rupture of alveoli leading to arterial gas emboli). 
Note:  Long-term effects resulting in chronic disabilities are more likely to result from saturation, rather than non-saturation, diving. 

VIII.iv.9.B.1.b.  Decompression Illness and AGE

  
In decompression illness, nearly all symptoms are present within 24 hours after the dive while some may occur within 3 hours.  While many signs and symptoms resolve rapidly if treated within minutes of onset, permanent injury or disability may result even with treatment.  Arterial gas emboli (AGE) are inert gas bubbles that form in the venous blood during decompression and can lodge in coronary, cerebral, or other arteries in the body with potentially catastrophic results.
 
DCS is divided into two types, depending on the symptoms involved, and some divers experience both types.  The table below describes some, but not all, of the symptoms and potential chronic effects of decompression illness and AGE. 
 
Diving-Related Disability
Symptoms
Potential Long-Term Effects
Type I decompression illness
Musculoskeletal and skin symptoms constituted by pain mainly in the arm and leg joints, and/or itching, mottling, and rashes of the skin.
  • Dysbaric osteonecrosis, and
  • chronic skin conditions
Type II decompression illness
Symptoms involving the brain, spinal cord, and organs of special sense.  Other symptoms include visual disturbances, altered mental status, respiratory symptoms, thrombus formations, or hypovolemic shock.  Coma and death occur in the most extreme cases. 
  • Any neurological deficit to include partial or complete paralysis, muscle weakness, sensory deficits, coordination difficulties, and cognitive deficits
  • hearing loss
  • vertigo
  • tinnitus
  • vision impairment, and
  • disequilibrium. 
AGE
Rupture of pulmonary alveoli, which allows gas from the lungs to enter into arterial circulation.  This may result in stroke, seizure, central nervous system effects, or myocardial infarction. 
Residuals such as stroke or myocardial infarction will result in chronic residuals. 

VIII.iv.9.B.1.c.  Toxic Effects of Gases in Diving

  
The table below describes the conditions and associated symptoms that may be due to the toxic effects of gases when diving.  Chronic disabilities may result from these responses to diving.
 
Condition
Symptoms
High pressure nervous/neurological syndrome (HPNS)
Dizziness, nausea, vomiting, tremors, incoordination, fatigue, somnolence, myoclonic jerking, stomach cramps, decreased intellectual performance, and disturbed sleep.
Nitrogen narcosis (also called “narcs” or “rapture of the deep”)
Resembles alcohol intoxication, with euphoria, confusion, irrational behavior, paranoia, and hallucinations.  May result in coma.
Oxygen toxicity
Muscle twitching, seizures, vision and hearing problems, and pulmonary problems such as cough or substernal burning.
Carbon dioxide toxicity
Respiratory impairment, headaches, unconsciousness, or other neurological impairment
Atmospheric contaminants
Acute toxic effects or subtle, unrecognized long-term toxicity

VIII.iv.9.B.1.d.  Potential Long-Term Effects of Diving

  
Many other long-term effects may result from diving, with or without incurrence of decompression illness.  The table below lists some, but not all, of the disabilities that may be associated with a history of diving.
 
Body System
Possible Disabilities
Musculoskeletal
Bone infarcts (dysbaric osteochondrosis), osteoarthritis
Skin
Eczema, infection
Ear
Chronic otitis externa, hearing loss, perforated eardrum, vestibular problems, tinnitus
Neurological
Stroke, seizures, paralysis, weakness, peripheral neuropathy, autonomic symptoms, cognitive deficits
Visual
Scotomas, diplopia, vision loss
Respiratory
Airflow obstruction
Cardiovascular
Myocardial infarction, arrhythmia, cold and heat injuries
Psychiatric
posttraumatic stress disorder
 

2.  Adjudication Considerations for Diving-Related Disabilities

 

Introduction

  
This topic contains information on disabilities that may be related to diving, including

Change Date

  
July 29, 2021

VIII.iv.9.B.2.a.  Examinations and Medical Opinions for Diving-Related Disabilities

  
An examination with medical opinion is needed for a claim for service connection for residuals of diving if there is not sufficient competent medical evidence to decide the claim, but the record contains
  • competent lay or medical evidence of a current diagnosed disability or persistent or recurrent symptoms of disability
  • evidence that the Veteran has a history of diving in service or incurred a diving-related injury in service, and
  • an indication that the claimed disability or symptoms may be associated with in-service diving or a diving-related injury. 
Submit complex or unusual questions related to a claim for disability compensation on the basis of diving or a diving-related injury to Compensation Service for an advisory opinion. 
 
References:  For more information on

VIII.iv.9.B.2.b.  Rating Residuals of Diving Injuries

  
In rating residuals of a diving injury, 38 CFR 4.71a, diagnostic code (DC) 5011, decompression illness, is used as it is the only DC specific to diving-related residuals.  38 CFR 4.71a, DC 5011, directs that manifestations of decompression illness should be rated under the DC appropriate to the affected body system.    
 
In service connecting any disability due to diving, use DC 5011 hyphenated with the appropriate code used for the disability evaluation.  For example, eczema due to a diving injury would be rated as DC 5011-7806.
 
Important:
  • Many conditions will be reported in the service treatment records; however, some, such as bone infarcts or arthritis, do not appear immediately and may not have been reported in service.
  • If there is a history of in-service diving, a diving etiology should be considered for such conditions as a bone infarct or arthritis (especially of the hip or shoulder), hearing loss, other ear or labyrinthine abnormalities, neurological conditions, and skin disorders.
  • Veterans who did saturation diving during the approximate time frame of the 1960s – 1980s were at greater risk for long-term health effects as they worked under different circumstances than current military divers, who have improved techniques and safety measures.