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Updated Sep 15, 2021

In This Section
This section contains the following topics:
Topic
Topic Name
1
2
3

1.  General Information on Tuberculosis

Introduction

 This topic contains general information about tuberculosis, including

Change Date

 April 15, 2015

V.iii.4.B.1.a.  Tuberculosis Classification Standards

 The following classification standards were adopted by the American Lung Association under The Diagnostic Standards and Classification of Tuberculosis in Adults and Children, 1999:
  • An individual is classified as Tuberculosis Suspect until diagnostic procedures are complete.  (Note:  Do not use the classification Tuberculosis Suspect for more than three months.)
  • Disease caused by other mycobacteria is classified as Other Mycobacterial Diseases.  (Note:  Disease caused by other mycobacteria is indistinguishable clinically, radiologically, and histologically from mycobacterium (M.) tuberculosis.)
Reference:  For more information on the classification standards, see The Diagnostic Standards and Classification of Tuberculosis in Adults and Children, 1999.

V.iii.4.B.1.b.  Considering Infection Caused by Other Mycobacteria
Other mycobacteria that may commonly be involved as pathogens are
  • M. kansasii
  • M. intracellulare, and
  • M. scrofulaceum.
Note:  M. bovis is
  • rarely responsible for disease where there is effective control of tuberculosis in cattle and pasteurization of milk and milk products, and
  • indistinguishable from M. tuberculosis except by culture.

V.iii.4.B.1.c.  Diagnosing Infection Caused by Other Mycobacteria
A definitive diagnosis for infection caused by other mycobacteria requires
  • evidence of disease (such as an infiltrate visible on a chest x-ray)
  • no other cause established by careful clinical and laboratory studies, and
  • either
    • appearance of the same strain of mycobacteria repeatedly, or
    • isolation of the mycobacteria from a closed lesion from which the specimen has been collected and handled under sterile conditions.
Note:  Diagnosis of other mycobacterial infection by skin test is not possible.  The current antigens for mycobacteria other than M. tuberculosis have high cross-reactivity and low specificity.

V.iii.4.B.1.d.  Classifying Disease Caused by Other Mycobacteria
With certain modifications, the classification for tuberculosis is adaptable for classifying other mycobacterial diseases.
When classifying mycobacterial diseases, do not use the following three categories used for tuberculosis
  • “no exposure, not infected”
  • “exposure, no evidence of infection,” or
  • “infection, without disease.”

V.iii.4.B.1.e.  Considering Chest X-Rays Under 38 CFR 3.370 and 38 CFR 3.371
If active pulmonary tuberculosis is claimed to be service-connected (SC) and entitlement is not established by other evidence, then consider the x-ray evidence in accordance with 38 CFR 3.370 and 38 CFR 3.371.
Reports of x-ray interpretations must be adequate for rating purposes.
Use the table below to determine which x-ray films are required to prove service connection (SC).
To prove …
Films required are …
direct SC
all service films.
presumptive SC
discharge film (or a service film used for this) and an adequate number of post-service films.

V.iii.4.B.1.f.  Referrals for X-Ray Interpretation Under 38 CFR 3.370 and 38 CFR 3.371
Only designees of the Under Secretary for Health are authorized to interpret x-ray films under 38 CFR 3.370 and 38 CFR 3.371.  Refer requests for interpretations to the Department of Veterans Affairs (VA) medical facility for the local regional office (RO).
Note:  If the local VA medical facility is not authorized to make such interpretations, the Director will keep the RO informed of the current location of the designated interpreter for the RO area.  In such a case, refer requests directly to the clinic, center, or hospital.

V.iii.4.B.1.g.  Processing Claims Based on Tuberculin Reaction

 Reference:  For more information on claims based on positive tuberculin reaction, see M21-1, Part VIII, Subpart iii, 2.A.1.

2.  Arrested Tuberculosis

Introduction
This topic contains information about arrested tuberculosis, including

Change Date

 August 3, 2011

V.iii.4.B.2.a.  Processing Graduated Ratings in Effect on August 19, 1968
For graduated ratings in effect on August 19, 1968,
  • award a total evaluation for two years after the date of complete arrest or inactivity established under 38 CFR 3.375(a)
  • as set forth under the general rating formula following 38 CFR 4.97, DC 6724 of the rating schedule
    • reduce the evaluation to 50 percent for four years, and
    • reduce the evaluation to 30 percent for another five years, and
  • after the expiration of the 11-year period
    • continue the 30-percent evaluation if far advanced active lesions exist
    • assign a 20-percent evaluation if there are moderately advanced lesions with continued disability, or
    • assign a 0-percent evaluation if the first two criteria do not apply.

V.iii.4.B.2.b.  Processing Ratings in Effect After August 19, 1968
If SC for pulmonary tuberculosis is established after August 19, 1968,
  • continue the 100-percent evaluation for one year after the date of inactivity established under 38 CFR 3.375(a), and
  • thereafter apply the general rating formula for residuals in the rating schedule under 38 CFR 4.97, DC 6731.

V.iii.4.B.2.c.  Requesting Examinations During the Graduated Rating Period
Do not request an examination for rating purposes during the period covered by the graduated ratings.

V.iii.4.B.2.d.  Processing Notification of Failure to Follow Treatment or Submit to Examination
Medical authorities will notify the RO of a Veteran’s failure to follow prescribed treatment or submit to examination requested for treatment purposes during the period of total disability following complete arrest of the tuberculosis.
After the notification is received, follow the due process procedures of 38 CFR 3.655 and furnish the Veteran a notice of proposed adverse action.  Upon expiration of the due process period
  • reduce the 100-percent evaluation to 50 percent by rating action, and
  • adjust the Veteran’s award as of the date of the last payment or the date indicated in the notice of proposed adverse action, whichever is later.
Notes:
  • The reduction of the 100-percent evaluation upon failure to submit to examination or follow prescribed treatment is applicable only when the tuberculosis has reached a stage of complete arrest or inactivity.
  • If the Veteran complies with the request for examination during the original two-year time frame for the 100-percent graduated rating, restore the 100-percent rating effective the date of reduction.

V.iii.4.B.2.e.  Processing Cases of Irregular Discharge
Do not suspend or discontinue payments merely because a Veteran with active tuberculosis receives an irregular discharge.  An irregular discharge is received for disciplinary reasons, the refusal to accept or follow treatment, the refusal to accept transfer, or failure to return from an authorized absence.
In the case of irregular discharge,
  • continue the 100-percent evaluation based on activity, and
  • request an examination six months from the date of irregular discharge.
If the Veteran fails to report for this examination, consider the tuberculosis to be completely arrested from the date of failure to report for examination.  Apply the provisions of graduated ratings based upon inactivity from this date.
Note:  Compensation payments are based upon the degree of disability, not on the basis of a Veteran’s willingness to accept treatment.

 3.  Exhibit:  Examples of Ratings for Arrested Tuberculosis

Introduction
This exhibit contains examples of ratings for arrested tuberculosis, including

Change Date

 December 29, 2007

V.iii.4.B.3.a.  Example 1
Situation:  A Veteran is 30-percent disabled based upon residuals of far advanced, inactive, pulmonary tuberculosis.  The rating for tuberculosis was in effect on August 19, 1968.  The tuberculosis became active on September 10, 2002.
Result:  Based upon the reactivation of pulmonary tuberculosis, reinstate the 100-percent evaluation for active tuberculosis and maintain control to ascertain the date of inactivity.
Coded Conclusion
1. SC (KC PRES)
6701
Tuberculosis, pulmonary, chronic, far advanced, active
30% from 08/01/1964
100% from 09/10/2002

V.iii.4.B.3.b.  Example 2
Situation:  Same facts as in Example 1.  Examination reveals tuberculosis was inactive as of May 10, 2003.
Result:  Continue the 100-percent evaluation for two years after the date of inactivity, followed by graduated reduction to 50 percent thereafter for four years.  Reduce to 30 percent from May 10, 2009, and thereafter based on far advanced lesions.
Coded Conclusion
1. SC (KC PRES)
6701
Tuberculosis, pulmonary, chronic, far advanced, active
30% from 08/01/1964
100% from 09/10/2002

V.iii.4.B.3.c.  Example 3
Situation:  Same facts as in Example 2.  Medical authorities provide notification of the Veteran’s failure to submit to examination for treatment purposes.  The notice of proposed adverse action advised that payments would be reduced effective June 1, 2004, but the date of last payment at the expiration of the due process period was July 1, 2004.
Result:  Reduce the evaluation for pulmonary tuberculosis to 50 percent effective the date of last payment and to 30 percent four years later.
Coded Conclusion
1. SC (KC PRES)
6721
Tuberculosis, pulmonary, chronic, far advanced inactive
100% from 05/10/2003
50% from 07/01/2004
30% from 07/01/2008

V.iii.4.B.3.d.  Example 4
Situation:  Same facts as in Example 3.  Medical authorities provide notification the Veteran has reported for examination on March 10, 2005.  The tuberculosis remains inactive.
Result:  Reinstate the 100-percent evaluation and reduce the evaluation to 50 percent two years after the date of inactivity of pulmonary tuberculosis.  Reduce to 30 percent four years later.
Coded Conclusion
1. SC (KC PRES)
6721
Tuberculosis, pulmonary, chronic, far advanced inactive
100% from 05/10/2003
50% from 05/10/2005
30% from 05/10/2009