18 VA Secondary Conditions Linked to Asthma: The Definitive Guide

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This article is the definitive guide on VA secondary conditions to asthma for disability benefits.

Asthma isn’t just about struggling to breathe; it can open the door to a host of other serious health issues that can impact every area of your work and life.

If you’re a veteran with service-connected asthma, you could be dealing with a host of secondary conditions like sleep apnea, GERD, chronic bronchitis, and even mental health challenges like anxiety or depression.

Knowing about these secondary conditions is crucial because they can significantly influence your overall VA disability rating.

By fully understanding the secondary impacts of your service-connected asthma, you can ensure you’re getting the benefits you’ve earned and deserve.

List of 18 VA Secondary Conditions to Asthma

Here’s a list of the 18 most common conditions that can be linked secondary to your service-connected asthma for VA disability compensation benefits:

1. Obstructive Sleep Apnea (OSA) Secondary to Asthma

Asthma is linked to an increased risk of developing obstructive sleep apnea (OSA) due to factors such as upper airway inflammation and nocturnal asthma symptoms, which can cause partial or complete obstruction of the airway during sleep. OSA is characterized by repeated episodes of shallow or paused breathing, leading to disrupted sleep and reduced oxygen levels. The chronic inflammation from asthma may contribute to the collapsibility of the upper airway, making individuals with asthma more susceptible to OSA. Research shows that treating OSA in asthma patients can improve asthma control and reduce nighttime symptoms​.

The VA rates obstructive sleep apnea (OSA) secondary to asthma under Diagnostic Code 6847, as outlined in 38 CFR § 4.97. The ratings range from 0% to 100%, depending on the severity of symptoms and the need for treatment. A 100% rating is given if chronic respiratory failure with carbon dioxide retention or cor pulmonale is present, or if a tracheostomy is required. A 50% rating is warranted if the condition requires the use of a continuous positive airway pressure (CPAP) machine. A 30% rating is assigned for persistent daytime hypersomnolence, and a 0% rating is given if there are no symptoms.

2. Gastroesophageal Reflux Disease (GERD) Secondary to Asthma

GERD is commonly seen in individuals with asthma and can exacerbate asthma symptoms by triggering bronchospasm or increased airway reactivity. The reflux of stomach acid into the esophagus can cause aspiration in the lungs, leading to irritation and inflammation of the airways. This is particularly problematic during sleep when reflux is more likely to occur. Studies suggest that up to 80% of asthma patients may experience GERD, and managing GERD symptoms can significantly improve asthma outcomes​.

The VA rates gastroesophageal reflux disease (GERD) secondary to asthma under Diagnostic Code 7206, as outlined in 38 CFR § 4.114. GERD ratings range from 0% to 80%, depending on the severity and impact of symptoms. An 80% rating is given for severe cases involving chronic vomiting, severe pain, substantial weight loss, and anemia, causing significant health impairment. A 60% rating applies when symptoms like persistent epigastric distress, regurgitation, and vomiting are not controlled by medication and considerably affect daily life. A 30% rating is for recurrent symptoms such as dysphagia, heartburn, and regurgitation that cause moderate health impairment, while a 10% rating is for mild symptoms. A 0% rating is assigned if the condition is asymptomatic or well-controlled with medication.

3. Chronic Bronchitis Secondary to Asthma

Chronic bronchitis, a form of chronic obstructive pulmonary disease (COPD), can develop secondary to asthma due to long-standing inflammation and recurrent infections in the airways. It is characterized by persistent cough and mucus production for at least three months over two consecutive years. The overlap of asthma and chronic bronchitis, often referred to as asthma-COPD overlap syndrome (ACOS), can complicate treatment and worsen respiratory symptoms. Patients with both conditions typically have more severe airflow limitation and are at higher risk of exacerbations.

Chronic bronchitis secondary to asthma is rated under Diagnostic Code 6600, according to 38 CFR § 4.97. The ratings range from 10% to 100%, based on the results of pulmonary function tests (PFTs), including FEV-1, FEV-1/FVC, and DLCO. A 100% rating is given for extremely severe symptoms, such as FEV-1 (Forced Expiratory Volume in one second) or FEV-1/FVC (Forced Vital Capacity ratio) less than 40%, or other serious complications like pulmonary hypertension or cor pulmonale (right heart failure), or the need for outpatient oxygen therapy. A 60% rating is assigned for moderate impairment, with FEV-1 or FEV-1/FVC values between 40-55% predicted. A 30% rating is for milder impairment with FEV-1 or FEV-1/FVC values between 56-70%, and a 10% rating is for minimal symptoms, with values between 71-80% predicted. These ratings reflect the severity of lung function decline and its impact on overall health.

4. Chronic Sinusitis Secondary to Asthma

Chronic sinusitis is inflammation of the sinuses lasting more than 12 weeks and is commonly associated with asthma. This relationship, known as the unified airway theory, suggests that inflammation in the nasal passages and sinuses can exacerbate asthma symptoms. Chronic sinusitis can lead to nasal congestion, facial pain, and a decrease in lung function. Effective management of sinusitis, such as through nasal corticosteroids or surgery, can improve asthma control and reduce the frequency of asthma attacks.

The VA rates chronic sinusitis secondary to asthma under Diagnostic Codes 6510-6514, in line with 38 CFR § 4.97. Ratings range from 0% to 50%, depending on the frequency of incapacitating episodes and the need for surgery. A 50% rating is for chronic osteomyelitis following radical surgery or with severe symptoms after repeated surgeries. A 30% rating is for three or more incapacitating episodes per year requiring prolonged antibiotic treatment or more than six non-incapacitating episodes per year. A 0% rating is if its detected by X-ray only without symptoms.

5. Anxiety and Depression Secondary to Asthma

The chronic and unpredictable nature of asthma, along with its impact on daily life, can contribute to anxiety and depression. The fear of asthma attacks and the limitations it imposes can lead to increased stress and emotional distress. Studies have shown that asthma patients have a higher prevalence of mental health conditions compared to the general population, and untreated anxiety or depression can worsen asthma symptoms, creating a vicious cycle that further impairs quality of life​.

The VA rates anxiety and depression secondary to asthma under Diagnostic Codes 9400 and 9434, using the General Rating Formula for Mental Disorders as outlined in 38 CFR § 4.130. Ratings range from 0% to 100%, based on the severity of symptoms and their impact on occupational and social functioning.

6. Hypertension Secondary to Asthma

Asthma, particularly when treated with long-term systemic corticosteroids, is associated with an increased risk of hypertension. Corticosteroids can cause fluid retention and alter blood pressure regulation, while chronic inflammation associated with asthma can also contribute to cardiovascular strain. This condition requires careful management to avoid further complications such as heart disease or stroke.

Hypertension secondary to asthma is rated under Diagnostic Code 7101, as outlined in 38 CFR § 4.104. Ratings range from 10% to 60% based on blood pressure readings. A 60% rating is given for diastolic pressure predominantly 130 or more. A 40% rating is for diastolic pressure predominantly 120 or more. A 20% rating is for diastolic pressure predominantly 110 or more, or systolic pressure predominantly 200 or more. A 10% rating is for diastolic pressure predominantly 100 or more, or systolic pressure predominantly 160 or more.

7. Weight Gain and Obesity Secondary to Asthma

Asthma can contribute to obesity due to reduced physical activity from breathing difficulties and the side effects of medications such as corticosteroids, which can increase appetite. Obesity, in turn, exacerbates asthma symptoms by increasing airway resistance and systemic inflammation. This bidirectional relationship complicates the management of both conditions, as weight loss is often necessary to improve asthma control, but exercise can be challenging for those with severe asthma​.

The VA does not directly rate obesity as a disability, but it can be considered an aggravating factor in other service-connected conditions as well as an “interim link” for secondary service connection. Obesity secondary to asthma can contribute to the worsening of service-connected conditions like diabetes mellitus or cardiovascular disease, potentially leading to secondary service connection and increased ratings for those conditions.

8. Cardiovascular Disease Secondary to Asthma

Chronic inflammation from asthma, combined with risk factors such as hypertension and obesity, can increase the likelihood of developing cardiovascular diseases, including heart disease and stroke. Asthma exacerbations can cause acute stress on the cardiovascular system, leading to complications such as arrhythmias or myocardial infarction in severe cases. Managing asthma effectively and controlling associated risk factors is crucial to reducing cardiovascular risk​.

Cardiovascular disease secondary to asthma is rated under various Diagnostic Codes in 38 CFR § 4.104, depending on the specific condition, such as coronary artery disease or heart failure. Ratings range from 10% to 100%, based on MET levels, ejection fraction, and symptoms such as heart failure or arrhythmias. A 100% rating is assigned if symptoms occur at a workload of 3.0 METs or less, indicating severe limitation. A 60% rating is given for symptoms occurring at 3.1-5.0 METs, and a 30% rating for symptoms at 5.1-7.0 METs or evidence of heart enlargement. A 10% rating applies when symptoms are triggered at 7.1-10.0 METs or if continuous medication is needed to manage the condition.

9. Diabetes Mellitus Secondary to Asthma

Long-term use of systemic corticosteroids in asthma treatment can lead to insulin resistance and hyperglycemia, increasing the risk of developing type 2 diabetes. This risk is particularly high in patients who require frequent or prolonged courses of corticosteroids for severe asthma. Regular monitoring of blood glucose levels is recommended for asthma patients on corticosteroid therapy to detect and manage diabetes early​.

The VA rates diabetes secondary to asthma under Diagnostic Code 7913, according to 38 CFR § 4.119. Ratings range from 10% to 100%, based on the need for insulin, diet restrictions, and regulation of activities. A 100% rating is assigned if diabetes requires multiple daily insulin injections, a restricted diet, regulated activities, frequent hospitalizations for ketoacidosis or hypoglycemia, and leads to severe complications such as weight loss or strength decline. A 60% rating is for diabetes requiring daily insulin, restricted diet, regulated activities, and less frequent hospitalizations or bi-weekly care visits. A 40% rating is given for daily insulin use, restricted diet, and activity regulation, while a 20% rating is for insulin or oral medication use with a restricted diet. A 10% rating is assigned when diabetes is manageable by diet alone.

10. Osteoporosis Secondary to Asthma

Osteoporosis, or weakened bones, can result from the long-term use of corticosteroids, which are often prescribed for chronic asthma management. Corticosteroids can decrease bone formation and increase bone resorption, leading to a higher risk of fractures. Asthma patients, especially postmenopausal women and older adults, should be monitored for bone density and advised on calcium and vitamin D supplementation.

Osteoporosis secondary to asthma, especially due to long-term corticosteroid use, is rated under Diagnostic Code 5013, as per 38 CFR § 4.71a. Ratings depend on the presence of fractures and the level of functional impairment. A 10% rating is assigned if there are incapacitating episodes with pain, while higher ratings are based on the number of fractures and functional limitations.

11. Chronic Fatigue Syndrome Secondary to Asthma

Chronic fatigue syndrome (CFS) can develop in asthma patients due to the persistent physical strain of managing breathing difficulties and disrupted sleep from nocturnal asthma symptoms. This condition is characterized by extreme, unexplained fatigue that does not improve with rest and can significantly impair daily functioning. Effective asthma management and treatment of associated conditions like sleep apnea can help alleviate chronic fatigue​.

The VA rates chronic fatigue syndrome secondary to asthma under Diagnostic Code 6354 for Chronic Fatigue Syndrome (CFS) in 38 CFR § 4.88b. Ratings range from 10% to 100% based on the impact of fatigue on daily activities, cognitive impairments, and response to therapy.

12. Panic Disorder Secondary to Asthma

Panic disorder is common in asthma patients, as the sensation of breathlessness and fear of an asthma attack can trigger panic attacks. The anxiety associated with asthma can lead to hyperventilation, dizziness, and a sense of losing control, which may be mistaken for an asthma exacerbation. Addressing both asthma and panic disorder is essential to improving the quality of life for affected individuals​.

Panic disorder secondary to asthma is rated under Diagnostic Code 9412, following the General Rating Formula for Mental Disorders in 38 CFR § 4.130. Ratings range from 0% to 100%, depending on the frequency and impact of panic attacks and any occupational and social impairment.

13. Vocal Cord Dysfunction (VCD) Secondary to Asthma

VCD involves the abnormal closure of the vocal cords during breathing, which can mimic asthma and complicate its management. This condition can cause symptoms such as shortness of breath, throat tightness, and wheezing. Asthma patients with VCD may not respond well to traditional asthma treatments, making accurate diagnosis and management critical to reducing symptoms​.

Vocal cord dysfunction secondary to asthma may be rated analogously to other respiratory conditions under 38 CFR § 4.97. Ratings depend on the severity of symptoms like shortness of breath and wheezing, which can be evaluated under codes for asthma or COPD, with ratings ranging from 10% to 100%.

14. Chronic Rhinitis Secondary to Asthma

Chronic rhinitis, characterized by persistent nasal congestion and sneezing, often coexists with asthma due to shared inflammatory pathways. This condition can exacerbate asthma by increasing upper airway resistance and triggering bronchospasm. Effective treatment of rhinitis, such as with nasal corticosteroids, can improve asthma control and reduce overall respiratory symptoms​.

Chronic rhinitis secondary to asthma is rated under Diagnostic Code 6522, as outlined in 38 CFR § 4.97. The ratings are either 10% or 30%, based on the presence of nasal polyps. A 30% rating is given if there are polyps, while a 10% rating is assigned if there is greater than 50% obstruction of the nasal passage on both sides or complete obstruction on one side.

15. Pulmonary Hypertension Secondary to Asthma

Severe, uncontrolled asthma can lead to pulmonary hypertension, a condition where high blood pressure affects the arteries in the lungs. This can result from chronic hypoxia or elevated pressure in the lungs due to frequent asthma exacerbations. Pulmonary hypertension can cause symptoms such as shortness of breath, fatigue, and chest pain, and it requires specialized management to prevent progression​.

Pulmonary hypertension secondary to asthma is rated under Diagnostic Code 6604 for COPD or under the specific pulmonary hypertension code in 38 CFR § 4.97. Ratings range from 10% to 100%, depending on the severity of symptoms such as dyspnea and fatigue, and the requirement for treatment like oxygen therapy.

16. Lung Infections Secondary to Asthma

Asthma patients are at higher risk for lung infections, such as pneumonia, due to compromised lung function and weakened immune defenses. Infections can trigger severe asthma attacks and lead to further lung damage, increasing the risk of chronic complications. Preventative measures, such as vaccinations and prompt treatment of respiratory infections, are essential for reducing this risk​.

Lung infections secondary to asthma, such as recurrent pneumonia, may be rated under 38 CFR § 4.97, Diagnostic Code 6845 for chronic pleural effusion or fibrosis, depending on the impact on lung function. Ratings are based on PFT results, ranging from 10% to 100% depending on severity of symptoms.

17. Eczema (Atopic Dermatitis) Secondary to Asthma

Eczema is part of the “atopic triad,” which includes asthma, allergic rhinitis, and eczema. These conditions often coexist, particularly in individuals with a genetic predisposition to allergic diseases. The chronic skin inflammation seen in eczema can worsen asthma symptoms by increasing systemic inflammation and stress.

Eczema secondary to asthma is rated under Diagnostic Code 7806, according to 38 CFR § 4.118. Ratings range from 0% to 60% based on the area of skin affected and the need for systemic therapy. A 60% rating is given if more than 40% of the body or exposed areas are affected or if constant systemic therapy is required. Lower ratings are also possible depending on symptoms.

18. Metabolic Syndrome Secondary to Asthma

Asthma patients, especially those with obesity, are at higher risk of developing metabolic syndrome—a cluster of conditions including hypertension, high blood sugar, and abnormal cholesterol levels. Metabolic syndrome increases the risk of heart disease, stroke, and diabetes. Addressing lifestyle factors and managing asthma effectively are key strategies for reducing the risk of metabolic syndrome​.

Metabolic syndrome itself is not directly rated, but conditions associated with it, such as diabetes or hypertension, can be rated individually under their respective Diagnostic Codes. Metabolic syndrome increases the risk of complications such as heart disease, which may be rated under cardiovascular codes in 38 CFR § 4.104.

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