Diagnostic Code 5324 · 38 CFR §4.73
Diaphragmatic rupture or herniation is a tear in the diaphragm — the dome-shaped muscle that separates the chest from the abdomen and drives breathing. When the muscle is torn by trauma, abdominal contents (stomach, spleen, intestine, liver) can push up into the chest cavity through the defect, producing chronic respiratory and digestive symptoms even after the acute injury has healed. The classic veteran mechanisms are blast injury (high-energy IED or vehicle blast deforming the trunk), high-speed vehicle trauma with rapid deceleration, penetrating injury (gunshot, shrapnel) crossing the chest-abdomen junction, and crush injury. Smaller diaphragmatic injuries can go undetected for years before slowly enlarging and producing symptoms. The VA rates DC 5324 under the muscle injury framework of 38 CFR §4.73, with the rating reflecting both the muscle defect itself and the secondary effects on breathing, digestion, and exercise tolerance.
| Rating | Criteria |
|---|---|
| 10% | Slight injury — small diaphragmatic defect, no significant abdominal organ herniation into the chest, mild symptoms with no functional limitation. |
| 30% | Moderate injury — definite diaphragmatic defect with partial herniation of abdominal organs into the chest, symptoms of post-prandial discomfort, occasional shortness of breath on exertion, or limited exercise tolerance. |
| 50% | Severe injury — large diaphragmatic defect with significant herniation of abdominal organs, persistent respiratory symptoms, functional limitation in daily activity, OR status post-surgical repair with significant residual scarring and functional limitation. |
Chest X-ray often shows the displaced abdominal contents in the chest cavity but is unreliable for smaller defects. CT of the chest and abdomen is the standard imaging — it characterizes the size and location of the defect and shows what abdominal organs have herniated. MRI may add detail for complex injuries. Pulmonary function tests document any restrictive deficit from herniated organs compressing the lung. The original trauma records — emergency department reports, operative notes from any laparotomy or thoracotomy — establish the in-service event. Any subsequent surgical repair records document the disease course. Service treatment records connecting the injury to a blast, vehicle, penetrating, or crush event close the nexus.
Yes. Diaphragmatic defects can slowly enlarge as repeated abdominal pressure from breathing, coughing, lifting, and straining stretches the existing tear. Veterans sometimes go decades between the original blast or trauma event and the eventual diagnosis of a symptomatic hernia, particularly when the initial imaging missed a small defect. A late diagnosis does not break the service connection if the original trauma event is documented in service treatment records.
DC 5324 (muscle injury, diaphragm) is rated under the muscle injury schedule and caps at 50% for severe disease. DC 6843 (traumatic chest wall defects) is rated under the respiratory schedule and uses the PFT-based General Rating Formula for Restrictive Lung Disease, which goes up to 100%. When the diaphragmatic injury produces measurable restrictive lung disease — herniated organs compressing the lung, significant PFT reduction — the respiratory code can produce a substantially higher rating. The rater should evaluate under both and apply the higher one.
Not always. Small, asymptomatic diaphragmatic defects may be observed rather than repaired. Symptomatic defects, defects with significant herniation, and defects causing respiratory compromise are typically repaired surgically — laparoscopically when possible, open repair for larger defects. The rating reflects the residual functional impairment regardless of whether repair was attempted; a successful repair with no residual symptoms can drop the rating to a non-compensable level, while a partially successful repair with persistent symptoms keeps the rating at the moderate or severe tiers.