Diagnostic Code 6838 · 38 CFR §4.97
Primary pulmonary hypertension (also called pulmonary arterial hypertension or PAH) is abnormally high blood pressure in the arteries of the lungs without a clearly identifiable external cause. This serious condition forces the right side of the heart to work harder, eventually leading to right heart failure. Veterans may develop PAH during or after service, and it may be related to toxic exposures, medications, or other service-connected conditions. The VA generally rates this condition at higher levels due to its severity.
| Rating | Criteria |
|---|---|
| 30% | Pulmonary hypertension documented by echocardiogram or right heart catheterization with mild functional limitation. Able to perform most daily activities but limited with strenuous exertion. |
| 60% | Moderate pulmonary hypertension with significant exercise limitation. Requires pulmonary hypertension-specific medications. Right ventricular enlargement on imaging. |
| 100% | Severe pulmonary hypertension with right heart failure, requiring continuous IV or subcutaneous prostacyclin therapy, or with an estimated pulmonary artery systolic pressure greater than 60 mmHg despite treatment. WHO Functional Class III-IV. |
Right heart catheterization results (gold standard for diagnosis). Echocardiogram showing elevated pulmonary pressures and right heart changes. Six-minute walk test results. WHO Functional Class assessment. Current medication list showing PAH-specific therapies. Documentation ruling out secondary causes.
Primary (DC 6838) means no identifiable external cause—it develops on its own. Secondary (DC 6839) results from another condition like COPD, sleep apnea, or blood clots. Both use similar rating criteria, but secondary PH may be easier to service-connect because you can link it to another service-connected condition.
No, but it is commonly rated at 60% or 100% because it is a serious progressive condition. A 30% rating is possible with mild disease. The rating depends on your documented pressure levels, functional limitation, and treatment requirements.