Pulmonary Alveolar Proteinosis

DC 6604Respiratory38 CFR 4.97, DC 6604

A rare lung disease where protein and fatty substances build up in the air sacs (alveoli), making it hard for oxygen to get into your blood. This causes progressive shortness of breath and coughing. The VA rates pulmonary alveolar proteinosis based on lung function tests.

How the VA rates this condition

The VA rates this condition based on objective clinical measurements and test results. The examiner will use standardized tests or lab values to determine the severity of your condition rather than relying primarily on subjective symptom reports.

Diagnostic code

DC 6604

Rating range

10% – 100%

Rating levels

Rating criteria are defined in 38 CFR 4.97, DC 6604. This guide presents a plain-language summary and is not a substitute for the full regulatory text. Always consult a VSO or VA-accredited attorney for case-specific advice.

Rating Levels

You have pulmonary alveolar proteinosis with FEV-1 less than 40 percent predicted, or DLCO (SB) less than 40 percent predicted, or you require supplemental oxygen therapy, or you have cor pulmonale or pulmonary hypertension.

What the VA looks for

FEV-1 less than 40% predicted
DLCO less than 40% predicted
Supplemental oxygen required
Cor pulmonale or pulmonary hypertension
Frequent whole lung lavage procedures

Common Pitfalls

⚠Not getting a DLCO (diffusing capacity) test — pulmonary alveolar proteinosis primarily impairs gas exchange, so DLCO is often the most abnormal PFT measurement and may support a higher rating than FEV-1 alone.
⚠Not documenting the frequency and need for whole lung lavage — this therapeutic procedure demonstrates disease severity and ongoing treatment burden.
⚠Not establishing a link to military dust, chemical, or silica exposure — occupational exposures during service can cause secondary pulmonary alveolar proteinosis.
⚠Not monitoring for superimposed infections — PAP increases infection risk, and recurrent infections may support additional service-connected claims.

Related DBQ Forms

DBQ Respiratory Conditions (other than Tuberculosis and Sleep Apnea)

View evidence checklist →See secondary conditions →

Condition Rating Guides

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Pulmonary Alveolar Proteinosis

How the VA rates this condition

Diagnostic code

DC 6604

Rating range

10% – 100%

Rating levels

Rating Levels

What the VA looks for

FEV-1 less than 40% predicted
DLCO less than 40% predicted
Supplemental oxygen required
Cor pulmonale or pulmonary hypertension
Frequent whole lung lavage procedures

Common Pitfalls

⚠Not getting a DLCO (diffusing capacity) test — pulmonary alveolar proteinosis primarily impairs gas exchange, so DLCO is often the most abnormal PFT measurement and may support a higher rating than FEV-1 alone.

⚠Not documenting the frequency and need for whole lung lavage — this therapeutic procedure demonstrates disease severity and ongoing treatment burden.

⚠Not establishing a link to military dust, chemical, or silica exposure — occupational exposures during service can cause secondary pulmonary alveolar proteinosis.

⚠Not monitoring for superimposed infections — PAP increases infection risk, and recurrent infections may support additional service-connected claims.