VA pulmonary function tests for asbestos claims: what the numbers mean

By David Kirkpatrick — Independent Veterans Benefits Writer | Reviewed & updated August 9, 2026

Independent and non-government. This site is not affiliated with, endorsed by, or sponsored by the U.S. Department of Veterans Affairs (VA) or any government agency. For official information, visit VA.gov.

The breathing test that quietly decides a great deal

VA pulmonary function tests for asbestos claims are the measurements that translate “I get short of breath climbing the stairs” into numbers a rating specialist can actually work with. If you served around asbestos — aboard ship, in a boiler room, on a flight line, in barracks built before the 1980s — and you now have asbestosis, pleural disease, asbestos-related lung cancer, or mesothelioma, there is a good chance a technician will sit you in a clear booth, hand you a mouthpiece, and ask you to blow as hard as you can for six seconds. What comes out of that machine shapes both your medical care and, for breathing conditions, how the VA evaluates severity.

This guide explains what VA pulmonary function tests for asbestos claims are, what the abbreviations mean, how the results relate to the rating criteria written in federal regulation, how to prepare so the numbers reflect your real lung function, and what to do if you think a result is wrong. It does not — and cannot — predict what rating anyone will receive. That depends on the whole record, the specific diagnostic code, and decisions made by people who have not met you yet. What this guide can do is remove the mystery from the test itself.

Part 1: What VA pulmonary function tests for asbestos claims actually measure

“Pulmonary function testing” (PFT) is the umbrella term behind VA pulmonary function tests for asbestos claims, and it covers several distinct measurements, usually performed in one sitting in a hospital pulmonary lab. Three of them matter most for asbestos-related disease.

Spirometry measures how much air you can move and how fast. You take the deepest breath you can, then blow out as hard and as long as possible into a tube. The key outputs are FVC (forced vital capacity — the total volume you exhaled), FEV1 (forced expiratory volume in one second — how much came out in the first second), and the FEV1/FVC ratio. Results are reported both as raw volumes and, more usefully, as a percentage of the value predicted for someone of your age, height, sex, and sometimes ethnicity.

DLCO, the diffusing capacity of the lung for carbon monoxide, measures how efficiently gas crosses from the air sacs into the blood. You inhale a harmless trace mixture, hold it about ten seconds, and exhale. DLCO is often the first value to fall in asbestos-related interstitial disease, sometimes before spirometry changes at all, because scarring thickens the barrier that gas has to cross.

Lung volumes, measured by body plethysmography (the clear booth) or gas dilution, give total lung capacity and residual volume. These separate a genuinely small, stiff lung from poor effort or airway obstruction.

Some labs add a six-minute walk test with oximetry, and a few add cardiopulmonary exercise testing that measures maximum oxygen consumption. Both appear in the rating criteria for severe respiratory impairment, so they are not merely academic.

Asbestos-related scarring typically produces a restrictive pattern: FVC down, FEV1 down proportionally, FEV1/FVC ratio normal or even high, total lung capacity reduced, DLCO reduced. That is the opposite of the obstructive pattern seen in COPD, where the ratio drops. Many veterans have both, because smoking and asbestos frequently traveled together, and a mixed pattern complicates interpretation.

Part 2: Who gets tested, and when

Two different roads lead to VA pulmonary function tests for asbestos claims, and it helps to know which one you are on.

The first is ordinary clinical care. If you are enrolled in VA health care and report breathlessness, cough, or chest tightness, your primary care provider or pulmonologist may order testing as part of diagnosis and monitoring. This is treatment, not evidence-gathering, though the results land in your medical record and are available to any later review. Enrollment rules are set out on VA’s health care eligibility page.

The second is the claims road. When you file for a respiratory condition connected to asbestos exposure, VA generally needs current severity data, and testing is commonly ordered as part of that development. VA describes how it handles these exposures on its asbestos exposure page, and the department’s position is that exposure alone is not a disability — there must be a diagnosed condition linked to service.

Timing matters more than most veterans realize. Regulation directs that post-bronchodilator results be used for rating purposes unless the results are poorer than pre-bronchodilator values or the medication is contraindicated. Results also need to be reasonably current; a study from five years ago rarely describes today’s lungs, particularly with a progressive condition.

Veterans with active mesothelioma sit in a somewhat different position. Malignant respiratory neoplasms are generally evaluated at the total level while the disease is active and for a defined period after treatment ends, after which evaluation shifts to the residual impairment — and that is where breathing measurements re-enter the picture. If you are in treatment, the practical takeaway is that testing during active disease is mostly about care decisions, and testing after treatment is what characterizes what you are left with.

You do not need to wait for anyone’s permission to be tested clinically. If you are short of breath, say so at your next appointment.

Part 3: How the numbers map onto the rating criteria

How VA pulmonary function tests for asbestos claims connect to evaluation criteria is the part everyone wants explained, and the part that requires the most caution. The evaluation criteria for respiratory conditions live in Title 38 of the Code of Federal Regulations, Part 4, Subpart B — the schedule of ratings for the respiratory system. You can read the current text at eCFR. Regulations are amended from time to time, so the official text always beats a summary in an article.

Asbestosis has its own diagnostic code and is evaluated under the general rating formula for interstitial lung disease. That formula keys off two numbers: FVC as a percentage of predicted, and DLCO as a percentage of predicted, with the higher resulting evaluation applying. Broadly, mild reduction sits at the low end of the scale, moderate reduction in the middle, and severe reduction — or the need for outpatient oxygen therapy, cor pulmonale, pulmonary hypertension, or very low maximum exercise capacity — at the top.

Measurement pattern	Generally indicates
FVC 75-80% predicted, DLCO 66-80%	Mild impairment, lowest compensable tier
FVC 65-74%, DLCO 56-65%	Moderate impairment
FVC 50-64%, DLCO 40-55%	Moderately severe impairment
FVC under 50%, DLCO under 40%, or need for outpatient oxygen	Severe impairment, top of the schedule

Two cautions about that table. First, it is a simplification of regulatory language and should never be used to predict a decision — VA applies the criteria to a full record, considers whether a different diagnostic code fits better, and may assign different evaluations for different periods. Second, pleural plaques and pleural thickening are often evaluated under the restrictive lung disease criteria rather than the interstitial formula, and asbestos-related lung cancer and mesothelioma under the malignant neoplasm codes. The label on your diagnosis changes which yardstick is used.

Notice that the criteria reward objective measurement over symptom description. That is exactly why preparation for the test matters, and it is why a veteran who needs supplemental oxygen at home should make sure that fact is documented — our guide to home oxygen prescribing and equipment explains how that gets into the record.

Part 4: Preparing for the test so the numbers are honest

VA pulmonary function tests for asbestos claims measure what you actually do on the day, not what your lungs are theoretically capable of. Poor preparation produces numbers better or worse than your true baseline, and both are problems. Reasonable preparation is not gaming anything — it is making sure the study is valid.

• Bring your medication list. The lab needs to know what inhalers you use and when you last used them. Ask the ordering clinician whether to hold bronchodilators beforehand; instructions vary.
• Avoid a heavy meal in the two hours before. A full stomach genuinely restricts a deep breath.
• No smoking or vaping for at least an hour, ideally longer. Carbon monoxide from recent smoking directly interferes with the DLCO measurement.
• Skip alcohol for at least four hours and heavy exercise for at least half an hour.
• Wear loose clothing. Belts and tight shirts limit chest expansion.
• Bring your dentures if you wear them — a good seal on the mouthpiece is essential.
• Tell the technician about anything that affects effort: recent surgery, a rib fracture, chest pain, a hernia, recent eye surgery, or a bad cough that day.

Give full effort on every attempt. Technicians will usually ask for at least three acceptable maneuvers and look for two that agree closely, and they will coach loudly to get maximum effort. Under-performing does not help you; a study flagged as showing “suboptimal effort” or “poor reproducibility” is worth less than a good study, whatever it shows, because reviewers discount it. Chest pain is a legitimate reason to stop and say so, and veterans dealing with significant pain should raise it beforehand — our guide to controlling cancer-related pain through VA covers who to ask.

If you have had a recent heart attack, unstable angina, a pneumothorax, or major surgery, tell the lab before the appointment, as testing may need to be postponed.

Part 5: What it costs and what VA covers

For enrolled veterans, VA pulmonary function tests for asbestos claims are part of the standard VA medical benefits package. Whether you owe anything depends on your priority group and whether the testing relates to a service-connected condition. Veterans being evaluated or treated for a service-connected condition generally owe no copayment for that care, and veterans rated at or above certain thresholds, former prisoners of war, and several other categories are generally exempt from outpatient copayments altogether. As of the 2026 rate tables, current amounts are published on VA’s copay rates page; because these are adjusted periodically, checking the source beats trusting a number quoted second-hand.

Testing ordered by VA as part of developing a claim is not billed to the veteran. Examinations arranged by VA in connection with a claim are provided at no cost, and you should never be asked to pay for one. If you receive a bill you believe relates to claim development, take it to the facility’s patient advocate or billing office rather than paying it quietly.

Travel is a separate benefit with separate rules. Some veterans qualify for mileage reimbursement to and from appointments, and some qualify for arranged transportation. Both are worth asking about at the same time you schedule, particularly if the pulmonary lab is at a larger facility some distance away.

Veterans who obtain testing privately — for instance, because a civilian pulmonologist ordered it — can generally submit those results as evidence. Private records are considered alongside VA records. The practical requirement is that the report be complete: the full numeric table, pre- and post-bronchodilator values where applicable, the predicted values used, and the interpreting physician’s signature. A one-page summary letter saying “moderate restriction” is far weaker evidence than the actual data sheet.

Part 6: Requesting, reading, and using VA pulmonary function tests for asbestos claims

Here is the practical sequence.

1. Report symptoms specifically. “I stop twice on one flight of stairs” and “I sleep on three pillows” are clinically meaningful. A vague “I get winded” often is not.
2. Ask for full testing, not just spirometry. Because DLCO is often the first abnormal value in asbestos-related disease, a spirometry-only study can miss meaningful impairment. Ask whether DLCO and lung volumes are included.
3. Attend, and give full effort. Missing the appointment is the single most common self-inflicted delay.
4. Get your results in writing. Download the full report rather than relying on a phone summary — our walkthrough of using your VA online health record shows how to pull reports and send secure messages.
5. Read the interpretation paragraph. It usually states the pattern (restrictive, obstructive, mixed, normal), the severity, and the quality of effort.
6. Compare over time. Two studies two years apart tell a progression story that one study cannot.
7. Talk to an accredited representative before deciding what to do with the results in a claim context.

When you read the report, focus on the “% predicted” column rather than the raw liters. A 4-litre FVC means nothing in isolation; 4 liters in a tall 45-year-old is normal and in a short 78-year-old is excellent. Note also whether the report flags “suboptimal effort”, “did not meet ATS criteria”, or “poor reproducibility” — those phrases undercut the study, and a repeat may be worth requesting.

If your test results seem inconsistent with how you actually feel, that is worth raising rather than swallowing. Equipment differences, altitude, the reference equations used, and having a bad day can all shift results. Asking your pulmonologist to review, or seeking another clinical view, is entirely reasonable; our guide to getting another expert opinion on a diagnosis covers how that works inside and outside VA.

Part 7: Comparisons, limits, and special cases

VA pulmonary function tests for asbestos claims are powerful but partial, and knowing its limits prevents a lot of frustration.

It does not diagnose asbestos disease. A restrictive pattern is consistent with many conditions — obesity, neuromuscular disease, chest wall deformity, other interstitial lung diseases. Diagnosis rests on imaging (high-resolution CT is far more sensitive than plain chest X-ray for pleural plaques and early fibrosis), exposure history, and sometimes tissue. The ATSDR asbestos resources from CDC give a good plain-language overview of how these conditions develop.

Normal numbers do not mean nothing is wrong. Pleural plaques frequently cause no measurable functional deficit at all. Early mesothelioma may not move the numbers much. Conversely, a veteran with substantial pleural thickening may have well-preserved spirometry and a badly reduced DLCO.

Mixed disease complicates everything. Smoking multiplies asbestos-related lung cancer risk considerably, and many veterans exposed decades ago also smoked. When obstruction and restriction coexist, interpretation requires lung volumes, not spirometry alone.

Pleural effusion changes results temporarily. Fluid in the chest reduces measured volumes; drainage can improve them substantially. A study done with a large effusion present describes that moment, not your baseline.

Reference equations changed. Modern labs use race-neutral reference equations recommended by professional societies, replacing older race-specific ones. The same blowing effort can therefore produce a different “% predicted” than it would have a decade ago, which occasionally explains a confusing change between old and new studies.

Finally, functional testing has a rehabilitative role, not just an evaluative one. Serial testing tracks whether a rehabilitation program is helping, and post-surgical testing helps set realistic recovery goals — the ground covered in our guide to rehabilitation after thoracic surgery.

Part 8: What spouses, caregivers, and families should know

Families have a real role around VA pulmonary function tests for asbestos claims, starting with observation: relatives often see the breathlessness more clearly than the veteran does. People adapt to gradual decline without noticing — they stop taking the stairs, park closer, decline invitations. A spouse who says “he hasn’t been to the workshop in eight months” gives a clinician information the veteran genuinely may not volunteer.

Practical help around testing day is straightforward and valuable. Drive if you can; the maneuvers are tiring and some veterans feel light-headed afterwards. Bring water. Bring the medication list. Sit in on the results conversation and take notes — reports contain a lot of numbers, and two people remember more than one.

Keep copies of everything. A simple folder or a scanned set of files with every pulmonary function report, CT scan report, and clinic note, sorted by date, is worth its weight later. Records are easier to gather as they arrive than to reconstruct years afterward. Downloading reports from the online health record as they appear takes minutes.

Watch for changes that need a call rather than a wait: increasing breathlessness at rest, new chest pain, fever, coughing blood, ankle swelling, or a sudden inability to lie flat. Some of these suggest a treatable effusion or infection, and prompt attention matters.

And look after yourselves as a household. Anxiety about test results is normal and corrosive, and there is a long gap between “the test was done” and “someone explained it”. VA social workers, chaplains, and Vet Centers all support families, and asking early is easier than asking in a crisis. If the veteran is also managing nutrition problems or appetite loss, our guide to VA dietitian services during cancer treatment may help; weight loss itself affects respiratory muscle strength and, indirectly, test performance.

Frequently Asked Questions

Does a pulmonary function test hurt?

No. It is uncomfortable rather than painful — you are asked to blow out with maximum force repeatedly, which is tiring and can trigger coughing or brief light-headedness. The DLCO maneuver requires holding your breath about ten seconds. The whole session usually takes 30 to 60 minutes including rests. Tell the technician if you have chest pain, a recent operation, or a hernia, because these can be reasons to modify or postpone testing rather than push through.

Which number matters most for asbestos-related disease?

Both FVC and DLCO matter, and in asbestos-related interstitial disease DLCO often drops first because scarring impairs gas transfer before it noticeably shrinks lung volume. The regulatory criteria for interstitial lung disease reference both, with the higher resulting evaluation applying. That is one reason to make sure your testing includes diffusing capacity rather than spirometry alone, and to ask specifically if the ordering paperwork is unclear.

Can I be rated on breathing tests alone?

No decision rests on a single number. VA considers the full record — diagnosis, imaging, treatment history, clinical findings, symptoms, and testing — and applies the diagnostic code that best fits the condition. Test results are one important input, not a verdict. Nobody, including this article, can tell you what evaluation you will receive, and any source promising a specific rating from a specific number is not being straight with you.

How often should testing be repeated?

It depends on the condition and what your clinicians are monitoring. Stable pleural disease may be checked every year or two; progressive fibrosis or post-treatment monitoring may warrant more frequent studies. From an evidence perspective, current results describe current severity better than old ones, and a series of studies over time shows progression in a way that a single snapshot cannot. Ask your pulmonologist what interval makes sense for your situation.

What if I could not complete the test properly?

Say so at the time and afterwards. If coughing, pain, fatigue, or equipment trouble prevented a valid study, ask for it to be repeated. Reports that note suboptimal effort or failure to meet acceptability criteria carry less weight, so a repeat under better conditions serves you better than leaving a flawed study in the record. A short note in your own words about what went wrong, sent through secure messaging, also documents the problem.

Do private test results count?

Yes, private medical evidence is generally considered. What matters is completeness: the full numeric report with predicted percentages, pre- and post-bronchodilator values where relevant, and the interpreting physician’s identification. A summary letter without the underlying data is much weaker. If you have testing done outside VA, request the complete report from the lab and keep a copy for yourself rather than assuming records will transfer automatically between systems.

I have mesothelioma. Do these tests still apply to me?

Yes, though their role differs. During active malignant disease, respiratory neoplasms are generally evaluated at the total level, so testing is primarily about treatment planning — deciding whether you can tolerate surgery, tracking response, guiding rehabilitation. After treatment concludes and the evaluation shifts to residual impairment, breathing measurements become central again. Either way, the results guide real care decisions, which is reason enough to attend and to give full effort.

Where do I go for help with the claim side?

An accredited Veterans Service Officer or VA-accredited representative, free of charge. They can explain which diagnostic code applies, what evidence is missing, and what deadlines matter. This site covers the health-care and testing side deliberately and does not give claims advice. Do not pay anyone for help filing an initial claim, and be wary of any organization that contacts you first promising a specific outcome.

Resources

• VA Health Care — enrollment, benefits package, and facility locator.
• VA Public Health: Asbestos — VA’s overview of military asbestos exposure.
• 38 CFR Part 4 (eCFR) — the current schedule for rating disabilities, including respiratory criteria.
• NHLBI: Lung Function Tests — plain-language explanation of spirometry and diffusing capacity.
• ATSDR / CDC: Asbestos — health effects of asbestos exposure.
• National Cancer Institute: Mesothelioma — clinical background and treatment overview.
• VA copay rates — current copayment tables.

Finding a Veterans Service Officer. Accredited VSOs assist free of charge with enrollment, evidence, and claims. The VFW, DAV, American Legion, and Vietnam Veterans of America all maintain accredited service officers, as do most state and county veterans affairs offices. Use VA’s accredited representative search to find someone near you; membership in the organization is not required.

Final Thoughts: Numbers are not the whole story, but they are your story on paper

It is easy to resent being reduced to a percentage of predicted. A lifetime of service, a workshop you no longer use, a grandchild’s ball game you watched from the car — none of that fits in a column on a lab report. But the report is how the system hears you, and it is worth making sure it says something true.

That means attending the appointment, preparing sensibly, giving honest maximum effort, asking for the full panel including diffusing capacity, keeping copies, and speaking up when a study does not reflect how you actually live. It also means getting free, accredited help with the claims side rather than guessing. You are not asking for a favour. You are asking a large system to measure something accurately, and that is an entirely reasonable request to make more than once.

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Medical disclaimer: This article is for informational purposes only and is not medical advice, diagnosis, or treatment. Consult a licensed physician or your VA care team about your specific situation.

Legal disclaimer: This article is for general information only and is not legal advice and does not create an attorney-client relationship. Consult a VA-accredited attorney, claims agent, or a Veterans Service Officer (VSO) about your specific claim.