Evidence Checklist: Pulmonary Fibrosis (Interstitial Lung Disease)

High-resolution CT scan (HRCT) showing fibrotic patternCritical

HRCT is essential for diagnosing pulmonary fibrosis, demonstrating honeycombing, traction bronchiectasis, reticular changes, and subpleural basal predominance characteristic of UIP/IPF or other fibrotic patterns.

PFTs including FVC, TLC (total lung capacity), and DLCOCritical

Comprehensive pulmonary function testing showing restrictive ventilatory defect (reduced FVC and TLC) and impaired gas exchange (reduced DLCO). The most impaired value drives the VA rating.

Serial DLCO measurements documenting progressionCritical

Serial diffusion capacity results over time demonstrating progressive decline in gas exchange, a key prognostic marker in pulmonary fibrosis that supports the severity of the claim.

Nexus opinion linking pulmonary fibrosis to service ("at least as likely as not")Critical

A medical opinion connecting your pulmonary fibrosis to in-service toxic exposures (burn pits, asbestos, chemical agents, radiation) or a service-connected condition such as sarcoidosis or connective tissue disease.

Pulmonologist evaluation with multidisciplinary diagnosis

A specialist evaluation confirming the fibrosis type (IPF, NSIP, COP, etc.) and documenting severity, prognosis, and treatment plan. Multidisciplinary team diagnosis is the standard of care.

Treatment records (antifibrotic agents, oxygen therapy, lung transplant evaluation)

Records documenting antifibrotic therapy (nintedanib, pirfenidone), supplemental oxygen requirements at rest or exertion, pulmonary rehabilitation, and any lung transplant evaluation.

Buddy statement from spouse, family, or fellow service member

A written statement from someone who can describe observable symptoms and how your condition affects daily life.

Completed DBQ Respiratory ConditionsCritical

Standardized form capturing PFT values, DLCO, oxygen requirements, and functional impact of pulmonary fibrosis.

Service treatment records (STRs)Critical

Military medical records showing in-service treatment, complaints, or injuries related to this condition.