Sinusitis is a condition that many veterans may experience, and it has gained more attention due to the PACT Act. If you are a veteran applying for VA disability benefits, it’s important to understand how the VA evaluates sinusitis during the Compensation and Pension (C&P) exam and how disability ratings are assigned under VA regulations. This article will provide a clear overview of chronic sinusitis, explain the C\&P exam process, and outline how the VA determines disability ratings for this condition. By understanding these steps, you can better navigate the claims process and ensure you receive the benefits you deserve.
This article discussing VA disability for sinusitis pertains to Diagnostic Codes:
- 6510 Sinusitis, pansinusitis, chronic
- 6511 Sinusitis, ethmoid, chronic
- 6512 Sinusitis, frontal, chronic
- 6513 Sinusitis, maxillary, chronic
- 6514 Sinusitis, sphenoid, chronic
This article will discuss sinusitis, the Compensation and Pension exam for sinusitis, and the 38 CFR VA Rating for Chronic Sinusitis.
Disease Overview
Sinusitis is a condition where the paranasal sinuses become inflamed, often due to infections, allergies, or issues like a deviated nasal septum.
The sinus cavity is composed of four distinct sections: the frontal sinuses, ethmoid sinuses, maxillary sinuses, and sphenoid sinuses. Pansinusitis occurs when all four sinuses become inflamed. Maxillary sinusitis, one of the most common types of sinus inflammation, is often connected to dental problems because of the maxillary sinuses’ close location to the upper teeth.
Common symptoms include headaches, sinus pain, tenderness around the sinuses, thick nasal discharge, and nasal crusting. These symptoms occur because the inflammation blocks the normal draining of the sinuses, leading to pressure buildup and discomfort. 1, 2
The nasal discharge seen with sinusitis is usually thick and may appear yellow or green, which can indicate a bacterial infection. Nasal crusting happens when mucus dries up, adding to the discomfort and blockage. The pain and pressure caused by sinusitis can make it hard for people to go about their daily activities, and in some cases, antibiotics may be needed to treat bacterial infections effectively. 3, 4
In more severe or chronic cases, when medications do not work, surgery like functional endoscopic sinus surgery (FESS) might be necessary to open blocked sinuses and relieve symptoms. Imaging tests, such as X-rays or CT scans, are often used to diagnose sinusitis. These tests can show blocked or fluid-filled sinuses and help identify complications like infections that spread to nearby bone structures. 4, 5, 6
Treatment for sinusitis typically starts with relieving symptoms using pain relievers and nasal rinses, which help clear mucus and keep the nasal passages moist. Antibiotics are prescribed if the infection is bacterial, especially if symptoms last more than 10 days, worsen after initially improving, or are severe. 4, 7, 8
A serious complication of sinusitis is osteomyelitis, where the infection spreads to nearby bones, such as those around the frontal or maxillary sinuses. This requires aggressive medical treatment, including surgery, to manage both the bone infection and the sinusitis. Recognizing and treating sinusitis early is important to prevent complications and reduce the impact on a person’s daily life. 6
People with systemic illnesses, such as diabetes or cystic fibrosis, may also be more likely to have recurring sinus infections. Additionally, sinusitis can worsen health issues like asthma and allergic rhinitis due to the inflammation it causes. 9, 10, 11, 12
Veterans experiencing Chronic Sinusitis symptoms should document them in a Statement in Support of Claim.
C&P Exam for Sinusitis
History
During a C&P exam, the veteran’s sinusitis condition is documented in the Sinusitis/Rhinitis and Other Conditions of the Nose, Throat, Larynx and Pharynx DBQ.
Section II is designated for the examiner to record the history of the condition.
Section III, Part A focuses on the VA rating for sinusitis. In this section, the examiner is required to document the location of the sinus disease. They are to note any findings, signs, or symptoms related to chronic sinusitis. This includes whether the condition is visible on imaging studies, if the veteran experiences episodes of sinusitis, near-constant sinusitis, headaches, pain or tenderness in the affected sinuses, purulent discharge, or crusting.
Additional questions address non-incapacitating episodes of sinusitis and whether they require 4 to 6 weeks of antibiotic treatment. If so, the examiner must indicate how many times this has occurred in the past 12 months. However, sinus disease requiring this level of antibiotic treatment is rarely seen in clinical settings.
The examiner is also asked about any sinus surgeries and whether osteomyelitis is associated with the sinus disease.
Physical Exam
A physical examination is not required for the DBQ regarding sinus disease. However, the examiner may choose to perform an examination of the sinuses and record their findings in the remarks section of the DBQ.
Testing
The C&P examiner may request an X-ray of your sinuses, but more advanced imaging, such as a CT scan, is typically not ordered. If you have had a CT scan of your sinuses and it supports your claim, it is important to ensure that this evidence is submitted to the VA Claims Intake Center.
VA Ratings for Sinusitis
Veterans seeking disability ratings for sinusitis can refer to diagnostic code 6510 – 6514 in the 38 CFR.
- 0% Rating
- Detected by X-ray only
- 10% Rating
- One or two incapacitating episodes per year of sinusitis requiring prolonged (lasting four to six weeks) antibiotic treatment, or; three to six non-incapacitating episodes per year of sinusitis characterized by headaches, pain, and purulent discharge or crusting
- 30% Rating
- Three or more incapacitating episodes per year of sinusitis requiring prolonged (lasting four to six weeks) antibiotic treatment, or; more than six non-incapacitating episodes per year of sinusitis characterized by headaches, pain, and purulent discharge or crusting
- 50% Rating
- Following radical surgery with chronic osteomyelitis, or; near constant sinusitis characterized by headaches, pain and tenderness of affected sinus, and purulent discharge or crusting after repeated surgeries
The rating schedule notes that “an incapacitating episode of sinusitis means one that requires bed rest and treatment by a physician.”
The M21-1 provides guidance for rating sinusitis and rhinitis. If both conditions are present and meet the requirements for service connection (SC), SC should be granted for each condition separately. The ratings should then be combined using the combined ratings table.
The M21-1 also addresses rhinosinusitis, stating that it should be rated as a type of sinusitis. This is done by using the general rating formula and selecting the most appropriate diagnostic code (DC) from 38 CFR 4.97, DC 6510 through 6514. The DC should correspond to the type of sinusitis that matches the location of the rhinosinusitis.
The DC for rhinosinusitis should begin with the analogous code indicator “DC 6599” because rhinosinusitis is not specifically listed in the rating schedule. Additionally, rhinosinusitis is considered a chronic disease linked to exposure to particulate matter, as outlined in 38 CFR 3.320(a)(2).
You can read the M21-1 Adjudication Procedures Manual regarding Chronic Sinusitis here.
Further Learning
Sinusitis is a common condition among veterans, which has received more attention due to the PACT Act. If you are a veteran applying for VA disability benefits, it is important to understand how the VA evaluates sinusitis during the C&P exam and assigns disability ratings. This article explains chronic sinusitis, the C&P exam process, and how the VA determines ratings under Diagnostic Codes 6510-6514 for different types of chronic sinusitis.
If you need help with your sinusitis claim, Valor 4 Vet may be able to provide a nexus letter to support your claim. Call or text 888-448-1011 to get started.
You can listen to Valor 4 Vet and Exposed Vet Productions, formerly Exposed Vet Radio Show, discussing Chronic Sinusitis from November 7, 2024 here.
References
1. Jeon, Cha Woong, Gye Yeon Lim, and Ja Un Moon, 2023. “Dedicated neuroimaging analysis in children with primary headaches: prevalence of lesions and a comparison between patients with and without migraines”, BMC Medical Imaging(1), 23. https://doi.org/10.1186/s12880-023-01122-2
2. Plawecki, Andrea, Abdulmalik Saleem, Dace Zvirbulis, Edward L. Peterson, Frederick Yoo, Ashhar Ali, and John R. Craig, 2022. “Clinical features and headache diagnoses in patients with chief complaint of craniofacial pain”, Annals of Otology Rhinology & Laryngology(6), 132:628-637. https://doi.org/10.1177/00034894221111254
3. Velasquez, Nathalia, W Strober, Amber D. Shaffer, and Amanda L. Stapleton, 2021. “Clinical and radiologic characterization of frontal sinusitis in the pediatric population”, Annals of Otology Rhinology & Laryngology(8), 130:923-928. https://doi.org/10.1177/0003489420987969
4. Shaikh, Nader, Alejandro Hoberman, Timothy R. Shope, Jong‐Hyeon Jeong, Marcia Kurs‐Lasky, Judith M. Martin, Sonika Bhatnagar et al., 2023. “Identifying children likely to benefit from antibiotics for acute sinusitis”, Jama(4), 330:349. https://doi.org/10.1001/jama.2023.10854
5. Xie, Yan, Shiqi Wu, Wanling Cui, Dandi Zeng, Feifei Chen, Fangqi Liang, Rongrong Lu et al., 2023. “Case report: endoscopic frontal sinus opening surgery for noninflammatory frontal sinus headache: a short case series”, Frontiers in Surgery, 10. https://doi.org/10.3389/fsurg.2023.1132450
6. Jawad, Jamal, Derar Al-Domaidat, and Mohamed Abaza, 2022. “Fibrous dysplasia of the sphenoid sinus: headache relieved by surgical excision—a case report”, Journal of Surgical Case Reports(11), 2022. https://doi.org/10.1093/jscr/rjac518
7. Yang, Yepeng, Yaning Sun, Feng Xiang, Min Zhang, Li Fu, and Qinxiu Zhang, 2022. “Efficacy and safety of traditional chinese medicine nasal irrigation on chronic rhinosinusitis recovery after endoscopic sinus surgery: a protocol for a systematic review and meta-analysis”, Plos One(8), 17:e0272371. https://doi.org/10.1371/journal.pone.0272371
8. Regnstrand, Tobias, Andrés Torres, Eline Petitjean, Paul Lambrechts, Daniel Benchimol, and Reinhilde Jacobs, 2021. “cbct‐based assessment of the anatomic relationship between maxillary sinus and upper teeth”, Clinical and Experimental Dental Research(6), 7:1197-1204. https://doi.org/10.1002/cre2.451
9. Wu, Tong, Sihan He, Zan Jiao, Liang Xiang, Yu Chen, HuoW. Liu, YongQ. Zhang et al., 2021. “Low molecular weight heparin improves the inflammatory state of acute sinusitis rats through inhibiting the tlr4-myd88-nf-κb signaling pathway”, Frontiers in Pharmacology, 12. https://doi.org/10.3389/fphar.2021.726630
10. Armbruster, Catherine R., Kelvin Li, Megan R. Kiedrowski, Anna C. Zemke, Jeffrey A. Melvin, John Allphin Moore, Samar Atteih et al., 2022. “Low diversity and instability of the sinus microbiota over time in adults with cystic fibrosis”,. https://doi.org/10.1101/2022.01.18.476814
11. Tang, Si-Jia, Heejin Lee, Tiantian Cui, Jae Min Lee, Ji Young Ahn, Sua Lee, and Saeyoon Kim, 2022. “A comparison of clinical features of youth with and without rhinitis signs and symptoms who are hospitalized for headache”, Children(8), 9:1241. https://doi.org/10.3390/children9081241
12. Dimitroyannis, Rose, David Fenton, S Cho, Rachel Nordgren, Jayant M. Pinto, and Christopher R. Roxbury, 2024. “A social media quality review of popular sinusitis videos on tiktok”, Otolaryngology(5), 170:1456-1466. https://doi.org/10.1002/ohn.688
