Sinusitis is also known as a sinus infection. This occurs when there is inflammation and swelling of the tissues that line the sinuses. This condition can be chronic. Chronic sinusitis lasts for three months or longer and may last up to eight weeks at a time. Veterans may be able to qualify for support with this condition under some circumstances.
VA Disability Ratings for Sinusitis
Sinusitis is also known as a sinus infection and has symptoms that include:
- Nasal inflammation
- Thick, colored discharge and a runny nose
- Postnasal drip or drainage
- Pain, swelling, and tenderness around the eyes, nose, cheeks, and forehead
Sinusitis may be linked to other conditions such as allergic rhinitis, asthma, ear infections, and deviated septums.
Chronic sinusitis affects 37 million Americans annually. Symptoms may last for 12 weeks or longer at a time.
Service Connection for Sinusitis
The Department of Veteran Affairs began processing claims for asthma, rhinitis, and sinusitis on August 2, 2021. The claims are now being processed on a presumptive basis for those who were exposed during their military service and when the condition manifested within 10 years of that service.
It was found that particulate matter pollution is associated with chronic sinusitis for veterans who once serviced in the Southwest Asia theater of operations, Syria, Djibouti, Uzbekistan, and Afghanistan.
To make a successful service connection, you will need to show evidence of:
- A current diagnosis of disability being claimed
- An in-service occurrence (or incident) that caused or aggravated the disability being claimed
- Medical nexus connecting the current, diagnosed disability to the in-service occurrence (or incident)
In-service connection occurrences might include incidents such as a diagnosed case of sinusitis while you were on duty after exposure to a particularly high-particulate day or a flare of sinusitis while working in the Southwest Asia theater of operations. Burn pit exposure has also been linked to this condition, so a history of exposure may help with proving an in-service connection.
Secondary Service Connection for Sinusitis
Secondary service connections apply to secondary disabilities. These are disabilities that result from a service-connected disability that has aggravated or caused a new or pre-existing illness, injury, or condition. For example, someone who develops a deviated septum due to injury or illness while working in the military may go on to develop chronic sinusitis. Sinusitis itself may go on to cause other secondary disability conditions such as laryngitis or bronchitis. It may also worsen sleep apnea.
It is necessary to show that the service-connected disability is directly linked to the secondary injury or illness. To do this, most people show a progression of the illness over time. For example, you may start with a diagnosis of a deviated septum. You may have a history of seeking treatment for allergies and rhinitis. Then, you may receive a diagnosis for sinusitis that clears with medication. Following this, the sinusitis may return again and show that it is chronic in nature, which would allow you to show a natural progression from the deviated septum to the new chronic sinusitis condition.
Service Connection by Aggravation
Veterans who have a history of a medical condition that is aggravated by their service may obtain a service connection by aggravation. For example, a veteran who noted a preexisting deviated septum or history of sinusitis may claim for a service connection by aggravation if the condition worsens and becomes more frequent as a result of their service (and not the natural progression of the disease). Veterans have to show that the aggravation is a non-temporary increase in the severity of the condition to qualify.
Compensation & Pension Exams for Sinusitis
After you file a disability claim, you will go through compensation and pension, or C&P, exam to determine if you qualify for VA disability benefits. This examination is not used to treat an illness or injury but instead to gather information on the condition for the purpose of making a decision on your claim.
During the exam, the medical provider will:
- Review the claim file with you
- Ask questions based on your medical records, such as those on the Disability Benefits Questionnaire
- Perform a physical examination
- Order tests, like blood work and X-rays
After this, the doctor will send the report to the VA claims processor.
If you receive an unfavorable examination, you have the option of going through the appeals process.
Some tips to make this examination easier include:
- Attending the exam on time
- Making sure all contact information is correct
- Being prepared to have multiple appointments if you have secondary disability claims
- Submitting all medical evidence to the office in advance
Remember that this examination will be different and may not be physical. You should be honest during the examination, so that the doctor understands your symptoms and how they affect you.
How does the VA Rate Sinusitis?
After your C&P exam, the VA has to determine if you qualify for disability compensation. Diagnostic Code 6510 correlates to sinusitis, para sinusitis, and chronic sinusitis. The general rating formula states:
- A 0% rating is awarded if sinusitis is detected by X-ray alone
- A 10% rating is awarded if sinusitis is manifested in one or two incapacitating episodes annually and requires prolonged (four to six weeks) antibiotic treatment. A 10% rating is also used when a person has three to six non-incapacitating episodes annually with symptoms of purulent discharge, crusting, pain, and headaches.
- A 30% disability rating is awarded if there are three or more incapacitating episodes annually that require long-term antibiotics of four to six weeks. A 30% rating may also be used for cases of six or more non-incapacitating episodes with symptoms of purulent discharge, crusting, pain, and headaches.
- A 50% disability rating is awarded for those requiring radical surgery for sinusitis with chronic osteomyelitis. A 50% rating may also be given to those with near-constant sinusitis that continues to cause symptoms following repeated surgeries.
Under the Diagnostic Code 6522, a 10% rating is used for vasomotor or allergic rhinitis without polyps but 50% or greater blockage of the nasal passages on both sides. It may also be used if one side is completely obstructed. If polyps (growths) are present, this rises to a 30% rating.
Incapacitating episodes occur when a vet is ordered by a doctor to remain on bed rest.
TDIU for Sinusitis
For most cases of sinusitis, the disability will need to be combined with secondary conditions to meet the 100% rating for total disability. For example, chronic asthma and sinusitis together may qualify at a higher percentage. However, even if the veteran doesn’t meet the 100% rating percent rating, they may qualify for TDIU if they are prevented from working due to the severity of the condition. For more information on TDIU, check out our VA Unemployability guide here!
Presumptive Sinusitis Disability Claims for Gulf War Veterans
The VA disability rating for sinusitis ranges from 10 to 50%. Veterans with this condition may seek VA benefits based on sinusitis being a presumptive condition related to particulate matter exposure in Djibouti, Afghanistan, Uzbekistan, or Syria between September. 19, 2001, to today or the Southwest Asia theater of operations from August 2, 1990, through today.
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