Allergic Rhinitis & Sinusitis VA Disability Ratings

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Video Transcript

Christian McTarnaghan: Hi everybody and welcome to CCK live. My name is Christian McTarnaghan and today I’m joined by Bethany Cooke and Mike Lostritto.

Today we’re gonna be talking about VA benefits for allergic rhinitis and chronic sinusitis. They’re similar conditions, but they’re rated differently. They might sound the same, but we’re gonna get into all that in a little bit. But most importantly, let’s just start at the beginning and let’s talk about what these conditions are.

Bethany, so what is allergic rhinitis?

Bethany Cooke: Sure. Allergic rhinitis is an allergic response to specific allergens, which is a substance that causes an allergic reaction. Symptoms tend to occur when you breathe in something that you’re allergic to like dust, animal dander, pollen, or any other irritants you can think of that you might be exposed to. Common symptoms of rhinitis would include sneezing, a runny or stuffy nose, coughing, sore or scratchy throat, itchy watery eyes, frequent headaches, eczema type symptoms, which is dry itchy skin, as well as hives or excessive fatigue. People might experience other symptoms due to allergies, but these are some of the most common ones.

There are two types of rhinitis. One would be seasonal and the other is perennial. Seasonal rhinitis or seasonal allergies occur during the spring and fall seasons and are typically in response to outdoor allergens, such as pollen. So, since these are seasonal, they’re likely to come and go, you would probably not experience them all year. Whereas perennial allergies can occur year-round. These are typically due to indoor allergens such as dust mites or pet dander, which might stick around all year. So, these symptoms might be chronic as you might constantly be exposed to the allergen that’s causing them.

Christian: All right, great. So, now we learned a little bit about rhinitis, what about sinusitis?

Mike Lostritto: Chronic sinusitis is a condition that affects a person’s sinuses. So, it’s really that space between a person’s nose and their head and it becomes inflamed and swollen. The chronic part of this condition is if it’s inflamed or swollen for three months or longer, despite the fact that the person might be seeking treatment and undergoing treatment. This condition, it is rather common actually, and typically interferes with the way mucus drains within someone’s sinuses and this can lead to a person’s nose being stuffy.

So, as a result of that, breathing through a person’s nose is difficult and the area around an individual’s eyes can become swollen or tender, and it has that effect. So, some common symptoms though, building on that for chronic sinusitis, include things like nasal inflammation, thick discolored discharge from the nose, drainage down the back of the throat, nasal obstruction or congestion, difficulty breathing, pain, tenderness or swelling around the eyes, cheeks, nose, forehead, really that sinus cavity area. Reduced sense of smell or reduced sense of taste, ear pain, aching in your upper jaw, cough, fatigue—there really are a whole host of symptoms as you can tell that can be caused by chronic sinusitis.

The causes of this condition really vary, but the following are kind of the most common causes. Nasal polyps, meaning tissue growths that block the nasal passages or the sinuses. The second common cause is a deviated septum. The septum is the wall between a person’s nostrils and oftentimes that septum can become what’s known as deviated or crooked or slanted, and that really can restrict a person’s breathing or block sinus passages. And the third kind of common cause of chronic sinusitis involves respiratory tract infections, and these are infections in your respiratory tract that can inflame and thicken sinus membranes and really block mucus discharge leading to the chronic sinusitis that a person might experience.

Christian: These two conditions, just like any other condition, can be found to be service connected caused by your service. So, we’re just gonna run through and remind everyone about the elements of service connection, right? Because the veteran has to show that their condition was caused or aggravated (made worse) by their service. So, you would need a current diagnosis of either of those conditions, in-service event, illness, or injury, and then, of course, a medical nexus or some medical evidence that links your current diagnosis to that in-service event.

So, one of the things that we want to highlight is that veterans who are exposed to environmental hazards, such as open-air burn pits, may be at a higher risk for developing these conditions. You know, those burn pits released a lot of toxins, hydrocarbons, VOCs, volatile organic compounds, dioxins, and they vary depending on where you were, what military installation you are at. But this definitely may contribute to a veteran’s condition, to your condition, and be the in-service injury that would warrant this sort of first element of service connection.

Another thing that we wanted to note is just like other conditions, these two sort of like head and nasal conditions can be related secondarily to other service-connected conditions, right? Just like anything else in VA law, if you have a service-connected disability, it causes another disability, you can be service-connected for that as if it were caused by service. And so, I mean, I have to admit, I don’t think that this is as common as at some other secondarily service-connected disabilities, but immune system disorders can lead to these types of nasal problems. Cystic fibrosis, multiple sclerosis, HIV, things like that. So, we just wanted you guys to know about the avenue for secondary service connection is not foreclosed for these conditions, but it’s definitely not something that I have seen in my practice particularly often, but it’s certainly possible. So, now we know what the conditions are, let’s get into a little bit about the ratings.

Bethany: Typically, allergic rhinitis is rated under 38 CFR 4.97 diagnostic code 6522. So, that diagnostic code includes two evaluations, a 10 percent rating, and a 30 percent evaluation based on different symptomology. So, if you have allergic rhinitis and it gets service connected and you experience polyps, which is an abnormal tissue growth on a mucous membrane, that would entitle you to a 30 percent rating under this rating criteria. However, if you don’t have polyps due to the allergic rhinitis, but you do experience a greater than 50 percent obstruction of the nasal passage on both sides or complete obstruction on one side of the nasal passage, that would get you a 10 percent rating under this rating criteria.

Now, given that there are just these two ratings under this rating criteria, it’s entirely possible that you might believe the severity of your allergic rhinitis is not accurately reflected in either the 10 percent or 30 percent rating, so, in that case, you may be eligible for an extra scheduler rating. Now, an extra scheduler VA disability rating may be warranted for veterans to experience unique or especially severe symptoms that aren’t accounted for by the rating criteria. The criteria for an extra scheduler rating falls under VA regulation of 38 CFR 3.321B. And I do think that we’ve done some other Facebook lives, you can find some information on our website as well, about how you might get an extra scheduler rating for your disability.

Christian: Yeah, and that can be a little tricky. Again, we do have a lot of information but, you have to sort of show an exceptional or unusual disability and sometimes just having more severe symptoms, you’re just not gonna see eye-to-eye on that, but it’s definitely something available, something that if you guys believe you’re entitled to it, something you should push. So, that was rhinitis. And what about, how does VA rate sinusitis, Mike?

Mike: VA rates chronic sinusitis under the regulation 38 CFR section 4.97, and again, it’s according to the general rating formula, diagnostic codes 6510 through 6514 here for sinusitis and it rates the condition on a scale of a few different ratings. So, the lowest rating a veteran can receive is a 0% non-compensable rating and we’ll go through these individually in a second. But next up from there, a veteran can receive a 10 percent rating, next highest would be a 30 percent, and then the maximum would be a 50 percent rating from there.

So, for a 0 percent rating, this is assigned where a veteran can show that they do have the condition, they do have sinusitis, but it’s only detected by an x-ray. And so, it doesn’t incapacitate the veteran further than that, or cause additional problems further than that. Beyond a non-compensable 0 percent rating to receive higher ratings from that, really, we’re looking at whether the veteran has incapacitating episodes of sinusitis. And by looking at incapacitating episodes, VA is really referring to bed rest treatment by a healthcare professional. And so, let’s go through those.

So, for a 10 percent rating, VA requires that the veteran have 1 or 2 incapacitating episodes per year of sinusitis, requiring prolonged antibiotic treatment or 3 to 6 non-incapacitating episodes per year characterized by things like headaches, pain, and discharge. To receive the next highest rating, a 30 percent rating, veterans would have to show that they have 3 or more incapacitating episodes per year of sinusitis requiring again, prolonged antibiotic treatment. Prolonged just means lasting 4 to 6 weeks. Or veterans can show that they have more than 6 non-incapacitating episodes per year characterized again, by headaches, pain, and discharge. Finally, a 50% rating is only going to be awarded where veterans can show that they’ve had surgery due to their condition or they really have near constant sinusitis characterized by again, headaches, pain, tenderness that affects the sinus, or discharge after repeated surgery. So, it’s a very severe condition at that point at the 50 percent rating level.

In my practice, I’ve seen veterans receive ratings that run the spectrum, but more likely in most instances, I should say, veterans receive a 10 percent or 30 percent rating in my experience. Non-compensable ratings again, the veteran has the conditions been diagnosed, but it’s really only detected by an x-ray. So, that really runs the spectrum of the ratings for chronic sinusitis and what a veteran can expect if they have this condition.

Christian: It is pretty interesting how severe sinusitis condition needs to be before you can get a 50% rating. That’s a pretty serious condition for sure.

Mike: I just got to say, like I said, in my practice, it certainly possible obviously to get a 50 percent rating, but I just say it’s fairly rare that I’ve seen that. Most of the time I see in the 10, the 30 percent rating criteria. But certainly if a veteran feels that they’re underrated for their condition, I would strongly recommend looking to appeal that rating decision, maybe filing some additional medical evidence, lay statements. There are a number of different things that you can do to try to prove that your condition is as severe as it really is.

Christian: So, I think that’s all for us today. Thank you very much for tuning in. Just remember if VA denied your claim for service connection for these conditions, the team here at CCK may be able to help you appeal that decision. So, make sure to reach out to us for a free consultation. And as always, be sure to subscribe to our channel to keep up with the latest veterans content on veterans’ disability benefits.