Rhinitis & Sinusitis: VA Rating Criteria

Plain-language guide

What this rating actually turns on

For sinusitis, the rating is a tally of documented flare-ups across a full year rather than a snapshot of your sinuses on exam day; for rhinitis, whether a scope turns up a single polyp can double it. The two conditions live in the same regulation but ride two different scales. Under 38 CFR 4.97, all five chronic sinusitis codes (pansinusitis 6510, ethmoid 6511, frontal 6512, maxillary 6513, sphenoid 6514) are rated off one shared table, the General Rating Formula for Sinusitis, while rhinitis is rated on its own under allergic or vasomotor 6522, bacterial 6523, and granulomatous 6524.

For sinusitis, the percentage turns on documented episodes over a year, not on how your sinuses look on a single exam day: 0 percent detected by X-ray only; 10 percent for one or two incapacitating episodes per year requiring prolonged (lasting 4–6 weeks) antibiotic treatment, or three to six non-incapacitating episodes per year characterized by headaches, pain, and purulent discharge or crusting; 30 percent for three or more incapacitating episodes per year requiring prolonged antibiotics, or more than six non-incapacitating episodes; and 50 percent following radical surgery with chronic osteomyelitis, or near-constant sinusitis with headaches, pain and tenderness of the affected sinus, and purulent discharge or crusting after repeated surgeries. The load-bearing definition is in the formula’s note: an incapacitating episode means one that requires bed rest and treatment by a physician. Miss that, and a flare you toughed through at home counts for nothing on the incapacitating side, though it may still count as a non-incapacitating episode if it brought headaches, pain, and purulent discharge or crusting.

Allergic or vasomotor rhinitis (6522) turns on one binary fact: polyps. It is 30 percent with nasal polyps and 10 percent without polyps but with greater than 50-percent obstruction of the nasal passage on both sides, or complete obstruction on one side. A documented polyp is what more than doubles the rating, so whether a scope found one is the whole game at that level.

A worked example

An Air Force veteran with chronic maxillary sinusitis (DC 6513) assumes she has a thin claim: she has never been put on bed rest, so by her count she has zero incapacitating episodes and nothing to show. But the formula does not run on incapacitating episodes alone. Pulling her clinic records for the past 12 months, she counts nine separate visits, each documenting headache, facial pain, and purulent discharge that her physician noted and treated, and none requiring the four-to-six-week antibiotic course or bed rest that defines an incapacitating episode. Those nine are non-incapacitating episodes, and the 30 percent line is met by “more than six” of them just as squarely as by three incapacitating ones. She lands at 30 percent without a single incapacitating episode, because she counted the right bucket. See the pay table on this page for what that adds to her combined rating.

What the C&P exam measures

The examiner completes the Sinusitis, Rhinitis and Other Conditions of the Nose, Throat, Larynx and Pharynx DBQ (VA Form 21-0960N-4). It tracks the formula directly: for sinusitis it asks the examiner to count the non-incapacitating episodes and the incapacitating episodes (again defined as requiring bed rest and treatment by a physician) in the past 12 months, and to note radical surgery, chronic osteomyelitis, or near-constant symptoms after repeated surgeries. For rhinitis it checks whether obstruction exceeds 50 percent on both sides or is complete on one side, and whether polyps are present. Because the rating runs on frequency, a snapshot exam on a good day cannot establish it, the count has to come from your treatment record, and the DBQ is on VA’s public list so a treating ENT can complete it.

What to have in your file

Per VA’s evidence requirements:

• Dated treatment notes for each flare, showing the physician visit, that bed rest was advised, and the antibiotic course length, the 4–6 week “prolonged” course is what makes an episode incapacitating.
• Imaging (sinus CT or X-ray) establishing chronic sinus disease, and operative reports if you have had functional endoscopic sinus surgery or radical surgery, plus any record of chronic osteomyelitis.
• ENT or rhinoscopy findings documenting purulent discharge or crusting, the percentage of obstruction, and, for 6522, the presence of nasal polyps.
• Lay statements (VA Form 21-10210) and a dated symptom log tying each flare to its treatment, so the rater can total the episodes.

Common mistakes

• Self-treating and never seeing a physician. OTC nasal sprays and toughing it out leave no countable episode. The formula rewards documented visits, prescribed antibiotics, and recorded symptoms, not misery.
• Confusing incapacitating with non-incapacitating. “Incapacitating” is a term of art (bed rest plus physician treatment, tied to a prolonged 4–6 week antibiotic course). Most veterans’ flares are non-incapacitating episodes, and those still count: three to six is 10 percent, more than six is 30 percent. Count the right bucket.
• Missing the polyp finding. Rhinitis under 6522 only jumps to 30 percent on documented polyps. If a scope found one, make sure it made it into the record.
• Letting sinusitis and rhinitis get lumped together. They are separate codes with separate criteria and can be rated concurrently when each is separately diagnosed, but do not expect double credit for the same symptom, 38 CFR 4.14 bars pyramiding.

Worth knowing

Chronic sinusitis, chronic rhinitis, and asthma are PACT Act presumptive conditions for Gulf War era veterans who served on or after August 2, 1990 in the covered Southwest Asia locations and for post-9/11 veterans who served on or after September 11, 2001 in the covered locations. If that is you, VA presumes the toxic exposure and the service connection, so you need only a current diagnosis and evidence of qualifying service, no nexus letter required. Our PACT Act guide walks the covered locations and how to claim; if your service instead points to undiagnosed Gulf War symptoms, see the Gulf War illness guide. Once a percentage is assigned, the calculator on this site combines it with your other ratings.

If your rating came back lower than this

A decision that ignores the criteria above is a frequent reason veterans are underpaid. Line your decision up against the levels on this page. If the evidence supports a higher level than VA assigned, you have three ways to challenge it, and the right one depends on why it went wrong:

• Something was missing from the record (an exam finding, a prescription, a flare-up statement, a nexus letter): add it with a Supplemental Claim.
• The evidence was already there and VA misread it: ask for a Higher-Level Review by a more senior rater, with no new evidence needed.
• A legal or judgment error: take it to the Board of Veterans' Appeals.

Before you file, recombine this rating with your others (VA math does not add ratings), check how long each lane is taking right now, and remember a VA-accredited representative or VSO will help you for free. You can also browse every other condition's criteria to make sure you are claiming everything you are owed.