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% rating, and a 30%
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% 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%
obstruction of the nasal passage on both sides or complete obstruction on one side
of the nasal passage, that would get you a 10% 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% or 30% 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%
rating, next highest would be a 30%, and then the maximum would be a 50% rating from there.
So, for a 0% 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% 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% 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% 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% 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%
or 30% 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% 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% 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.
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