DC 6513 · 38 CFR 4.97
Sinusitis / Rhinitis C&P Exam Prep
To evaluate the current severity and functional impact of chronic sinusitis, rhinitis, and related upper respiratory/ENT conditions for VA disability rating purposes under 38 CFR - 4.97.
- Format:
- Interview + Physical
- Typical duration:
- 30 minutes
- DBQ form:
- Sinusitis_Rhinitis_and_Other_Conditions_of_the_Nose_Throat_Larynx_and_Pharynx (Sinusitis_Rhinitis_and_Other_Conditions_of_the_Nose_Throat_Larynx_and_Pharynx)
- Examiner:
- Physician
What the examiner evaluates
- Type, location, and chronicity of sinus involvement (maxillary, frontal, ethmoid, sphenoid, or pan-sinusitis)
- Frequency and duration of sinusitis episodes or near-constant sinusitis
- Presence and character of signs/symptoms: facial pain, headaches, purulent discharge, crusting, sinus tenderness
- Rhinitis type (allergic, non-allergic, bacterial, granulomatous) and associated nasal obstruction
- History of sinus surgery including type, sinuses operated on, and dates
- Imaging findings (X-ray, CT, MRI) documenting sinus disease
- Nasal endoscopy findings if available
- Presence of associated conditions: deviated septum (traumatic or otherwise), nasal polyps, laryngeal or pharyngeal involvement
- Functional impact on daily activities and employment
- Treatment history including medications, therapeutic procedures, and surgical interventions
The exam will typically begin with a review of your medical history and a structured interview, followed by a physical examination of the nose, sinuses (facial palpation/percussion), and potentially the throat. Bring all relevant medical records, imaging reports, and a written summary of your symptoms. You have the right to request that the exam be recorded in most states - confirm your state's laws in advance.
Measurements and tests
Nasal Passage Obstruction Assessment
What it measures: Degree of nasal airway obstruction, which factors into rating criteria under DC 6523 (bacterial rhinitis) and related rhinitis codes.
What to expect: The examiner will visually inspect the nasal passages and may perform anterior rhinoscopy. They will note whether obstruction is unilateral or bilateral and estimate the percentage of obstruction.
Critical thresholds
- Greater than 50% obstruction on both sides OR complete obstruction on one side 10% under DC 6523 (bacterial rhinitis with permanent turbinate hypertrophy)
- Rhinoscleroma present 50% under DC 6523
Tips
- Tell the examiner if your obstruction is worse on certain days, after allergen exposure, or during flare-ups
- Note whether obstruction is positional (worse lying down) or constant
- Describe any prior nasal surgery and whether it improved or worsened obstruction
Pain considerations: Describe any pain or pressure associated with nasal obstruction, including its location, intensity, and frequency.
Sinus Palpation and Percussion
What it measures: Tenderness over affected sinuses (maxillary, frontal, ethmoid, sphenoid) as evidence of active or chronic sinusitis.
What to expect: The examiner will apply gentle pressure over the cheekbones (maxillary), forehead (frontal), and around the eyes (ethmoid) to elicit tenderness or pain. Tell them accurately whether this causes pain.
Critical thresholds
- Tenderness of affected sinus present Supports active sinusitis findings and documents current symptomatology on the DBQ
Tips
- Do not minimize or suppress pain responses during palpation - accurate reporting is essential
- If you are having a relatively good day at the exam, verbally tell the examiner your pain is typically worse
- Note which sinuses are more painful and whether pain radiates
Pain considerations: Sinus pain/pressure is a key DBQ field. Accurately describe its location (e.g., behind cheeks, above eyes, between eyes, top of head), severity on a 0-10 scale, and how it affects concentration, sleep, and daily functioning.
Sinusitis Episode Frequency Assessment
What it measures: Number, duration, and frequency of discrete sinusitis episodes per year, or whether sinusitis is near-constant - a critical factor in the General Rating Formula for Sinusitis.
What to expect: The examiner will ask how often you experience sinusitis episodes, how long they last, how many antibiotic courses you have needed, and whether symptoms are continuous versus episodic.
Critical thresholds
- Near-constant sinusitis Highest rating tier - supports maximum disability rating under the General Rating Formula
- 3 or more episodes per year requiring antibiotic treatment Supports moderate-to-moderately severe rating
- 1-2 episodes per year Supports milder rating tier
Tips
- Count and document every episode over the past 12-24 months before your exam
- Include episodes that may not have resulted in a doctor visit but were treated with over-the-counter medications
- Note any hospitalizations or ER visits for sinusitis complications
- Describe the duration of each episode - a 3-week episode is more significant than a 3-day episode
Pain considerations: Describe how pain and pressure during episodes affects your ability to work, concentrate, sleep, and perform daily activities.
Nasal Endoscopy (if performed)
What it measures: Direct visualization of nasal passages, turbinates, sinus ostia, and any polyps, discharge, or mucosal thickening.
What to expect: A flexible or rigid scope may be inserted into the nasal passage. This is not always performed at C&P exams but may occur if the examiner has ENT training or equipment. Imaging studies (CT, MRI, X-ray) may be reviewed instead.
Critical thresholds
- Purulent discharge documented Supports active sinusitis diagnosis and higher severity rating
- Mucosal thickening or polyps Supports chronic disease documentation
Tips
- If nasal endoscopy was performed by your treating ENT, bring the report
- Bring any CT sinus imaging reports showing mucosal thickening, opacification, or polyps
- Prior CT or MRI findings are extremely valuable - they document pathology objectively
Pain considerations: Note any post-nasal drip causing chronic throat irritation, cough, or disrupted sleep.
Rating criteria by percentage
50%
Rhinoscleroma (a severe granulomatous bacterial infection of the nasal passages caused by Klebsiella rhinoscleromatis) - rated at 50% under DC 6523.
Key symptoms
- Progressive nasal obstruction
- Crusting and fetid discharge
- Destruction of nasal structures
- Hard, rubbery nasal masses (scleroma stage)
- Voice changes due to laryngeal involvement
From 38 CFR: DC 6523: Rhinoscleroma rated at 50%. A severe, chronic granulomatous bacterial infection requiring this level reflects the serious nature and functional impairment of the condition.
30%
Near-constant sinusitis with headaches, pain, and purulent discharge OR three or more surgical interventions (including endoscopic sinus surgery). This tier reflects severe, persistent sinusitis with significant daily functional impairment under the General Rating Formula for Sinusitis.
Key symptoms
- Near-constant facial pain or pressure
- Frequent, severe headaches attributable to sinus disease
- Persistent purulent nasal discharge
- Significant nasal obstruction
- Multiple antibiotic-dependent exacerbations
- History of repeated sinus surgery
- Significant impact on sleep and daily function
From 38 CFR: General Rating Formula for Sinusitis (DC 6510-6514): Near-constant sinusitis characterized by headaches, pain, and purulent discharge, or three or more surgical procedures. Veterans should accurately document the near-daily nature of their symptoms.
20%
Chronic sinusitis with at least six episodes per year OR with incapacitating exacerbations requiring antibiotic use averaging at least six per year. This tier reflects moderately severe chronic sinusitis with frequent exacerbations requiring medical intervention.
Key symptoms
- Six or more documented antibiotic-requiring sinusitis episodes per year
- Recurrent severe headaches
- Frequent purulent discharge
- Significant nasal obstruction
- Recurrent facial pain or pressure
- Sleep disruption from congestion or post-nasal drip
- Impact on work attendance or productivity
From 38 CFR: General Rating Formula for Sinusitis: Six or more episodes per year or incapacitating exacerbations of chronic sinusitis six or more times per year requiring antibiotic treatment.
10%
Chronic sinusitis with one to two episodes per year OR bacterial rhinitis with permanent turbinate hypertrophy causing greater than 50% bilateral obstruction or complete unilateral obstruction.
Key symptoms
- One to two antibiotic-requiring episodes per year
- Mild to moderate chronic nasal congestion
- Intermittent facial pressure or headaches
- Turbinate hypertrophy with measurable obstruction
- Mild post-nasal drip
- Some impact on sleep or breathing
From 38 CFR: General Rating Formula for Sinusitis: One to two episodes per year or a single surgical intervention. DC 6523: Bacterial rhinitis with permanent turbinate hypertrophy and greater than 50% obstruction bilaterally or complete obstruction unilaterally - 10%.
0%
Chronic sinusitis detected only by imaging studies (CT, MRI, X-ray) with no significant clinical symptoms, or asymptomatic rhinitis with minimal functional impairment.
Key symptoms
- Radiographic evidence of mucosal thickening only
- No current episodes requiring antibiotic treatment
- Minimal or no functional impairment
- Condition managed with over-the-counter medications only
From 38 CFR: General Rating Formula for Sinusitis: Chronic sinusitis detected only by imaging studies - 0%. Note: A 0% rating still establishes service connection, which may be important for future increases or secondary conditions.
Describing your symptoms accurately
Sinusitis Episode Frequency and Severity
How to describe it: State specifically how many distinct sinusitis episodes you have experienced in the past 12 months. Describe each: how long it lasted, what symptoms were present (facial pain, pressure, fever, thick colored discharge, headache), whether you needed antibiotics or other treatment, and whether it caused you to miss work or limit activities. Be precise - 'about 6 times' is more useful than 'frequently.'
Example: On my worst days, I wake up with severe facial pressure over both cheeks and across my forehead that rates 8/10 in intensity. I have thick yellow-green discharge constantly draining in the back of my throat, a pounding headache behind my eyes, and I cannot concentrate enough to work. The pain makes it impossible to bend forward or lie flat. During a bad episode lasting two to three weeks, I need prescription antibiotics and sometimes miss an entire week of work.
Examiner listens for: The examiner is specifically listening for the number of antibiotic-requiring episodes per year (the key threshold for 10%, 20%, and 30% ratings), whether symptoms are near-constant versus episodic, any surgical history, and documentation of functional impairment.
Avoid: Saying 'I get sinus infections sometimes' without quantifying frequency. Avoid describing only your current (potentially better) day rather than your typical or worst symptom pattern.
Facial Pain, Pressure, and Headaches
How to describe it: Identify which sinuses are most affected and describe the pain precisely: location (cheeks, forehead, bridge of nose, top of head, behind eyes), character (dull ache, sharp pressure, throbbing), intensity (0-10 scale), frequency (daily, episodic), duration (hours, days), and what makes it worse (bending forward, weather changes, allergens, dry air, smoke).
Example: My worst headaches from my sinuses feel like a vice squeezing both sides of my face and above my eyes simultaneously. They are a 9/10 in severity and last all day. I cannot drive, read, or look at a computer screen. I need both over-the-counter and prescription pain relievers, and I often have to lie down in a dark room for hours. This happens multiple times per month.
Examiner listens for: The examiner needs to know whether headaches are attributable to sinusitis versus other causes, how disabling they are, and how frequently they occur. This directly supports higher rating tiers.
Avoid: Saying 'I get headaches' without clearly attributing them to your sinusitis or describing their disabling nature. Do not minimize headache frequency because you are managing them with medication - report the underlying symptom burden, not just whether you are currently comfortable.
Nasal Obstruction and Discharge
How to describe it: Describe whether obstruction is unilateral or bilateral, constant or intermittent, and its percentage of blockage if known. Note the character of discharge: color (clear, yellow, green, bloody), consistency (thin, thick, mucoid, purulent), volume, and whether it causes post-nasal drip, chronic cough, throat irritation, or disturbed sleep.
Example: During a flare-up, I cannot breathe through my nose at all on either side. I breathe exclusively through my mouth, which dries out my throat and causes me to wake up multiple times per night. The discharge is thick and green, and I constantly feel like I am drowning in mucus running down the back of my throat. This triggers coughing fits that have caused me to vomit.
Examiner listens for: Purulent (colored, infected) discharge is a key DBQ field and supports active sinusitis findings. Persistent obstruction supports rhinitis severity ratings and may support a secondary sleep disturbance claim.
Avoid: Describing discharge as 'just a runny nose' when it is actually purulent, thick, or constant. The character of discharge is clinically meaningful - use accurate descriptors.
Functional Impact on Daily Life and Work
How to describe it: Be specific about how sinusitis affects your ability to work, concentrate, sleep, exercise, and socialize. Quantify missed work days, reduced productivity, activity restrictions, and any accommodations you have needed. Include how medications affect you (drowsiness from antihistamines, upset stomach from antibiotics).
Example: During a bad sinusitis episode, I miss 3-5 days of work at a time because the pain and pressure prevent me from concentrating on anything. Even on days I force myself to work, I am only functioning at about 50% capacity. I cannot exercise because exertion worsens the sinus pressure. I have missed family events, social commitments, and have had to turn down work responsibilities during flare-ups. Over the past year, I have missed approximately 20 work days due to sinusitis alone.
Examiner listens for: Functional impact is directly relevant to the DBQ field asking the examiner to describe the functional impact of each condition. It also supports any claims for unemployability.
Avoid: Focusing only on physical symptoms while not describing how they prevent or limit your daily activities. The functional impact section of the DBQ is critical and often underdocumented.
Treatment History and Surgical Interventions
How to describe it: List all treatments chronologically: nasal steroid sprays, antihistamines, decongestants, saline rinses, oral steroids, antibiotics (how many courses per year), biologics, allergy shots, and any surgical procedures. For surgery, name the procedure (e.g., functional endoscopic sinus surgery, septoplasty, turbinate reduction), which sinuses were operated on, the date(s), and whether it provided relief.
Example: I have had two functional endoscopic sinus surgeries - one in [year] on my maxillary and ethmoid sinuses, and a revision in [year] on the same sinuses because the first surgery failed to resolve my chronic infections. Despite two surgeries and daily nasal steroid spray, I still require antibiotics 5-6 times per year and my symptoms have never fully resolved.
Examiner listens for: Surgical history is explicitly captured in the DBQ and directly affects the rating tier. Three or more surgical procedures support the 30% rating level. The examiner also needs to know whether surgery improved or worsened the condition.
Avoid: Forgetting to mention all surgical procedures, including minor ones like turbinate reduction or polyp removal. Each procedure counts and must be documented.
Associated Rhinitis Symptoms
How to describe it: If you have allergic or non-allergic rhinitis alongside sinusitis, describe sneezing frequency, watery eyes, itching, post-nasal drip, seasonal versus perennial patterns, known triggers (dust, pollen, mold, chemical irritants, smoke), and how rhinitis relates to your sinusitis exacerbations.
Example: During high pollen season, my allergic rhinitis triggers daily sneezing attacks of 15-20 sneezes in a row, continuous watery discharge, and eye swelling. Within 24-48 hours of heavy allergen exposure, I predictably develop a secondary bacterial sinusitis infection requiring antibiotics. My rhinitis is not seasonal only - I also react to dust mites and mold year-round.
Examiner listens for: The relationship between rhinitis and sinusitis is clinically important. The examiner may rate both conditions separately or consider them together. Clearly establishing that rhinitis precipitates sinusitis infections can support a higher frequency count.
Avoid: Treating rhinitis and sinusitis as completely separate when they are directly linked. If your rhinitis consistently causes sinusitis flares, say so explicitly.
Common mistakes to avoid
Describing only how you feel on the day of the exam rather than your typical or worst symptoms
Why: C&P exams often occur on days when veterans are not in active flare-ups. The examiner may only document what they observe that day, resulting in an underrating.
Do this instead: Explicitly tell the examiner: 'Today is a relatively good day for me. My typical experience is [describe worst/average symptoms]. Let me tell you what my worst days look like.' Per M21-1 guidance, veterans should report their worst-day symptom profile to ensure accurate documentation.
Impact: Can mean the difference between 10% and 30%
Failing to count and document exact episode frequency before the exam
Why: The rating criteria for sinusitis are directly tied to episode count (1-2 per year = 10%, 6+ per year = 20%, near-constant = 30%). Vague answers like 'I get it pretty often' cannot support a specific rating tier.
Do this instead: Review your medical records and personal calendar before the exam. Count every episode where you took antibiotics, saw a doctor, or experienced significant symptoms over the past 12-24 months. Write it down and bring the list.
Impact: Determines whether you receive 10%, 20%, or 30%
Not mentioning all sinus surgeries or procedures
Why: Three or more surgical procedures is a specific threshold for the 30% rating tier. Veterans sometimes forget minor procedures like turbinate reduction, polyp removal, or septoplasty because they seem less significant than formal sinus surgery.
Do this instead: List every ENT procedure you have had, including the date, the facility, the specific procedure name, and which sinuses were involved. Bring operative reports if possible.
Impact: Can mean the difference between 20% and 30%
Failing to describe the functional and occupational impact of sinusitis
Why: The DBQ has a specific field for functional impact. Without this information, the examiner may document only physical findings and miss the full disability picture needed for a fair rating or unemployability consideration.
Do this instead: Prepare specific examples: 'I missed X days of work in the past year,' 'I cannot concentrate when in a flare-up,' 'I have had to turn down overtime,' 'My supervisor has documented my absences.' Connect symptoms to real-world limitations.
Impact: Relevant at all rating levels; critical for TDIU consideration
Confusing 'episodes' with 'symptoms' - veterans may say they have no episodes if they are managing with daily medication
Why: If you are taking daily nasal steroids, antihistamines, or other preventive medications, you may feel you have fewer episodes - but this means your condition requires ongoing daily treatment, which itself is evidence of severity.
Do this instead: Report all antibiotic courses taken, all significant flare-ups regardless of treatment, and explicitly state: 'Even with daily medication, I still experience X episodes per year. Without medication, my symptoms would be significantly worse.'
Impact: Can suppress rating from 20% down to 10%
Not bringing imaging reports to the exam
Why: Sinus CT scans, MRIs, or X-rays are the most objective evidence of chronic sinusitis. Without them, the examiner relies solely on history and physical exam findings, which may not fully capture disease burden.
Do this instead: Bring printed copies of all sinus imaging reports (CT, MRI, X-ray) and, if possible, the imaging CDs themselves. CT sinuses is the gold standard and findings such as mucosal thickening, air-fluid levels, or complete opacification are highly relevant.
Impact: Can prevent a 0% 'imaging only' finding from being upgraded
Not connecting rhinitis to sinusitis exacerbations when they are linked
Why: If allergic rhinitis consistently triggers bacterial sinusitis infections, this establishes a pattern that supports higher episode frequency and potentially a secondary condition claim. Veterans often describe these as separate issues.
Do this instead: Explicitly state the relationship: 'Every time my allergic rhinitis flares due to pollen exposure, I develop a bacterial sinus infection within days that requires antibiotics.' This pattern should be documented in the medical record.
Impact: Supports higher frequency count (20% vs. 10%)
Prep checklist
- critical
Count and document all sinusitis episodes over the past 24 months
Go through your medical records, pharmacy records (antibiotic prescriptions), and personal calendar. Record the approximate start date, duration, symptoms, and treatment (especially antibiotic courses) for each episode. Write this down to bring to the exam. This single step is the most important preparation you can do.
before exam
- critical
Gather all sinus imaging reports and CDs
Collect CT sinus scans, MRIs, and plain X-rays from all treating facilities. Bring printed radiology reports AND imaging CDs if available. CT of the sinuses is the most important - findings of mucosal thickening, air-fluid levels, or opacification are objective evidence of chronic disease.
before exam
- critical
Create a complete surgical history list
List every ENT procedure: date, facility, surgeon name, specific procedure (e.g., functional endoscopic sinus surgery - FESS, turbinate reduction, septoplasty, adenoidectomy), and which sinuses were operated on. Note whether each procedure provided improvement and for how long. Three or more procedures support the 30% rating tier.
before exam
- critical
Write a 'worst day' symptom narrative
Prepare a one-page written description of your worst sinusitis day that covers: sinus locations affected, pain/pressure intensity (0-10), headache characteristics, discharge character and volume, nasal obstruction degree, associated symptoms (fever, fatigue, sleep disruption), and functional limitations (work missed, activities prevented). Bring this to the exam and ask the examiner to include it in the record.
before exam
- critical
Compile complete medication list
List all current and past medications for sinusitis/rhinitis: nasal steroid sprays (e.g., fluticasone, mometasone), antihistamines, decongestants, saline rinses, oral steroids, antibiotics (name, frequency per year), biologics (e.g., dupilumab for nasal polyps), and any immunotherapy/allergy shots. Include how long you have been on each medication and whether it controls your symptoms adequately.
before exam
- recommended
Request and review your VA claims file (C-file)
If time permits before your exam, request your C-file to review what evidence the examiner will have access to. Ensure key records are in the file: service treatment records documenting sinus issues, post-service treatment records, and any prior C&P exam reports. If important records are missing, submit them to the VA before or at the exam.
before exam
- recommended
Write a personal statement (buddy statement) or lay statement
Prepare a written lay statement (VA Form 21-4138) describing the in-service onset and continuity of your sinusitis. Include: when symptoms first started, any in-service medical treatment, how symptoms have progressed since service, and the current daily impact. A personal statement is valuable evidence the examiner can reference.
before exam
- recommended
Check your state's laws on recording C&P exams
Most states allow veterans to record their C&P examinations with proper notice. Research your state's one-party or two-party consent laws before your exam. If recording is permitted, bring a recording device or use your smartphone. Inform the examiner at the start that you will be recording the exam.
before exam
- recommended
Document work and daily activity impact
Collect documentation of sinusitis-related missed work (employer attendance records, leave records, supervisor statements). Note any workplace accommodations, job duties you cannot perform during flare-ups, or positions you have been unable to take due to sinusitis. This supports functional impairment documentation on the DBQ.
before exam
- recommended
Identify and note any associated or secondary conditions
Consider whether you have related conditions that may be secondary to your sinusitis or rhinitis: sleep apnea (from nasal obstruction), asthma (often comorbid with rhinitis), deviated septum (traumatic or worsened by service), chronic laryngitis, or depression/anxiety from chronic pain. These may warrant separate claims.
before exam
- recommended
Do NOT use nasal decongestants or antihistamines that morning unless medically necessary
Avoid medications that could temporarily improve your nasal symptoms before the exam (e.g., oral decongestants, sedating antihistamines). Your nasal passages should reflect their typical condition. Nasal steroid sprays used daily for maintenance are fine to continue - stopping them could cause a rebound. Consult your doctor if unsure.
day of
- critical
Bring all documentation in an organized folder
Organize materials in sections: (1) episode frequency log, (2) imaging reports, (3) surgical history, (4) medication list, (5) worst-day narrative, (6) work impact documentation, (7) personal statement, (8) any independent medical opinions. Give copies to the examiner and keep originals.
day of
- recommended
Arrive 15-20 minutes early and note the examiner's name and credentials
Confirm the examiner's name, title (MD, DO, PA, NP), and specialty. Write this down. If the examiner is not a physician as expected, you have the right to note this for your records. A specialist in ENT or internal medicine is ideal for this type of exam.
day of
- critical
Describe your typical and worst symptoms - not just today's symptoms
If you are having a better day, explicitly say: 'Today is not representative of my typical condition. On a typical day, my symptoms are [describe]. On my worst days, [describe].' The examiner must document what you report, not just what they observe. Per M21-1 guidance, worst-day reporting is appropriate.
during exam
- critical
State specific episode frequency numbers clearly
Say: 'I have had [X] sinusitis episodes in the past 12 months that required antibiotics, lasting approximately [X] days each.' If episodes are near-constant (symptoms present most days), use that exact language: 'My sinusitis is near-constant - I have symptoms on most days of the month.'
during exam
- recommended
Confirm the examiner is documenting all sinuses affected
The DBQ has separate checkboxes for maxillary, frontal, ethmoid, sphenoid, and pansinusitis. Confirm that all affected sinuses are being documented. If you have pansinusitis (all sinuses involved), say so explicitly.
during exam
- recommended
Ask the examiner to document functional impact in the remarks section
The DBQ has a functional impact field. Ask: 'Will you be documenting how my sinusitis affects my ability to work and perform daily activities?' If not already discussed, provide specific examples of functional limitations.
during exam
- critical
Ensure surgical history is completely documented
Confirm with the examiner that all your ENT surgical procedures are being recorded, including dates and which sinuses were operated on. If you have had three or more procedures, ensure all are captured - this is a specific rating threshold.
during exam
- critical
Write down your recollections of the exam immediately afterward
As soon as you leave, write down what was asked, what you answered, what the examiner examined, what was not discussed, and any concerns about the exam's thoroughness. Note the examiner's name, credentials, and approximate exam duration. This documentation is critical if you need to challenge an inadequate exam.
after exam
- critical
Request a copy of the completed DBQ
You are entitled to a copy of your C&P examination report. Request it through your VA ebenefits account, VA.gov, or by submitting a FOIA request. Review it carefully for accuracy, completeness, and any errors or omissions. A missing or inaccurate exam report can be the basis for a supplemental claim or Board appeal.
after exam
- recommended
File a complaint if the exam was inadequate
If the examiner spent fewer than 10-15 minutes, did not perform a physical examination, failed to review your records, dismissed your reported symptoms, or did not address the required DBQ fields, document this and consider: (1) submitting a complaint to the contractor (QTC, LHI, VES), (2) requesting a new exam, (3) obtaining an independent medical examination (IME), or (4) submitting a nexus letter from your treating physician.
after exam
Your rights during a C&P exam
- You have the right to an examination that is adequate for rating purposes - the examiner must address all relevant DBQ fields and must not dismiss your reported symptoms without clinical justification.
- You have the right to submit a personal statement (VA Form 21-4138) describing your symptoms, their history, and their impact, which must be considered as evidence.
- You have the right to request a copy of your completed C&P examination report after the exam via VA.gov, eBenefits, or a FOIA request.
- In most states, you have the right to record your C&P examination. Research your state's consent laws (one-party vs. two-party consent) before the exam and notify the examiner at the start.
- You have the right to challenge an inadequate, insufficient, or inaccurate C&P examination by requesting a new exam, submitting a supplemental claim with additional evidence, or appealing to the Board of Veterans' Appeals.
- You have the right to obtain an Independent Medical Examination (IME) or a nexus letter from a private physician at your own expense, which VA must weigh against any unfavorable C&P opinion.
- Per the benefit of the doubt standard (38 CFR - 3.102), when there is an approximate balance of positive and negative evidence, the benefit of the doubt must be given to the veteran.
- You have the right to have a Veterans Service Organization (VSO) representative accompany you to the exam as a witness and advocate.
- You have the right to request a higher-level review or supplemental claim if you receive a rating decision you believe does not accurately reflect the severity of your condition.
- Under 38 CFR - 4.96, certain coexisting respiratory conditions cannot be separately evaluated - you have the right to understand how your conditions are being rated together and to challenge a combined rating that reduces your overall compensation.
- You are entitled to have the VA consider your worst-day symptom profile, not just how you present at the moment of examination - the VA rating schedule is intended to capture the full range of your disability.
Related conditions
- Allergic Rhinitis Allergic rhinitis (DC 6522) frequently coexists with and precipitates bacterial sinusitis. If your rhinitis consistently triggers sinusitis episodes, these may be rated separately or together. Establishing this relationship can support higher episode frequency counts.
- Sleep Apnea Chronic nasal obstruction from sinusitis or rhinitis can cause or aggravate obstructive sleep apnea (DC 6847, rated at 0%, 30%, 50%, or 100%). If you have been diagnosed with sleep apnea and have chronic sinusitis, consider a secondary service connection claim.
- Asthma Rhinitis and sinusitis are strongly associated with asthma (the 'unified airway' concept). Uncontrolled rhinosinusitis often worsens asthma control. Under 38 CFR - 4.96, certain coexisting respiratory conditions have combined rating restrictions - understand how your conditions interact before filing.
- Deviated Nasal Septum (Traumatic) A traumatic deviated nasal septum (DC 6502) can worsen sinusitis and rhinitis by obstructing drainage pathways. If your septum deviated due to a service-connected injury or trauma, this may be independently ratable and may support the overall severity of your sinus disease.
- Chronic Laryngitis Post-nasal drip from chronic sinusitis and rhinitis commonly causes chronic laryngitis (DC 6516) with hoarseness. The same ENT DBQ covers laryngeal conditions - if you have hoarseness or voice changes attributable to post-nasal drip, ensure this is documented in the exam.
- Nasal Polyps Nasal polyps are a common complication of chronic sinusitis and allergic rhinitis. They cause significant obstruction and may require repeated surgical removal. If you have polyps, ensure they are documented on the DBQ and consider whether they warrant separate documentation.
- Migraines / Headaches Severe headaches caused by sinus disease are captured within the sinusitis rating criteria. However, if you have separately diagnosed migraines that are aggravated by or secondary to your sinusitis, this may be a separate ratable condition under DC 8100. Ensure the etiology of your headaches is clearly documented.
Get a personalized prep packet
This guide covers what to expect for any veteran with this condition. If you have already uploaded your medical records, sign in to generate a packet that maps your specific symptoms to the DBQ fields your examiner will fill out.
This C&P exam preparation guide is for educational purposes only and does not constitute legal, medical, or claims advice. Always consult with a qualified Veterans Service Organization (VSO) representative or VA-accredited attorney for guidance specific to your claim. Never exaggerate, minimize, or fabricate symptoms during a C&P examination.