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VA Rating Assistant

DC 6522 · 38 CFR 4.97

Sinusitis / Rhinitis C&P Exam Prep

To document the current severity of your sinusitis or rhinitis condition, establish the specific diagnosis, determine the degree of nasal obstruction, identify the presence of polyps, and evaluate how the condition affects your daily life and functioning.

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

  • Specific diagnosis type: allergic rhinitis, vasomotor rhinitis, bacterial rhinitis, chronic sinusitis, or other ENT condition
  • Presence or absence of nasal polyps (critical for 30% vs 10% rating under DC 6522)
  • Degree of nasal passage obstruction (greater than 50% bilateral or complete unilateral obstruction for a 10% rating)
  • Which sinuses are affected: maxillary, frontal, ethmoid, sphenoid, or pansinusitis
  • Frequency and pattern of sinusitis episodes: near-constant vs. episodic
  • Physical findings: sinus tenderness, purulent discharge, crusting, headaches
  • Surgical history: type of sinus surgery, dates, whether radical open or endoscopic
  • Current treatments: medications, antibiotics, nasal sprays, allergy shots, surgery
  • Functional impact on daily activities, work, and quality of life
  • Related ENT findings: laryngeal involvement, vocal cord changes, pharyngeal conditions

The exam will include a physical examination of your nasal passages, sinuses, and potentially your throat. Bring all relevant medications (nasal sprays, antihistamines, decongestants, prescribed antibiotics). If imaging studies such as CT scans or X-rays have been performed, bring copies or ensure the examiner has access. You have the right to request that the exam be recorded in most states.

Measurements and tests

Nasal Passage Obstruction Assessment

What it measures: The degree of blockage in the nasal passages on each side, expressed as a percentage of obstruction. This directly determines your rating level under DC 6522.

What to expect: The examiner will visually inspect your nasal passages, possibly using a nasal speculum or endoscope. They will assess airflow and structural narrowing on both the left and right sides. You may be asked to breathe through each nostril separately.

Critical thresholds

  • Greater than 50% obstruction on BOTH sides bilaterally 10% rating under DC 6522 (without polyps)
  • Complete obstruction on ONE side (unilateral) 10% rating under DC 6522 (without polyps)
  • Nasal polyps present (regardless of obstruction degree) 30% rating under DC 6522

Tips

  • Do not take decongestants the morning of your exam, as they may temporarily reduce observable swelling and underrepresent your true baseline obstruction.
  • Tell the examiner which nostril is more blocked and whether both sides are affected on your worst days.
  • Describe any history of nasal polyps documented in your medical records even if polyps are not visible at the time of exam.
  • If you have allergies that worsen your obstruction seasonally, describe that variability and explain that today may not reflect your worst presentation.

Pain considerations: Describe any facial pain or pressure associated with nasal obstruction, particularly over the sinus areas. Note whether bending forward, changes in weather, or barometric pressure changes worsen your sinus pain and pressure.

Nasal Endoscopy (if performed)

What it measures: Direct visualization of the nasal passages, turbinates, sinus openings, and presence of polyps, discharge, or mucosal thickening.

What to expect: A thin flexible or rigid scope may be inserted into your nostril. The procedure is brief but may cause mild discomfort. It is the most accurate way to document polyps and degree of obstruction.

Critical thresholds

  • Polyps identified on endoscopy Supports 30% rating under DC 6522
  • Hypertrophied turbinates with significant mucosal edema Supports obstruction finding for 10% rating

Tips

  • Mention if prior endoscopy or CT scans have shown polyps even if they are not visible today due to current treatment.
  • Ask the examiner to document any mucosal thickening, turbinate hypertrophy, or discharge findings in the report.

Pain considerations: If the procedure causes significant discomfort, this itself is informative. Note aloud if you experience pain during the exam.

CT Scan / Imaging Review

What it measures: Radiographic evidence of sinus disease, mucosal thickening, opacification of sinuses, bony changes, and extent of disease affecting one or more sinus cavities.

What to expect: The examiner may review existing CT scans, X-rays, or MRI images. If imaging has been done previously, ensure results are in your claims file. New imaging is typically not ordered during the C&P exam itself.

Critical thresholds

  • Mucosal thickening or opacification on CT Supports diagnosis of chronic sinusitis; relevant to DC 6512 and related codes
  • Evidence of chronic sinusitis detected only by imaging studies May support chronic sinusitis diagnosis even without acute symptoms on exam day

Tips

  • Bring printed copies of any radiology reports showing sinus disease.
  • Point out imaging dates to show chronicity and duration of your condition.
  • If imaging shows involvement of multiple sinus cavities, mention pansinusitis findings.

Pain considerations: Correlate imaging findings with your reported symptoms of sinus pain, pressure, and headaches.

Sinus Tenderness Palpation

What it measures: Physical tenderness over the maxillary, frontal, and ethmoid sinus areas upon palpation or percussion.

What to expect: The examiner will press or tap over your sinus areas on your face and forehead. This is a quick physical exam step.

Critical thresholds

  • Tenderness present on affected sinus palpation Supports active sinusitis finding; documented under DBQ field for tenderness of affected sinus

Tips

  • Tell the examiner truthfully if you experience pain when the sinus areas are pressed.
  • Mention whether the tenderness is constant or only during flare-ups.
  • Note if you have had tenderness in these areas repeatedly over the years.

Pain considerations: Describe the quality of sinus pain: pressure, aching, stabbing. Note radiation to teeth, eyes, or forehead.

Rating criteria by percentage

30%

Allergic or vasomotor rhinitis WITH polyps. This is the highest rating available under DC 6522. Nasal polyps must be documented by physical examination, endoscopy, imaging, or prior surgical history.

Key symptoms

  • Confirmed presence of nasal polyps (bilateral or unilateral)
  • Chronic nasal obstruction due to polypoid tissue
  • Recurrent or persistent nasal congestion unresponsive to routine treatment
  • Possible post-nasal drip, decreased sense of smell, facial pressure
  • History of polypectomy or endoscopic sinus surgery for polyps
  • Frequent sinusitis episodes secondary to polyp-related obstruction

From 38 CFR: 38 CFR 4.97, DC 6522: 'Allergic or vasomotor rhinitis: With polyps - 30%'

10%

Allergic or vasomotor rhinitis WITHOUT polyps, but with greater than 50-percent obstruction of nasal passage on both sides OR complete obstruction on one side. Obstruction must be documented on physical examination or imaging.

Key symptoms

  • Significant bilateral nasal obstruction (greater than 50% each side)
  • Complete blockage of one nasal passage
  • Chronic nasal congestion and stuffiness
  • Difficulty breathing through the nose at rest or with exertion
  • Mouth breathing due to nasal obstruction
  • Turbinate hypertrophy contributing to obstruction
  • Deviated nasal septum contributing to unilateral complete obstruction
  • Recurrent sinus infections related to poor drainage

From 38 CFR: 38 CFR 4.97, DC 6522: 'Without polyps, but with greater than 50-percent obstruction of nasal passage on both sides or complete obstruction on one side - 10%'

0%

Rhinitis or sinusitis that does not meet the threshold for 10% (no polyps AND obstruction does not meet the bilateral greater than 50% or complete unilateral standard). A 0% rating may still establish service connection for future increases.

Key symptoms

  • Mild intermittent nasal congestion
  • Seasonal allergic symptoms controlled with over-the-counter medication
  • Rhinitis with less than 50% bilateral obstruction
  • Diagnosed condition that is currently in remission or well-controlled
  • Documented condition without current significant obstruction

From 38 CFR: Below threshold for 10% under DC 6522 - condition exists but does not meet obstruction or polyp criteria.

Describing your symptoms accurately

Nasal Obstruction and Congestion

How to describe it: Describe which side or both sides are blocked, how often the obstruction occurs, whether it is constant or intermittent, and what percentage of your nasal airway feels blocked on a typical worst day. Use concrete comparisons: 'I can barely breathe through my left nostril at all' or 'Both sides feel 75% blocked every morning when I wake up.'

Example: On my worst days, both nasal passages feel almost completely blocked. I cannot breathe through my nose at all and have to breathe entirely through my mouth. This happens at least 3 to 4 days per week and lasts all day. It is worse in cold weather, with dust or pollen exposure, and when I am under stress.

Examiner listens for: Specific laterality (left, right, or bilateral), degree of obstruction as described by the veteran, frequency and duration of obstruction, and any factors that worsen or relieve it.

Avoid: Do not say 'my nose gets a little stuffy sometimes.' Instead, describe the true frequency and severity. Avoid minimizing by saying it is 'manageable' without explaining the effort required to manage it.

Nasal Polyps

How to describe it: If you have been told you have polyps by any provider, state this clearly. Mention any history of polypectomy surgery. Describe symptoms consistent with polyps: loss of smell, persistent congestion unresponsive to sprays, nasal fullness, voice changes.

Example: I was told I had nasal polyps in [year] and had them removed in [year]. They have regrown. I have completely lost my sense of smell. My nose feels permanently full and blocked regardless of what medications I use. My voice sounds nasal and muffled all the time.

Examiner listens for: Prior documentation of polyps, surgical history for polypectomy, loss of smell (anosmia), and treatment-resistant obstruction that suggests polypoid tissue.

Avoid: Do not fail to mention polyps if they have ever been diagnosed or surgically treated, even if you are unsure whether they are currently present. The examiner needs this history to accurately document the DBQ.

Sinus Pain, Pressure, and Headaches

How to describe it: Describe the location of pain (forehead, cheeks, behind the eyes, upper teeth), its intensity on a 0-10 scale, how often it occurs, and whether it interferes with your ability to work, concentrate, or sleep. Note if the pain worsens when bending forward or with changes in barometric pressure.

Example: On bad days, I have a constant 7 out of 10 pressure headache across my forehead and both cheekbones. Bending over to tie my shoes makes it feel like my head is going to explode. I cannot concentrate at work and have called in sick multiple times because of sinus headaches. This happens at least 2 to 3 times per week.

Examiner listens for: Frequency of sinus headaches, interference with occupational and daily activities, tenderness on palpation, and correlation between sinus congestion episodes and headache occurrence.

Avoid: Do not describe your headaches as mild if they cause you to miss work or limit activities. Do not say the pain goes away with over-the-counter medication without noting how frequently you take it and whether it actually resolves the pain fully.

Purulent Discharge and Infections

How to describe it: Describe the color, consistency, and frequency of nasal or post-nasal discharge. Note how many times per year you experience acute sinus infections requiring antibiotics. Describe the duration of each episode. Indicate whether infections result in missed work days, ER visits, or hospitalization.

Example: I get thick green discharge and face pain about 6 to 8 times a year. Each infection lasts 2 to 3 weeks. I have required antibiotics for almost every episode. Last year I missed 12 days of work because of sinus infections. The infections have become more frequent and harder to clear over the past 3 years.

Examiner listens for: Frequency of acute sinusitis episodes per year, antibiotic use, duration of episodes, and functional impact including work absenteeism.

Avoid: Do not round down the number of infections per year. Think back carefully over the past 12 months and count each episode where you had significant symptoms even if you did not always seek treatment.

Functional Impact and Daily Life Limitations

How to describe it: Describe specific activities you cannot do or do with difficulty because of your sinusitis or rhinitis. Include impacts on sleep, exercise, concentration, social activities, occupational performance, and use of medications.

Example: I sleep with my mouth open and wake up multiple times a night because I cannot breathe through my nose. I am exhausted every day because of poor sleep quality. I cannot exercise because physical exertion worsens my sinus congestion. I avoid social situations because I am constantly blowing my nose or my voice sounds congested. I take antihistamines and nasal sprays every single day and they only partially help.

Examiner listens for: Sleep disruption, occupational limitations, social impact, medication burden, and whether the condition is near-constant or episodic.

Avoid: Do not say the condition 'does not really affect' your life if you take daily medication for it, lose sleep, or modify activities to accommodate your symptoms. Daily medication use is itself evidence of functional impact.

Treatment History and Medication Use

How to describe it: List all current and past treatments: prescription nasal corticosteroid sprays, antihistamines, decongestants, leukotriene modifiers, biologic injections, immunotherapy, antibiotics, and any surgical procedures. State how well treatments control your symptoms and what residual symptoms remain despite treatment.

Example: I use fluticasone nasal spray twice daily, take cetirizine every morning, and use saline rinses. Despite this regimen, I still have significant bilateral congestion, headaches, and post-nasal drip every day. I have had functional endoscopic sinus surgery twice and my symptoms returned within 2 years each time.

Examiner listens for: Ongoing treatment need, treatment resistance, surgical history, and symptom burden despite maximum medical therapy.

Avoid: Do not skip mentioning prior surgeries or their dates. Repeated sinus surgeries are significant evidence of severity and chronicity.

Common mistakes to avoid

Not taking medications as usual before the exam in hopes of appearing worse

Why: Deliberately altering your medical regimen before an exam is inadvisable and could be considered misrepresentation. Your goal is to accurately represent your condition, not to manipulate the exam.

Do this instead: Take your medications as prescribed. Instead, clearly communicate to the examiner that even with daily medication use, you still experience significant symptoms. The need for daily medication is itself important evidence of severity.

Impact: 10% and 30%

Not mentioning polyps because you think they are gone or no longer visible

Why: Prior documented polyps are critically important to the 30% rating under DC 6522. Even if polyps were surgically removed, their prior existence and tendency to recur is highly relevant to your rating.

Do this instead: Tell the examiner about every prior diagnosis of nasal polyps, every polypectomy or endoscopic sinus surgery performed for polyps, and any symptoms consistent with polyp recurrence such as lost sense of smell or treatment-resistant obstruction.

Impact: 30%

Describing obstruction in vague terms without specifying laterality or degree

Why: The VA rating criteria for DC 6522 requires greater than 50% bilateral obstruction or complete unilateral obstruction. If you only say 'my nose is stuffy,' the examiner cannot document the level of obstruction needed for the rating threshold.

Do this instead: Be specific: state which side is more blocked, estimate the percentage of blockage on each side on your worst days, and explain whether you experience complete blockage of one or both sides.

Impact: 10%

Only describing symptoms on the day of the exam rather than typical worst-day symptoms

Why: VA examiners are instructed to rate the average severity of the condition, including worst-day presentations. If your condition fluctuates and you happen to be having a relatively good day at the exam, the examiner may underestimate your impairment.

Do this instead: Explicitly state: 'Today is not my worst day. On my worst days...' and describe your most severe symptom presentation. M21-1 guidance supports reporting the full range of your symptoms including flare-up severity.

Impact: 10% and 30%

Failing to report the frequency and duration of acute sinusitis episodes

Why: The number of sinusitis episodes per year and their duration are key factors in distinguishing episodic from near-constant sinusitis. Near-constant sinusitis significantly impacts functional capacity and the examiner's overall severity assessment.

Do this instead: Before your exam, count and write down every sinusitis episode in the past 12 months, including those you treated at home. Bring this list to the exam and share it with the examiner.

Impact: 10% and 30%

Not mentioning secondary conditions caused by rhinitis or sinusitis

Why: Rhinitis and sinusitis can cause secondary conditions such as sleep apnea, asthma exacerbation, ear problems, and chronic fatigue. These may be separately ratable or may support a higher overall evaluation.

Do this instead: Tell the examiner about any conditions that have developed or worsened because of your rhinitis or sinusitis. Ask that these be documented in the remarks section of the DBQ.

Impact: All levels

Minimizing symptoms because the condition seems minor compared to other service-connected disabilities

Why: Every service-connected disability is rated on its own merits. Rhinitis rated at 10% or 30% contributes to your combined disability rating and may push you into a higher combined rating tier.

Do this instead: Describe your rhinitis and sinusitis symptoms fully and accurately regardless of your other disabilities. Each condition deserves complete and honest reporting.

Impact: All levels

Prep checklist

  • critical

    Compile a complete list of all ENT-related diagnoses and dates

    List every diagnosis related to your sinuses, nose, throat, and ears with approximate dates of first diagnosis. Include allergic rhinitis, sinusitis (specify maxillary, frontal, ethmoid, sphenoid, or pansinusitis), deviated septum, nasal polyps, and any related conditions.

    before exam

  • critical

    Document all prior sinus surgeries with dates and procedure types

    Write down every sinus or nasal surgery you have had, including functional endoscopic sinus surgery (FESS), radical open sinus surgery, polypectomy, septoplasty, or turbinate reduction. Include the dates, which sinuses were operated on, and which side (left, right, bilateral).

    before exam

  • critical

    Count sinusitis episodes in the past 12 months

    Review your medical records, pharmacy records, and memory to count how many acute sinusitis episodes you had in the past year. Note how long each lasted, whether you took antibiotics, and whether you missed work or sought medical care.

    before exam

  • critical

    Gather all imaging reports related to sinuses

    Collect reports from CT scans, X-rays, or MRI studies of your sinuses or nasal passages. These provide objective evidence of disease even if you appear well on exam day.

    before exam

  • critical

    Compile a current medication list for all ENT-related treatments

    List every nasal spray, antihistamine, decongestant, antibiotic, leukotriene inhibitor, biologic agent, or other medication you use for your sinusitis or rhinitis. Include dose, frequency, and how long you have been taking each.

    before exam

  • critical

    Write down your worst-day symptom description

    Before the exam, write a paragraph describing your worst sinusitis or rhinitis day: level of nasal obstruction, pain level, functional limitations, and how frequently worst days occur. Bring this written description to the exam and share it.

    before exam

  • recommended

    Review your service treatment records for ENT entries

    Check your military and VA treatment records for any documentation of sinus problems, upper respiratory infections, allergy treatment, or ENT referrals during service. Bring any relevant documentation to the exam.

    before exam

  • recommended

    Request a copy of the DBQ form to review the questions in advance

    The DBQ for ENT Sinusitis and Rhinitis is publicly available on the VA website. Reviewing it before your exam helps you understand what the examiner will be documenting and prepares you to provide thorough answers to each section.

    before exam

  • optional

    Check your state's laws regarding recording C&P exams

    Many states permit veterans to audio or video record their C&P examination. Research your state's law in advance and decide whether you want to record the exam. Bring appropriate recording equipment if you choose to do so.

    before exam

  • critical

    Take your regular ENT medications as prescribed

    Do not alter your medication regimen before the exam. Use your nasal sprays and antihistamines as you normally would. Your symptoms while on medication represent your true baseline condition and are what the examiner should evaluate.

    day of

  • critical

    Bring your written symptom summary and medication list

    Hand the examiner a one-page written summary of your worst-day symptoms, current medications, surgical history, and frequency of sinusitis episodes. This ensures important details are captured in the record even if the exam is brief.

    day of

  • recommended

    Arrive early and avoid decongestants if not part of your regular regimen

    If decongestants are not part of your regular daily regimen, avoid taking them on exam day as they may temporarily reduce observable swelling. Only take what you normally take.

    day of

  • recommended

    Note your symptom severity that morning before the exam

    Rate your nasal congestion, pain, and overall symptom burden on a 0-10 scale that morning. If today is better or worse than average, tell the examiner and provide context.

    day of

  • critical

    Explicitly state that today may not represent your worst-day presentation

    At the start of the exam, tell the examiner: 'I want to make sure you understand that today may not represent my worst symptoms. On my worst days...' and describe your peak severity. This is consistent with M21-1 worst-day reporting guidance.

    during exam

  • critical

    Confirm that the examiner documents the specific sinuses affected

    Make sure the examiner knows and records which sinuses are affected (maxillary, frontal, ethmoid, sphenoid, or pansinusitis). The affected sinus type influences which diagnostic code applies and the overall severity assessment.

    during exam

  • critical

    Describe functional impact on work and daily activities

    Tell the examiner specifically how your sinusitis or rhinitis affects your ability to work, sleep, exercise, and perform daily tasks. Provide concrete examples: missed work days, inability to exercise, disrupted sleep, constant need to blow your nose.

    during exam

  • critical

    Mention all prior polyp diagnoses and surgeries even if not currently visible

    Polyps are critical to the 30% rating. If you have ever been told you have polyps or have had polyp surgery, state this clearly even if the examiner does not ask directly.

    during exam

  • recommended

    Ask the examiner to document near-constant vs. episodic sinusitis pattern

    Clarify whether your sinusitis is near-constant (present most days) or episodic (distinct flare-ups with intervals of improvement). This is a specific DBQ field and affects the overall severity assessment.

    during exam

  • recommended

    Describe all symptoms: headaches, pain, discharge, crusting, smell loss

    Do not wait for the examiner to ask about each symptom individually. Proactively mention headaches, facial pain, purulent discharge, crusting, post-nasal drip, loss of smell, and voice changes as applicable.

    during exam

  • critical

    Request a copy of the completed DBQ as soon as it is available

    You are entitled to a copy of the DBQ completed by the examiner. Request it through your MyHealtheVet account, VBMS access via a VSO, or by submitting a records request. Review it carefully for accuracy.

    after exam

  • critical

    Review the DBQ for accuracy and completeness within 30 days

    Check that the examiner documented: correct diagnosis type, presence or absence of polyps, degree of obstruction, sinuses affected, surgical history, frequency of episodes, and functional impact. If important information is missing or inaccurate, notify your VSO or accredited claims agent promptly.

    after exam

  • recommended

    Document your recollection of the exam immediately after leaving

    As soon as the exam is over, write down everything that was discussed, what the examiner examined, and what you reported. Note whether the examiner seemed to fully consider your symptoms or appeared to rush through the evaluation.

    after exam

  • recommended

    Consult your VSO if the DBQ is incomplete or inaccurate

    If the DBQ does not accurately reflect your condition, work with your VSO, claims agent, or attorney to submit a written statement correcting the record, request a supplemental claim, or request a new examination if the DBQ is inadequate.

    after exam

Your rights during a C&P exam

  • You have the right to be examined in person by a qualified healthcare provider. If your exam is conducted via telehealth or records review only, this should be documented and you may request an in-person exam if clinically appropriate.
  • You have the right to audio or video record your C&P examination in most states. Check your state's recording consent laws in advance and bring recording equipment if you choose to exercise this right.
  • You have the right to review all evidence in your claims file, including the completed DBQ. You may request a copy through your MyHealtheVet account, your VSO, or via a records request.
  • You have the right to submit a written statement correcting any factual errors in the DBQ before a rating decision is issued.
  • You have the right to request a new examination if the existing DBQ is inadequate, incomplete, or based on an inaccurate history. An inadequate examination is one that does not consider all relevant symptoms or does not apply the correct rating criteria.
  • You have the right to submit a buddy statement or lay statement describing how your sinusitis and rhinitis affect your daily life. These statements are considered evidence and can supplement the DBQ findings.
  • You have the right to representation by a Veterans Service Organization (VSO), accredited claims agent, or VA-accredited attorney at no cost to you during the claims process.
  • You have the right to request that the VA obtain all relevant treatment records before your exam. If your treating ENT physician has documented polyps, surgical history, or imaging findings, this evidence should be in your claims file before the examiner reviews it.
  • You have the right to disagree with a rating decision and file a supplemental claim, request a higher-level review, or appeal to the Board of Veterans Appeals if you believe the rating does not accurately reflect your condition.
  • You have the right to a fully favorable rating based on the total evidence of record. The VA must apply the benefit of the doubt in your favor when evidence is in approximate balance.

Related conditions

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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.

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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.