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C&P Exam Prep: Sinusitis / Rhinitis
DBQ Overview
Interview + Physical- Form Name
- Sinusitis_Rhinitis_and_Other_Conditions_of_the_Nose_Throat_Larynx_and_Pharynx
- Form Code
- Sinusitis_Rhinitis_and_Other_Conditions_of_the_Nose_Throat_Larynx_and_Pharynx
- Page Count
- 9
- Examiner Type
- Physician
- Estimated Duration
- 30 minutes
- Exam Format
- Interview + Physical
What to Expect During Your Exam
Exam Overview
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.
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.
Typical duration: 30 minutes
Nasal Passage Obstruction Assessment
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.
Key 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)
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.
Key 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
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.
Key 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
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.
Key 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 Breakdown
| Rating % | Criteria | Key Symptoms |
|---|---|---|
| 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. |
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. |
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. |
CFR: Below threshold for 10% under DC 6522 - condition exists but does not meet obstruction or polyp criteria. |
30% Allergic or vasomotor rhinitis WITH polyps. This is the high ...
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
CFR: 38 CFR 4.97, DC 6522: 'Allergic or vasomotor rhinitis: With polyps - 30%'
10% Allergic or vasomotor rhinitis WITHOUT polyps, but with grea ...
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
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 1 ...
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
CFR: Below threshold for 10% under DC 6522 - condition exists but does not meet obstruction or polyp criteria.
How to Describe Your Symptoms
Nasal Obstruction and Congestion
How to describe:
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.'
Worst-day 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.”
What the 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.
Understatements to 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:
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.
Worst-day 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.”
What the examiner listens for:
Prior documentation of polyps, surgical history for polypectomy, loss of smell (anosmia), and treatment-resistant obstruction that suggests polypoid tissue.
Understatements to 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:
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.
Worst-day 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.”
What the 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.
Understatements to 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:
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.
Worst-day 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.”
What the examiner listens for:
Frequency of acute sinusitis episodes per year, antibiotic use, duration of episodes, and functional impact including work absenteeism.
Understatements to 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:
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.
Worst-day 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.”
What the examiner listens for:
Sleep disruption, occupational limitations, social impact, medication burden, and whether the condition is near-constant or episodic.
Understatements to 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:
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.
Worst-day 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.”
What the examiner listens for:
Ongoing treatment need, treatment resistance, surgical history, and symptom burden despite maximum medical therapy.
Understatements to 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
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.
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
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.
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
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.
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
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.
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
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.
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
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.
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
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.
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
Before Your Exam
Day Of
During the Exam
After the 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
- Chronic Sinusitis (Frontal) DC 6512 covers frontal sinusitis specifically. If your sinusitis primarily affects the frontal sinus, the examiner may rate under DC 6512 rather than DC 6522. Both fall under 38 CFR 4.97. Veterans may have both rhinitis and sinusitis rated separately if they are distinct conditions.
- Deviated Nasal Septum (Traumatic) A traumatic deviated nasal septum (DC 6502) can contribute to or worsen nasal obstruction. If caused by military service, it may be separately ratable or may serve as secondary evidence supporting the degree of nasal obstruction documented under DC 6522.
- Obstructive Sleep Apnea Chronic nasal obstruction from rhinitis or sinusitis can cause or worsen obstructive sleep apnea. If your sinusitis related nasal obstruction has been linked to sleep apnea, secondary service connection for sleep apnea may be available. Document any sleep studies and physician opinions connecting the two conditions.
- Asthma Allergic rhinitis and asthma frequently co occur (the unified airway model). If you have both conditions, they may each be separately ratable under 38 CFR 4.97. Note that 38 CFR 4.96 prohibits certain combined evaluations for coexisting respiratory conditions, so ensure each condition is independently documented.
- Chronic Laryngitis Post nasal drip from chronic rhinitis or sinusitis can cause or worsen chronic laryngitis (DC 6516). If you have hoarseness, voice changes, or throat symptoms secondary to your rhinitis, mention these at the exam. The ENT DBQ includes fields for laryngeal and vocal cord findings.
- Bacterial Rhinitis DC 6523 covers bacterial rhinitis including rhinoscleroma. If your rhinitis has been confirmed as bacterial in origin rather than allergic or vasomotor, the applicable diagnostic code and rating criteria differ from DC 6522. Ensure the correct diagnosis type is documented by the examiner.
- Pansinusitis Pansinusitis refers to inflammation of all paranasal sinuses simultaneously. It is a more severe presentation of sinusitis and is specifically documented as a separate finding on the ENT DBQ. If your imaging or history shows pansinusitis, ensure this is documented as it reflects greater disease severity than single sinus involvement.
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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.