SINUSITIS

T. V. CASEY · 2026 · Case ID: A26035022

DENIED

Summary

The veteran, who served in the U.S. Navy and Marine Corps from November 1981 to November 1985 and September 1991 to May 2005, appeals the denial of an increased disability rating for sinusitis. The Board of Veterans' Appeals (Board) reviewed the case following a prior remand from the Court of Appeals for Veterans Claims. The veteran sought an increased rating beyond the 10% previously granted, claiming more than seven non-incapacitating episodes per year with headaches, pain, and purulent discharge or crusting. The Board considered the veteran's lay statements, a VA examination, and a private Disability Benefits Questionnaire (DBQ). The VA examiner diagnosed chronic sinusitis and allergic rhinitis, noting mucoperiosteal thickening but finding no current signs or symptoms, nor any incapacitating or non-incapacitating episodes meeting the rating criteria. The Board found the VA examination reports of limited probative value but also found the veteran's lay statements less persuasive due to self-interest and inconsistencies with other evidence. The Board noted the lack of purulent discharge or crusting in the evidence and the absence of treatment records from VA facilities, despite having VA medical coverage. The Board concluded that the sinusitis did not meet the criteria for a 30% rating or approximate it, and a separate rating for headaches would constitute pyramiding. Therefore, the claim for an increased rating beyond 10% was denied.

Rationale

Veteran's lay statements found less probative due to self-interest and inconsistencies.; Lack of evidence for purulent discharge or crusting.; No VA treatment records for sinusitis during the review period.; VA examination showed no current signs/symptoms of sinusitis or incapacitating episodes.

Service Branch

NAVY

Special Benefit

NO SPECIAL BENEFIT

Diagnostic Code

6513

Docket No.

220217-221795

Full Decision Text

Citation Nr: A26035022
Decision Date: 04/15/26 Archive Date: 04/15/26

DOCKET NO. 220217-221795
DATE: April 15, 2026

ORDER

Entitlement to a disability rating in excess of 10 percent for sinusitis is denied.

FINDING OF FACT

The evidence of record persuasively weighs against finding the Veteran's sinusitis has more nearly approximated the disability picture for a 30 percent rating during the review period.

CONCLUSION OF LAW

The criteria for entitlement to an initial disability rating in excess of 10 percent for chronic sinusitis have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 4.1, 4.3, 4.7, 4.97, Diagnostic Code (DC) 6510-6514.

REASONS AND BASES FOR FINDING AND CONCLUSION

The Veteran served on active duty in the United States Navy from November 1981 to November 1985 and May 1989 to September 1991, and in the United States Marine Corps from September 1991 to May 2005.

This matter comes before the Board of Veterans' Appeals (Board) on appeal from a December 2021 rating decision by the Department of Veterans Affairs (VA) regional office, which is the Agency of Original Jurisdiction (AOJ).

The Veteran elected the Board's Evidence Submission docket. See February 2022 VA Form 10182. This restricts the Board's review to the evidence of record (not including argument) at the time of the December 2021 rating decision and any evidence submitted by the Veteran or his representative with, or within 90 days from receipt of, the VA Form 10182. 38 C.F.R. § 20.303.

In May 2025, the Board issued a decision that, in part, granted a 10 percent disability rating for the service-connected sinusitis. In December 2025, the United States Court of Appeals for Veterans Claims (Court) granted a joint motion for partial remand (JMPR) and remanded this claim for further consideration. The parties agreed that the Board's May 2025 decision failed to address all relevant information in the February 2022 private examination report and needed to reconsider the probative value of the report. The decision also failed to include a general statement that informed the Veteran about his options to have the AOJ consider evidence submitted outside of an applicable evidentiary window.

Though the Veteran had not submitted any evidence outside of the applicable evidentiary windows at the time of the Board's May 2025 decision, the Board recognizes the Veteran has since submitted evidence to VA. If the Veteran would like VA to consider such evidence, the Veteran may file a supplemental claim (VA Form 20-0995) and identify the new and relevant evidence that the AOJ should consider. 38 C.F.R. § 3.2501. Specific instructions for filing a supplemental claim are included following this decision (which the Board had also included with the May 2025 decision).

Increased Rating

Disability evaluations are determined by evaluating the extent to which a Veteran's service-connected disability adversely affects the Veteran's ability to function under the ordinary conditions of daily life, including employment, by comparing the Veteran's symptomatology with the criteria set forth in the Schedule for Rating Disabilities. 38 C.F.R., Part 4. The percentage ratings represent as far as can be practicably determined the average impairment in earning capacity resulting from such diseases and injuries and the residual conditions in civilian occupations. 38 U.S.C. § 1155; 38 C.F.R. § 4.1. Generally, the degree of disabilities specified are considered adequate to compensate for considerable loss of working time from exacerbation or illness proportionate to the severity of the several grades of disability. Id. The basis of disability ratings is the ability of the body as a whole, or of the psyche, or of a system or organ of the body, to function under the ordinary conditions of daily life, including employment. 38 C.F.R. § 4.10.

Where there is a question as to which of two evaluations shall be applied, the higher evaluation will be assigned if the disability picture more nearly approximates the criteria required for that rating; otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7. Any reasonable doubt regarding the degree of disability will be resolved in favor of the Veteran. 38 C.F.R. § 4.3. "Staged ratings" are, however, appropriate for an increased rating claim when the factual findings show distinct time periods where the service-connected disability exhibits symptoms that would warrant different ratings.
the body, to function under the ordinary conditions of daily life, including employment. 38 C.F.R. § 4.10.

In every instance where a rating schedule does not identify specific rating criteria for a noncompensable rating (zero percent), a noncompensable rating will be assigned when the requirements for a compensable rating are not met. 38 C.F.R. § 4.31.

The evaluation of the same disability under several diagnostic codes, known as "pyramiding," must be avoided. 38 C.F.R. § 4.14. However, separate ratings may be assigned for distinct disabilities resulting from the same injury, so long as the symptomatology for one condition is not duplicative of or overlapping with the symptomatology of the other condition. Id.

When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, the Veteran will receive the benefit of the doubt. 38 U.S.C. § 5107; 38 C.F.R. §§ 3.102, 4.3, 4.7; Lynch v. McDonough, 21 F.4th 776, 781-82 (Fed. Cir. 2021) (en banc).

Entitlement to a disability rating in excess of 10 percent for sinusitis.

Upon further review of the claims file, the review period for this claim begins on February 17, 2020, one year prior to the date VA received an intent to file an application for compensation benefits followed by the Veteran's August 2021 application for disability compensation benefits. 38 C.F.R. §§ 3.114, 3.155, 3.400(o). The evidentiary record is limited to the evidence in the claims file at the time of the December 2021 rating decision and any evidence the Veteran submitted with or within 90 days of the February 2022 VA Form 10182. 38 U.S.C. § 7113; 38 C.F.R. §§ 20.300, 20.303.

An October 2005 rating decision awarded service connection for "allergic rhinitis and sinusitis" and assigned a noncompensable (zero percent) disability rating under DC 6513-6522 with an effective date of June 1, 2005. The December 2021 rating decision awarded a separate evaluation for sinusitis and assigned a noncompensable disability rating under DC 6513 with an effective date of February 17, 2021. See also December 2021 Rating Decision - Codesheet.

Sinusitis is rated under the General Ratings Formula for Sinusitis. 38 C.F.R. § 4.97, DCs 6510-6514. A noncompensable rating is assigned when sinusitis detected by x-ray only. A 10 percent rating is assigned if there is evidence of one or two incapacitating episodes of sinusitis per year requiring prolonged antibiotic treatment lasting at least a four-week period; or three to six non-incapacitating episodes of sinusitis per year that are characterized by headaches, pain, and purulent discharge or crusting. A 30 percent rating is assigned when there is evidence of no less than three incapacitating episodes of sinusitis per year requiring prolonged antibiotic treatment lasting four to six weeks; or more than six non-incapacitating episodes of sinusitis per year that are characterized by headaches, pain, and purulent discharge or crusting. A 50 percent rating is assigned if the evidence shows the claimant has chronic osteomyelitis following radical surgery; or near constant sinusitis characterized by headaches, pain and tenderness of affected sinus, and purulent discharge or crusting after repeated surgeries.

The corresponding Note defines an incapacitating episode as requiring bed rest and treatment by a physician. Id.

The claims file shows that, in the August 2021 application, the Veteran elected to have his claim processed through VA's Fully Developed Claim (FDC) program. His attorney-representative certified on his behalf that all information/evidence supporting the claim was included with the application and/or could be retrieved from a Federal facility
by headaches, pain, and purulent discharge or crusting. A 50 percent rating is assigned if the evidence shows the claimant has chronic osteomyelitis following radical surgery; or near constant sinusitis characterized by headaches, pain and tenderness of affected sinus, and purulent discharge or crusting after repeated surgeries.

The corresponding Note defines an incapacitating episode as requiring bed rest and treatment by a physician. Id.

The claims file shows that, in the August 2021 application, the Veteran elected to have his claim processed through VA's Fully Developed Claim (FDC) program. His attorney-representative certified on his behalf that all information/evidence supporting the claim was included with the application and/or could be retrieved from a Federal facility. See August 2021 VA Form 21-526EZ. The certification also included acknowledging receipt of the Notice to Veteran/Service Member of Evidence Necessary to Substantiate a Claim for Veterans Disability Compensation and Related Compensation Benefits included as an attachment to the application form.

On the August 2021 application, the Veteran did not identify any VA or Department of Defense facility where he received medical care related to sinusitis. Id.; see also August 2021 Brief (entitled Third Party Correspondence). He did not include any private treatment records or identify a provider whom he received treatment for sinusitis and/or symptoms associated with the sinusitis from. In the brief, which the Veteran co-signed, the Veteran asserted that the severity of the sinusitis had increased since the December 2004 VA examination and requested a new VA examination. "Presently [he has] 7 or more non-incapacitating episodes per year, on average." The attorney pointed out that the Federal Circuit has held that a veteran is competent to testify as to symptoms and experiences that are capable of lay observation. 38 C.F.R. § 3.159; Buchanan v. Nicholson, 451 F.3d 1331, 1336 (Fed. Cir. 2006) (lay statements regarding medical symptoms may not be rejected simply because they are not accompanied by contemporaneous medical records).

The claims file contains no evidence that the Veteran has received any treatment for sinusitis or symptoms reasonably related to sinusitis through a private provider/facility or at a VA facility just prior to or during the review period.

The Veteran was afforded a VA sinus/rhinitis examination in October 2021. See November 2021 C&P Exams. The diagnoses were chronic sinusitis (maxillary and frontal) with allergic rhinitis. His medical history showed a diagnosis of sinusitis around 1996. His symptoms were nasal congestion with stuffiness, which were relieved with over-the-counter medication. "Sometimes, gets bilateral headaches with sinusitis." He reported getting a headache whenever he gets sinusitis but that his treatment provides relief. The examiner stated that the Veteran had no current findings, signs, or symptoms attributed to chronic sinusitis, to include headaches, sinus pain, or purulent discharge or crusting. The examiner found no evidence of non-incapacitating episodes characterized by headaches, pain, and purulent discharge or crusting within the last 12 months, or incapacitating episodes requiring prolonged antibiotic treatment within the last 12 months. The Veteran had no history of sinus-related surgical procedures. The clinical examination showed no evidence of nasal obstruction, permanent hypertrophy, or nasal polyps. Imaging showed mucoperiosteal thickening of the frontal, ethmoid, and maxillary sinuses.

The VA examiner also completed a VA headaches examination report. See id. The diagnosis was sinus headaches. His medical history was a headache "whenever he gets sinusitis" and obtained "[r]elief with treating sinus condition." His treatment regimen did not include any medication specifically for headaches. The examiner stated that the Veteran's symptoms included pain on both sides of the head with no other symptoms. The headaches lasted less than a day. The examiner opined that the sinus headaches were not characteristic of prostrating attacks, or very prostrating and prolonged attacks producing severe economic inadaptability.

The Board finds the October 2021 examination reports of limited probative value and gives them limited weight. The examination reports contain a brief summary of the Veteran's pertinent medical history and lay statement about his symptoms at the time (nasal congestion, stuffiness, and headaches), of which did not include a history of purulent discharge or crusting. As noted in the May 2025 Board decision, the VA examiner's response when identifying the Veteran's then-current findings, signs, or symptoms (Question A2) appears to be limited to specific findings at the time of the examination, of which there were none, and did not necessarily consider symptoms that may have been present during the review period. It is reasonable that the examiner limited discussing the sinus headaches in the sinus/rhinitis examination report because the examiner discussed them in the headache
limited weight. The examination reports contain a brief summary of the Veteran's pertinent medical history and lay statement about his symptoms at the time (nasal congestion, stuffiness, and headaches), of which did not include a history of purulent discharge or crusting. As noted in the May 2025 Board decision, the VA examiner's response when identifying the Veteran's then-current findings, signs, or symptoms (Question A2) appears to be limited to specific findings at the time of the examination, of which there were none, and did not necessarily consider symptoms that may have been present during the review period. It is reasonable that the examiner limited discussing the sinus headaches in the sinus/rhinitis examination report because the examiner discussed them in the headache examination report. Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008); Stefl v. Nicholson, 21 Vet. App. 120, 124 (2007).

The Board has considered but finds no reason to remand this matter for a new VA examination just so that the examiner can select findings, signs, or symptoms consistent with the Veteran lay statements or information elsewhere in the claims file at the time of the VA examination in a sinus/rhinitis examination report. Of note, there are no medical records for this specific condition. The evidence before the Board, which effectively consists of the Veteran's lay statements as to his symptoms, is adequate for adjudication. 38 U.S.C. § 5103A.

The claims file also includes the Veteran's submission of a private Disability Benefits Questionnaire (DBQ). See February 2022 VA Examination. The private examiner stated that the DBQ was completed after the examiner reviewed the "entire" claims file and the Veteran's sworn statement. See also February 2022 Correspondence. There is nothing to indicate the examiner personally examined the Veteran (who resides in a state different from that which the examiner practices). The diagnoses were chronic sinusitis and allergic rhinitis. The examiner described the Veteran's medical history as chronic cold-like symptoms during service and that he "[h]as primarily treated [the sinusitis] with [over-the-counter Claritin and fluticasone] with slight relief." The private examiner described the current clinical findings, signs, and symptoms as follows: episodes of sinusitis, near constant sinusitis despite over-the-counter medication, pain and tenderness of affected sinuses, and purulent discharge or crusting. Of note, the private examiner did not select headaches though later in the DBQ, when discussing how the sinusitis might impact the Veteran's ability to work, states that the Veteran's symptoms include headaches. The private examiner stated that the Veteran was afflicted with the listed signs and symptoms to some degree greater than seven times a year, consistent with greater than seven non-incapacitating episodes in the last 12 months. The private examiner found no evidence of incapacitating episodes.

The Board finds the private opinion not probative and gives it no weight. The opinion appears to be based solely on a paper review of the claims file and weighs heavily on the Veteran's lay statements, statements which the Board finds not fully persuasive in light of all of the information in the claims file with respect to review period. Thus, the examiner's "opinion" is effectively a restatement of the Veteran's lay statements. As stated in the Board's May 2025 decision, the opinion is also partly inconsistent with the Veteran's own description of his symptoms. For example, the Veteran has identified his sinus symptoms to include headaches. The examiner, however, did not select this as a current symptom and only referred to it when discussing how the service-connected sinusitis might impact the Veteran's ability to work. There is no discussion about the fact that the Veteran's original assertion was that the headaches were related to his claimed neck disability (which the AOJ denied in a second December 2021 rating decision). See August 2021 Third Party Correspondence. The examiner also characterized the Veteran's report of "discharge" as purulent discharge (or crusting) without explaining what evidence supported the specific characterization. Though it is possible that the examiner obtained additional evidence, such as personally examining or interviewing the Veteran, such is not evident in the DBQ. Nieves-Rodriguez, 22 Vet. App. at 304; Stefl, 21 Vet. App. at 124.

Additionally, the Board has given due consideration to the pertinent lay evidence. 38 U.S.C. § 1154(a); Layno v. Brown, 6 Vet. App. 465, 470 (1994). The Veteran initially described his sinusitis and allergic rhinitis symptoms as a runny nose, itchy eyes, nasal congestion, stuffiness, and bilateral headaches. See October 2021 C&P Exam. In a sworn statement,
possible that the examiner obtained additional evidence, such as personally examining or interviewing the Veteran, such is not evident in the DBQ. Nieves-Rodriguez, 22 Vet. App. at 304; Stefl, 21 Vet. App. at 124.

Additionally, the Board has given due consideration to the pertinent lay evidence. 38 U.S.C. § 1154(a); Layno v. Brown, 6 Vet. App. 465, 470 (1994). The Veteran initially described his sinusitis and allergic rhinitis symptoms as a runny nose, itchy eyes, nasal congestion, stuffiness, and bilateral headaches. See October 2021 C&P Exam. In a sworn statement, he further reported cold-like symptoms, which typically consists of pain in his nasal passages with headaches, discharge, and tender sinuses. See February 2022 Correspondence. Over the course of a 12-month period, he stated he experiences over six significant episodes per year on average and this has been the case for several years.

Though the Veteran is competent to describe his symptoms and the frequency at which he experiences such symptoms, the Board finds the Veteran's statements made during the October 2021 VA examinations (in light of the evidence elsewhere in the record) more compelling and probative than the statements he has specifically advanced for the purpose of supporting, and bolstering, his claim for (now) a disability rating in excess of 10 percent. Jandreau v. Nicholson, 492 F.3d 1372, 1377 n.4 (Fed. Cir. 2007); Kahana v. Shinseki, 24 Vet. App. 428, 435 (2011); see also Madden v. Gober, 125 F.3d 1477, 1481 (Fed. Cir. 1997) (Board is entitled to discount the credibility of evidence in light of its own inherent characteristics and its relationship to other items of evidence); Cartwright v. Derwinski, 2 Vet. App. 24 (1991) (pecuniary interest in benefits may affect credibility of claimant's testimony); Pond v. West, 12 Vet. App. 341 (1999) (although the Board must take into consideration the Veteran's statements, it may consider whether self-interest may be a factor in making such statements).

The Board finds self-interest to be a factor and, thus, the lay statements are less probative. The Board is not persuaded that the sinusitis has resulted in purulent drainage or crusting. It is reasonable that the Veteran may experience some degree of drainage and/or crusting. There is, however, no evidence, and the Veteran has not personally characterized the symptoms as purulent drainage or crusting. As to the headaches, the Veteran asserted in a statement submitted with his August 2021 application that the headaches were secondary to a claimed neck condition and argued that headaches are "a common known complication of his claimed neck condition," claims that VA has denied (and he did not pursue). Though he may experience headaches, the Board is not persuaded that the etiology of the headaches are solely related to the sinusitis.

Additionally, VA originally awarded service connection for sinusitis in 2005. Because the Veteran has had medical coverage through the VA for sinusitis, the Board would have expected the Veteran to have sought some degree of medical care for the covered condition at a VA facility if the sinusitis symptoms were as severe and frequent as he is alleging.

Having considered all of the evidence, the Board finds that the sinusitis has not met the criteria for a 30 percent disability rating, nor nearly approximated the criteria, during the review period. As previously stated in the May 2025 Board decision, the Veteran has no history of nasal surgery. He has not identified a provider or facility where he has received treatment for sinusitis, to include prescribing antibiotic treatment for sinus infections and ordering bed rest. While he has described his symptoms to include headaches, sinus pain, and discharge, he himself has not described and there is no clinical evidence that his symptoms have included purulent, or pus-like, discharge or crusting. See August 2021 Brief; November 2021 C&P Exams; February 2022 Correspondence; see also Merriam-Webster Dictionary online, available at https://www.merriam-webster.com/

dictionary/purulent. The February 2022 private examiner did not identify what evidence he relied on when describing the discharge as purulent. Though the Veteran has effectively described sinusitis symptoms as recurring, the October 2021 VA examiner observed no evidence of sinusitis, to include observable signs of purulent discharge or crusting.

Pursuant to 38 C.F.R. § 4.7, the Board's May 2025 decision awarded a 10
or pus-like, discharge or crusting. See August 2021 Brief; November 2021 C&P Exams; February 2022 Correspondence; see also Merriam-Webster Dictionary online, available at https://www.merriam-webster.com/

Pursuant to 38 C.F.R. § 4.7, the Board's May 2025 decision awarded a 10 percent disability rating because the service-connected sinusitis has reasonably resulted in more than a disease detected by an x-ray. The Veteran's disability picture has included symptoms of sinus headaches and sinus pain without purulent discharge or crusting. The Board is unpersuaded by the Veteran's lay statements as to the frequency of the non-capacitating episodes. Missing the frequency of the required non-incapacitating episodes and one of the three identified characteristics, the Board cannot find the sinusitis has more nearly approximated a disability rating of 30 percent.

Because DCs 6510 through 6514 takes into consideration sinusitis may include sinus headaches, the Board cannot award a separate rating for sinus headaches under another DC, such as DC 8100 (by analogy), because this would violate VA's rule against pyramiding. 38 C.F.R. § 4.20.

For the above reasons, the evidence persuasively weighs against finding a disability rating in excess of 10 percent for the service-connected chronic sinusitis warranted. Therefore, the claim for a higher disability rating is denied.

T. V. Casey

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board T. Burden, Associate Counsel

The Board's decision in this case is binding only with respect to the instant matter decided. This decision is not precedential and does not establish VA policies or interpretations of general applicability. 38 C.F.R. § 20.1303.

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