Chronic sinusitis and allergic rhinitis frequently appear in the same treatment note, and veterans often assume that means one rating covers both. It does not necessarily. They are separate diagnostic codes with separate criteria, and separate evaluations are permissible where each condition produces its own distinct disabling manifestations.
The pyramiding rule
38 CFR 4.14 prohibits evaluating the same disability under different diagnoses, and the same manifestation under different codes. The rule is about symptoms, not diagnoses. Two separately diagnosed conditions can be separately rated; the same headache cannot be counted twice.
In practice this means the record has to distinguish which findings belong to which condition - obstruction and polyps on the rhinitis side, imaging-confirmed sinus disease and episode history on the sinusitis side.
What separate evaluations look like
A veteran with imaging-confirmed chronic maxillary sinusitis producing four non-incapacitating episodes per year, plus allergic rhinitis with greater than 50 percent bilateral obstruction, has findings that fit two different sets of criteria. The episode count belongs to DC 6513; the obstruction measurement belongs to DC 6522.
The criteria for each are set out in rhinitis and sinusitis ratings explained.
How the percentages combine
Separate evaluations do not add. Under 38 CFR 4.25 the VA combines them using the combined ratings table, applying each successive evaluation to the remaining efficiency. A 30 and a 10 combine to 37, which rounds to 40 for the final combined evaluation once all disabilities are accounted for.
Our VA rating calculator shows how this works across a full list of conditions.
Where veterans start
Every case is different, and there is no obligation at any step. When veterans want to understand what their records actually support, these are the two most common starting points:
- Medical records review
A licensed physician reviews your records for a $250 flat fee and identifies which conditions the available evidence may support. The fee is refunded in full if nothing supportable is identified.
- Nexus letter
When the records support one, a licensed provider writes the medical opinion that addresses the link between your respiratory condition and your service or an already service-connected disability.
Headaches attributable to sinus disease
Headaches, pain, and tenderness are built into the sinusitis rating formula, so they cannot also support a separate evaluation as part of the same disability picture. Where a separately diagnosed headache disorder exists with prostrating attacks, a separate evaluation under Diagnostic Code 8100 may be appropriate - see our migraine ratings guide.
Why claims in this pairing get under-rated
The usual reason is a single examination report that treats the two conditions as one narrative. When a report describes chronic sinus symptoms without recording nasal obstruction percentages, there is nothing for the rhinitis code to attach to; when it notes allergic rhinitis without an episode history, the sinusitis code produces 0 percent.
Both conditions need their own findings in the record.
Checking what the file supports
Determining whether separate evaluations are supportable is a records question. A paid medical records review reads the file against both sets of criteria. See also our respiratory evidence guide.