Question About Sinuses And Pyramiding

[TALON II FE]

Below is the chart on award percentages. My question is this: If you have sinusitis, let's say they would rate it at 50% for radical surgery, and you also had rhinitis with polyps, rateable at 30%, would they rate you individually for each, or would the take the higher rating of the two? They are separated from each other in the scale, but are affecting the same area / body system, which is why I am asking. These crossovers like this are still a bit confusing to me. Does anyone know?

Schedule of Ratings tables for Sinusitis and Allergic Rhinitis:

6510 Sinusitis, pansinusitis, chronic.
6511 Sinusitis, ethmoid, chronic.
6512 Sinusitis, frontal, chronic.
6513 Sinusitis, maxillary, chronic.
6514 Sinusitis, sphenoid, chronic.

General Rating Formula for Sinusitis (DC’s 6510 through 6514):
50% Following radical surgery with chronic osteomyelitis, or; near constant sinusitis characterized by headaches, pain and tenderness of affected sinus, and purulent discharge or crusting after repeated surgeries

30% Three or more incapacitating episodes per year of sinusitis requiring prolonged (lasting four to six weeks) antibiotic treatment, or; more than six non-incapacitating episodes per year of sinusitis characterized by headaches, pain, and purulent discharge or crusting

One or two incapacitating episodes per year of sinusitis requiring prolonged (lasting four to six weeks) antibiotic treatment, or; three to six non-incapacitating episodes per year of sinusitis characterized by headaches, pain, and purulent discharge or crusting 10

0% Detected by X-ray only

Note: An incapacitating episode of sinusitis means one that requires bed rest and treatment by a physician.




6522 Allergic or vasomotor rhinitis:

30% With polyps

10% Without polyps, but with greater than 50-percent obstruction of nasal passage on both sides or complete obstruction on one side

[USN_HM_VSR]

Below is the chart on award percentages. My question is this: If you have sinusitis, let's say they would rate it at 50% for radical surgery, and you also had rhinitis with polyps, rateable at 30%, would they rate you individually for each, or would the take the higher rating of the two? They are separated from each other in the scale, but are affecting the same area / body system, which is why I am asking. These crossovers like this are still a bit confusing to me. Does anyone know?

Schedule of Ratings tables for Sinusitis and Allergic Rhinitis:

6510 Sinusitis, pansinusitis, chronic.

6511 Sinusitis, ethmoid, chronic.

6512 Sinusitis, frontal, chronic.

6513 Sinusitis, maxillary, chronic.

6514 Sinusitis, sphenoid, chronic.

General Rating Formula for Sinusitis (DC’s 6510 through 6514):

50% Following radical surgery with chronic osteomyelitis, or; near constant sinusitis characterized by headaches, pain and tenderness of affected sinus, and purulent discharge or crusting after repeated surgeries

30% Three or more incapacitating episodes per year of sinusitis requiring prolonged (lasting four to six weeks) antibiotic treatment, or; more than six non-incapacitating episodes per year of sinusitis characterized by headaches, pain, and purulent discharge or crusting

One or two incapacitating episodes per year of sinusitis requiring prolonged (lasting four to six weeks) antibiotic treatment, or; three to six non-incapacitating episodes per year of sinusitis characterized by headaches, pain, and purulent discharge or crusting 10

0% Detected by X-ray only

Note: An incapacitating episode of sinusitis means one that requires bed rest and treatment by a physician.

6522 Allergic or vasomotor rhinitis:

30% With polyps

10% Without polyps, but with greater than 50-percent obstruction of nasal passage on both sides or complete obstruction on one side

Although they are in the respiratory conditions they are separate conditions and would most like be rated individually probably depending on how you claimed it as say a secondary or if the medical evidence linked them and then they'd probably lump them all together. Are you rated for this?

[TALON II FE]

I only came off of AD in September, still waiting for the VA to untangle the mess made by my inexperienced, well intending VSR. But yes, I have individual claims in for both. If rated correctly (from my interpretation of the reg) I should get 50% (but probably 30%) for pansinusitis for radical surgery; they actually totally removed my ethmoid and sphenoid sinuses completely and combined my frontal into a single cavity, and a lot of "scraping", etc, it was a 5+ hr procedure.. I have had multiple surgeries and the last 2 they removed polyps as well, so I believe that should be 30%. The way I read it, I thought they may rate separately, but all the rules on pyramiding and what is lumped together vs what is rated individually is still confusing to me, I think it varies too much from item to item.

What I am waiting for is when the VA says I can't be rated for pansinusitis because those sinus cavities have been removed, that's going to be an awesome day, lol.

Edited July 8, 2015 by TALON II FE

[Fat]

Rhinitis and Sinusitis are rated separately.

[TALON II FE]

Thanks