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ShuMan

Sinusitis C&P

Question

ShuMan    54

Team, 

I'm thinking this is a 0%, What do you think?

-Thank You!!

 

---------------------------------------------

Sinusitis, Rhinitis and Other Conditions of the Nose, Throat,

Disability Benefits Questionnaire

========================================================

Indicate method used to obtain medical information to complete this

document:

[ ] Review of available records (without in-person or video telehealth

examination) using the Acceptable Clinical Evidence (ACE) p

rocess because

the existing medical evidence provided sufficient information on which

to

prepare the DBQ and such an examination will likely provide no

additional

relevant evidence.

[ ] Review of available records in conjunction with a telephone interview

with the Veteran (without in-person or telehealth examination) using the

ACE process because the existing medical evidence supplemented with a

telephone interview provided sufficient information on which to prepare

the DBQ and such an examination would likely provide no additional

relevant evidence.

[ ] Examination via approved video telehealth

[X] In-person examination

Evidence review

---------------

Was the Veteran's VA claims file reviewed?

[ ] Yes[X] No

If no, check all records reviewed:

[X] Military service treatment records

[X] Veterans Health Administration medical records (VA treatment

records)

========================================================

 

SECTION I: Diagnosis:

---------------------

Does the Veteran now have or has he/she ever been diagnosed with a sinus,

nose, throat, larynx, or pharynx condition? (This is the condition the

Veteran is claiming or for which an exam has been requested)

[X] Yes [ ] No

[X] Chronic sinusitis ICD code: J32.2 Date of diagnosis: 2015

SECTION II: Medical history

---------------------------

The Veteran reports intermittent symptoms of URI and sinusitis while in

service (so noted in STR's). He denies pre-service episodes. He has

been

evaluated at the VA and treated. He reports several episodes per year that

require antibiotic treatment.

SECTION III: Nose, throat, larynx or pharynx conditions

-------------------------------------------------------

Does the Veteran have any of the following nose, throat, larynx or pharynx

conditions?

[X] Yes [ ] No

[X] Sinusitis

1. Sinusitis

------------

a. Indicate the sinuses/type of sinusitis currently affected by the

Veteran's

chronic sinusitis (check all that apply):

[ ] None [ ] Maxillary [ ] Frontal

[X] Ethmoid [ ] Sphenoid [ ] Pansinusitis

b. Does the Veteran currently have any findings, signs or symptoms

attributable to chronic sinusitis?

[ ] Yes [X] No

If yes, check all that apply:

[ ] Chronic sinusitis detected only by imaging studies (see Diagnostic

testing section)

[ ] Episodes of sinusitis

[ ] Near constant sinusitis

If checked, describe frequency:

[ ] Headaches

[ ] Pain of affected sinus

[ ] Tenderness of affected sinus

[ ] Purulent discharge

[ ] Crusting

========================================================

 [ ] Other

For all checked conditions, describe:

c. Has the Veteran had NON-INCAPACITATING episodes of sinusitis

characterized

by headaches, pain and purulent discharge or crusting in the past 12

months?

[X] Yes [ ] No

If yes, provide the total number of non-incapacitating episodes over the

past 12 months:

[ ] 1 [X] 2 [ ] 3 [ ] 4 [ ] 5 [ ] 6 [ ] 7 or more

d. Has the Veteran had INCAPACITATING episodes of sinusitis requiring

prolonged (4 to 6 weeks) of antibiotics treatment in the past 12 months?

[ ] Yes [ ] No

NOTE: For VA purposes, an incapacitating episode of sinusitis means one

that requires bed rest and treatment prescribed by a physician.

If yes, provide the total number of incapacitating episodes of sinusitis

requiring prolonged (4 to 6 weeks) of antibiotic treatment over past 12

months:

[ ] 1 [ ] 2 [ ] 3 or more

e. Has the Veteran had sinus surgery?

[ ] Yes [ ] No

If yes, specify type of surgery:

[ ] Radical (open sinus surgery) [ ] Endoscopic [ ] Other:

Type of procedure, sinuses operated on and side(s):

Date(s) of surgery (if repeated sinus surgery, provide all dates of

surgery):

If Veteran has had radical sinus surgery, did chronic osteomyelitis

follow

the surgery?

[ ] Yes [ ] No

f. Has the Veteran had repeated sinus-related surgical procedures performed?

[ ] Yes[ ] No

6. Other pertinent physical findings, scars, complications, conditions,

signs

and/or symptoms

-----------------------------------------------------------------------------

a. Does the Veteran have any scars (surgical or otherwise) related to any

conditions or to the treatment of any conditions listed in the Diagnosis

========================================================

section above? : No answer provided

b. Does the Veteran have any other pertinent physical findings,

complications, conditions, signs and/or symptoms related to any

conditions

listed in the Diagnosis section above?: No answer provided

c. Does the Veteran have loss of part of the nose or other scars of the nose

exposing both nasal passages?: No answer provided

d. Does the Veteran have loss of part of the nose or other scars causing

loss

of part of one ala?: No answer provided

e. Does the Veteran have loss of part of the nose or other scars causing

other obvious disfigurement?: No answer provided

SECTION IV: Diagnostic testing

------------------------------

a. Have imaging studies of the sinuses or other areas been performed?

No answer provided

b. Has endoscopy been performed?

No answer provided

c. Has the Veteran had a biopsy of the larynx or pharynx?

No answer provided

d. Has the Veteran had pulmonary function testing to assess for upper airway

obstruction due to laryngeal stenosis?

No answer provided

e. Are there any other significant diagnostic test findings and/or results?

No answer provided

SECTION V: Functional impact and remarks

----------------------------------------

1. Functional impact

--------------------

Does the Veteran's sinus, nose, throat, larynx or pharynx condition

impact

his or her ability to work?

No answer provided

2. Remarks, if any:

-------------------

========================================================

VBMS P. 1 dated 07/02/2015 STR's P. 4-5 Sinusitis.

STR's P. 4/7 pseudoephedrine RX for ALLERGY symptoms.

STR's dated 05/26/2005 P. 4-5/93 noted 6 simultaneous diagnosis: URI,

allergic rhinitis, viral syndrome, sinusitis, bronchitis and acute

bronchitis.

Rhinitis noted on STR's P 58/93. Being treated with medications for

allergies

and nasal congestion, however in the past medical history of 04/07/2009 NO

allergy or hayfever was entered in the note

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Vync    1,335

In my opinion, from what I read, it does not look promising. Based on what the C&P doc X'd off, they said you have non-chronic ethmoid sinusitis with two (2) non-incapacitating episodes within the last twelve months. The "non-chronic" and not having 3+ non-incapacitating episodes is the downer here.

Direct service connection will require proof of having the condition in service, proof you have it now, plus a doctor's IMO/nexus stating it is at minimum "least as likely as not" or 50/50% chance or better that it is due to your service.

It said they based the findings on your service treatment records and VAMC treatment records. It explicitly stated they did not have your claims file for review. If you happen to have other records showing otherwise, it could help turn this around. If you sent in some doc in the box records, but they ignored them, I would contest it. I had this happen where they did their own exam and denied me for "not being chronic", but the evidence showing the long history of chronic sinus problems was sitting in my my claims file. Once I got them to take a look at it, they changed their tune.

Additionally, I noticed it mentioned you were treated in the service for allergic rhinitis. If that is still a problem, it could be another avenue, but it based on polyps, deviated septum/nasal blockage.

Here's the rating criteria for Sinusitis: http://www.ecfr.gov/cgi-bin/text-idx?rgn=div5;node=38:1.0.1.1.5

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): 
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 surgeries50
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 crusting30
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 crusting10
Detected by X-ray only0
Note: An incapacitating episode of sinusitis means one that requires bed rest and treatment by a physician. 
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ShuMan    54

Thank you!

If you have time one more questions:

1.(I know this happens a lot) I said in my C&P exam that i had 5 - 6 non-incapacitating episodes a year and 1 - 2  incapacitating episodes. The only proof I have for the incapacitating episodes would be last years medical records. Is there any way to prove the non-incapacitating episodes? What should I do next if I don't agree?

Agreed about the allergies route..its a possibility. 

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Vync    1,335

It's not uncommon for you to verbally indicate having 5-6 non-incapacitating episodes, but not all docs write everything down. If you have medical visits showing this, it can help to counter it. Even though those are last years medical records, they might be worth it because you likely filed your claim within a year or two. If you can show consistent occurrences, the VA might consider this a pattern. In my case, I went back five years and showed every time I went to the doc in the box for sinus problems. I made a quick list showing which dates, doctors, diagnosis, and medications/injections/etc. If you give them a nice laundry list, backed up by evidence, it can help show that the problem is chronic. The mere word 'chronic' is a headache. If you show something happening on an average basis, it can help. If you have a good relationship with your current doctor, it might be worth it asking them to note that you have chronic sinusitis and have been treated on average X times a year by them. It can help.

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Reddit    8

In the future if you can, every time you think that you are coming down with a sinus infection get to a doctor, whether it is VA or private, and get it on records, then when you have your prescription fill, keep a copy of the prescription and or empty bottle. 

You only need to have one sinus infection per year with antibiotics, and or six or more non-incapacitate sinus infection treated over the counter meds.

PEOPLE HAVE SAID IT HERE MANY TIMES.,   READ THE DBQ BEFORE GOING TO THE C&P EXAM., IF WILL HELP YOU A LOT.  

I think you only would get service connected at 0%., but that would be good then come back with the evidence.

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Vync    1,335

Also, before you go to the exam, consider stopping the sinus/allergy medications a day or two ahead of time. They mask the underlying problem. You want the VA to see how bad the problem can be, not how well your medication works.

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Andyman73    874

Shuman and Vync,

Forgive me, I know it's not my thread, but this is same topic, and I don't want to forget that I saw this topic...cuz I will.

I noticed that the chart says 6 or more non-incapacitating episodes per year.  I have 9-12 episodes per year, and mostly treat with otc meds.  I do have a few strs where antibiotics were prescribed.  Do I have an honest chance with this?  Or is this something that needs to be tied in with my sleep issues, and such?

Again, my humblest apologies for asking this on your thread, Shuman,

Semper Fi.

Andyman

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