Please help! CP exam for rhinitis and sinusitis

[LT Haylo]

Hello,

Can you all please help me understand the results of my recent C&P examination. I asked for an increase of my service connected rhinitis and went from a 0% to a 10% but I believe it should be rated 30% based on the fact that my CT scan showed a 3x5mm Polyp. The CP examiner noted that my CT scan showed a polyp and then he marked no on the polyp question! I provided a DBQ from my personal family doctor that indicated I have a nasal polyp but I think that since the CP examiner was an ENT doc they trumped my family doctor. They also denied my secondary claim for chronic sinusitis secondary to my rhinitis. My CT scan also showed chronic sinus disease. Any help is greatly appreciated! I'm working on going from 90-100% schedular. 

filename-1.pdf

 

Edited November 3, 2018 by LT Haylo

[Vync]

Regarding rhinitis, the evidence should speak for itself. I assume it could be a case of the ENT marking the wrong box and/or not completely reading the CT results.

I recommend submitting the CT results as part of a request for reconsideration. If you don't hear back before your 1 year NOD clock expires, submit a formal Notice of Disagreement so your effective date is preserved.

 

Regarding sinusitis secondary to your rhinitis, keep in mind the criteria is considerably different.

They should have included their justification for denial in the Reasons and Bases section of your decision letter. Keep in mind for secondary SC, you would need:
1. Existing SC condition (you have that)
2. Current diagnosis
3. Nexus connecting 1 and 2

 

§4.97   Schedule of ratings—respiratory system

Quote

6522   Allergic or vasomotor rhinitis:
With polyps	30
Without polyps, but with greater than 50-percent obstruction of nasal passage on both sides or complete obstruction on one side	10

 

 

Quote   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 surgeries 50 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 30 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 Detected by X-ray only 0