Are nasal polyps and mucous retention cysts viewed as equal for rating purposes?

[NoZZZ's]

Hello all,

As part of submitting my claim for Allergic Rhinitis/Sinusitis, I have been reading a lot of BVA decisions. Many of those decisions will be a denial of higher than 0% at initial rating (or denial of increased rating) for allergic rhinitis that does not include "polyps," but where there are mucous retention cysts present. I did find, however, one decision where the rater analogized that polyps and mucous retention cysts have functionally the same effect:

The Board nevertheless has considered whether the several mucous retention cysts
present are analogous to polyps for the purposes of Diagnostic Code 6522.  Given
that both are growths located in the same area, and that mucous retention cysts can,
in some cases, cause some of the same effects as nasal polyps, the Board finds that
the Veteran's mucous retention cysts are functionally equivalent to nasal polyps,
and that the Veteran is entitled to a 30 percent evaluation for allergic rhinitis.

This ruling is from 2015:

Citation Nr: 1540763
Decision Date: 09/22/15

This is the only example I have found like this so far. Has anyone else found this to be true as well?

Thanks!

[broncovet]

It sounds like you did your homework.  Go for it.  Remember, BVA decisions are not precedential, you have to research CAVC "panel" or CAVC "en banc" decisions to find those which are precedential.  

"Precedential" means that a precedent is set, so that you should be able to count on this also applying to you, as it is enforced by the court.  

[ladysnoopee]

NoZZZ's, 

What was the rating outcome of your Allergic Rhinitis/Sinusitis claim?  I am Service Connected with 0% rating for Sinusitis, but I now have Maxillary Sinus Retention Cysts, which I claimed as a secondary to Sinusitis. Initially, it was Denied Service Connected, but after a recent QTC exam the status has changed to deferred.  

[ToxicSgt73]

I am interested in this also, I will post my question soon. I had a MRI in 92 that showed a maxillary sinus polyp/ and further MRI's that showed complete impaction of maxillary sinus, whatever it was popped when I started neti pots about 6 years ago, now MRI's show mucousal thickening (nih.gov says one way is chemical agents).  Civilian Docs wanted to do a nose job and drill against the skull....I will post mine elsewhere, but, I am interested in what happens.

My issues started in service and documented, chronic.

Over 90 skin tests, over 20 interdermal tests,  3 vials of serum, allergy shots, after service. After sinus, bronchitis, then pnemonia & pleursy at 29 yrs. Working up mine hard right now. Got my first VAMC doc to document chronic rhinitis without trying so far.....LIke I said, watching this closely. 

Chemicals, seem to do a lot of things.

[NoZZZ's]

I just recently received the decision...30% for allergic rhinitis with sinusitis.  This is based on regular, recurrent sinus headaches and crusting (and persistent post nasal drip) however, and not the retention cyst. The cyst was not mentioned in the rating decision, so I am not sure how its presence effected the claim (if any), other than as a symptom affirming that I have sinusitis. Cysts are not mentioned in the DBQ for sinusitis. I had filed two separate claims, one for AR and one for Sinuses, but they were combined into one rating. I am assuming the AR would have been 0% if it had been rated separately.

It sounds like you are experiencing multiple retention cysts. What are the symptoms (and importantly, the functional impact) you are experiencing as a result? Sinus pain/pressure? Discharge? That is what you will be rated on. 

A doctors opinion would be required to equate your mucous retention cysts to polyps, as was the case in the BVA decision I cited in the first post.  That would be helpful if you were service connected with allergic rhinitis, though. The mere presence of tissue growths is not rateable under sinusitis (at least, it is not in the DBQ) from what I have found.

The rating criteria for Sinusitis, from militarydisabilitymadeeasy.com:

If the sinusitis is constant or near-constant with headaches, tenderness to the touch, and the discharge of puss or crusting after repeated surgeries, or if a radical surgery was performed and there is ongoing infection in the facial bones (osteomyelitis), it is rated 50%.

If there are 3 or more incapacitating episodes each year that requires 4 to 6 weeks of antibiotic treatment, or if there are more than 6 episodes (not incapacitating) each year of headaches, tenderness and the discharge of puss or crusting, it is rated 30%.

If there are 1 or 2 incapacitating episodes each year that requires 4 to 6 weeks of antibiotic treatment, or if there are 3 to 6 episodes each year of headaches, tenderness, and the discharge of puss or crusting, it is rated 10%.

Anything less is rated 0%.

So, the cysts can be an affirmative symptom that you have sinusitis, but it is the symptoms quoted above that would determine any rating you would receive.

That is my understanding of it, at least.

 

[Buck52]

you may try to look at these rating critera sheets  I had problems reading them  but you can set your computer to read larger text formats.

https://www.govinfo.gov/content/pkg/CFR-2003-title38-vol1/pdf/CFR-2003-title38-vol1-part4.pdf

 

https://www.va.gov/vetapp15/Files5/1540763.txt

Edited September 30, 2019 by Buck52

[ToxicSgt73]

2 hours ago, NoZZZ's said:

I just recently received the decision...30% for allergic rhinitis with sinusitis.  This is based on regular, recurrent sinus headaches and crusting (and persistent post nasal drip) however, and not the retention cyst. The cyst was not mentioned in the rating decision, so I am not sure how its presence effected the claim (if any), other than as a symptom affirming that I have sinusitis. Cysts are not mentioned in the DBQ for sinusitis. I had filed two separate claims, one for AR and one for Sinuses, but they were combined into one rating. I am assuming the AR would have been 0% if it had been rated separately.

It sounds like you are experiencing multiple retention cysts. What are the symptoms (and importantly, the functional impact) you are experiencing as a result? Sinus pain/pressure? Discharge? That is what you will be rated on. 

A doctors opinion would be required to equate your mucous retention cysts to polyps, as was the case in the BVA decision I cited in the first post.  That would be helpful if you were service connected with allergic rhinitis, though. The mere presence of tissue growths is not rateable under sinusitis (at least, it is not in the DBQ) from what I have found.

The rating criteria for Sinusitis, from militarydisabilitymadeeasy.com:

If the sinusitis is constant or near-constant with headaches, tenderness to the touch, and the discharge of puss or crusting after repeated surgeries, or if a radical surgery was performed and there is ongoing infection in the facial bones (osteomyelitis), it is rated 50%.

If there are 3 or more incapacitating episodes each year that requires 4 to 6 weeks of antibiotic treatment, or if there are more than 6 episodes (not incapacitating) each year of headaches, tenderness and the discharge of puss or crusting, it is rated 30%.

If there are 1 or 2 incapacitating episodes each year that requires 4 to 6 weeks of antibiotic treatment, or if there are 3 to 6 episodes each year of headaches, tenderness, and the discharge of puss or crusting, it is rated 10%.

Anything less is rated 0%.

So, the cysts can be an affirmative symptom that you have sinusitis, but it is the symptoms quoted above that would determine any rating you would receive.

That is my understanding of it, at least.

 

NoZZZ's, 

The more I try to simplify my conditions, the more complex they become.  Almost two months non stop pouring through my medical records (the bits and pieces I can find and locate). 

I believe I understand the rating criteria as written, finally, after reading it many times and looking at your explanations and the cases, listed here and elsewhere. 

It looks like for ratings purposes, the only polyps that mentioned would be in the nose (not in the sinus cavities). I think I understand the concept.  The disabling factor is blocking the airway. This is for rhinitus.

Polyps in the sinus cavities that don't cause any 'pain', and 'discharge' 'crusting' ie....anything that doesn't interfere with working, is not disabling for rating purposes. 

At least that is the thought process I am using at the moment. 

I just received an ENT full workup that I had in 2007. It seems to suggest yet another rare 'bird' in my collection of 'rare' diseases connected to my time in the service.   It suggests that my fully blocked maxillary sinus cavity was fungal infection in origination.

Interesting: STR shows a Sinus Infection treated with antibiotics (labeled first of many) in NOV 73, I arrived at tech school the last day of August 73, during the time I was AFI, waiting on classes to start, one of the duties I pulled was to shovel pigeon crap, in front, in back, and sides, of 'Radar Love' building, along with who knows where else.  It is just incredulous....where these bullets come from....I am looking harder at my pneumonia in 84' that permanently scarred my lungs.....

My research into bird poop, especially pigeon poop and fungal diseases.....really nasty stuff....

I am still working all of this stuff up, I knew the pigeon poop shoveling could not have been beneficial.....I just didn't realize until just a few minutes ago about the fungus connection to the sinuses? maybe? I am going to need half a dozen IMO's. My sinus and bronchial issues have always been handled as bacterial, but I can't remember anyone ever taking a sample and analyzing it.

I do get crusting, nasty colorful discharge, I could write a 4 four page paper on the process all the way to multiple pneumonia's over the years.....and then I could write a two page tutorial on how I prevent that most of the time.  With a antihistamines, nasal steroids, saline wash, a machine to vacuum my sinuses (Navage) and a Steam Machine to moisturize them and 'melt' the nastiest. A go to box with expectorant, an old reliable of really deep coughing (until I found out that my 9 day stint in the hospital with AFIB may have been caused by that deep coughing to prevent pneumonia. But the best medicine, is prevention.....a big bubble, that one stays inside of. I can't visit any of my three children at their houses.  They all have animals in the house.