How the VA rates asthma, rhinitis, and sinusitis
The PACT Act made three respiratory conditions presumptive for anyone who served near burn pits. The presumption gets you past service connection. It does not get you a rating. The rating comes from three separate codes, and two of them are easy to under-rate.
Who gets the presumption
The PACT Act of 2022 added asthma, allergic rhinitis, and chronic sinusitis (along with rhinosinusitis and a list of cancers) to the conditions presumed to be caused by airborne hazards for veterans with covered service: on or after August 2, 1990 in Bahrain, Iraq, Kuwait, Oman, Qatar, Saudi Arabia, Somalia, or the UAE; and on or after September 11, 2001 in Afghanistan, Djibouti, Egypt, Jordan, Lebanon, Syria, Uzbekistan, Yemen, or the airspace above any of those locations. A single day of covered service qualifies.
For these three conditions there is no requirement that the diagnosis appear within a set period after service. A diagnosis of asthma twenty years after a deployment to Iraq is presumed service connected if you had covered service. There is also no burn-pit registry requirement and no need to prove you were near a burn pit; location and dates are the proof. The presumptive conditions guide covers how presumptions work generally and how to reopen an old denial.
What the PACT Act does not change is the rating schedule. Once the condition is service connected, it is rated on the same criteria as anyone else's, and those criteria turn on test results and treatment records most veterans do not have when they file. The common outcome on a first PACT Act claim is a 0% or 10% rating for a condition the veteran knows is worse than that, because the spirometry was never done and the antibiotic history was never written down.
Asthma: DC 6602
Asthma is rated in 38 CFR § 4.97 on pulmonary function tests and medication, whichever gives the higher rating.
| Rating | What the schedule requires (any one) |
|---|---|
| 10% | FEV-1 of 71 to 80% predicted; or FEV-1/FVC of 71 to 80%; or intermittent inhalational or oral bronchodilator therapy. |
| 30% | FEV-1 of 56 to 70% predicted; or FEV-1/FVC of 56 to 70%; or daily inhalational or oral bronchodilator therapy; or inhalational anti-inflammatory medication. |
| 60% | FEV-1 of 40 to 55% predicted; or FEV-1/FVC of 40 to 55%; or at least monthly physician visits for exacerbations; or intermittent (at least three per year) courses of systemic corticosteroids. |
| 100% | FEV-1 less than 40% predicted; or FEV-1/FVC less than 40%; or more than one attack per week with episodes of respiratory failure; or daily systemic high-dose corticosteroids or immunosuppressives. |
Read the 30% row carefully. Inhalational anti-inflammatory medication is an inhaled corticosteroid, the maintenance inhaler most people with persistent asthma are prescribed. A veteran on a daily controller inhaler is at 30% on medication alone, regardless of what the breathing test says. Veterans rated 10% for asthma are very often on a controller and simply did not bring the prescription to the exam. The 60% tier is reached by three or more courses of oral prednisone in a year, which is a pharmacy record.
The note to the code says that in the absence of clinical findings of asthma at the exam, a diagnosis requires a documented history of asthmatic attacks with PFT evidence. Get the spirometry done, with a bronchodilator response, and bring the report.
Allergic or vasomotor rhinitis: DC 6522
| Rating | What the schedule requires |
|---|---|
| 10% | Without polyps, but with greater than 50% obstruction of the nasal passage on both sides, or complete obstruction on one side. |
| 30% | With polyps. |
There is no 0% tier listed, but rhinitis that does not meet the obstruction threshold is rated 0% as service connected without a compensable degree. The obstruction finding is made by the examiner looking in your nose, so the timing of the exam relative to your symptoms matters, and an ENT note documenting the obstruction and any polyps is worth far more than your description of congestion. If you have had a nasal endoscopy or a CT of the sinuses, that report establishes polyps definitively.
Chronic sinusitis: DC 6510 to 6514
The five sinusitis codes (pansinusitis, ethmoid, frontal, maxillary, sphenoid) all use one General Rating Formula:
| Rating | What the schedule requires |
|---|---|
| 0% | Detected by X-ray only. |
| 10% | One or two incapacitating episodes per year requiring prolonged (four to six weeks) antibiotic treatment; or three to six non-incapacitating episodes per year characterized by headaches, pain, and purulent discharge or crusting. |
| 30% | Three or more incapacitating episodes per year requiring prolonged antibiotics; or more than six non-incapacitating episodes per year. |
| 50% | Following radical surgery with chronic osteomyelitis; or near-constant sinusitis with headaches, pain, tenderness, and purulent discharge or crusting after repeated surgeries. |
An incapacitating episode is defined in the note as one requiring bed rest and treatment by a physician. The practical route to 30% for most veterans is the non-incapacitating count: more than six episodes a year with headache, pain, and discharge. That is a number nobody can reconstruct at an exam, and a log of sinus infections, with dates and the antibiotic prescribed, converts directly into the tier. Pharmacy records showing repeated antibiotic courses are the corroboration.
Three conditions, three ratings, and what they combine with
Asthma, rhinitis, and sinusitis are separate conditions under separate codes, and a veteran with all three gets three ratings, provided the symptoms the examiner attributes to each are distinct. A 30% asthma rating, a 10% rhinitis rating, and a 30% sinusitis rating combine to 56%, which rounds to 60%. The combined rating guide shows the arithmetic.
These conditions are also primaries for secondary claims. Chronic nasal obstruction and sinusitis are a recognized contributor to obstructive sleep apnea, and sleep apnea secondary to a PACT Act rhinitis or sinusitis rating is one of the most common secondary theories filed since 2022. It requires a medical opinion; the presumption does not extend to the secondary. See the secondary conditions guide.
The exam
The respiratory DBQ will include spirometry if the examiner orders it; ask that it be done, and bring any prior PFTs. Bring your full medication list with dates, including every inhaler and every course of oral steroids or antibiotics. For sinusitis and rhinitis, bring ENT records, imaging, and your episode log. The examiner also fills in a section on whether your condition is related to the claimed exposure; for covered service, that box is already answered by the statute, and you can say so. Read Preparing for a C&P exam for the general approach.
The checklist
- Proof of covered service: DD-214, deployment orders, or personnel records showing location and dates.
- A current diagnosis for each condition claimed, from a treating provider.
- Asthma: spirometry with FEV-1 and FEV-1/FVC, and the prescription history for every inhaler and steroid course.
- Rhinitis: an ENT examination documenting the degree of obstruction and whether polyps are present.
- Sinusitis: an episode log and pharmacy records of antibiotic courses, plus any CT or surgical history.
- Each condition listed separately on the 21-526EZ.
READY214's daily check-in records symptoms by date and turns them into the frequency evidence the sinusitis and asthma tiers are built on. Free, no account needed to look.