PACT Act sinusitis, rhinitis, and asthma ratings

The PACT Act wrote three respiratory conditions into law as presumptive for veterans who served in the burn-pit locations. 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.

Last reviewed October 2026 · Not legal advice, VA.gov always controls

For veterans with covered burn pit service, the PACT Act presumes chronic sinusitis, chronic rhinitis, chronic bronchitis, and asthma diagnosed after that service are service connected, so no nexus opinion is needed. The rating is a separate step under the respiratory schedule: sinusitis 0% to 50% by episodes, rhinitis 10% or 30% by obstruction and polyps, and asthma and chronic bronchitis 10% to 100% by breathing tests, with medication also counting for asthma (38 U.S.C. § 1120(b); 38 CFR § 4.97).

Who gets the presumption

The PACT Act of 2022 lists asthma diagnosed after service, chronic rhinitis, and chronic sinusitis (along with a list of cancers and other conditions, including several chronic lung diseases) as presumed service connected for veterans with covered service. Under 38 U.S.C. § 1119(c), that means being assigned to a duty station in Bahrain, Iraq, Kuwait, Oman, Qatar, Saudi Arabia, Somalia, or the UAE on or after August 2, 1990. It also means a duty station in Afghanistan, Djibouti, Egypt, Jordan, Lebanon, Syria, Uzbekistan, Yemen, or any other country the Secretary determines relevant, on or after September 11, 2001. The airspace above any of these countries counts too.

VA's own regulation, 38 CFR § 3.320, also makes asthma, rhinitis, and sinusitis (including rhinosinusitis) presumptive. For these three conditions, § 3.320 also counts service on or after August 2, 1990 in the waters of the Southwest Asia theater (the Persian Gulf, Red Sea, Gulf of Oman, Gulf of Aden, and Arabian Sea) and the neutral zone between Iraq and Saudi Arabia, including the airspace above them, so service aboard ship in those waters qualifies. Neither the statute nor § 3.320 sets a minimum length of service in the covered location.

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.

Asthma: DC 6602

Asthma is rated in 38 CFR § 4.97 on pulmonary function tests and medication, whichever gives the higher rating. VA proposed rewriting the respiratory and ear, nose, and throat criteria in February 2022, with a supplemental proposal in September 2024, but no final rule has been published as of October 2026, so the criteria in this guide are the ones in force.

Read the 30% row carefully. Inhalational anti-inflammatory medication includes inhaled corticosteroids, the daily maintenance (controller) inhalers used for persistent asthma. A veteran on a daily controller inhaler is at 30% on medication alone, regardless of what the breathing test says. If an asthma rating comes back at 10% while a controller inhaler is prescribed, check whether that prescription was in the record the rater saw. 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 if there are no clinical findings of asthma at the time of the exam, a verified history of asthmatic attacks must be of record. Get the spirometry done, with a bronchodilator response, and bring the report.

Allergic or vasomotor rhinitis: DC 6522

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, bring that report too, since the 30% tier turns on whether polyps are present.

Chronic sinusitis: DC 6510 to 6514

The five sinusitis codes (pansinusitis, ethmoid, frontal, maxillary, sphenoid) all use one General Rating Formula:

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.

One limit applies inside the respiratory codes. Under 38 CFR § 4.96(a), ratings under DCs 6600 to 6817 and 6822 to 6847, a range that takes in asthma, COPD (6604), and sleep apnea (6847), are not combined with each other. VA assigns one rating under the code for the predominant disability, raised to the next higher level where the overall severity warrants it; the sleep apnea guide covers the rule in full. Rhinitis and sinusitis sit outside that range and combine normally.

These conditions are also primaries for secondary claims. Obstructive sleep apnea can be claimed secondary to a PACT Act rhinitis or sinusitis rating under 38 CFR § 3.310, where the evidence shows the nasal condition caused or worsened it. That claim requires a medical opinion; the presumption does not extend to the secondary. See the secondary conditions guide.

The exam

The respiratory DBQ has a section for pulmonary function test results and notes that most respiratory conditions require them; ask that the test be done unless results already in the record reflect your current condition, 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 published respiratory DBQ has no question on exposure; for covered service, the link to service is presumed by 38 U.S.C. § 1120 (for asthma, only if it was diagnosed after that service), and you can say so if the question comes up. Read Preparing for a C&P exam for the general approach.

The checklist

1. Proof of covered service: DD-214, deployment orders, or personnel records showing location and dates.
2. A current diagnosis for each condition claimed, from a treating provider.
3. Asthma: spirometry with FEV-1 and FEV-1/FVC, and the prescription history for every inhaler and steroid course.
4. Rhinitis: an ENT examination documenting the degree of obstruction and whether polyps are present.
5. Sinusitis: an episode log and pharmacy records of antibiotic courses, plus any CT or surgical history.
6. Each condition listed separately on the 21-526EZ.

Sources

• 38 CFR § 4.97, Schedule of ratings: respiratory system. The asthma tiers by FEV-1, FEV-1/FVC, and medication, the chronic bronchitis (DC 6600) and COPD (DC 6604) tiers, the General Rating Formula for Sinusitis with its incapacitating-episode note, and the two rhinitis tiers.
• 38 CFR § 4.96, Special provisions regarding evaluation of respiratory conditions. Paragraph (a) bars combining asthma with other ratings in DCs 6600 to 6817 and 6822 to 6847, including COPD and sleep apnea.
• 38 CFR § 4.31, Zero percent evaluations. A 0% rating is assigned where a code has no 0% tier and the compensable criteria are not met, as with rhinitis.
• 38 CFR § 4.25, Combined ratings table. How separate ratings combine, largest first, and how the result is rounded to the nearest 10.
• 38 CFR § 3.320, Claims based on exposure to fine particulate matter. VA's regulatory presumption for asthma, rhinitis, and sinusitis including rhinosinusitis, manifest to any degree at any time after separation from qualifying service.
• 38 U.S.C. § 1119(c), Presumptions of toxic exposure. The PACT Act definition of a covered veteran: the countries, start dates, and airspace that count as covered service.
• 38 U.S.C. § 1120(b), Presumption of service connection for certain diseases associated with exposure to burn pits and other toxins. The statutory list of burn-pit presumptive diseases, including asthma diagnosed after service, chronic bronchitis, chronic sinusitis, and chronic rhinitis.
• 87 FR 8474 (Feb. 15, 2022), Schedule for Rating Disabilities: Ear, Nose, Throat, and Audiology Disabilities; Special Provisions Regarding Evaluation of Respiratory Conditions; Schedule for Rating Disabilities: Respiratory System, proposed rule. VA's proposed rewrite of the respiratory and ear, nose, and throat rating criteria, which has not been finalized. A supplemental proposal, 89 FR 74162 (Sept. 12, 2024), added a code for constrictive bronchiolitis to the same rulemaking.