VA Diagnostic Code 6513Sinusitis, maxillary, chronic.
Rated from 0% to 50% under § 4.97. Here is what the VA requires at each level.
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What each rating requires
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- 50%
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
- 30%
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
- 10%
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
- 0%
Detected by X-ray only
General rating formula
General Rating Formula for Sinusitis (DC's 6510 through 6514)
Notes on this code
These notes are part of the regulation. They change how the levels above are applied.
- Note: An incapacitating episode of sinusitis means one that requires bed rest and treatment by a physician.
Chronic Maxillary Sinusitis (VA Diagnostic Code 6513)
Respiratory System · 38 CFR § 4.97
Understanding This Condition
Chronic maxillary sinusitis is a long-term inflammation of the maxillary sinuses (the sinus cavities located in the cheekbones, behind the face). The VA rates this condition under Diagnostic Code 6513, using the General Rating Formula for Sinusitis that applies to Diagnostic Codes 6510 through 6514.
When evaluating sinusitis, the VA distinguishes between two types of flare-ups:
- Incapacitating episodes — episodes that require bed rest and treatment by a physician.
- Non-incapacitating episodes — flare-ups characterized by headaches, pain, and purulent discharge or crusting that do not require bed rest.
Understanding which type of episode you experience, and how often, is central to how this condition is rated.
Available Rating Levels
The VA assigns one of the following disability ratings based on the frequency and severity of your symptoms:
50% Rating
Assigned following radical surgery with chronic osteomyelitis, or near-constant sinusitis characterized by headaches, pain and tenderness of the affected sinus, and purulent discharge or crusting after repeated surgeries.
30% Rating
Assigned for 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 characterized by headaches, pain, and purulent discharge or crusting.
10% Rating
Assigned for 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 characterized by headaches, pain, and purulent discharge or crusting.
0% Rating
Assigned when the condition is detected by X-ray only.
What the VA Looks For
When rating chronic maxillary sinusitis, the VA focuses on:
- The number of incapacitating episodes per year — episodes requiring bed rest and treatment by a physician.
- Whether episodes require prolonged antibiotic treatment lasting four to six weeks.
- The number of non-incapacitating episodes per year — flare-ups with headaches, pain, and purulent discharge or crusting.
- Specific symptoms, including headaches, pain and tenderness of the affected sinus, and purulent discharge or crusting.
- Surgical history, including radical surgery, repeated surgeries, and the presence of chronic osteomyelitis.
- X-ray findings, particularly where the condition is detected by X-ray only.
This information is based on the VA General Rating Formula for Sinusitis (Diagnostic Codes 6510 through 6514) under 38 CFR § 4.97. Individual ratings depend on the specific medical evidence in each case.
These criteria are a rendering of § 4.97, diagnostic code 6513. The official version is the one that governs your rating.
View official sourceHow to claim this
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