a. Types of Chronic Upper Respiratory Tract Infections Chronic upper respiratory tract infections include chronic rhinitis chronic sinusitis chronic tonsillitis, and chronic laryngitis. b. Evaluating Sinusitis Evaluate sinusitis under . When applying the higher of two possible evaluations under , a history of radical surgery or repeated surgeries is not required if the criteria under the rating formula are otherwise met. Example: The application of results in an evaluation of 50 percent when the evidence shows chronic osteomyelitis, or near constant sinusitis, characterized by headaches pain and tenderness of affected sinus, and purulent discharge, and no evidence of radical surgery or repeated surgery. Reference: For more information on the schedule of rating respiratory conditions, see . c. Identifying the Cause of Coexisting Chronic Upper Respiratory Tract Infections The cause of two or more coexisting chronic upper respiratory tract infections is commonly the same infectious process. However, if two or more chronic infections persist over a period of years, give the probability of causation by separate types of organisms due weight. d. Continuous Upper Respiratory Tract Infections First Manifest After Discharge If all respiratory conditions do not originate in service, there must be evidence of a fairly continuous infection in one or more parts of the upper respiratory tract to warrant service connection (SC) for other conditions first manifest after discharge. Carefully consider the character of the infection and possible intervening causes.
direct SC all service films. presumptive SC discharge film (or a service film used for this) and an adequate number of post-service films. f. Referrals for X-Ray Interpretation Under 38 CFR 3.370 and 38 CFR 3.371 Only designees of the Under Secretary for Health are authorized to interpret x-ray films under and . Refer requests for interpretations to the VA medical facility for the local regional office (RO). Note: If the local VA medical facility is not authorized to make such interpretations, the Director will keep the RO informed of the current location of the designated interpreter for the RO area. In such a case, refer requests directly to the clinic, center, or hospital. g. Processing Claims Based on Tuberculin Reaction Reference: For more information on claims based on positive tuberculin reaction, see M21-1, Part IV, Subpart ii, 1.I.1. 3. Arrested Tuberculosis Introduction This topic contains information about arrested tuberculosis, including processing graduated ratings in effect on August 19, 1968 processing ratings in effect after August 19, 1968 requesting examinations during the graduated rating period processing notification of failure to follow treatment or submit to examination, and processing cases of irregular discharge. Change Date August 3, 2011
tuberculosis has reached a stage of complete arrest or inactivity. If the Veteran complies with the request for examination during the original two-year time frame for the 100-percent graduated rating, restore the rating effective the date of reduction. e. Processing Cases of Irregular Discharge Do not suspend or discontinue payments merely because a Veteran with active tuberculosis receives an irregular discharge. An irregular discharge is received for disciplinary reasons, the refusal to accept or follow treatment, the refusal to accept transfer, or failure to return from an authorized absence. In the case of irregular discharge, continue the 100-percent evaluation based on activity, and request an examination six months from the date of irregular discharge. If the Veteran fails to report for this examination, consider the tuberculosis to be completely arrested from the date of failure to report for examination. Apply the provisions of graduated ratings based upon inactivity from this date. Note: Compensation payments are based upon the degree of disability, not on the basis of a Veteran’s willingness to accept treatment. 4. Exhibit 1: Examples of Ratings for Arrested Tuberculosis Introduction This exhibit contains four examples of ratings for arrested tuberculosis. Change Date December 29, 2007 a. Example 1 Situation: A Veteran is 30-percent disabled based upon residuals of far advanced, inactive, pulmonary tuberculosis. The rating for tuberculosis was in effect on August 19, 1968. The tuberculosis became active on September 10, 2002. Result: Based upon the reactivation of pulmonary tuberculosis, reinstate the 100-percent evaluation for active tuberculosis and maintain control to ascertain the date of inactivity. Coded Conclusion