The Eyes

Topics:

Visual Impairment Rating System
Diseases of the Eye
Conditions of the Conjunctiva
Conditions of the Cornea
Conditions of the Lens
Conditions of the Retina
Conditions of the Optic Nerve
Other Nerve Conditions
Conditions of the Eyelids and Tears
Loss of Eyebrows and Eyelashes
Tuberculosis of the Eye
Cancer and Tumors of the Eye
Other Eye Conditions
DBQ for Eye Conditions
Principles that Apply

Reminder: The VA will give a Military Disability Rating for each service-connected condition a service member has, but the DoD will only rate service-connected conditions that make a service member Unfit for Duty.

Additional compensation is given by the VA for blindness. See the Special Monthly Compensation to see if your condition qualifies.

The eye is the organ that senses light and transmits that light as images to the brain. The colored part of the eye is the iris. The dark spot in the middle is the pupil. The pupil allows light to enter the eye. The sclera is the white part of the eye. The iris is covered by a clear dome called the cornea, and the sclera is covered by a clear layer called the conjunctiva.

Once the light enters the eye through the pupil, the crystalline lens helps focus the light on the retina at the back of the eye. The retina then converts the light into electric pulses that run along the optic nerve to the brain.

the anatomy of the eye

Image 1


Note: Your general examining physician CANNOT perform the tests necessary to rate eye conditions. Only a licensed optometrist or ophthalmologist can ensure a rating. The optometrist must clearly diagnose the condition that causes any visual impairment. The necessary tests to rate visual field problems or eye muscle dysfunctions (“double vision”) will only be done IF the optometrist diagnoses a condition that is known to cause these problems.

Normal loss of vision with aging is not ratable, but loss of vision that is caused by an injury or disease can be rated.

Additionally, the back of the eye must be examined while the pupils are dilated to get the most accurate rating. These evaluations are automatically done during VA physicals for individuals complaining of eye problems, but it is ultimately up to you to make sure you get the proper exam and tests so that can you get the best rating possible.



Visual Impairment Rating System

There are three things taken into consideration when rating a vision disability:

– Central visual acuity is how focused or blurry an image is when looking straight at it (“central vision”). “Near-sighted” and “far-sighted” both describe central visual acuity.
– Visual field is the entire visual range that can be seen. Generally, the central vision is the part of the vision that is sharp and focused, while the peripheral vision is blurry. The central vision and peripheral vision to all sides (up, down, right, and left) make up the entire visual field.

the visual field of the eye

Image 2

– Muscle function is literally how well the muscles are able to move the eye to look in different directions. Muscle defects cause what is known as double vision (“diplopia”). Since the two eyes are not able to move and focus together on the same object, a single object is seen and interpreted to be at two different locations.

double vision of the eye

Image 3


This discussion on the Visual Impairment Rating System is divided as follows:

Central Visual Acuity Rating System

Visual Field Rating System

Muscle Dysfunction Rating System

Muscle Dysfunction and Central Visual Acuity
Muscle Dysfunction and Visual Field
Muscle Dysfunction, Central Visual Acuity, and Visual Field

Both visual acuity and visual field can be rated separately. If one eye has a condition that affects both, then it will receive two ratings, one for each. If an eye has a condition that only affects the muscle function, it is rated on its own. If, however, the condition affects the muscle function AND affects visual acuity or visual field, then the rating for visual acuity or visual field will increase depending on how severely the muscle function is impaired. A bit confusing, but this will be discussed in greater detail below.

Note: If only one eye is affected (the other is normal: 20/40 vision or better), then the combined rating of both visual acuity and visual field (including any increase because of limited muscle function) cannot equal more than 30%, unless the affected eye is actually missing. So if only one eye is affected, and the other has perfectly normal 20/20 vision, then 30% is the maximum rating for visual impairment regardless of the severity of the condition. These ratings for visual impairment, however, can be combined to equal more than 30% with other ratings for non-visual eye conditions. Only the total combined rating for visual impairment cannot be more than 30%. Please see the VA Math section for more information on combining ratings.

 


Central Visual Acuity Rating System

Visual acuity is how focused or blurry images are at different distances. To properly rate central visual acuity, it is essential that the examining optometrist performs tests for near and far vision for both uncorrected and corrected (with glasses, contacts, etc.) sight. The most common test is Snellen’s test that has the patient read a chart of letters from a certain distance, and this test or its equivalent must be used in order to rate the condition.

The results of visual acuity will appear in a 20/20 format. The top number in this fraction is the distance in feet between the person and the object being viewed. The bottom number describes how well they see. For example, 20/20 vision tells us that the person can see an object at 20 feet the way a normal person would see it.

This is a bit of a vague concept. Let’s see if we can break it down. If a person has 20/20 vision, he can see an object at 20 feet as well as a “normal” person would see it. If a person has 20/40 vision, he can see the object half as well as a normal person. The bigger the bottom number, the worse vision the individual has. 20/20 vision, however, is NOT perfect vision! 20/20 is merely average, normal vision. A person with 20/10 vision can see the object twice as well as a normal person. The smaller the bottom number, the better the vision. Got it?

For rating purposes, the range of vision goes from 20/40 to 5/200 (decreasing the top number simply makes the bottom number even worse, so 5/200 vision is twice as bad as 10/200 vision. The top number is decreased because the largest letter on the standard eye test chart is 20/200. If the individual is still not able to read it he is moved closer to the chart, thus 10/200—10 feet from the chart, or 5/200—5 feet from the chart). Anything worse than 5/200 is considered blind. Anything better than 20/40 vision is rated as 20/40 vision (so 20/20 or 20/10, etc., is simply rated as 20/40). If the results of the test name a vision that falls between two of the visions listed in the chart below (this would be unusual), simply round to the next worse vision. For example, there is nothing between 20/70 and 20/100 vision, so if the test results say 20/80, it should be rated as 20/100.

Visual acuity is rated for both eyes together. If one eye is not tested, it is assumed to have 20/40 vision for rating purposes.

IMPORTANT!!!!!! VISUAL ACUITY IS ONLY RATED ON CORRECTED DISTANT VISION.

When visual acuity is tested, both near and distant vision will be noted on the report. Only distant vision is used to rate a visual acuity condition, and only CORRECTED distant vision at that. So, no matter how bad the vision is without glasses or contacts, it is rated on how good the vision is with glasses or contacts. If the vision can be corrected, then it is not independently ratable. This includes any correction of astigmatism that can be corrected by contacts but not by glasses. We know this doesn’t quite seem fair, especially since hearing impairments are rated without the use of a hearing aid, but for some reason, the VASRD thinks that glasses and contacts are good enough. Sorry.

The proper corrective lenses must be used during testing to get the ratable best-corrected vision. Make sure that you only use the corrected vision test results when figuring out your rating here in order to find the proper rating.

In the table below, the best eye is listed across the top, and the worst eye is down the left side. The number in the corresponding box is the rating for visual acuity.

Best Eye →
Worst Eye ↓

5/200

10/200

15/200

20/200

20/100

20/70

20/50

20/40

Complete loss of the eye
Code 6063

100%

90%

80%

70%

60%

60%

50%

40%

Complete loss of vision (blind)
Code 6064

100%

90%

80%

70%

60%

50%

40%

30%

5/200
Code 6065

100%

90%

80%

70%

60%

50%

40%

30%

10/200
Code 6066

 

90%

80%

70%

60%

50%

40%

30%

15/200
Code 6066

 

 

80%

70%

60%

40%

30%

20%

20/200
Code 6066

 

 

 

70%

60%

40%

30%

20%

20/100
Code 6066

 

 

 

 

50%

30%

20%

10%

20/70
Code 6066

 

 

 

 

 

30%

20%

10%

20/50
Code 6066

 

 

 

 

 

 

10%

10%

20/40
Code 6066

 

 

 

 

 

 

 

0%

Table 1


A few more important codes:

Code 6061: If both eyes are completely gone, then it is rated 100%.

Code 6062: If both eyes are blind, then it is rated 100%.

Special circumstances:

Both near and distant corrected visions are tested, but only the distant vision is used for rating. If, however, in a single eye the best corrected near vision is two or more steps worse than the best corrected distant vision, then the visual acuity is adjusted upward one step for the distant vision. For example, if the individual has distant visual acuity of 20/40 and near visual acuity of 20/70, then the eye is rated for a distant visual acuity of 20/50.

The prescription of glasses or contacts is measured in diopters. Diopters simply refer to the unit of measurement of lenses. These can be noted as positive or negative. Negative diopters improve the ability to see far away, and positive diopters improve the ability to see close to the body. If the prescription in the worst eye is more than 3 diopters different than the prescription for the best eye, then the worst eye can be rated on corrected or uncorrected vision, whichever results in the better vision when both eyes are used together.

For example, let’s say that the left eye has 20/200 vision that requires a prescription of -4.5 to improve it to 20/50, and the right eye has 20/50 vision that requires a prescription of -1.25 to improve it to 20/20. The difference of the two prescriptions is 3.25, more than 3 diopters. The left eye is either rated at 20/200 or 20/50 depending on whether use of the correction in the left eye results in better or worse vision when both eyes are used. If worse, use the uncorrected vision 20/200 for a rating of 20%. If better, use 20/50 for a rating of 10%.

One last special circumstance. If one of the eyes is missing, and an artificial one cannot be worn because of a medical reason, then the rating for visual acuity increases by 10%. So, if the right eye has best corrected vision of 20/50 and the left eye is missing and unable to wear an artificial eye, then the rating would be 60% (50% for the lost eye and 20/50 vision plus an additional 10%). This condition can additionally be rated under code 7800 for disfigurement since an artificial eye cannot be worn.

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Visual Field Rating System

The visual field is the entire range of vision that can be seen when looking at a fixed point straight ahead. Visual field testing is performed using several different automatic tests. These tests chart the range of vision of each eye without moving the eyeball. A copy of these results is also essential to rating. The chart must be in the medical records.

Here is an example of a plain chart for both eyes. There could also be a chart for only one eye.

the visual field of the eye

Chart 1

The tests chart 16 meridians of the visual field for each eye, but only 8 directions are used for rating: upward, downward, nasally (toward the nose), temporally (away from the nose), and once midway between each of these. These directions are noted in red in the picture above.

The visual field is measured by objects moving from outside the visual field to inside the visual field. As soon as they can be seen, the location is charted. Normally, these objects are rings of light (called “isopters”) produced by the testing machines. Each ring has a different width and brightness, and usually more than one is tested. Based on their width and brightness, each ring has a different name. While many can be tested, the measurements of only one ring are used for rating purposes. If your crystalline lens functions normally or close to normal with contact lenses or an implant, then the ring used for rating purposes is III4e. If the lens does not function normally or is absent or displaced, then the ring used for rating purposes is IV4e. The rings must be labeled on the chart to be properly rated.

Here is an example of a chart with multiple rings.

military disability for ispoters of the eye

Chart 2


The color of the rings is unimportant, but the labels are essential. So in this example, only the green ring, labeled III4e is ratable.

On the following chart is the normal visual field.

military disability for visual field of the eye

Chart 3


The normal field is 65° down, 50° down nasally, 60° nasally, 55° up nasally, 45° up, 55° up temporally, 85° temporally, and 85° down temporally. If you add all these degrees together, the total normal visual field equals 500°.

When the visual field is less than normal, it is called a concentric contraction. It is this concentric contraction that is needed to rate a diminished visual field.


Let’s walk through an example to calculate the concentric contraction.

Below is a concentric contraction of the right eye.

military disability for visual field of the eye

Image 4

The measurements for this ring are as follows:

Up: 35°
Up temporally: 40°
Temporally: 55°
Down temporall
y: 70°
Down: 60°
Down nasally: 25°
Nasally: 40°
Up nasally: 55°

The ratings are based on the average concentric contraction. All we have to do to find this is add all of these measurements together and divide by 8.

35 + 40 + 55 + 70 + 60 + 25 + 40 + 55 = 380

380 ÷ 8 = 47.5°

47.5° is the average concentric contraction of the remaining field, and this is the measurement needed to rate the condition.

Let’s do one more example before getting to the ratings. Here is a concentric contraction in both eyes.

military disability for visual field of the eye

Chart 4

First, let’s calculate the left eye. The measurements are as follows:

Up: 25°
Up temporally: 20°
Temporally: 45°
Down temporally: 40°
Down: 20°
Down nasally: 35°
Nasally: 45°
Up nasally: 35°

Add all these amounts together.

25 + 20 + 45 + 40 + 20 + 35 + 45 + 35 = 265

Divide this by 8 to get the average concentric contraction.

265 ÷ 8 = 33°

33° is the average concentric contraction of the left eye. Now let’s calculate the right eye. The measurements are as follows:

Up: 20°
Up temporally: 25°
Temporally: 50°
Down temporally: 75°
Down: 15°
Down nasally: 10°
Nasally: 10°
Up nasally: 15°

Add all the measurements together and then divide this by 8 to get the average concentric contraction of the remaining field.

20 + 25 + 50 + 75 + 15 + 10 + 10 + 15 = 220

220 ÷ 8 = 27.5°

27.5° is the average concentric contraction of the remaining field of the right eye, and 33° is the left.

Now on to codes and ratings.

Code 6081: Scotoma is a condition where blind spots appear in the visual field with perfectly normal vision all around them. If the blind spots affect ¼ or more of the visual field or if they are centrally located (within the 30° ring), it is rated 10%. If a rating under visual field would give a higher rating than 10%, then it can be used to rate this condition.

Code 6080: All other visual field conditions are rated under this code.

These conditions are either rated on specific visual field loss or on the calculated average concentric contraction. If the condition does not fit into any of the specific visual field losses listed below, it is then rated on the following system:

If the average concentric contraction of the remaining field is 5° or less, it is rated 30% for one eye and 100% for both eyes. If the remaining field is 6-15°, it is rated 20% for one eye and 70% for both eyes. If the remaining field is 16-30°, it is rated 10% for one eye and 50% for both eyes. If it is 31-45°, it is rated 10% for one eye and 30% for both eyes. If it is 46-60°, it is rated 10% for one eye or both eyes.

Here are all the specific visual field losses that have their own ratings:

Homonymous hemianopsia is a condition where one half of the visual field is lost, right or left, in both eyes due to brain damage. This results in blindness on one side and near normal vision on the other. This condition is rated 30%.

military disability for homonymous hemianopsia of the eye

Chart 5

If there is a complete loss of the temporal half of the visual field in one eye, it is rated 10%. If both eyes have a complete loss of the temporal half of the visual field (this would be opposite sides for the eyes – away from the nose), it is rated 30%.

military disability for visual field of the eye

Chart 6

If there is a complete loss of the nasal half of the visual field in one eye, it is rated 10%. If both eyes have a complete loss of the nasal half of the visual field, then it is rated 10%.

military disability for visual field of the eye

Chart 7

If there is a complete loss of the bottom half of the visual field in one eye, it is rated 10%. If both eyes have a complete loss of the bottom half of the visual field, then it is rated 30%.

military disability for visual field of the eye

Chart 8

If there is a complete loss of the top half of the visual field in one eye, it is rated 10%. If both eyes have a complete loss of the bottom half of the visual field, then it is rated 10%.

military disability for visual field of the eye

Chart 9
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Muscle Dysfunction Rating System

military disability for diplopia of the eye

Diplopia (“double vision”) is the term most commonly used to describe limited muscle function in the eye. Literally it means that you see two images when looking at a single object because both eyes aren’t able to move and focus on the object properly. The examining optometrist must chart any decrease in muscle function in all four quadrants on a Goldmann perimeter chart in order for the condition to be rated.

To measure the decrease in muscle function, the Goldmann chart is split into four quadrants: up, down, nasally, and temporally. These are divided by the red x’s in the chart below.

military disability for diplopia of the eye

Chart 10

Muscle dysfunction can exist in one or both eyes. However, it can only be rated for one eye—the worst eye. To rate muscle dysfunction in the eye, a visual acuity measurement (20/20, 20/100, etc.) needs to be assigned to each eye. If only one eye is affected and the other is perfectly normal, then the normal eye is assigned a visual acuity of 20/40, and the other is assigned a visual acuity determined by the degree of limited muscle function. If both have muscle dysfunction, then the worst eye is given a visual acuity based on muscle dysfunction, and the other is assigned 20/40.

The visual acuity assignments for muscle dysfunction are illustrated in the chart below. Each color represents a different visual acuity assignment. The blue section is 5/200. The green section is 15/200. The red section is 20/200. The purple section is 20/100. The orange section is 20/70, and the yellow section is 20/40.

military disability for diplopia of the eye

Chart 11

If there is limited muscle motion in more than one quadrant, then only the quadrant that would get the highest rating is used. So if the motion is limited in the nasal quadrant to 40° and it is also limited in the upper quadrant to 20°, then the upper quadrant would get the higher rating since it has the worse visual acuity assignment: 5/200.

Additionally, if diplopia exists in completely separate areas of the same eye (they are divided by areas of perfectly fine muscle motion), as demonstrated on the chart below, then rate the quadrant that would give the worst visual acuity assignment and then increase the visual acuity to the next worse vision. So, if the assigned visual acuity is 15/200, the next worse would be 10/200.

military disability for diplopia of the eye

Chart 12

The shaded grey areas are the areas where there is double vision. In this case, all four quadrants are in question. In the upper quadrant, the double vision begins at 30° in the far temporal side of the quadrant, even though there is no double vision when looking straight upwards, so this quadrant would be assigned a 20/70 visual acuity. The nasal quadrant is also limited to 30°, an assignment of 20/100. The lower quadrant is only limited to about 50-55°, an assignment of 20/40. The temporal quadrant is completely limited to 25°, an assignment of 20/100.

20/100 is the worst of all these visual acuities, and so it is used to rate the condition. Additionally, because these two areas of muscle dysfunction are separated by areas of good muscle function, the visual acuity will moved to the next worse acuity, 20/200. The visual acuity assignment for this eye is thus 20/200.

Once we have the assigned visual acuity, we can then rate the muscle condition based on the table below. These ratings are only applicable, however, if there are no other visual conditions in either eye. If there are other visual conditions, then it is rated a bit differently, and we’ll discuss this below.

Code 6090: So, as long as there are no central visual acuity or visual field problems as well, it is rated under this code on the following table. We’ll do examples in just a bit to sort out any confusion.

Remember that if the other eye is perfectly normal or hasn’t been tested, it is considered 20/40 for rating purposes.

Muscle-Only Eye →
Other Eye ↓

5/200

10/200

15/200

20/200

20/100

20/70

20/50

20/40

Complete loss of the eye

100%

90%

80%

70%

60%

60%

50%

40%

Complete loss of vision

100%

90%

80%

70%

60%

50%

40%

30%

5/200

100%

90%

80%

70%

60%

50%

40%

30%

10/200

90%

90%

80%

70%

60%

50%

40%

30%

15/200

80%

80%

80%

70%

60%

40%

30%

20%

20/200

70%

70%

70%

70%

60%

40%

30%

20%

20/100

60%

60%

60%

60%

50%

30%

20%

10%

20/70

50%

50%

40%

40%

30%

30%

20%

10%

20/50

40%

40%

30%

30%

20%

20%

10%

10%

20/40

30%

30%

20%

20%

10%

10%

10%

0%

 
Table 2

If the diplopia occurs only occasionally or is corrected with glasses or contacts, it is rated 0%.

Now for an example. Let’s say that the left eye is normal and was not tested. This would then be given an assigned 20/40 visual acuity for rating purposes. The right eye has normal visual acuity and no ratable condition except a muscle dysfunction as noted in the chart below.

military disability for diplopia of the eye

Chart 13

The muscle movement is clearly limited in every quadrant, but only the quadrant that would get the highest rating is used. So first, let’s decide which would get the highest rating. Refer back to Chart 4 to determine the visual acuity assignment. The upper quadrant is limited to 25°, which gets a visual acuity of 20/70. The temporal quadrant is limited to about 35°, which is also assigned 20/70. The lower quadrant is limited to 25°, which is assigned 15/200. The nasal quadrant is limited to 25°, which is 20/100.

The worst visual acuity will get the higher rating, and the worst in this case is 15/200 (the bigger the bottom number or smaller the top number, the worse the vision).

Now we have both eyes’ visual acuities: 20/40 for the left and 15/200 for the right. The corresponding square between these two in Table 2 gives the rating as 20%. Got it?

 

Let’s try a harder one. Both eyes have normal central visual acuity and no ratable condition except double vision as noted in the chart below.

military disability for diplopia of the eye

Chart 14

We must determine which eye is worse, so let’s first find the assigned visual acuity for both. Once we know which is worse, that one will keep the assigned visual acuity, and the other will return to a visual acuity of 20/40 for the condition to be rated.

Start with the left eye. This eye’s movement is limited in all quadrants, so let’s find which has the worst visual acuity assignment. Again refer to Chart 11 to determine the visual acuity assignment. The upper quadrant is limited to 30°, so its assignment is 20/70. The nasal quadrant is limited to 35°, and is also assigned 20/70. The lower quadrant is limited to 30°, so its assignment is 15/200. Lastly, the temporal quadrant is limited to 25°, 20/100.

Of these assigned visual acuities, 15/200 is the worst, so this is the assignment for the left eye.

Now for the right eye. The upper quadrant is limited to 40°, a visual acuity of 20/40. The temporal quadrant is 25°, 20/100. The lower quadrant is 25°, 15/200, and the nasal quadrant is 30°, 20/100. The worst of these is 15/200, and this can be increased to the next worse vision 5/200 since there are two separate areas of muscle dysfunction.

With the right eye assigned 5/200 and the left assigned 15/200, the right eye is the worse eye, and so this one continues to be assigned a 5/200 for rating purposes while the left eye returns to 20/40. The condition can now be rated on Table 2 above, and the rating for this condition is 30%.

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Muscle Dysfunction and Central Visual Acuity

All right, now it’s going to get more complicated. If there are also central visual acuity problems in either eye, then muscle dysfunction is not independently rated. Instead, the rating level of the visual acuity is increased. So if the left eye is normal, and thus assigned 20/40 visual acuity, and the right eye has a measured central visual acuity of 20/100 AND a muscle dysfunction, then the 20/100 will increase (get worse) depending on how bad the muscle dysfunction is. To determine this, we must first determine the assigned visual acuity of the muscle dysfunction as described above, and then use the table below to determine how many steps to raise the central visual acuity.

Assigned Visual Acuity

Steps

10/200 or 5/200

3

20/200 or 15/200

2

20/70 or 20/100

1

20/40 or 20/50

0

 
Table 3

These steps are not allowed to raise the central acuity to more than 5/200. 5/200 is the max.

So, let’s say that the assigned visual acuity from double vision is 20/70. Then the central acuity of 20/100 will get worse by 1 step: 20/200. Now the rating is found in Table 2 for 20/200 for this eye and 20/40 for the other eye: 20%.

Simple? It’s not too bad. One more thing to add to the pot, though. Remember that the rating for a muscle dysfunction is given to the worse eye. When visual acuity is also present, then there are two different times when this comes into play: once when determining which eye to get the muscle dysfunction assignment from, and once when deciding which eye gets the bonus from the muscle dysfunction. Let’s expand this a bit.

If both eyes have both central visual acuity and muscle dysfunction, then we first need to determine which has the worst muscle dysfunction. Once we know which has the worst, that muscle dysfunction is converted to the assigned visual acuity and the number of steps to raise the central visual acuity is determined. Now comes the second stage. Regardless of which eye had the worst muscle dysfunction, the one that has the worst central visual acuity gets the bonus steps from the muscle dysfunction. Got it? So regardless of the muscle dysfunction (let’s say it calculated to 2 steps), if the right eye has a visual acuity of 20/70, and the left 20/100, then the left is the worst eye, and it is increased by 2 steps.


Here’s a full example. The right eye has a corrected central visual acuity of 20/100. The left eye has a corrected central visual acuity of 20/70. It also has a muscle dysfunction as noted in
the chart below.

military disability for diplopia of the eye

Chart 15

Since only the left eye has a muscle dysfunction, it is obviously the worst. So let’s find the assigned visual acuity for this eye due to muscle dysfunction. Refer to Chart 11 to determine the visual acuity assignment. The upper quadrant is limited to 45°, and so is assigned 20/40. The nasal quadrant is limited to 20°, 5/200. The lower quadrant is limited to 30°, 15/200, and the temporal quadrant is not limited at all, 20/40. The worst is 5/200, and because there are two split areas of muscle dysfunction, this should be increased, but 5/200 is the highest, and so it remains.

Now we need to translate the assigned visual acuity to the number of steps to raise the central visual acuity. Refer to Table 3 for the steps. The assigned visual acuity of 5/200 raises the central visual acuity 3 steps.

Now we need to adjust the central visual acuity of the worst eye. The right eye has a central visual acuity of 20/100, and the left of 20/70. The right eye is worse and so it receives the muscle dysfunction bonus of 3 steps, increasing from 20/100 to 15/200. Now we can rate the visual acuity on Table 2: 20/70 for the left and 15/200 for the right—40%.

Another example. The left eye’s central visual acuity is 20/200, and the right eye’s is 20/70. The muscle dysfunction is noted on the chart below.

 

military disability for diplopia of the eye

Chart 16

First we need to determine which eye’s muscle dysfunction is worse. Don’t let the graphs deceive you. One might look worse, but not receive the higher rating, so let’s work them both out.

Let’s start with the left eye. The upper quadrant is limited to 10°, which is assigned 5/200 (Chart 11). The nasal quadrant is limited to 25°, 20/100. The lower quadrant is not limited, 20/40, and the temporal quadrant is limited to 15°, 5/200. The worst muscle dysfunction in this eye is 5/200.

Let’s find the muscle dysfunction of the right eye. The upper quadrant is limited to 40°, 20/40. The temporal quadrant is limited to 40°, 20/70. The lower quadrant is limited to 50°, 20/40. And the nasal quadrant is limited to 40°, 20/70. So the worst muscle dysfunction in the right eye is 20/70.

With a muscle dysfunction of 5/200, the left eye is unquestionably the worst, so this muscle dysfunction is used to determine how many steps the central visual acuity will be raised. Refer to Table 3: 5/200 allows the central visual acuity to raise 3 steps.

Now it is the eye with the worst central visual acuity that gets this 3-step bonus. With the right eye’s central visual acuity at 20/70, and the left’s at 20/200, it is the left eye that get the bonus. So the 20/200 visual acuity raises 3 steps to 5/200.

Now we are ready find the rating on Table 2. 5/200 for the left and 20/70 for the right gets a rating of 50%.

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Muscle Dysfunction and Visual Field

If there is both visual field and muscle dysfunction present, then muscle dysfunction is not independently rated. Instead, the visual field is calculated, converted to visual acuity, and then increased depending on the degree of muscle dysfunction. How much more confusing can it get?

To be able to calculate this correctly, we need to know the visual acuity/visual field equivalents. After the concentric constriction of the remaining field is calculated, use Table 4 below to convert it into a visual acuity measurement.

Remaining Field Contraction

Visual Acuity Equivalent

Loss of temporal half

20/70

Loss of nasal half

20/50

Loss of upper half

20/50

Loss of bottom half

20/70

5° or less

5/200

6 to 15°

20/200

16 to 30°

20/100

31 to 45°

20/70

46 to 60°

20/50

61° or more

20/40

 

Table 4

Now we can increase this visual acuity depending on the degree of muscle dysfunction. After finding the assigned visual acuity of the muscle dysfunction as described in the muscle dysfunction section, the following table is used to determine how many steps to increase the visual acuity that was converted from the visual field.

Assigned Visual Acuity

Steps

10/200 or 5/200

3

20/200 or 15/200

2

20/70 or 20/100

1

20/40 or 20/50

0

 

Table 5

It’s important to note that the muscle dysfunction bonus is given to the worst eye. There are two important steps to this. First, if both eyes have a muscle dysfunction, it is the worst muscle dysfunction that is used to determine how many steps to raise the visual acuity. In the second step, we must determine which of the eyes is raised by the muscle dysfunction. Regardless of which eye had the worst muscle dysfunction and was thus used to determine the number of steps, the eye with the worst visual acuity (this visual acuity is converted from the visual field as noted in Table 4) is the one that gets the bonus. So regardless of which eye had the worst muscle dysfunction, if the right eye’s visual field is converted to a visual acuity of 20/70, and the left eye’s visual field is converted to a visual acuity of 20/100, then the left eye is worse, and so it is the one that is raised however many steps. If only one eye has a visual field dysfunction, then it is the one that is raised.


Here’s an example. The left eye is perfectly normal (20/40 for rating purposes), and the right eye has both a muscle dysfunction and a visual field as charted below.

military disability for diplopia of the eye

Chart 17


Because only one eye is affected, it is the only eye that is used to calculate muscle dysfunction and the visual acuity from the visual field.

First, calculate the visual field. The measurements for the 8 main points are as follows:

Up: 25°
Up temporally: 50°
Temporally: 55°
Down temporally: 40°
Down: 30°
Down nasally: 35°
Nasally: 50°
Up nasally: 40°

Now add all the measurements together and then divide this by 8 to get the average concentric contraction of the remaining field.

25 + 50 + 55 + 40 + 30 + 35 + 50 + 40 = 325
325 ÷ 8 = 40.6°

40.6° is the measurement of the remaining field of the right eye.

Using Table 4, this is converted into an assigned visual acuity of 20/70.

Now we have to find the assigned visual acuity for the muscle dysfunction in this eye. First, find the assigned visual acuities for each quadrant. The upper quadrant is limited to 35°, a visual acuity of 20/40 (see the assigned visual acuities for muscle dysfunction Chart 11 for these assignments). The temporal quadrant is limited to 30°, a visual acuity of 20/100. The lower quadrant is limited to 35°, 20/200, and the nasal quadrant is limited to 40°, 20/70.

The worst visual acuity of these is 20/200, and this we use to determine how many steps to raise the visual acuity converted from the visual field, Table 5. 20/200 = 2 steps. So, our visual acuity that we calculated from the visual field, 20/70, is increased 2 steps to 20/200.

The visual acuity of the left eye is 20/40, and the visual acuity of the right eye is 20/200. This combination receives a rating of 10% found in Table 2.

Here’s a more complicated example: This time, both eyes are affected by both conditions. The right eye has a limited visual field and limited muscle function as shown below.

military disability for diplopia of the eye

Chart 18


The left eye also has a limited visual field and limited muscle function.

military disability for diplopia of the eye
Chart 19


Step 1: Let’s start by finding the muscle dysfunction for both eyes to determine which is worse.

First, find the assigned visual acuities for each quadrant of the right eye. These assignments are noted on Chart 11. The upper quadrant is limited to 45°, a visual acuity of 20/40. The temporal quadrant is limited to 35°, a visual acuity of 20/70. The lower quadrant is limited to 30°, 15/200, and the nasal quadrant is limited to 30°, 20/100. The worst of these is 15/200.

Now let’s do the left to see whether the right or left eye is worse. The upper quadrant is limited to 30°, a visual acuity of 20/70. The temporal quadrant is limited to 30°, a visual acuity of 20/100. The lower quadrant is limited to 25°, 15/200, and the nasal quadrant is limited to 30°, 20/100. The worst of these is 15/200, the same as the right eye. Remember, however, that if the areas of muscle dysfunction are separate like they are in this one, then the assigned visual acuity is raised by one step. So instead of a tie, the left eye has the worst muscle dysfunction at 10/200.

Step 2: Next we must determine how many steps to raise the visual acuity calculated from the visual field.

Using Table 5, we know that 10/200 for muscle dysfunction equals 3 steps.

Step 3: Now we have to convert the visual fields into visual acuities. Both eyes need to be done.

For the left eye, the measurements for the 8 main points are as follows:

Up: 35°
Up temporally: 30°
Temporally: 35°
Down temporally: 30°
Down: 40°
Down nasally: 45°
Nasally: 50°
Up nasally: 40°

Add all the measurements together and then divide this by 8 to get the average concentric contraction of the remaining field.

35 + 30 + 35 + 30 + 40 + 45 + 50 + 40 = 305
305 ÷ 8 = 38°

38° is the measurement of the remaining field of the left eye.

Using Table 4, this is converted into an assigned visual acuity of 20/70.


Now for the right eye. The measurements for the 8 main points are as follows:

Up: 45°
Up temporally: 50°
Temporally: 75°
Down temp
orally: 65°
Down: 60°
Down nasally: 40°
Nasally: 40°
Up nasally: 45°

Add all the measurements together and then divide this by 8 to get the average concentric contraction of the remaining field.

45 + 50 + 75 + 65 + 60 + 40 + 40 + 45 = 420
420 ÷ 8 = 52.5°

52.5° is the measurement of the remaining field of the right eye.

Using Table 4, this is converted into and assigned visual acuity of 20/50.

Step 4: Determine which eye gets the muscle dysfunction bonus. The eye with the worst assigned visual acuity calculated from the visual field gets it, which in this case would be the left eye at 20/70. We know this acuity needs to be raised 3 steps (we figured it out in step 2), so 20/70 becomes 10/200.

Step 5: Finally, find the rating in Table 2.

Based on our calculations, the right eye’s final visual acuity converted from the visual field is 20/50, and the left eye’s is 10/200. The rating for this condition is 40%.

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Muscle Dysfunction, Central Visual Acuity, and Visual Field in the Same Eye

If an eye has all three visual problems, then the system above that would result in the highest rating is used.


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Diseases of the Eye

All diseases of the eyes are rated on the same system.

The codes:

Code 6000: Choroidopathy is the swelling of the tissue beneath the retina.

Code 6001: Keratopathy (a.k.a. Thygeson’s superficial punctate keratopathy, TSPK) is a condition where small lumps form on the cornea of the eye, causing discomfort and irritation.

Code 6002: Scleritis is the irritation and swelling of the sclera.

Code 6006: Retinopathy (or maculopathy) is the swelling of the retina.

Code 6007: Intraocular hemorrhage is bleeding in the eye that can be caused by injury or disease.

Code 6008: Detachment of the retina can occur if fluid is able to get under the retina, whether through a tear or from swelling. This can lead to blindness if not treated immediately.

Code 6009: All other unhealed eye injuries are rated under this code.

These conditions are either rated on the Visual Impairment Rating System or on incapacitating episodes, whichever gives the higher rating. An “incapacitating episode” is a period of severe symptoms that requires bed rest and treatment prescribed by a physician. If the physician did not prescribe bed rest, it is not considered an incapacitating episode.

If there were incapacitating episodes adding up to 6 weeks or more during the last 12 months, it is rated 60%. If the incapacitating episodes over the last 12 months add up to 4 to 6 weeks, it is rated 40%. Two to 4 weeks is rated 20%, and 1 to 2 weeks is rated 10%.

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Conditions of the Conjunctiva

Code 6017: Trachomatous conjunctivitis is the swelling of the conjunctiva due to a bacterial infection, that continues despite treatment. This is not pink eye. Pink eye is caused by a viral infection and is rated below.

If the condition is currently active, it is rated on any visual impairment. The minimum rating for this condition is 30%. So regardless of the severity of visual impairment, it will at least be rated 30%. If the condition is not currently active, then it is rated on any lasting symptoms.

Code 6018: All other conjunctivitis conditions are rated under this code. Conjunctivitis can be caused by many things including reactions to chemical exposure and viruses. Viral conjunctivitis is popularly known as “pink eye.” Conjunctivitis is not ratable unless it is chronic—lasts a long time and is not responsive to treatment, or regularly returns despite treatment.

If the conjunctivitis is currently active with symptoms like redness, irritation, seeping, etc., it is rated 10%. If it is not active, it is rated on any lasting symptoms like visual impairment.

Code 6037: Pinguecula is a condition where the collagen in the conjunctiva thin because of UV light exposure, and so is most commonly seen in tropical climates. It causes the conjunctiva to turn yellow, but usually causes no other symptoms. If it is severe it can only be rated based on disfigurement (code 7800) because of the color of the eye.

Code 6091: Symblepharon occurs when the lining of the eyelid attaches to the conjunctiva because of injury or disease. This restricts the movement of the eye and the ability to open the eyelid. It is either rated on visual impairment, the inability to close the eyelids (code 6022), disfigurement (code 7800), or on other symptoms. Each symptom can be rated separately.

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Conditions of the Cornea

Code 6035: Keratoconus is a condition where the cornea gradually changes its shape, causing significant vision problems. This condition is rated on the Visual Acuity Rating System. Since the VASRD clearly states that this condition is to be rated on visual acuity, it cannot also be rated for visual field or muscle dysfunction unless they are caused by an entirely different condition.

Code 6036: A corneal transplant is rated on the Visual Impairment Rating System. If there is also pain and sensitivity to light, the minimum rating for this condition is 10%.

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Conditions of the Lens

Code 6027: A cataract occurs when the crystalline lens becomes cloudy. It can be slightly cloudy or completely block any light from passing through the lens. This condition can be corrected by surgery. If the surgery has not yet been performed, it is rated on the Visual Impairment Rating System.

If the surgery has been performed, it is still rated on the Visual Impairment Rating System, however it is important to note that the visual field will be measured differently depending on the outcome of the surgery. If a replacement lens is in place (“pseudophakia”) and functions normally, then the ring (isopter) used to rate the condition is the III4e. If it is in place but does not function normally, the ring used to rate it is IV4e. See the lens discussion under the Visual Field Rating System for more specific information.

If a replacement lens was not implanted, then the condition is rated on the next code.

Code 6029: Aphakia is a condition where there is no lens in the eye. If there is a lens, but it has been dislocated, then it is also rated under this code. This condition is rated on the Visual Impairment Rating System.

These conditions can be corrected by contact lenses in some instances. If the condition can be corrected so that the eye functions normally or close to normally, then the ring used to rate it is III4e. If the condition is not satisfactorily corrected, the ring used to rate it is IV4e. See the lens discussion under the Visual Field Rating System for more specific information.

Once the visual impairment is calculated, it is raised one step. So, if the visual acuity is 20/70, it would be raised to 20/100 before being rated. The same goes for the visual field. The minimum rating for this condition is 30%.

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Conditions of the Retina

Code 6011: Any retina condition (scars, atrophy, etc.) not rated in the Diseases of the Eye section is rated under this code. If the condition causes irregular vision with double images, extra large images, extra small images or other irregularities, it is rated 10%. This 10% rating is given whether there is one eye or both eyes affected. The condition can be rated on the Visual Impairment Rating System if it would receive a higher rating.

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Conditions of the Optic Nerve

Code 6012: Angle-closure glaucoma (or closed-angle glaucoma) is a condition where the optic nerve is damaged, normally by high fluid pressure in the eye, causing loss of vision. It is very sudden and painful, and the loss of vision can occur very quickly if not treated right away. This condition is either rated on the Visual Impairment Rating System or on incapacitating episodes (below), whichever results in the higher rating.

An incapacitating episode is defined as a period of severe symptoms that requires bed rest prescribed by a physician. If the physician did not prescribe it, then it does not qualify to be rated as an incapacitating episode.

If there were incapacitating episodes that equal a total of 6 weeks or more during the past 12 months, it is rated 60%. If the episodes equal a total of 4-6 weeks during the past 12 months, it is rated 40%. If they equal a total of 2-4 weeks during the past 12 months, it is rated 20%. The minimum rating is 10% if medication is constantly needed to control the symptoms.

Code 6013: Open-angle glaucoma is a condition where the optic nerve is damaged, normally by high fluid pressure in the eye, causing loss of vision. Unlike angle-closure glaucoma, it progresses slowly over time and is harder to detect before significant vision loss occurs. This condition is rated on the Visual Impairment Rating System. If continuous medication is required for the condition, the minimum rating is 10%.

Code 6026: Optic neuropathy is basically damage to the optic nerve. Any optic nerve damage that is not caused by high fluid pressure (glaucoma) is rated under this code. This condition is rated on the Visual Impairment Rating System.

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Other Nerve Conditions

Code 6030: Paralysis of accommodation is a condition where the oculomotor nerve is damaged. This condition causes the eye to be unable to focus or change sight from near to far vision. It is rated 20%.

Code 6016: Central nystagmus is a condition of excessive eye movement (like twitching) that is caused by a central nerve condition and can lead to vision loss. Nystagmus can also be caused by other medical or mental conditions, but only nystagmus caused by a nerve condition can be rated here. It is rated 10%.

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Conditions of the Eyelids and Tears

Code 6019: Ptosis is the drooping of the upper or lower eyelid. Normally this is due to weakness or tiredness in the muscles. It can cause vision problems if left untreated. If it does interfere with proper vision, it can be rated on the Visual Impairment Rating System. If it does not affect vision, then it is rated on disfigurement (code 7800). Only one rating is given for this condition whether or not one or both eyes are involved.

Code 6020: Ectropion is a condition where the lower eyelid turns inside out that is normally caused by weakening muscles or tissues. If it affects one eye, it is rated 10%. If both eyes, it is rated 20%.

Code 6021: Entropion is a condition where the eyelid folds inward. Most often it affects only the lower eyelid, but the upper can be affected as well. If it affects one eye, it is rated 10%. Both eyes, it is rated 20%.

Code 6022: Lagophthalmos is a condition where the eyelids are unable to fully close. This can lead to dryness and infections in the eye. If one eye is affected, it is rated 10%. Both eyes, it is rated 20%.

Code 6032: Loss of the eyelids, whether partial or complete, is rated on both the Visual Impairment Rating System and on any nonvisual condition like disfigurement.

Code 6025: Any condition that affects the production of tears (disorders of the lacrimal apparatus) is rated under this code. If one eye is affected, it is rated 10%. Both eyes, it is rated 20%.

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Loss of Eyebrows and Eyelashes

Code 6023: If there is a complete loss of eyebrows, whether on one eye or both, it is rated 10%.

Code 6024: If there is a complete loss of eyelashes, whether on one eye or both, it is rated 10%.

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Tuberculosis of the Eye

Code 6010: Tuberculosis of the eye is rated as nonpulmonary tuberculosis.

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Cancer and Tumors of the Eye

Cancer is the growth of abnormal cells. These cells can be benign—they do not attack the good cells around them—or they can be malignant—they attack the cells around them.

Code 6034: Pterygium is a condition where benign fibers of the conjunctiva grow into the cornea. This condition is either rated on visual impairment, disfigurement, or conjunctivitis, whichever most closely reflects the symptoms of the condition.

Code 6015: All other benign tumors affecting the eye are rated under this code and can be rated two times. Once for any effect it has on visual ability, and once for any nonvisual impairment like disfigurement.

Code 6014: Malignant tumors of the eyeball itself are rated under this code. If other things are also affected by the cancer, then each system can be rated separately. So, if the cancer is in the eye and the surrounding skin, then the eye and the skin are each rated separately.

If the cancer is active, and requires chemotherapy, x-ray therapy, surgery, or similar treatments to more than just the eye area, it is rated 100%. This 100% rating will continue for the first 6 months following the completion of the any treatment. The condition will then be reevaluated and rated based on any continuing symptoms, like vision loss.

If the cancer is active, but does not require chemotherapy, x-ray therapy, surgery, or similar treatments to more than just the eye area, then each symptom, like visual impairment, muscle impairment, or disfigurement, is individually rated.

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Other Eye Conditions

All other eye conditions will be rated analogously (see the Analogous and Equivalent Codes page) with the above ratings. The bottom line rule is to rate any condition under the code that BEST describes it, even if it is not exact.

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DBQ for Eye Conditions

Here is the Disability Benefits Questionnaire (DBQ) used for eye conditions: Eye Conditions DBQ.

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Principles that Apply

Special Monthly Compensation: If your condition makes it impossible to see more than light, you may qualify for the VA’s Special Monthly Compensation.

Pyramiding: A single condition can only be rated once! However, if another condition exists that is additional to the eye condition (not simply caused by it), then it can also be rated.

Probative Value: If two exams record the condition differently, the exam with the most thorough data and performed by the most qualified person in that specialty will be the exam the rating is based on.

A Tie Goes to the Veteran: If there are two equally strong exams with conflicting information, or if the condition can be equally rated under two different codes, then the one that gives the highest rating will be assigned. Every conflict should be resolved in favor of the higher rating.

Accurate Measurements: It is essential that the necessary information to rate your condition is recorded by the physician in your exam. With the information on this page, you should know what needs to be measured and recorded. Make sure this happens correctly to ensure that you receive a proper rating.

Hospital or Convalescent Ratings: Some conditions require periods of hospitalization or constant medical care (at-home nurse, etc.). Any condition that requires this is rated 100% during this intensive treatment. Once it ends, then the 100% rating will continue for a certain period. This period is 3 months unless another length (6 months, 1 year, etc.) is directly specified in the condition ratings. Some patients may need more time to recover than others, so the physician or Rating Authorities can lengthen this time period if they see fit.


Please see the VASRD Principles page for further guidance.



For conditions of the nerves or brain, see The Central Nervous System page. If the condition is caused by trauma to the brain, see the Traumatic Brain Injury (TBI) page. For all other related conditions, see The Ears, the Taste and Smell, The Skin, The Facial Muscles, and The Skull pages.

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