Overview
In This Section |
This section contains the following topics:
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1. Basic Rating Principles for Eye Conditions
Introduction |
This topic contains basic rating principles for eye conditions, including
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Change Date |
May 14, 2018
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III.iv.4.C.1.a. Evaluating Visual Acuity |
Evaluate central visual acuity on the basis of corrected distance vision with central fixation, even if a central scotoma is present.
Exception: Evaluate the visual acuity of the poorer eye using either its uncorrected or corrected visual acuity, whichever results in better combined visual acuity, when
Reference: For more information on evaluating based on visual acuity, see 38 CFR 4.76.
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III.iv.4.C.1.b. Measuring Field of Vision |
The examining medical facility retains discretion in the exact method used to measure visual fields. However when visual field testing is required, the facility must use one of the following:
Notes:
References: For more information on
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III.iv.4.C.1.c. Examination Requirements for Diplopia |
38 CFR 4.78 requires use of Goldmann Bowl kinetic perimeter testing or the Tangent Screen for examination of muscle function. The examiner must document the results of muscle function testing by identifying the quadrant(s) and range(s) of degrees in which diplopia exists. Documentation on a Goldmann Perimeter Chart is not required but is acceptable.
A diagnosis of diplopia that reflects the disease or injury that is the cause of the diplopia must be of record.
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III.iv.4.C.1.d. Evaluating Diplopia With Impairment of Visual Acuity or Field |
When the affected field with diplopia extends beyond more than one quadrant or range of degrees, evaluate diplopia based on the quadrant and degree range that provides the higher (or highest) evaluation. When diplopia exists in two separate areas of the same eye, increase the equivalent visual acuity under 38 CFR 4.79, diagnostic code (DC) 6090 to the next poorer level of visual acuity, but not to exceed 5/200.
Follow the steps in the table below when assigning an evaluation to visual impairment when a claimant has both
Example:
Result:
Note: Diplopia that is occasional or that is correctable with corrective lenses is evaluated at zero percent.
Reference: For examples of rating decisions for diplopia, see M21-1, Part III, Subpart iv, 4.C.4.
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III.iv.4.C.1.e. Considering Impairments of Both Visual Acuity and Visual Field |
When there are impairments of both visual acuity and visual field
The combined evaluation for visual impairment can then be combined with any other disabilities that are present.
Example
Situation:
Result: Under 38 CFR 4.25, combine the 30-percent evaluation for visual field loss with the 10-percent evaluation for visual acuity, which results in a 40-percent combined evaluation for bilateral visual impairment.
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III.iv.4.C.1.f. Incapacitating Episodes of Eye Disease |
An incapacitating episode, for the purpose of evaluating diseases of the eye, is a situation in which symptoms are severe enough to require a clinic visit to a provider specifically for treatment purposes.
Notes:
Reference: For more information on incapacitating episodes of diseases of the eye, as well as examples of treatment sufficient to meet the criteria for incapacitating episodes, see 38 CFR 4.79, General Rating Formula for Diseases of the Eye, Notes 1 and 2.
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III.iv.4.C.1.h. Evaluating Anatomical Loss of One Eye With Inability to Wear a Prosthesis |
When the evidence shows anatomical loss of one eye together with inability to wear a prosthesis, increase the evaluation for visual acuity under 38 CFR 4.79, DC 6063 by 10 percent.
Notes:
Reference: For information on consideration of special monthly compensation for anatomical loss of an eye, see M21-1, Part IV, Subpart ii, 2.H.4.j.
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III.iv.4.C.1.i. Considering Visual Acuity in an NSC Eye When the Other Eye Is SC |
When visual impairment of only one eye is SC, either directly or by aggravation, consider the visual acuity of the non-service-connected (NSC) eye to be 20/40, subject to the provisions of 38 CFR 3.383(a).
Example 1 (Direct incurrence)
Situation:
Result:
Example 2 (Aggravation)
Situation:
Result:
References: For more information on
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2. Congenital or Developmental Defects and Refractive Error of the Eyes
Introduction
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This topic contains information on congenital or developmental defects and refractive errors of the eyes, including
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Change Date
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February 2, 2018
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III.iv.4.C.2.c. Refractive Errors |
The effects of uncomplicated refractive errors must be excluded in considering impairment of vision from the standpoint of service connection (SC) and evaluation.
Exception: Myopia may progress rapidly during the periods of service and lead to destructive changes, such as
Notes:
Reference: For more information on considering SC for refractive error of the eye, see 38 CFR 3.303(c).
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III.iv.4.C.2.d. Amblyopia |
Ascertain the etiology of amblyopia in each individual case since a diagnosis may refer to either developmental or acquired causes of lost visual acuity.
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3. Other Eye Conditions
Introduction |
This topic contains information on specific eye conditions, including
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Change Date |
May 14, 2018
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III.iv.4.C.3.a. Glaucoma |
Glaucoma is recognized as an organic disease of the nervous system and is subject to presumptive SC under 38 CFR 3.309(a).
Consider glaucoma, manifested to a compensable degree within one year of separation from an entitling period of service, to be SC on a presumptive basis unless there is
Notes:
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III.iv.4.C.3.b. Cataracts |
38 CFR 4.79, DC 6027, requires that preoperative cataracts are to be evaluated under the General Rating Formula for Diseases of the Eye. If cataracts are postoperative in nature, evaluate under the General Rating Formula for Diseases of the Eye if a replacement lens is present (known as pseudophakia). If there is no replacement lens, evaluate based on aphakia under 38 CFR 4.79, DC 6029.
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III.iv.4.C.3.d. Decision Making Principles – Dry Eye Syndrome |
SC can be established for dry eye syndrome when it is directly incurred in, or aggravated by, service or when secondary to an SC condition.
Exception: Elective procedures, such as laser eye surgery (e.g., LASIK), without unusual results or additional disability attributed to elective procedures are noteligible for SC. Dry eye syndrome is a common result of laser eye surgery, and thus would not be eligible for SC if the etiology of the dry eye syndrome is due solely to an elective procedure.
The disability picture present with dry eye syndrome varies and, therefore, an appropriate analogous DC must be selected dependent on the symptoms noted and etiology. Appropriate DCs may include 38 CFR 4.79, DCs 6013, 6018, or 6025, depending upon the nature and symptomatology. It may also be appropriate to evaluate as a symptom under the evaluation of the underlying condition.
Minimal symptomatology only requiring treatment by non-prescription eye drops would typically only warrant a zero percent evaluation under 38 CFR 4.79, DCs 6013, 6018, or 6025, as it clearly does not approximate the criteria required for a compensable evaluation.
References: For more information on the
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4. Exhibit 1: Examples of Rating Decisions for Diplopia
Introduction |
This exhibit contains three examples of rating decisions for diplopia.
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Change Date |
August 3, 2011
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III.iv.4.C.4.a. Example 1 |
Situation: The Veteran filed an original claim for bilateral impairment of visual acuity on June 1, 2009. VA examination reveals the best distant vision obtainable after correction is 20/200 (6/60) in the right eye and 20/70 (6/21) in the left eye. Diplopia secondary to thyroid myopathy has been diagnosed and is within 24 degrees in the upward quadrant. Diplopia within 24 degrees in the upward quadrant is ratable as 20/70 (6/21) under DC 6090.
Rationale: Because the evaluation for diplopia is 20/70, evaluate visual acuity in the poorer eye (right) as 15/200 per 38 CFR 4.78, one step poorer than it would otherwise warrant.
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III.iv.4.C.4.b. Example 2 |
Situation: The same facts as in Example 1, except the diplopia exists within 24 degrees in the downward quadrant. Diplopia within 24 degrees in the downward quadrant is ratable as 15/200 (4.5/60) under DC 6090.
Rationale: Because the evaluation for diplopia is 15/200, evaluate visual acuity in the poorer eye (right) as 10/200 per 38 CFR 4.78, two steps poorer than it would otherwise warrant.
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III.iv.4.C.4.c. Example 3 |
Situation: The Veteran is SC for impairment of the visual field in the right eye secondary to trauma. The average contraction of the visual field is to 50 degrees, and is ratable equivalent to 20/50 (6/15) at 10 percent. Diplopia has been diagnosed secondary to trauma and exists within 20 degrees in the central area. Diplopia within 20 degrees in the central area is ratable as 5/200 (1.5/60).
Rationale: Since the evaluation for diplopia is 5/200, evaluate the visual field impairment in the SC eye (right) as 20/200 per 38 CFR 4.78, three steps poorer than it would otherwise warrant.
Result: Assign a 20-percent evaluation under 38 CFR 4.79, DC 6090-6066 for diplopia with impairment of the visual field, right eye. Do not assign a separate 10-percent evaluation for contraction of the visual field.
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Historical_M21-1III_iv_4_SecC_04-24-15.doc | May 15, 2019 | 206 KB |
5-14-18_Key-Changes_M21-1III_iv_4_SecC.docx | May 15, 2019 | 65 KB |
Historical_M21-1III_iv_4_SecC_1-14-16.docx | May 15, 2019 | 71 KB |
1-14-16_Key-Changes_M21-1III_iv_4_SecC.docx | May 15, 2019 | 59 KB |
Change-April-24-2015-Transmittal-Sheet-M21-1III_iv_4_SecC_TS.doc.docx | May 15, 2019 | 40 KB |
12_13_05.doc | May 15, 2019 | 54 KB |
in Chapter 4 Rating Specific Disabilities, Part III General Claims Process, Subpart iv General Rating Process
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