Eyes & Vision — VA Disability Ratings

How Eyes & Vision conditions are rated

Under 38 CFR §4.75(a), visual impairment is evaluated on three measures: visual acuity (excluding developmental errors of refraction), visual field, and muscle function. The examination must be done by a licensed optometrist or ophthalmologist, who must identify the disease, injury or other process causing any impairment found. Visual fields and muscle function are tested only when there is a medical indication of a condition that may affect them.

Visual acuity is rated on "corrected distance vision with central fixation" (§4.76(b)), that is, distance vision as corrected by lenses. Section 4.76 prints a few exceptions: a difference of more than three diopters between the lenses the two eyes need, corneal disorders that contact lenses correct better than glasses, and near vision two or more steps worse than distance vision, in which case corrected distance vision is rated one step poorer than measured. Where measured vision falls between two listed levels, the rater uses the one "which permits the higher evaluation." The percentage comes from a table that pairs the vision in one eye with the vision in the other (DC 6061 to 6066).

Two limits shape single-eye claims. If only one eye is service-connected, §4.75(c) treats the other eye's acuity as 20/40, subject to §3.383(a). And under §4.75(d), the evaluation for visual impairment of one eye "must not exceed 30 percent unless there is anatomical loss of the eye," though other disabilities of the same eye that are not based on vision, such as disfigurement under DC 7800, are combined with it.

Visual fields are measured with Goldmann kinetic perimetry or the automated equivalents §4.77(a) names, recording at least 16 meridians for each eye. The rater finds the average concentric contraction by adding the remaining field at eight principal meridians and dividing by eight; §4.76a lists a normal total of 500 degrees. DC 6080 rates homonymous hemianopsia, loss of half a field, and concentric contraction, and for half-field loss and concentric contraction lets each affected eye instead be evaluated as an equivalent visual acuity. When both acuity loss and field loss are service-connected, each is evaluated separately and the two are combined under §4.25 (§4.77(c)).

Double vision is rated under DC 6090 by where it occurs: diplopia within the central 20 degrees is treated as equal to 5/200 acuity, with lesser equivalents farther out. It is assigned to one eye only, and when it occurs alongside other visual impairment, §4.78(b) makes the poorer eye's acuity one, two or three steps worse, never beyond 5/200. A note to DC 6090 rates diplopia that is "occasional or that is correctable with spectacles" at 0 percent.

Many eye diseases, including uveitis, keratopathy, retinopathy and glaucoma, use the General Rating Formula for Diseases of the Eye. It says to "Evaluate on the basis of either visual impairment due to the particular condition or on incapacitating episodes, whichever results in a higher evaluation." An incapacitating episode is "an eye condition severe enough to require a clinic visit to a provider specifically for treatment purposes," and the formula counts treatment visits over the past 12 months: 10% for one or two, 20% for three or four, 40% for five or six, and 60% for seven or more. Injections, laser treatment, surgery and systemic immunosuppressants are among the printed examples of treatment. Both glaucoma codes add a 10% minimum when continuous medication is required, and the glaucoma pages show how the two paths compare.