Status Post Corneal Transplant — VA Disability Rating Criteria (DC 6036)

Diagnostic Code 6036 · 38 CFR §4.79

What Is It?

The entry for DC 6036 in 38 CFR 4.79 is short and specific: "Status post corneal transplant: Evaluate under the General Rating Formula for Diseases of the Eye. Minimum, if there is pain, photophobia, and glare sensitivity — 10." Those are the code's only terms. There is no automatic evaluation for the first year after surgery and no post-operative convalescent tier written into the schedule; the code's single minimum is 10 percent, and it is conditional on a symptom triad rather than on time since surgery. Read the minimum as a conjunctive test. The schedule names pain, photophobia and glare sensitivity together. A record documenting one of the three is weaker than a record documenting all three, so it is worth making sure each appears in the clinical notes in its own words. Above that floor, the General Rating Formula governs: evaluate on either visual impairment due to the condition or on documented incapacitating episodes, whichever produces the higher evaluation. The episode count is of treatment visits over the past twelve months — 60 percent at seven or more, 40 percent at five or six, 20 percent at three or four, 10 percent at one or two. Note (1) defines an incapacitating episode as an eye condition severe enough to require a clinic visit to a provider specifically for treatment purposes; there is no bed-rest element. That definition suits a transplanted eye particularly well. Post-keratoplasty care is visit-intensive by nature — suture adjustment and removal, topical steroid titration, intraocular pressure checks on steroid therapy, and any rejection episode with its accelerated follow-up. A veteran in an active rejection episode or a difficult first post-operative year can meet the higher rows on visits alone. As with every code under this formula, the visual-impairment alternative sends the claim to 38 CFR 4.75 through 4.78 and the visual codes at the end of 4.79, subject to the 30 percent one-eye ceiling in 38 CFR 4.75(d) unless the eye has been anatomically lost. One feature of keratoplasty deserves emphasis when acuity is measured. A clear graft frequently produces high irregular astigmatism at the graft-host junction, so spectacle-corrected acuity can substantially understate function while rigid or scleral lens correction restores it — if the eye tolerates the lens. Under 38 CFR 4.76(b)(1) acuity is evaluated on corrected distance vision, which makes the correction actually used a material fact rather than a clinical detail. Where transplantation followed keratoconus, the untransplanted fellow eye remains under DC 6035.

Rating Criteria

Evidence Needed

The operative report establishes the transplant and its type — penetrating keratoplasty, DSAEK, DMEK or deep anterior lamellar — which sets the expected follow-up burden. Alongside it, the records that establish the underlying corneal condition as service-connected, since the transplant is a treatment for that condition rather than an injury of its own. For the minimum evaluation, clinical notes recording pain, photophobia and glare sensitivity by name. For the episode count, a dated list of post-operative visits over the past twelve months, including suture adjustments and removals, steroid reviews, pressure checks and any rejection episode. For visual impairment, best-corrected acuity stated with the correction used, keratometry or topography documenting graft astigmatism, and pachymetry and specular microscopy where endothelial cell loss is being tracked.

C&P Exam Tips

Ask the examiner to state whether the graft is clear, whether any rejection line or oedema is present, and what the current topography shows. Have acuity measured with the best correction you can actually wear, and make sure the report says what that correction was — the difference between spectacle and scleral lens acuity after keratoplasty is often several lines. Report pain, photophobia and glare separately and in those terms rather than describing general discomfort, because the code names all three. Bring the dated visit list; post-transplant care generates a large number of qualifying visits that will not be counted if they are not produced. Mention ongoing topical steroid use and any pressure-lowering drops, since steroid-induced ocular hypertension is a distinct consequence and is separately evaluable under the glaucoma codes.

How to File

File under DC 6036 with the operative report, the records connecting the underlying corneal disease to service, and both rating bases — the dated treatment-visit list and the acuity and topography findings. Do not claim an automatic first-year evaluation; the schedule does not provide one, and a claim built on it invites a denial of the theory rather than an examination of the evidence. Where the graft is failing or has failed, say so plainly and seek an increase on the current findings. Where transplantation followed keratoconus and only one eye was operated on, the fellow eye continues under DC 6035 and should be evaluated in the same decision.

Common Mistakes

Believing there is a minimum 30 percent evaluation for the first year after transplant is the most common misunderstanding of this code, and it is not in the schedule. DC 6036's only minimum is 10 percent, conditioned on pain, photophobia and glare sensitivity. Building a claim on a first-year floor that does not exist wastes the strongest argument actually available, which is the treatment-visit count that post-operative care generates. The second mistake is accepting spectacle-corrected acuity without noting that the graft's irregular astigmatism needs rigid or scleral correction. The third is failing to tie the underlying corneal condition to service, which leaves the transplant itself unconnected. Finally, steroid-induced pressure elevation is treated as a side effect rather than claimed, though it is separately ratable.

Frequently Asked Questions

Is there a minimum 30 percent rating for the first year after a corneal transplant?

No. That provision is not in 38 CFR 4.79. DC 6036 carries one minimum — 10 percent, and only where there is pain, photophobia and glare sensitivity. Otherwise the code is evaluated under the General Rating Formula for Diseases of the Eye. If you have been told to expect an automatic first-year 30 percent, that expectation has no basis in the current schedule.

What is the minimum evaluation and how do I meet it?

Ten percent, where there is pain, photophobia and glare sensitivity. The schedule names all three together, so make sure each is documented in the clinical record in its own terms rather than summarised as discomfort. It is a floor, not a ceiling — the General Rating Formula can produce a higher figure on treatment visits or on visual impairment.

Do my post-operative follow-up visits count toward a rating?

Visits for treatment do. Note (1) to the formula defines an incapacitating episode as an eye condition severe enough to require a clinic visit to a provider specifically for treatment purposes, and Note (2) includes surgical interventions among qualifying treatment. Suture manipulation, steroid titration and rejection management are treatment. Seven or more such visits in twelve months is the 60 percent criterion.

What happens if my graft is rejected?

Rejection clouds the graft and can cause it to fail, which is a change in condition supporting an increased evaluation on the current findings. It also generates intensive follow-up, which counts toward the episode-based rows. A repeat transplant is common; it does not restart any first-year period, because no such period exists in the code.

Why does my acuity look better at the clinic than it does at home?

Usually because of the correction. Keratoplasty commonly leaves high irregular astigmatism at the graft-host junction, which rigid or scleral lenses neutralise and spectacles do not. Under 38 CFR 4.76(b)(1) acuity is evaluated on corrected distance vision, so the record must show which correction produced the figure — and whether you can tolerate wearing it for a working day.

Should I claim the glaucoma my steroid drops caused?

Yes, separately. Steroid-induced ocular hypertension and open-angle glaucoma are well recognised after keratoplasty, and glaucoma has its own codes — DC 6012 for angle-closure and 6013 for open-angle, each with a minimum of 10 percent where continuous medication is required. It is a consequence of treating the service-connected condition and is claimed as secondary rather than mentioned in passing.