Keratoconus — VA Disability Rating Criteria (DC 6035)

Diagnostic Code 6035 · 38 CFR §4.79

What Is It?

DC 6035 appears in 38 CFR 4.79 as a bare line — "6035 Keratoconus" — with an empty rating column and no criteria beside it. The criteria are supplied by the section's opening instruction, which directs that unless otherwise directed, diseases of the eye are evaluated under the General Rating Formula for Diseases of the Eye. That formula pays whichever is higher of two bases: visual impairment due to the condition, or documented incapacitating episodes counted as treatment visits over the past twelve months. For most keratoconus claims the visual-impairment route decides the outcome, and one rule decides that route. Under 38 CFR 4.76(b)(1), central visual acuity is evaluated on corrected distance vision. The question that follows is what correction you can actually wear. Keratoconus is corrected properly only by rigid gas-permeable, scleral or hybrid lenses; spectacles cannot neutralise an irregular cornea, and many veterans lose lens tolerance as the disease advances. An examination that records acuity through a lens you cannot tolerate for a working day measures a vision you do not have. Get intolerance documented in the clinical record, with the fitting history behind it, rather than asserting it at the examination. The same paragraph carries a second rule that keratoconus routinely triggers. Where the lens required to correct distance vision in the poorer eye differs by more than three dioptres from the lens required in the better eye — and the difference is not congenital or developmental refractive error — the poorer eye may be evaluated on either its corrected or uncorrected acuity, whichever produces better combined acuity. Asymmetric keratoconus regularly produces a difference that large, so raise it explicitly. Keratoconus is progressive thinning and conical protrusion of the cornea. Onset is typically in the late teens and twenties, which places it squarely in the years most veterans are on active duty, and it is frequently first documented at a military optometry visit. Corneal cross-linking can halt progression but does not reverse the existing distortion; where the cornea has scarred or lens tolerance is gone, transplantation follows, and a transplanted eye moves to DC 6036. Note also 38 CFR 4.75(d): the visual-impairment evaluation for one eye cannot exceed 30 percent unless the eye has been anatomically lost.

Rating Criteria

Evidence Needed

Corneal topography is the objective record of the disease and, taken serially, the record of its progression — bring the maps rather than a report describing them. Add best-corrected acuity stated together with the correction used, so it is clear on the face of the record whether the figure was obtained through spectacles, rigid lenses or scleral lenses. Contact lens fitting notes are the evidence of tolerance or intolerance, and refits, discomfort entries and abandoned trials matter more than a single statement. Service treatment records showing the first documented keratometry or a change in refraction during service are what carry direct service connection, and entrance examination findings are what an aggravation theory turns on. Include operative records for cross-linking, intrastromal ring segments or transplantation, and pachymetry showing corneal thickness.

C&P Exam Tips

Make sure the examination states which correction the acuity was measured through. Best-corrected means nothing on this page without that detail, and an acuity obtained through scleral lenses you can wear two hours a day is not the vision you live with. If you cannot tolerate rigid lenses, say so and point to the fitting record rather than describing the discomfort. Bring topography maps from more than one date so progression is visible in the file. Ask for the dioptric power of the correcting lens in each eye to be recorded, which is what makes the three-dioptre rule in 38 CFR 4.76(b)(1) checkable. Describe function specifically — ghosting and multiple images around headlights at night, streaking, the print size at which reading fails — since those are the symptoms an acuity chart in a bright lane will not reproduce.

How to File

File under DC 6035 with topography, the acuity figures and the correction used to obtain them, and the service records placing the onset or worsening in service. State the theory: direct service connection where the condition was first documented on active duty, or aggravation where it pre-existed and progressed faster than its natural course. If lens intolerance has developed, put it in the claim in terms, because it changes which acuity figure the evaluation is properly built from. Where the eye has since been transplanted, that eye is evaluated under DC 6036 instead.

Common Mistakes

Accepting an acuity measured through a lens you cannot actually wear is the mistake that most often produces a rating far below the disability. It is rarely challenged because the record looks unremarkable — a normal-seeming corrected acuity with no note about tolerance. The second mistake is never obtaining topography, which leaves the claim resting on refraction figures that also move with ordinary refractive error. Third, the three-dioptre provision in 38 CFR 4.76(b)(1) goes unraised in asymmetric cases where it plainly applies. Finally, veterans whose keratoconus was noted at entrance abandon the claim, when a condition noted at entry can still be service-connected on aggravation if service accelerated it beyond natural progression.

Frequently Asked Questions

Why does 38 CFR 4.79 show no criteria beside DC 6035?

Because the section states the standard once, at the top. Section 4.79 directs that unless otherwise directed, diseases of the eye are evaluated under the General Rating Formula for Diseases of the Eye. Several codes therefore print with an empty rating column. It means the formula applies, not that the code carries no criteria.

How does VA rate keratoconus if I cannot wear rigid contact lenses?

The evaluation should be built on the acuity you achieve with correction you can actually use. Get the intolerance into the clinical record with the fitting history behind it — refits, trial lenses abandoned, wearing time achieved — rather than raising it for the first time at the examination. An acuity figure obtained through a lens you cannot wear is not a measure of your corrected vision.

What is the three-dioptre rule and does it help me?

Under 38 CFR 4.76(b)(1), where the lens required to correct distance vision in the poorer eye differs by more than three dioptres from the better eye, and the difference is not congenital or developmental refractive error, the poorer eye may be evaluated on either corrected or uncorrected acuity — whichever gives better combined acuity. Asymmetric keratoconus commonly crosses that threshold, so ask for the dioptric powers to be recorded.

Can I claim keratoconus if it started before service?

Yes, on aggravation. If it was not noted at entrance, the presumption of soundness applies and the claim proceeds as direct service connection. If it was noted, you can still succeed by showing service worsened it beyond its natural progression — which is a comparison of measurements over time, so entrance findings and serial topography are what the theory is built from.

Does corneal cross-linking affect my rating?

It halts progression but does not undo the distortion already present, so it rarely reduces an evaluation. It does two useful things for a claim: it documents that the disease was progressing enough to warrant intervention, and the procedure and its follow-up are treatment visits, which count toward the incapacitating-episode basis of the formula.

I had a corneal transplant. Does DC 6035 still apply?

The transplanted eye is evaluated under DC 6036, status post corneal transplant, which is governed by the same General Rating Formula but adds a minimum of 10 percent where there is pain, photophobia and glare sensitivity. If only one eye has been transplanted, the other keratoconic eye continues to be evaluated under DC 6035.