Retinal Dystrophy and Macular Degeneration — VA Disability Rating Criteria (DC 6042)
Diagnostic Code 6042 · 38 CFR §4.79
What Is It?
DC 6042 was added to 38 CFR 4.79 by the rule effective 13 May 2018 and its full title in the schedule is broad: "Retinal dystrophy (including retinitis pigmentosa, wet or dry macular degeneration, early-onset macular degeneration, rod and/or cone dystrophy)." Like several codes added or amended by that rule, it prints with an empty rating column. The criteria come from the section's opening instruction — unless otherwise directed, evaluate diseases of the eye 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. Note (1) defines an incapacitating episode as an eye condition severe enough to require a clinic visit to a provider specifically for treatment purposes — no bed rest, no minimum duration. Note (2) lists intravitreal or periocular injections and laser treatments among qualifying treatments, which is directly relevant to wet macular degeneration: a veteran on a monthly anti-VEGF schedule reaches the seven-visit criterion for 60 percent on visits alone. Dry macular degeneration and the inherited retinal dystrophies rarely generate that treatment burden, so those claims usually run on the visual-impairment route instead. That sends the evaluation to 38 CFR 4.75 through 4.78 and the visual codes at the end of 4.79. Two features of central retinal disease are worth naming when the claim is prepared. Corrected distance acuity is evaluated with central fixation "even if a central scotoma is present" under 38 CFR 4.76(b)(1), which is a rule written for exactly this disease. And the acuity ladder does bottom out — under DC 6066, 20/40 in one eye and 20/40 in the other is 0 percent — so a real, progressive diagnosis can carry a non-compensable evaluation for years before it becomes compensable. Retinitis pigmentosa and the rod-cone dystrophies present the mirror image: they take peripheral field and night vision first and central acuity last. For those, DC 6080 is the operative code, and its concentric contraction rows are unforgiving in a useful way — a remaining field of 5 degrees is 100 percent bilateral and 30 percent unilateral, 6 to 15 degrees is 70 and 20, 16 to 30 degrees is 50 and 10. A claim examined only with an acuity chart will miss all of that. When VA declined in 2018 to add separate criteria for night blindness, glare sensitivity, loss of contrast and loss of colour vision under this code, its stated reason was that those symptoms are almost always accompanied by measurable changes in acuity, visual field or muscle function — the three components of visual impairment under 38 CFR 4.75. In other words, get the measurements.
Rating Criteria
| Rating | Criteria |
|---|---|
| 60% | Documented incapacitating episodes requiring 7 or more treatment visits for an eye condition during the past 12 months. Alternatively, evaluate on visual impairment if that produces a higher evaluation. |
| 40% | Documented incapacitating episodes requiring at least 5 but less than 7 treatment visits for an eye condition during the past 12 months. |
| 20% | Documented incapacitating episodes requiring at least 3 but less than 5 treatment visits for an eye condition during the past 12 months. |
| 10% | Documented incapacitating episodes requiring at least 1 but less than 3 treatment visits for an eye condition during the past 12 months. |
Evidence Needed
Which evidence matters depends on which form of the disease you have. For wet macular degeneration, the dated list of intravitreal injections over the past twelve months is the highest-value document, because it scores directly against the rating table. For dry macular degeneration and the retinal dystrophies, the case is built on measurement: optical coherence tomography showing drusen, geographic atrophy or outer retinal loss; best-corrected distance and near acuity; formal perimetry under 38 CFR 4.77(a); and, for the dystrophies, electroretinography and any genetic testing that establishes the diagnosis. Amsler grid records document central distortion between visits. For service connection, evidence of the exposure or the service-connected condition relied on, plus a medical opinion; where the condition pre-existed service, the records showing its rate of progression before and after are what an aggravation theory is built from.
C&P Exam Tips
Ask for both distance and near acuity. Central retinal disease damages near vision first in daily life, and an examination that records distance only understates it. Request formal visual-field testing even if your complaint is central — the retinal dystrophies take field before acuity, and a field defect is separately evaluated under DC 6080. Bring OCT images rather than a report summarising them. If you are on injections, hand over the dated list. Describe function in concrete terms — the print size you can no longer read, the distance at which faces stop resolving, whether you still drive at night — rather than as blurring. If you have a rod-cone dystrophy, say so explicitly, because the examination it needs is not the examination age-related macular degeneration needs.
How to File
File under DC 6042 with the diagnosis, the measurements, and the theory of service connection stated plainly — direct, secondary to a service-connected condition, or aggravation of a condition that pre-existed service. Submit both rating bases where both exist: the treatment-visit list and the visual-impairment testing, since the formula requires VA to pay the higher. Where peripheral field is the impaired component, name DC 6080 in the claim so perimetry is ordered rather than assumed unnecessary.
Common Mistakes
Assuming an age-related or inherited condition cannot be service-connected ends more of these claims than any rating argument. Aggravation and secondary service connection are both available, and neither requires the disease to have originated in service. The second mistake is accepting an acuity-only examination for a condition that attacks the visual field — the dystrophies in particular are systematically under-rated this way. Third, veterans on anti-VEGF injections often argue their vision loss and never mention the visit count, when the count alone can produce a higher evaluation than the vision does. Finally, a non-compensable evaluation is treated as a loss and left unappealed, when it has in fact established service connection and the effective date for every increase that follows.
Frequently Asked Questions
Why does 38 CFR 4.79 show no criteria beside DC 6042?
Because the section supplies them once at the top rather than repeating them at each code. Section 4.79 directs that, unless otherwise directed, diseases of the eye are evaluated under the General Rating Formula for Diseases of the Eye. DC 6042 was added by the rule effective 13 May 2018 without its own criteria for that reason. An empty rating column means the formula governs.
Does this code cover retinitis pigmentosa?
Yes, by name. The schedule title is "Retinal dystrophy (including retinitis pigmentosa, wet or dry macular degeneration, early-onset macular degeneration, rod and/or cone dystrophy)." That breadth is deliberate — VA widened the title in 2018 in response to comments asking whether particular dystrophies were covered.
Can age-related macular degeneration be service-connected?
It can, though not on the basis that it appeared during service. The usual routes are secondary service connection to an already service-connected condition, or aggravation — a showing that service worsened the condition beyond its natural progression. Both require a medical opinion that addresses causation or the rate of worsening, not merely the coexistence of two diagnoses.
I get monthly injections for wet AMD. Does that affect my rating?
Substantially. Note (2) to the General Rating Formula lists intravitreal or periocular injections as qualifying treatment, and seven or more treatment visits in the past twelve months is the 60 percent criterion. Five or six is 40 percent, three or four is 20, one or two is 10. A monthly schedule reaches the top row on visits alone, independent of what your acuity measures.
My acuity is 20/40 in both eyes. Why is my rating 0 percent?
Because that is where the acuity table bottoms out. Under DC 6066, 20/40 in one eye with 20/40 in the other is expressly 0 percent. A zero is not a denial — service connection is established, the effective date is fixed, and you are entitled to VA treatment. For a progressive disease that is a foundation, and increases from it are decided on severity alone.
What if my problem is night vision and glare rather than acuity?
Those are real and they are not separately listed in the schedule. When VA was asked in 2018 to add criteria for night blindness, glare sensitivity, contrast loss and colour loss, it declined on the ground that those symptoms are almost always accompanied by measurable changes in acuity, visual field or muscle function. The practical answer is to have the measurable components measured — particularly perimetry, since field loss is what night-vision complaints usually reflect.