Paralysis of Accommodation — VA Disability Rating Criteria (DC 6030)

Diagnostic Code 6030 · 38 CFR §4.79

What Is It?

DC 6030 is a single-figure code. Its entry in 38 CFR 4.79 reads, in full, "Paralysis of accommodation (due to neuropathy of the Oculomotor Nerve (cranial nerve III)) — 20." One criterion, one percentage. There is no bilateral tier and no unilateral tier: the schedule draws no laterality distinction under this code, and 20 percent is the evaluation whether one eye or both are affected. That is worth stating plainly because the neighbouring codes do split by laterality and it is easy to assume this one follows suit. DC 6020 ectropion, DC 6021 entropion, DC 6022 lagophthalmos and DC 6025 disorders of the lacrimal apparatus are each 20 percent bilateral and 10 percent unilateral. DC 6030 is not written that way. A decision assigning 10 percent for unilateral paralysis of accommodation has applied a rule from a different code. The parenthetical in the title is not decorative — it is the code's scope. This is paralysis of accommodation due to neuropathy of the oculomotor nerve, cranial nerve III. That nerve carries the parasympathetic fibres to the ciliary muscle, which changes the shape of the lens to focus at near. When those fibres are damaged the ciliary muscle cannot contract and the eye is locked at its distance focus, so near work becomes impossible without a separate correction. In veterans the recurring mechanisms are traumatic brain injury, orbital and midface fracture, blast, and compressive or ischaemic lesions along the nerve's course. Because cranial nerve III also supplies four of the six extraocular muscles and the levator of the upper lid, accommodation is rarely the only deficit when it is truly paralysed. Look for the companions and claim them: ptosis is DC 6019, diplopia is DC 6090 and is scored by the degrees of the visual field in which double vision appears, and a fixed dilated pupil produces disabling photophobia. Note that where a compensable evaluation is not warranted, 38 CFR 4.31 provides for a 0 percent evaluation — that is the general rule for the whole schedule rather than a tier under this code.

Rating Criteria

Evidence Needed

Two things have to be established: that accommodation is genuinely paralysed, and that the cause is oculomotor nerve neuropathy rather than the ordinary hardening of the lens that comes with age. For the first, near-point-of-accommodation measurement in centimetres, ideally at more than one visit, and the reading addition required in each eye. For the second, the injury or lesion record — the traumatic brain injury documentation, the orbital or midface fracture imaging, or the MRI showing a compressive or ischaemic lesion along the nerve. Pupil findings help substantially, because a sluggish or fixed pupil on the affected side is objective evidence of parasympathetic involvement that a claimant cannot produce at will. Where ptosis or ocular motility restriction accompany the accommodation loss, those examination findings corroborate the cranial nerve III localisation and are separately ratable.

C&P Exam Tips

Ask for accommodation to be tested and recorded as a measurement — near point in centimetres, or amplitude in dioptres — rather than described. Ask for pupil reactivity to be documented in both eyes. If you are under about forty, say so and make the point directly: presbyopia at that age is not expected, and the contrast between your measured amplitude and the age-normal value is the clearest evidence available that this is a neurological deficit. Bring the record of the injury. Describe the functional consequence in specific tasks — reading a screen, reading instrument panels, close work in your trade — since that is what near-vision loss actually costs. If your eyelid droops or you see double, report both; they point to the same nerve and each carries its own evaluation.

How to File

File under DC 6030 with accommodation measurements and the record of the oculomotor nerve injury. Where the cause is a service-connected traumatic brain injury or facial fracture, file as secondary to that condition and name the nerve in the claim. Address the presbyopia question in the claim itself rather than waiting for it to be raised against you, using your age and the measured amplitude. Claim ptosis under DC 6019 and diplopia under DC 6090 in the same filing where they are present, since cranial nerve III lesions commonly produce all three and each is separately evaluated.

Common Mistakes

Accepting a unilateral evaluation of 10 percent is the mistake specific to this code. The schedule assigns 20 percent for paralysis of accommodation without distinguishing one eye from two, and the 10 percent unilateral figure belongs to neighbouring codes that do make that distinction. Read the decision to see which code the rater actually applied. The second common problem is the claim being absorbed into presbyopia — the answer is a measured amplitude compared against the age-normal value, not an argument. Third, veterans present accommodation loss alone when the nerve lesion has also produced ptosis and diplopia, leaving two separately ratable conditions unclaimed. Finally, the loss is described as needing reading glasses, which understates a deficit that reading glasses correct at exactly one distance and no other.

Frequently Asked Questions

Does DC 6030 pay less for one eye than for two?

No. The schedule assigns a single figure — 20 percent — with no unilateral or bilateral split. That is unusual among its neighbours: ectropion, entropion, lagophthalmos and lacrimal disorders are each 20 percent bilateral and 10 percent unilateral. If a decision assigns 10 percent for unilateral paralysis of accommodation, it has borrowed a rule from a code that does not govern.

How is this different from needing reading glasses?

Presbyopia is the gradual stiffening of the lens with age and is expected in everyone by the mid-forties. Paralysis of accommodation is failure of the ciliary muscle because the nerve supplying it is damaged, and it can happen at any age from a single injury. The schedule states the mechanism in the code title itself — neuropathy of the oculomotor nerve, cranial nerve III — which is what has to be established.

Can traumatic brain injury cause it?

Yes, and it is one of the common routes. Cranial nerve III can be damaged by direct trauma, by the shearing forces of a closed head injury, by raised intracranial pressure, or by orbital and midface fracture. Where the TBI is service-connected, the accommodation loss is claimed as secondary to it. The claim needs an opinion naming the nerve, not just records showing both conditions exist.

What evidence proves this is not age-related?

A measured near point or accommodative amplitude compared against the age-normal range, ideally with your age well below the presbyopic years. Pupil findings strengthen it considerably — a sluggish or fixed pupil on the affected side shows parasympathetic involvement of the same nerve, and it is a sign that cannot be produced voluntarily. A documented injury with a plausible mechanism completes the picture.

What else should I claim alongside it?

Whatever else the nerve supplies. Cranial nerve III also innervates the levator muscle of the upper lid and four of the six extraocular muscles, so ptosis under DC 6019 and diplopia under DC 6090 are frequent companions and each is separately evaluated. A fixed dilated pupil causes real photophobia. Claiming only the accommodation loss leaves the rest of the lesion unrated.

Why does the page show only one percentage?

Because the code assigns only one. Some diagnostic codes carry a ladder of tiers and some carry a single figure; DC 6030 is the second kind. Where the criteria for a compensable evaluation are not met, 38 CFR 4.31 provides for a 0 percent evaluation, but that is a general rule applying across the whole rating schedule rather than a tier written into this code.