Symblepharon — VA Disability Rating Criteria (DC 6091)

Diagnostic Code 6091 · 38 CFR §4.79

What Is It?

Diagnostic Code 6091 assigns no percentage of its own. The entry in 38 CFR 4.79 reads, in full, "Symblepharon: Evaluate under the General Rating Formula for Diseases of the Eye, lagophthalmos (diagnostic code 6022), disfigurement (diagnostic code 7800), etc., depending on the particular findings, and combine in accordance with § 4.25." Your evaluation is built from whichever of those codes your findings reach, and the results are combined. The General Rating Formula is one of those routes. Its opening line reads "Evaluate on the basis of either visual impairment due to the particular condition or on incapacitating episodes, whichever results in a higher evaluation." Documented incapacitating episodes requiring 7 or more treatment visits for an eye condition during the past 12 months are 60 percent; at least 5 but less than 7 are 40 percent; at least 3 but less than 5 are 20 percent; and at least 1 but less than 3 are 10 percent. Note (1) defines an incapacitating episode as "an eye condition severe enough to require a clinic visit to a provider specifically for treatment purposes." Visual impairment is measured under 38 CFR 4.75 through 4.78 and the visual codes at the end of 4.79. Lagophthalmos, the second route the schedule names, is rated under DC 6022 at 20 percent bilateral and 10 percent unilateral. Symblepharon is an adhesion between the conjunctiva of the eyelid and the conjunctiva of the eyeball. It occurs when scar tissue forms between these surfaces, typically after chemical burns, thermal burns, radiation exposure, or severe infections. For veterans, this condition most commonly results from chemical or thermal burns sustained during service. Symblepharon can restrict eye movement, cause chronic dryness, and impair vision depending on its location and extent.

Rating Criteria

Evidence Needed

Ophthalmology examination documenting the location and extent of the adhesion, photographs showing the symblepharon, documentation of the causative injury (chemical burn, thermal burn), records of eye movement limitation, and visual acuity testing if the cornea is involved. Because the schedule sends symblepharon to several codes, bring evidence for each route your findings reach: a dated list of treatment visits during the past 12 months for the General Rating Formula, best-corrected acuity, visual fields and any double vision for visual impairment, a record of whether the lids close fully for lagophthalmos under DC 6022, and clinical photographs for disfigurement under DC 7800.

C&P Exam Tips

Request that the examiner photograph the adhesion and measure how it restricts lid movement and eye rotation. If it causes chronic dryness from poor tear distribution, ensure this is documented. Describe the injury event that caused the scarring and any surgeries attempted to correct it.

How to File

File under DC 6091 with documentation of the service-connected injury (burn, chemical exposure) that caused the scarring. DC 6091 assigns no percentage itself, so expect the decision to name the codes your findings reach, such as the General Rating Formula, lagophthalmos under DC 6022, or disfigurement under DC 7800, combined under 38 CFR 4.25. If the adhesion restricts eye movement and causes double vision, say so in the claim so that diplopia under DC 6090 is examined.

Common Mistakes

Not raising the effects of symblepharon (dry eye, restricted movement, diplopia, incomplete lid closure) so that each is examined. Not documenting the full extent of eye movement limitation. Failing to connect the adhesion to the specific burn or chemical exposure during service. Expecting a fixed percentage for the adhesion itself: DC 6091 has none, so the decision should show which codes were applied to the findings and how they were combined.

Frequently Asked Questions

What percentage does DC 6091 pay?

None by itself. The schedule directs VA to evaluate symblepharon under the General Rating Formula for Diseases of the Eye, lagophthalmos (DC 6022), disfigurement (DC 7800), etc., depending on the particular findings, and to combine the results under 38 CFR 4.25. The percentages in your decision come from those codes.

Can symblepharon be surgically corrected?

Surgery can release the adhesion, but recurrence is common, especially after severe burns. Even if surgery is attempted, the scar tissue may reform. Document any surgical attempts and recurrences to support ongoing disability.

Is symblepharon from chemical burn exposure service-connectable?

Yes. Chemical burns during service are a direct cause of symblepharon. Document the exposure event, any immediate treatment received, and the subsequent development of the adhesion.