At the beginning of June, the VA published their proposed changes to the rating requirements for The Eyes. In response to our blog on these changes, we received a number of comments from you that we have compiled and submitted to the VA. The VA is required to fully consider every comment received before finalizing these changes, so this is a wonderful opportunity for us to speak up and help effect change at a fundamental level.
The VA is rewriting the entire VASRD, so many more opportunities to comment will be coming. Make sure to check back with our blog regularly. We’ll discuss each section of proposed changes thoroughly and request comments from you. Thanks to all who submitted comments for The Eye section. Hopefully, we’ll be able to make a difference.
Here are the comments we submitted to the VA:
On behalf of our staff and the disabled veterans whom we serve, we at www.MilitaryDisabilityMadeEasy.comwould like to submit the following comments regarding the proposed changes to the ratings for The Eyes.
One of the main goals with the rewrites of this section of the VASRD was to categorize the conditions in a way that would make it easier to find the appropriate codes and to apply analogous ratings. To more fully meet this goal, we suggest the following changes:
While the conjunctiva lines the inside of the eyelids (an external part), it also covers the sclera (an internal part). Some conditions involving the conjunctiva, like conjunctivitis, are categorized under the Corneal Diseases section. It thus would make more sense for Code 6034, pterygium (a condition involving the conjunctiva and the cornea), and Code 6037, pinguecula (a condition specifically involving the conjunctiva in between the cornea and sclera), to be categorized under the Corneal Diseases section. They really are not external eye conditions since they predominantly affect the conjunctiva in the eye itself, not the eyelid.
To more precisely define these conditions and categories, it may be more effectual to rename the Corneal Diseases section to Corneal and Conjunctival Diseases, or instead to create an entirely new category specifically for Conjunctival Diseases. The Conjunctival Diseases section would then include four codes: 6034, 6037, 6017, and 6018.
Similarly, code 6019 for ptosis would be more appropriately listed under External Eye Diseases, not Neuro-Ophthalmic Conditions. It is true that nerve damage is the leading cause of ptosis, but it is not the only cause. Trauma to the muscles, lesions, and other mechanical and myogenic instigators can also cause ptosis. Thus, by categorizing this as a nerve condition, it seems to suggest that this code is limited to only ptosis caused by nerve damage. Further, since this code includes disfigurement as a rating option, the code itself attests that one of the main disabilities caused by ptosis is the drooping of the eyelid itself, thus supporting the reclassification as an External Eye Disease, which includes all other conditions of the eyelid.
The Evaluation of Visual Acuity as it is currently found in the VASRD is based on corrected distance vision. This is in line with the predominant principle found throughout the VASRD that a condition that can be satisfactorily treated does not really constitute a disability and thus should not be rated. No functional disability, no rating.
There is, however, a huge conflict in the way vision conditions are rated and the way hearing conditions are rated. While vision is rated on corrected vision, hearing is not rated on corrected hearing. All tests for auditory conditions are performed without the use of hearing aids and rated as such. This is a huge inequality, especially considering that a person who loses their glasses or contacts would be much more immediately encumbered than one who loses their hearing aids. To create greater fairness throughout the VASRD and to ensure that our disabled veterans are equally compensated for their disabilities, we suggest rating visual acuity based on uncorrected vision.
Following along with the idea that the requirements for rating visual acuity do not fully reflect all veterans’ visual disability, we suggest further developing the rating requirements for visual conditions that cause a greater overall disability than can be properly recorded by the required visual acuity tests. We’ll fully illustrate this point by using a particular example.
One of our veterans has significant keratoconus, but is rated only 0% since he wore his scleral contact lenses during the exam. He was recorded as having 20/40 corrected vision in both eyes.
In reality, however, this veteran has a disability that seriously impacts his daily life. Because of the disease, he is unable to wear his scleral contacts for more than 5 hours every day before they become too painful—enough time to take a vision test, but not enough to function in a full-time job. Currently, he has to drive to work without the contacts (a rather dangerous feat), work for as long as he can, and then spend the rest of the day “being useless.” His disability very definitely affects every aspect of his life, and yet he is rated only 0%.
We acknowledge that the proposed changes to the code for keratoconus would now allow it to be rated on Visual Fields, Muscle Function, or Incapacitating Episodes—a definite improvement in the rating options, but still not necessarily enough to properly rate each case. For example, for Incapacitating Episodes, depending on the rate of progression of the disease, 10 or more visits to the optometrist may not be needed. Just because a veteran doesn’t need to see the optometrist frequently doesn’t mean that his day-to-day life isn’t seriously hindered.
On behalf of this veteran, and others like him, we suggest that one or more of the following changes be made to the ratings of keratoconus and other eye conditions with similar needs. First, allow for visual acuity to be rated on uncorrected vision or otherwise broaden the requirements for rating visual acuity. If not that, then the vision tests should be performed while wearing whatever implement the veteran is able to wear all day, not just the ones that give him the better results in the moment. Alternatively, provide a minimum rating to ensure that the issues that are not being taken into account by the rating systems are otherwise addressed and rated.
It depends on your conditions and the strength of your current evidence in proving service-connection. Compare your evidence and conditions to the information we have on our Nexus Letter page:
I have provided the VA with my records from my physician and letters from individuals stating my disease and how it has affected me everyday. I believe the military missed my eye condition during the physical. What kind of NEXUS letter do I need?
You'll need to provide them with much more evidence in order for them to agree that your condition was caused by this particular event in service. Right now, the evidence implies that the condition could have existed prior to service since your eyes were already bad before basic.
Do you have any evidence that your eyes got significantly worse after this event? Were your eyes treated for anything at all following this event? Is there any clear evidence that shows that your eye condition before the event was definitely not keratoconus?
The VA needs to see some clear evidence that this event affected your eyes. They will then also need to see evidence that your current diagnosis is linked to that event. A Nexus Letter from the physician treating your eyes will be essential.
I had been diagnosed with Keratoconus 20 years ago or more and I served in the Army from 1985-1988. They prescribed me glasses when I wen to basic training as my eyes were already bad. I recently filed for disability for keratoconus because I think my eye problems were caused by the military from chemicals and smoke and powder from fragments from a device that went off during trainning in Germany. They denied me disability so do you think I should request my records from my eye doctor to the VA.
Not yet. We'll update the site as soon as they are, but no definite date on when that will be.
Dr. Johnson do you know if the new rules have gone into effect yet? I have a va appeal to appear before the board on 20 Apr 2018 concerning my eye disability. The new rules if published are more advantages to me if they are in effect. I can't find anywere that the have been changed yet.. thanks Rick
Keratoconus is rated on corrected Visual Acuity, so if your visual acuity with your contacts is not 20/40 in both eyes, then you do qualify for a rating higher than 0%. You can compare the exact visual acuities of both of your eyes with the rating chart on our site to determine what your correct rating should be.
The VA will rate conditions over time, so as they worsen, all you have to do is submit VA Form 21-526b to receive an increased evaluation.
Dr. Johnson. Thank you for your service. I have a question should I reapplied to received a different percent of my service connected diagnosed of keratoconus.
I was diagnosed with keratoconus in my left eye, and I received 0% percent, but it was listed as service connected. After I retired from the military, my keratoconus has moved into my right eye, and it is causing a lot of issues. Before I retired, I was prescribed Gas permeable contact lenses.
Over the past years, I've been seeing an eye specialist, and they stated my vision is getting worse, but I am not ready for corneal transplant.
Should I receive a different rating on my keratoconus because my visual acuity is not correctable to 20/50 in both eyes with corrected lenses or contacts?
Thanks for sharing your thoughts.
The VA doesn't recognize connection between keratoconus and Afghanistan service or asbestos exposure, but possibly a connection will be made in the future.
As for employment, the VA looks at all conditions and how they affect the veteran's ability to hold any gainful employment. As with all vision conditions, we are hoping that they will adjust the corrected vision requirements for ratings (as noted in our comments above), but the type of job is not as much of an issue when looking at their more general rule for employment.
All ratings are based on the presence of a limiting disability, so there are many conditions, that if properly treated so that there are no limiting symptoms, are only rated 0%.
Sir, thank you for your service, and answering all of our questions! It seems the world over is learning to deal with keratoconus and the research into this disease is progressing significantly which I am thankful for! A main concern of mine, is you mentioned before there was no distinct link to scratching eyes and keratoconus, but I would venture to say all of us were told with confidence that was the number one issue. Do you know what else causes this disease? I never required any form of corrective lenses until I reached Kandahar airfield, Afghanistan in 2011. I was at the end of the age window when keratoconus normally begins and I noticed my vision wasn’t as sharp. Once I returned to my home station in 2012 I immediately sought optometry attention and received glasses. As many others I’m sure, nobody knew it was keratoconus for a few more years when I routinely told my doctor the glasses were ineffective after 3-6 months. At Kandahar we were exposed to constant burning of trash and a base wide septic system designed for approximately 2,000 people when there were approximately 20,000 people at the base. This septic system had to be heated and stirred regularly in an attempt to evaporate what could. These were very noticeable! We also held training in a building that we later learned had asbestos chemicals. I am not sure if I am shooting in the dark or not, but seeing there is a doctor interested in the situation I did not know if me speaking my mind would connect any dots at the strategic level for identifying what really does cause keratoconus.
Speaking to the ratings, I wonder how if the VA is able to consider CIV job loss due to illness keratoconus still receives a 0%. Police departments, federal agencies, fire departments, many jobs that interest military members or that typically offer a more comforting transition are forbidden (just as the military) to accept candidates with keratoconus. If they choose to consider vision disability with corrective lenses I believe that should only be for vision problems related to age that would be considered “normal wear and tear.” Are there any other disabilities, surgeries, that claim 0% because it has a less than adequate correction?
In the majority of cases, keratoconus is disqualifying for military service since it is progressive, and the rate of progression is unpredictable. Even though it is only in one eye, it is unlikely that you will pass MEPS.
I only have keratoconus in my left eye can I pass meps
It is incredibly unlikely that they are going to consider your condition service-connected. Scratches are not directly connected to the development of keratoconus, and so I cannot imagine that the VA would consider this service-connected. I honestly think it would not be worth your time to apply for this condition since it was diagnosed so long after service and you don't have a strong connection.
I am trying to find information on applying for benefits. The VA provides my eye exams and I have been diagnosed with Keratoconus. I have 20/400 vision in my right eye without specially made contacts which make my life much more difficult. I received the initial diagnosis in the early 2000's. I was in the army from 89-94 and scratched my eyes multiple times while working in old ammunition supply bunkers in Korea from 90-92. I am just curious to know if this is worth fighting for?
Hi Tierney –
The VASRD does not give an automatic 30% for keratoconus. The official guidelines simply state that it is rated on the Visual Rating System, which does not give any special minimum for keratoconus or for contacts. The proposed changes would also not institute this 30% minimum, so I'm not sure where you got that information from. There is not a minimum rating for this condition as the laws now stand.
As far as I know with keratoconus if contact lenses are prescribed it is an automatic 30% rating.