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Tuesday, April 17, 2018

Official Changes to the Rating for the Eyes

On April 10th, the VA published their final changes to the ratings for The Eyes. Of the nine sets of changes that have been proposed so far as part of the VA’s complete rewrite of the VASRD, this is the fifth to be made official and final. 

The other finalized changes were to the ratings for Dental and Oral Conditions and the Endocrine System made last fall, the Mental Disorders made in 2014, and the new Female Reproductive System changes that will go into effect the same time as these Eye changes. 

Other proposed changes include the Hemic and Lymphatic System, the Skin, the Genitourinary System, and the Musculoskeletal System

The following changes will go into effect May 13, 2018, and we’ll officially update all the information on our website at that time. Any Eye conditions rated on or after May 13thwill be based on these new ratings.

Below are the final changes for the ratings of The Eyes. Not everything in the VASRD will be changing, so if something is not discussed below, then it will remain the same as it is now and can be found on our current The Eyes page. 
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The Eye Rating Systems

There are currently two different options for rating Eye conditions: The Visual Impairment Rating System and Incapacitating Episodes. All Eye conditions are rated under one of these two options unless other ratings are specified. Under the new changes, these two options will still be available, but with the following adjustments. 

The Visual Impairment Rating System

Visual Field Rating System

Currently, when rating a Visual Field condition, the entire visual field must be charted using a Goldmann kinetic perimetry test or its equivalent, and the chart must be included in the medical records. If the chart is not included, then the VA Disability Claim is sent back to the physician. Because this causes so many delays, the VA has decided to change the VASRD to only require the physician to clearly record the information needed to rate a visual field condition. The chart itself is no longer required. Similarly, if any additional testing is done, the physician need only record the results, not include the actual chart of the additional tests. The ratings remain the same.

Muscle Dysfunction Rating System

When rating Muscle Dysfunction, the VASRD currently requires a Goldmann kinetic perimetry test to be done and for the chart to be included in the medical records. The new changes will allow a Tangent Screen test to be used instead of a Goldmann, and, just like with the Visual Field, the chart itself will not need to be included in the medical records as long as sufficient information needed to rate the condition is recorded in the physician’s notes. The ratings remain the same.

Incapacitating Episodes

Current:

An “incapacitating episode” is a period of severe symptoms that requires bed rest and treatment prescribed by a physician. If the physician did not prescribe bed rest, it is not considered an incapacitating episode.

If there were incapacitating episodes adding up to 6 weeks or more during the last 12 months, it is rated 60%. If the incapacitating episodes over the last 12 months add up to 4 to 6 weeks, it is rated 40%. Two to 4 weeks is rated 20%, and 1 to 2 weeks is rated 10%.

New: 

An “incapacitating episode” is a period of severe symptoms that requires a visit to a physician for treatment. A treatment must actually be given in order for the visit to count as an incapacitating episode. “Treatments” include laser treatments, surgeries, injections into the eye area, immunosuppressant medications, etc. These visits and the treatments and progress of the condition must be thoroughly documented in medical records. 

A 60% rating is given if there are incapacitating episodes requiring 7 or more treatment visits in the past 12 months. A 40% rating is given if there are incapacitating episodes requiring 5 or 6 treatment visits in the past 12 months. A 20% rating is given if there are incapacitating episodes requiring 3 or 4 treatment visits in the past 12 months. A 10% rating is given if there are incapacitating episodes requiring 1 or 2 treatment visits in the past 12 months.
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The Eye Conditions

Now on to the changes being made to the eye codes themselves. I’ll first list the code exactly as it is now with a link to it on our site. Then I’ll discuss the new code and changes. 
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Code 6006: Retinopathy (or maculopathy) is the swelling of the retina.

- New- Code 6006Retinopathy (or maculopathy) is the swelling of the retina. This code covers all types of retinopathy and maculopathy that are not covered by any other code.

The only change to this code is to specify that all types not covered elsewhere are rated here. Seems pretty obvious, but okay. 
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Code 6009All other unhealed eye injuries are rated under this code.

-New- Code 6009: All other unhealed eye injuriesare rated under this code, including orbital trauma—injury to the bone of the eye socket—and other eye injuries.

The VA decided to add orbital trauma to this code. Currently damage to the bones in the eye socket isn’t addressed, so choosing the right code has been problematic. With these changes, it will be rated under this code. 
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Code 6011Any retina condition(scars, atrophy, etc.) not rated in the Diseases of the Eye section is rated under this code. If the condition causes irregular vision with double images, extra large images, extra small images or other irregularities, it is rated 10%. This 10% rating is given whether there is one eye or both eyes affected. The condition can be rated on the Visual Impairment Rating System if it would receive a higher rating.

-New- Code 6011Any retina condition(scars, atrophy, etc.) not listed elsewhere is rated under this code. If the condition causes irregular vision with double images, extra large images, extra small images or other irregularities, it is rated 10%. This 10% rating is given whether there is one eye or both eyes affected. The condition can be rated on the Visual Impairment Rating System oron Incapacitating Episodes if it would receive a higher rating under one of those systems.

This code is being changed to ensure that all retina conditions not rated elsewhere is covered by this code. It also expands the rating options for these conditions by allowing them to be rated on either the Visual Impairment Rating System or on Incapacitating Episodes. 
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Code 6013Open-angle glaucoma is a condition where the optic nerve is damaged, normally by high fluid pressure in the eye, causing loss of vision. Unlike angle-closure glaucoma, it progresses slowly over time and is harder to detect before significant vision loss occurs. This condition is rated on the Visual Impairment Rating System. If continuous medication is required for the condition, the minimum rating is 10%.

-New- Code 6013Open-angle glaucoma is a condition where the optic nerve is damaged, normally by high fluid pressure in the eye, causing loss of vision. Unlike angle-closure glaucoma, it progresses slowly over time and is harder to detect before significant vision loss occurs. This condition is rated on the Visual Impairment Rating System or in Incapacitating Episodes, whichever gives the higher rating. If continuous medication is required for the condition, the minimum rating is 10%.

The only change to this code is that it can now be rated on the Incapacitating Episodes rating system if it gives a higher rating.
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Code 6014Malignant tumorsof the eyeball itself are rated under this code. If other things are also affected by the cancer, then each system can be rated separately. So, if the cancer is in the eye and the surrounding skin, then the eye and the skin are each rated separately.

If the cancer is active, and requires chemotherapy, x-ray therapy, surgery, or similar treatments to more than just the eye area, it is rated 100%. This 100% rating will continue for the first 6 months following the completion of the any treatment. The condition will then be reevaluated and rated based on any continuing symptoms, like vision loss.

If the cancer is active, but does not require chemotherapy, x-ray therapy, surgery, or similar treatments to more than just the eye area, then each symptom, like visual impairment, muscle impairment, or disfigurement, is individually rated.

-New- Code 6014: Malignant tumorsof the eye, eye socket, conjunctiva, eyelids, or lacrimal apparatus are rated under this code. If the cancer also affects other things, like the skin, then they can be rated separately. So, if the cancer is in the eye and the surrounding skin, then the eye and the skin are each rated separately.

If the cancer is active, and requires chemotherapy, x-ray therapy, surgery, or similar treatments to more than just the eye area, it is rated 100%. This 100% rating will continue for the first 6 months following the completion of the any treatment. The condition will then be reevaluated and rated based on any continuing symptoms, like vision loss.

If the cancer is active, but does not require chemotherapy, x-ray therapy, surgery, or similar treatments to more than just the eye area, then each symptom, like visual impairment, muscle impairment, or disfigurement, is individually rated.

Basically, the only thing that changed for this code was to expand it from just the eyeball to include the socket, eyelids, conjunctiva, and lacrimal apparatus.
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Code 6015All other benign tumors affecting the eye are rated under this code and can be rated two times. Once for any effect it has on visual ability, and once for any nonvisual impairment, like disfigurement.

-New- Code 6015: All other benign tumors affecting the eye, eye socket, conjunctiva, eyelids, or lacrimal apparatus are rated under this code and can be rated two times:  once for any effect it has on visual ability, and once for any nonvisual impairment like disfigurement.

This code was also changed to include the eye, socket, eyelids, conjunctiva, and lacrimal apparatus. The ratings requirements remain the same.
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Code 6017: Trachomatous conjunctivitis is the swelling of the conjunctiva due to a bacterial infection, that continues despite treatment. This is not pink eye. Pink eye is caused by a viral infection and is rated below.

If the condition is currently active, it is rated on any visual impairment. The minimum rating for this condition is 30%. So regardless of the severity of visual impairment, it will at least be rated 30%. If the condition is not currently active, then it is rated on any lasting symptoms.

-New- Code 6017: Trachomatous conjunctivitis is the swelling of the conjunctiva due to a bacterial infection, that continues despite treatment. This is not pink eye. Pink eye is caused by a viral infection and is rated below.

If the condition is currently active, it is rated on Visual Impairment or Incapacitating Episodes, whichever gives the higher rating. The minimum rating for this condition is 30%. If the condition is not currently active, then it is rated on any lasting symptoms.

The only change to this code is to include Incapacitating Episodes as a rating option for an active infection.
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Code 6018: All other conjunctivitis conditions are rated under this code. Conjunctivitis can be caused by many things including reactions to chemical exposure and viruses. Viral conjunctivitis is popularly known as “pink eye.” Conjunctivitis is not ratable unless it is chronic—lasts a long time and is not responsive to treatment, or regularly returns despite treatment.

If the conjunctivitis is currently active with symptoms like redness, irritation, seeping, etc., it is rated 10%. If it is not active, it is rated on any lasting symptoms like visual impairment.

-New- Code 6018: All other conjunctivitis conditions are rated under this code. Conjunctivitis can be caused by many things including reactions to chemical exposure and viruses. Viral conjunctivitis is popularly known as “pink eye.” Conjunctivitis is not ratable unless it is chronic—lasts a long time and is not responsive to treatment, or regularly returns despite treatment.

If the conjunctivitis is currently active, it is rated either on the Visual Impairment Rating System or on Incapacitating Episodes, whichever gives the higher rating. The minimum rating for an active condition is 10%. If it is not active, it is rated on any lasting symptoms, like visual impairment. 

The rating options for this code are being expanded to include Incapacitating Episodes, and a 10% minimum rating is being added for an active condition. 
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Code 6026: Optic neuropathy is basically damage to the optic nerve. Any optic nerve damage that is not caused by high fluid pressure (glaucoma) is rated under this code. This condition is rated on the Visual Impairment Rating System.

-New- Code 6026Optic neuropathyis basically damage to the optic nerve. Any optic nerve damage that is not caused by high fluid pressure (glaucoma) is rated under this code. This condition is rated on the Visual Impairment Rating System or Incapacitating Episodes, whichever gives a higher rating. 

The changes to this code allow Incapacitating Episodes to be a rating option.
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Code 6027: A cataract occurs when the crystalline lens becomes cloudy. It can be slightly cloudy or completely block any light from passing through the lens. This condition can be corrected by surgery. If the surgery has not yet been performed, it is rated on the Visual Impairment Rating System.

If the surgery has been performed, it is still rated on the Visual Impairment Rating System, however it is important to note that the visual field will be measured differently depending on the outcome of the surgery. If a replacement lens is in place (“pseudophakia”) and functions normally, then the ring (isopter) used to rate the condition is the III4e. If it is in place but does not function normally, the ring used to rate it is IV4e. See the lens discussion under the Visual Field Rating System for more specific information.

If a replacement lens was not implanted, then the condition is rated as aphakia.

-New- Code 6027: A cataract occurs when the crystalline lens becomes cloudy. It can be slightly cloudy or completely block any light from passing through the lens. This condition can be corrected by surgery. If the surgery has not yet been performed, it is rated on the Visual Impairment Rating System or on Incapacitating Episodes, whichever gives the higher rating.

If the surgery has been performed, it is still rated on the Visual Impairment Rating System or on Incapacitating Episodes, however it is important to note that the visual field will be measured differently depending on the outcome of the surgery. If a replacement lens is in place (“pseudophakia”) and functions normally, then the ring (isopter) used to rate the condition is the III4e. If it is in place but does not function normally, the ring used to rate it is IV4e. See the lens discussion under the Visual Field Rating System for more specific information.

If a replacement lens was not implanted, then the condition is rated as aphakia.

The changes to this code allow Incapacitating Episodes to be a rating option.
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Code 6034: Pterygium is a condition where benign fibers of the conjunctiva grow into the cornea. This condition is either rated on visual impairmentdisfigurement, or conjunctivitis, whichever most closely reflects the symptoms of the condition.

-New- Code 6034Pterygium is a condition where benign fibers of the conjunctiva grow into the cornea. This condition is either rated on visual impairment, incapacitating episodes, disfigurement, or conjunctivitis, whichever most closely reflects the symptoms of the condition.

The changes to this code allow Incapacitating Episodes to be a rating option.
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Code 6035: Keratoconus is a condition where the cornea gradually changes its shape, causing significant vision problems. This condition is rated on the Visual Acuity Rating System. Since the VASRD clearly states that this condition is to be rated on visual acuity, it cannot also be rated for visual field or muscle dysfunction unless they are caused by an entirely different condition.

-New- Code 6035Keratoconus is a condition where the cornea gradually changes its shape, causing significant vision problems. This condition is rated on the Visual Impairment Rating System or Incapacitating Episodes, whichever gives a higher rating.

This condition is currently limited to being rated only on visual acuity. The new changes, however, remove this limitation and allow it to be rated either on the Visual Impairment Rating System or on Incapacitating Episodes.
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Code 6036: A corneal transplant is rated on the Visual Impairment Rating SystemIf there is also pain and sensitivity to light, the minimum rating for this condition is 10%.

-New- Code 6036: A corneal transplant is rated on the Visual Impairment Rating System or on Incapacitating Episodes, whichever gives the higher rating. If there is pain and sensitivity to light, the minimum rating for this condition is 10%.

The only change to this code is to allow it to be rated on the Incapacitating Episodes rating system if it provides a higher rating.
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-NEW CODE- Code 6040: Diabetic retinopathy is any damage to the retina caused by diabetes. It is rated on the Visual Impairment Rating System or on Incapacitating Episodes, whichever gives the higher rating.

This is a brand new code that the VA is adding to specifically cover visual impairment resulting from diabetes.
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-NEW CODE- Code 6042Retinal dystrophy is the degeneration of the retina over time. Many cases of retinal dystrophy are genetic, but cases that develop in service and meet the requirements for service-aggravation can be rated under this code. All types of retinal dystrophy, including retinitis pigmentosawet or dry macular degenerationearly-onset macular degeneration, and rod and cone dystrophy are all rated under this code. 

It is rated on the Visual Impairment Rating System or on Incapacitating Episodes, whichever gives the higher rating.

The VA is adding this code to cover the large number of occurrences in the veteran population.
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-NEW CODE- Code 6046Post-chiasmal disorders is a broad category that includes many different conditions. The optic chiasm is the part of the brain surrounding the optic nerve. If there is any damage to the brain that affects the eyes, it is rated under this code. This includes any visual problems resulting from TBI, brain infections, degeneration of the brain tissues, etc. Any condition rated under this code is either rated on the Visual Impairment Rating System or on Incapacitating Episodes, whichever provides the higher rating.

Since many brain conditions can affect the eyes, the VA is adding this code to clearly instruct how eye involvement in brain conditions should be rated. 
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Code 6091: Symblepharon occurs when the lining of the eyelid attaches to the conjunctiva because of injury or disease. This restricts the movement of the eye and the ability to open the eyelid. It is either rated on visual impairment, the inability to close the eyelids (code 6022), disfigurement (code 7800), or on other symptoms. Each symptom can be rated separately.

-New- Code 6091Symblepharon occurs when the lining of the eyelid attaches to the conjunctiva because of injury or disease. This restricts the movement of the eye and the ability to open the eyelid. 

It is rated on either visual impairment or incapacitating episodes, whichever gives the higher rating, AND on any other symptoms present not covered by these systems, like the inability to close the eyelids (code 6022), disfigurement (code 7800), or other symptoms. Each additional symptom can be rated separately.

The new changes allow Incapacitating Episodes to be a rating option.

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