The Comments Submitted on Your Behalf Regarding Proposed Changes to the Ratings of the Eyes

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.com would like to submit the following comments regarding the proposed changes to the ratings for The Eyes.

Item #1:

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.

Item #2:

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.

Item #3:

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.