Vision loss and VA benefits

Glasses alone are not a claim — but an injury on top of them is

This is where most vision claims die.

• Refractive error — nearsightedness, farsightedness, astigmatism — is not by itself something VA can compensate. 38 CFR 3.303(c) says congenital or developmental defects and refractive error of the eye "are not diseases or injuries within the meaning of applicable legislation," and 38 CFR 4.75(a) measures visual acuity "excluding developmental errors of refraction."
• The door that is open: if an in-service disease, injury or surgery caused extra eye disability on top of your refractive error, that is compensable. File for the disease or the injury — the trauma, the surgery, the infection — not for needing glasses.
• A second open door. Under 38 CFR 4.76(b)(1), if your poorer eye needs a lens more than three diopters different from your better eye, that difference is not congenital or developmental refractive error, and the poorer eye or both eyes are service-connected, VA evaluates the poorer eye on whichever of its uncorrected or corrected vision gives the better combined result. That rule favors you. Ask that it be applied.

Four ways your eyes can be rated

Ratings run 0% to 100%. The rules are at 38 CFR §§ 4.75–4.79 on eCFR.gov.

• Visual acuity — how well you see at distance, corrected (38 CFR 4.75, 4.76).
• Visual field — how much peripheral vision you have lost (38 CFR 4.77).
• Muscle function — eye movement, alignment, double vision (38 CFR 4.78).
• Incapacitating episodes — for many eye diseases, VA rates on required treatment visits instead, if that is higher. See the next card. Nobody tells veterans about this one.

You can be paid on clinic visits even if your vision tests well

The General Rating Formula for Diseases of the Eye rates on visual impairment OR on incapacitating episodes — whichever gives the higher evaluation.

• 10% for 1–2 required treatment visits in 12 months
• 20% for 3–4 · 40% for 5–6 · 60% for 7 or more

If only one eye is service-connected

Three rules decide almost every single-eye outcome. Learn all three.

• Your other eye is treated as 20/40. 38 CFR 4.75(c): if visual impairment of only one eye is service-connected, VA uses 20/40 for the other eye no matter what it actually measures. This is why a veteran with one good eye cannot reach the high acuity ratings.
• 30 percent is the ceiling on one eye. 38 CFR 4.75(d): the evaluation for visual impairment of one eye must not exceed 30 percent unless there is anatomical loss of that eye. If you are at 30% on one eye, that is the regulation, not a lowball. Do not pay anyone to chase an increase the rule forbids.
• Anatomical loss with no prosthesis. 38 CFR 4.75(e) provides additional evaluation where there is anatomical loss of one eye and you cannot wear a prosthesis. Say so if that is you.

Eye diagnostic codes

This is not an all-inclusive list. The full schedule is 38 CFR §§ 4.75–4.79.

Diplopia is rated by where in your field it happens

• Diplopia is converted to an equivalent visual acuity depending on where in the field it occurs — as poor as 5/200 in the central 20 degrees, down to 20/40 at 31–40 degrees upward — then read against the acuity codes (38 CFR 4.78).
• An evaluation for diplopia is assigned to only ONE eye (38 CFR 4.78(b)).
• Diplopia that is occasional, or correctable with spectacles, is 0% under DC 6090. A 0% rating still establishes service connection — keep it, and file for an increase if it worsens.
• If you have diplopia plus decreased acuity or field loss, your poorer eye's acuity level is stepped one step poorer (6090 value 20/70 or 20/100), two steps (20/200 or 15/200) or three steps (5/200). It is not rated twice.
• There is no 10% cap on muscle function. Visual impairment of one eye can reach 30%, and more with anatomical loss.

Dry eye has no code — so the code you argue for matters

• VA rates dry eye by analogy to the closest listed eye code under 38 CFR 4.20 and 4.27. Candidates: DC 6001 keratopathy and DC 6018 chronic conjunctivitis — both under the General Rating Formula with a 10% minimum while active — and DC 6025, disorders of the lacrimal apparatus, 20% bilateral / 10% unilateral.
• Ask your examiner to document which pathology is actually present. That is what decides the code.
• Where dry eye is a manifestation of a systemic disease such as Sjögren's syndrome, the systemic condition is rated and the eye impairment is evaluated as part of it.

Direct, secondary, and toxic exposure

A vision condition does not have to have started in uniform to be compensable.

• Secondary service connection. If a service-connected condition caused or worsened your eye condition, you may be eligible. Common paths: traumatic brain injury, diabetes mellitus, hypertension, autoimmune disorders, and the medications or treatments for a service-connected condition.
• Direct. Blast exposure, traumatic injury, disease or surgery during service.

Special Monthly Compensation, and a vehicle

These pay on top of your percentage. They are not automatic and most vision flyers never mention them.

• Special Monthly Compensation (SMC) — paid on top of the schedular rating for anatomical loss or loss of use of an eye, and for blindness. 38 CFR 4.75(f) sends the rater to 38 CFR 3.350 for it, and 38 CFR 4.79 itself footnotes SMC review under 3.350 for diagnostic codes 6061–6065 and for 6080 at 5-degree bilateral concentric contraction. SMC(k) covers loss of use of one eye having only light perception; higher levels — l, m, n, o and the aid and attendance levels — apply to blindness in both eyes and to blindness with deafness. Ask in writing whether you are entitled to SMC.
• Automobile or other conveyance allowance — a one-time payment, VA Form 21-4502, Application for Automobile or Other Conveyance and Adaptive Equipment.
• Adaptive equipment for a motor vehicle — VA Form 10-1394.
• The vision standard for both (38 CFR 3.808(b)(3)): permanent service-connected impairment of vision of both eyes — central visual acuity of 20/200 or less in the better eye with corrective glasses, or more than 20/200 where the peripheral field has contracted so the widest diameter subtends no more than 20 degrees in the better eye.

Exams, glasses, and the rehab program

• Eye exams are for every enrolled veteran. Routine eye exams and preventive vision testing, including glaucoma testing, are part of VA medical benefits for enrolled veterans. You do not need a service-connected eye condition to get an eye exam. If you are enrolled, book one.
• Eyeglasses are the part with a gate. Under 38 CFR 17.149(a), VA furnishes eyeglasses and contact lenses only to veterans otherwise receiving VA care or services — and you must also meet at least one category in 17.149(b): a compensable service-connected disability; former prisoner of war; Purple Heart recipient; receiving benefits under 38 U.S.C. 1151; receiving increased pension for regular aid and attendance or permanently housebound; vision impairment resulting from another medical condition for which you receive VA care, or from its treatment; significant functional or cognitive impairment; or vision impairment severe enough that aids are needed for you to take part in your own medical treatment.
• There is no "one pair per year" rule. Nothing in 38 CFR 17.149 or on VA.gov imposes one. Replacement is based on need — ask your VA eye clinic.
• Contact lenses may be covered when medically necessary.
• Low vision aids, surgery and treatment, medications, therapy and adaptive equipment may be covered.

File it right, and start the clock early

Three review options — and three different clocks

A denial is not the end. But the deadlines are not the same, and missing one costs retroactive pay.

• Higher-Level Review — VA Form 20-0996. Within ONE YEAR of the date on your decision letter. A senior reviewer looks at the same evidence again.
• Board Appeal — VA Form 10182. Within ONE YEAR of the date on your decision letter. Goes to a Veterans Law Judge.
• Supplemental Claim — VA Form 20-0995. You add new and relevant evidence. No deadline — 38 CFR 3.2501 allows it any time after VA issues notice of a decision, whether the claim is pending or finally decided.
• Contested claim — 60 days, and it goes only to the Board.

Who can help, and what they may charge you

• A Veterans Service Officer (VSO) is free. 38 CFR 14.636 provides that recognized organizations, including their accredited representatives acting as such, "are not permitted to receive fees." They never charge you. Find one: va.gov/get-help-from-accredited-representative
• No one may charge you to file your initial claim. Accredited claims agents and attorneys may charge a fee only for representation provided after VA issues notice of its initial decision, and only under a filed fee agreement.
• Know the ceiling before you sign. Under 38 CFR 14.636, a fee not exceeding 20 percent of past-due benefits awarded is presumed reasonable, and a fee exceeding 33 1/3 percent of past-due benefits is presumed unreasonable. Read the percentage on the agreement out loud before you sign it. If it is above those numbers, take it to a VSO first.
• VA benefits hotline: 800-827-1000 (TTY: 711). VA's hours: 8:00 a.m. to 9:00 p.m. ET, Monday through Friday.
• Eye condition DBQs are published at benefits.va.gov/compensation/dbq_publicdbqs.asp so you can see what the examiner is asked.