VA Disability Ratings for Diabetic Retinopathy

CCK Law: Our Vital Role in Veterans Law

What is Diabetic Retinopathy?

Diabetic retinopathy is an eye disease that affects people who have diabetes.  It occurs when high blood sugar levels damage the blood vessels in the retina.  The blood vessels in the retina may then swell and leak, or even close entirely, preventing blood from passing through.  Diabetic retinopathy can significantly impact a person’s vision.

Types of Diabetic Retinopathy

There are two different classifications of diabetic retinopathy: non-proliferative diabetic retinopathy and proliferative diabetic retinopathy.

• Non-Proliferative Diabetic Retinopathy—This term is used to refer to the early stage of the disease, where symptoms may be mild or nonexistent. The blood vessels in the eye can be weakened and have tiny bulges, or microaneurysms, which can leak fluid into the retina.
• Proliferative Diabetic Retinopathy—Proliferative diabetic retinopathy is the more advanced stage. As the swelling of blood vessels can create issues with circulation, the retina can become deprived of oxygen.  This can cause fragile blood vessels to grow in the retina and create a fluid which may fill the back of the eye.  The blood vessels may also leak blood, which can cloud vision.  Glaucoma and the detachment of the retina are complications that can occur with proliferative diabetic retinopathy.  The optic nerve can also become damaged due to the great pressure placed on the eye which, if untreated, may cause severe vision loss or blindness.

Symptoms of Diabetic Retinopathy:

• Blurred vision
• Spots in field of vision, or floaters
• Dark areas in vision
• Poor night vision
• Faded colors in vision
• Loss of vision

Importantly, diabetic retinopathy symptoms usually affect both eyes.

Risk Factors for Diabetic Retinopathy

As one would imagine, diabetes is a risk factor for developing diabetic retinopathy.  Specifically, those who have Type 1 or Type 2 diabetes are at significant risk for developing diabetic retinopathy.  Additionally, the period of time a person has diabetes can impact their likelihood of developing diabetic retinopathy.  People with diabetes for longer periods of time are more likely to develop diabetic retinopathy than others.

In addition to diabetes, other medical conditions can impact a person’s likelihood to develop diabetic retinopathy.  Specifically, high blood pressure and high cholesterol can make a person more susceptible to developing diabetic retinopathy.

Family history can also play a part in whether a person may develop diabetic retinopathy.  Pregnancy can pose an additional risk, as pregnant women are more likely to develop diabetes and diabetic retinopathy.

Diagnosing Diabetic Retinopathy

Usually, a comprehensive eye exam can diagnose diabetic retinopathy.  This eye exam may include:

• Measuring the patient’s visual field
• Refraction testing
• Physical examination of the structures of the eye
• Measuring eye pressure
• Retinal photography
• Fluorescein angiography, or testing to examine abnormal blood vessel growth

Treatment

There are various forms of treatment that may be used to treat diabetic retinopathy.  Some lifestyle changes can also help abate symptoms of diabetic retinopathy.  These can include changes in diet, increased exercise, avoiding alcohol and smoking, and monitoring high blood pressure.  Other treatments may include:

• Oral medications
• Laser surgery
• Injections

VA Service Connection for Diabetic Retinopathy

Generally, a grant of VA disability benefits requires three things:

• An in-service event, injury, or illness;
• A current diagnosis by a medical professional; and
• A medical nexus, or link, between your in-service event, injury, or illness and your current diagnosis.

Additionally, lay evidence, or lay statements, can be written by the veteran, or anyone who knows the veteran and can speak to their condition, to support the claim.

Presumptive Service Connection

Presumptive service connection removes the need for a veteran to provide a nexus between their in-service event and their current disability.  This means that veterans do not need to submit evidence proving that their condition was caused by service because the presumption provides the nexus.

Type 2 Diabetes is a condition eligible for presumptive service connection if the veteran developed diabetes as a result of exposure to Agent Orange.  Importantly, the veteran must meet certain service requirements—meaning they must have served in specified locations and time periods—in order to be eligible for presumptive service connection for Type 2 Diabetes.

Secondary Service Connection

To establish secondary service connection, veterans must show that an already service-connected condition caused a subsequent condition.  If VA agrees that your already service-connected condition led to the development of a secondary condition, then that secondary condition should be subject to compensation.

Veterans who developed diabetic retinopathy as a result of their diabetes can become service-connected for it on a secondary basis.  This means that the veteran will have to be service-connected for diabetes as the primary service-connected condition. 

Compensation & Pension (C&P) Exams for Diabetic Retinopathy

VA may request a Compensation and Pension exam, or C&P exam during the claims process.  VA may call the veteran or send a letter.  Attending the exam is crucial, as VA may deny the claim if the veteran fails to attend.

The exam will usually be performed by a VA physician or a VA contracted physician.  Since an evaluation for diabetic retinopathy will most likely examine the eyes, the examiner may be an optometrist or ophthalmologist.

Before the exam, the examiner will review the veteran’s c-file.  This will contain any documentation that has been previously submitted to VA, as well as the veteran’s medical and service records.

A Disability Benefits Questionnaire (DBQ) may also be used to support the veteran’s claim.  A Disability Benefits Questionnaire is a form created by VA that allows the veteran to address important aspects of their condition, such as symptoms, severity, and possible causes, as well as the relationship between their condition and other disabilities.

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VA Ratings for Diabetic Retinopathy

VA rates diabetic retinopathy, which can also be referred to as diabetic retinitis, under 38 C.F.R. § 4.84a, Diagnostic Code 6006.  Ratings can range anywhere from 10 percent to 60 percent, and the amount of compensation a veteran receives will correlate to the percentage at which they have been rated.  The rating criteria are as follows:

• 60%—Veterans who experience incapacitating episodes that last a total duration of at least 6 weeks during the past 12 months can receive the 60 percent rating.
• 40%—The 40 percent rating is given to veterans who experience incapacitating episodes that last a total duration of at least 4 weeks, but less than 6 weeks, during the past 12 months.
• 20%—Veterans rated at 20 percent experience incapacitating episodes that last at least 2 weeks, but less than 4 weeks, during the past 12 months.
• 10%—To receive the 10 percent rating, veterans will need to experience incapacitating episodes that last a total duration of at least 1 week, but less than 2 weeks, during the past 12 months.

Toxic Exposure: Diabetes and Diabetic Retinopathy

Many veterans who have been exposed to varying toxins have gone on to develop diabetes, and diabetic retinopathy, as a result of their service.  With some forms of exposure, VA does acknowledge presumptive service connection, while others it does not.

Agent Orange Exposure

Agent Orange is one of several herbicides, or “rainbow herbicides,” that were used during the Vietnam War era.  Specifically, Agent Orange was a mixture of two different kinds of highly toxic chemicals: 2, 4-D and 2, 4, 5-T.  The highly toxic dioxin contaminant known as 2, 3, 7, 8-TCDD is a byproduct that is produced by Agent Orange.  Many veterans came into contact with Agent Orange, including those who served in areas other than Vietnam.

VA does acknowledge presumptive service connection for Type 2 Diabetes associated with Agent Orange exposure.  This means that if a veteran served in an approved area and time period, VA acknowledges that they were likely exposed to Agent Orange during their service.  As of 2021, veterans must have served in the following locations/timeframes to be eligible for presumptive service connection:

• Boots-on-the-ground in Vietnam, veterans with service aboard a ship that operated in the inland waterways of Vietnam (i.e., Brown Water veterans), or veterans with service aboard a ship in Vietnam’s territorial seas (i.e., Blue Water Navy veterans) between January 9, 1962 and May 7, 1975
• On or near the Korean demilitarized zone (DMZ) between September 1, 1967 and August 31, 1971
• Active duty and reservist personnel who had regular contact with C-123 aircraft between 1969 and 1986

A presumption of exposure essentially replaces the element of service connection that requires veterans to provide proof of an in-service event, injury, or illness that led to their current disability.  As such, veterans who meet the above criteria do not need to provide proof of an in-service event, injury, or illness, since VA acknowledges Agent Orange exposure.

However, while VA does have presumptive service connection for Type 2 Diabetes, there is no presumption for diabetic retinopathy.  In order to receive benefits for diabetic retinopathy as a result of Agent Orange exposure, veterans will likely have to first establish presumptive service connection for their diabetes and then establish that their diabetic retinopathy is secondarily connected to their diabetes.

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Military Burn Pits

In addition to exposure to Agent Orange, exposure to military burn pits has also been linked to Type 2 Diabetes in many post-9/11 era veterans.  However, the path to service connection for veterans exposed to military burn pits can be very complicated.

Military burn pits are large areas of land in which the military and its contractors incinerated all waste generated by military bases, including plastics, medical waste, rubber, human waste, and more.

The U.S. military used burn pits as part of their waste disposal protocol in places such as Iraq and Afghanistan in the post-9/11 era during Operations Iraqi and Enduring Freedom.  While the practice was effective in reducing large quantities of waste, burn pits emitted plumes of toxic smoke.  This was especially problematic in places such as the Middle East, as the desert wind carried the smoke for miles.

Many U.S. military veterans have suffered health consequences from burn pit exposure.  Most of the negative effects involve temporary ailments of the respiratory system, though limited evidence suggests a link between burn pit exposure and the long-term deterioration of lung health.

These burn pits were used extensively throughout the Middle East and have affected veterans who served in Operation Iraqi Freedom, Operation Enduring Freedom, and Operation New Dawn.

Research continues to be done to link burn pit exposure to a variety of different conditions, such as cancers and respiratory conditions.  While further research will need to be conducted, it has indicated that one of the known chemical compounds which was found in Agent Orange, called TCDD, was also released by burn pits.

Although VA acknowledges presumptive service connection for veterans who developed Type 2 Diabetes as a result of exposure to Agent Orange, VA does not have presumptive service connection for veterans who developed Type 2 Diabetes due to burn pit exposure.  As such, service connection can be very difficult for veterans who developed Type 2 Diabetes due to burn pit exposure, let alone service connection for diabetic retinopathy.

VA does not have a consistent approach to deciding burn pit condition claims, so lay evidence from veterans is key to winning these claims. Often, VA does not have a way of proving veterans were near burn pits, so statements from the veteran themselves or buddy statements can help prove exposure.
New Proposed Burn Pit Legislation 2021
As of 2021, there are several major bills currently pending in Congress, that deal with the toxic exposure caused by burn pits.  These bills include:

• Conceding Our Veterans’ Exposure Now and Necessitating Training Act (COVENANT)
• Presumptive Benefits for War Fighters Exposed to Burn Pits and Other Toxins Act of 2021
• Veterans Burn Pit Exposure Recognition Act
• Toxic Exposure in the American Military Act (TEAM)

Any of these bills, if passed, would offer much-needed relief to veterans suffering the toxic effects of burn pit exposure

VA Individual Unemployability (TDIU) and Diabetic Retinopathy

Diabetic retinopathy can severely impact a person’s vision, which may make it difficult to complete the tasks of daily living and to secure and maintain gainful employment.  As such, veterans who are prevented from working because of their diabetic retinopathy, or their diabetes, may be eligible for a monthly VA disability benefit called total disability based on individual unemployability, or TDIU.  This benefit compensates veterans at the 100 percent rating level, even if their disability rating may be less than that.

Veterans who are rated at least 60 percent for their diabetic retinopathy, or have a combined rating of 70 percent, where one condition is at a minimum of 40 percent, may be able to receive schedular TDIU.  Extraschedular TDIU is another form of this benefit for veterans who may not meet the requirements for schedular TDIU.

Were You Denied VA Disability Benefits for Diabetic Retinopathy?

VA disability claims for diabetic retinopathy can be complicated.  Often, they can be dependent on whether a veteran is service-connected for their diabetes.

Additionally, diabetic retinopathy claims may be denied if the veteran’s diabetes was caused by burn pit exposure.  Since there is no presumption of exposure for burn pits, veterans who developed diabetes and diabetic retinopathy due to burn pit exposure are often left without benefits.

If your claim for diabetic retinopathy has been denied, our experienced VA disability attorneys may be able to help you.  Contact our office today for a free consultation.