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Veterans Law

VA Disability Ratings for Astigmatism

July 1, 2022
VA Disability Ratings for Astigmatism

Eye conditions are very common among veterans.  As of VA’s 2020 Annual Benefits Report, nearly 350,000 veterans are service connected for an eye condition.

Veterans who suffer from eye conditions, including those that involve symptoms of astigmatism, may qualify for VA disability benefits.

What is Astigmatism?

According to the American Academy of Opthamology, astigmatism is “an imperfection in the curvature of your eye’s cornea or lens.”  While the normal eye is shaped more like a basketball, an eye with astigmatism is shaped more like a football or an egg.

There are different ways the curvature can run:

  • With-the-rule—the steepest curve runs vertically (with the “football” on its side)
  • Against-the-rule—the steepest curve runs horizontally (with the “football” on its point)

How Does Astigmatism Affect the Eye?

Typically, the cornea and lens of the eye are curved in a way that helps a person to refract, or bend, light into the retina in the back of the eye.  If a person has astigmatism, and their cornea or lens is curved or rigid, then the light rays are not being refracted properly.  This can be called a refractive error.

If the cornea is misshapen, then a person would have corneal astigmatism.

If the lens is misshaped, then a person would have lenticular astigmatism.

With both corneal and lenticular astigmatism, a person near and far vision can be distorted and blurry.  People with astigmatism may also have nearsightedness or farsightedness.

What Causes Astigmatism?

As mentioned above, astigmatism is caused by a curvature in the eye, specifically in the cornea or lens.  While doctors do not necessarily know why a person’s cornea or lens shape may differs from person to person, it is likely that astigmatism has a genetic component, meaning that it can be inherited.

Additionally, astigmatism can occur after eye disease, injury, or surgery.

How to Diagnose Astigmatism

Astigmatism can usually be diagnosed during an annual eye exam by an eye doctor.  An eye doctor may need to use several devices during the exam, such as a phoropter, autorefractor, or keratometer, to determine if a person’s cornea or lens is curved.

Treating Astigmatism

Contacts or eyeglasses can usually be used to compensate for uneven curves in the eye.  Additionally, sometimes LASIK surgery can be an option for treating astigmatism.

How to Get VA Disability Benefits for Astigmatism

VA does not offer VA disability compensation for astigmatism if the veteran was born with astigmatism or if their vision can be corrected with contacts.  There is no diagnostic code or rating criteria established specifically for astigmatism.  However, VA may take a veteran’s astigmatism into account as a symptom of another condition that is ratable, such as an eye injury.

For example, the Eye Conditions Disability Benefits Questionnaire (DBQ) has an entire section dedicated to astigmatism as a symptom.

A Disability Benefits Questionnaire is a form created for veterans’ use in the evaluation process for VA disability benefits.  Specifically, DBQs are intended to speed up the processing of claims for service-connected compensation and give veterans more control over the disability claims prorcess.  These forms were created to answer questions about important aspects of disability, including symptoms, severity, possible causes, and relation to other disabilities, and to capture information required under the VA Schedule of Disability Ratings found within the Code of Federal Regulations.

With the Eye Conditions DBQ, the section on astigmatism asks if the veteran has severe astigmatism, if they need to wear contact lenses to correct their astigmatism, and how much the corrective lenses improve their visual acuity.

In M21-1MR, Part III, Subpart iv, Chapter 4, Section B, VA specifically notes that refractive errors, such as astigmatism, are not eligible for service connection unless the astigmatism:

  • Is “unusually developed”; AND
  • Produces uncorrectable impairment of the vision

In the criteria, VA specifically notes that irregular astigmatism may be caused by corneal inflammation due to injury or operation.  As such, astigmatism as a symptom after an eye injury or surgery could increase a veteran’s rating for their eye condition.

How to Establish Service Connection for an Eye Condition

As mentioned above, if an eye injury or eye surgery caused you to develop astigmatism that cannot be corrected, you may be entitled to VA disability compensation.  However, in order to receive benefits for any condition, a veteran must become service connected.  When seeking service connection, veterans will need to submit three things to VA:

  • A diagnosis of an eye condition;
  • An in-service event or stressor which caused or aggravated the eye condition;
  • A nexus, which links the veteran’s eye condition to their service

Veterans can submit a claim for service connection on VA From 21-526EZ.  The form can be submitted to VA in the following ways:

  • Online – using VA’s eBenefits platform
  • By mail – directed to the Department of Veterans Affairs, Evidence Intake Center, PO Box 4444 in Janesville, WI 53547-4444
  • In person – bringing a completed VA Form 21-526EZ to a VA Regional Office near you
  • With a legal representative – completing the form with a Veterans Service Organization (VSO) or a VA accredited agent or attorney
Eye Conditions VA Disability Claims

How Does VA Rate Eye Conditions?

VA rates all eye conditions using the same criteria.  Specifically, there are three main measurements that are used to determine a rating: (1) central visual acuity; (2) visual field; and (3) muscle function.

Central Visual Acuity

Central visual acuity refers to the ability to distinguish shapes and details of objects at a given distance.  Specifically, it pertains to how focused or blurry an image is when looking at it from certain distances.  “Near-sighted” and “far-sighted” are both terms that describe central visual acuity.  Astigmatism typically affects central visual acuity, meaning that veterans with astigmatism will be given a rating based on how affected their central visual acuity is.

VA usually tests central visual acuity using a basic eye chart examination.  The measurements range from 20/20 to 5/200 and VA then assigns an evaluation based on the veteran’s corrected distant vision (if it can be corrected).  However, since astigmatism can only be service connected if it produces uncorrectable impairment, ratings for astigmatism can only be taken into consideration if glasses or contacts do not correct the veteran’s vision.

If a veteran’s vision is worse than 5/200, they are considered blind.  Importantly, VA rates both eyes together, meaning veterans will receive one combined rating that accounts for both impairments.

Visual Field

Visual field refers to the entire range of vision that can be seen when looking at a fixed point straight ahead.  Visual field testing is performed using several different automatic tests that measure the range of vision of each eye without moving the eyeball.

Most often, eye exams have a chart included with 16 meridians for each eye moving outward from the center; however, only eight directions are used for rating: upward, downward, nasally (toward the nose), temporally (away from the nose), and once midway between each of these.  The normal visual field is as follows:

  • 65 degrees down
  • 50 degrees down nasally
  • 60 degrees nasally
  • 55 degrees up nasally
  • 45 degrees up
  • 55 degrees up temporally
  • 85 degrees temporally; and
  • 85 degrees down temporally

The total normal visual field equals 500 degrees.  When the visual field does not match up to these measurements, a disability evaluation will be assigned depending on the extent of the vision loss.

Muscle Dysfunction

Muscle dysfunction involves how well the muscles of the eye move and is measured on the same type of chart as the visual field.  To measure the decrease in muscle function, the visual chart is divided into four quadrants: up, down, nasally, and temporally.  Muscle dysfunction can exist in one or both eyes, but once again, veterans will only receive one disability rating.

Understanding the Importance of C&P Exams for Astigmatism

After these three main measurements have been obtained, VA will rate the eye condition using scales that combine all three measurements for both eyes.  It is important to note that only an optometrist or ophthalmologist is considered qualified to make these measurements.  This will likely occur at a Compensation & Pension examination.

Veterans should understand that a Compensation & Pension (C&P) examination will be required in order to determine service connection and receive a VA disability rating for any eye condition.

A C&P exam is an exam that VA uses to evaluate the veteran’s claimed condition and determine if service connection is warranted.  During the exam, the examiner will also collect evidence to assign a rating if service connected is granted.

Importantly, only an optometrist or ophthalmologist is qualified to take the measurements needed for rating an eye condition.  If a C&P exam for eye conditions is being conducted by someone who is not an optometrist or ophthalmologist, veterans should notify VA immediately.  In this case, VA should deem the C&P examination inadequate for rating purposes.  Again, all other medical professionals lack the qualifications necessary to conduct proper eye examinations.  Also, if veterans are not satisfied with the optometrist’s findings, it may be beneficial to submit an argument to VA explaining why.

How Much VA Disability Compensation Can Veterans Receive?

The amount of compensation a veteran can receive corresponds to the rating they have been assigned.  With astigmatism, the rating will be assigned based on how the veteran’s vision is affected.

Ratings as described below:

No More Light Perception in One Eye, and

  • 100%–5/200 in the other eye (1.5/60)
  • 90%–10/200 in the other eye (3/60)
  • 80%–15/200 in the other eye (4.5/60)
  • 70%–20/200 in the other eye (6/60)
  • 60%–20/100 in the other eye (6/30)
  • 50%–20/70 in the other eye (6/21)
  • 40%–20/50 in the other eye (6/15)
  • 30%–20/40 in the other eye (6/12)

Vision in one eye 5/200, and

  • 100%–5/200 in the other eye (1.5/60)
  • 90%–10/200 in the other eye (3/60)
  • 80%–15/200 in the other eye (4.5/60)
  • 70%–20/200 in the other eye (6/60)
  • 60%–20/100 in the other eye (6/30)
  • 50%–20/70 in the other eye (6/21)
  • 40%–20/50 in the other eye (6/15)
  • 30%–20/40 in the other eye (6/12)

Vision acuity in one eye 10/200 (3/60), and

  • 100%–5/200 in the other eye (1.5/60)
  • 90%–10/200 in the other eye (3/60)
  • 80%–15/200 in the other eye (4.5/60)
  • 70%–20/200 in the other eye (6/60)
  • 60%–20/100 in the other eye (6/30)
  • 50%–20/70 in the other eye (6/21)
  • 40%–20/50 in the other eye (6/15)
  • 30%–20/40 in the other eye (6/12)

Vision acuity in one eye 15/200 (4.5/60), and

  • 100%–5/200 in the other eye (1.5/60)
  • 90%–10/200 in the other eye (3/60)
  • 80%–15/200 in the other eye (4.5/60)
  • 70%–20/200 in the other eye (6/60)
  • 60%–20/100 in the other eye (6/30)
  • 50%–20/70 in the other eye (6/21)
  • 40%–20/50 in the other eye (6/15)
  • 30%–20/40 in the other eye (6/12)

Vision acuity in one eye 20/200 (6/60), and

  • 100%–5/200 in the other eye (1.5/60)
  • 90%–10/200 in the other eye (3/60)
  • 80%–15/200 in the other eye (4.5/60)
  • 70%–20/200 in the other eye (6/60)
  • 60%–20/100 in the other eye (6/30)
  • 50%–20/70 in the other eye (6/21)
  • 40%–20/50 in the other eye (6/15)
  • 30%–20/40 in the other eye (6/12)

Vision acuity in one eye 20/100 (66/30) and

  • 100%–5/200 in the other eye (1.5/60)
  • 90%–10/200 in the other eye (3/60)
  • 80%–15/200 in the other eye (4.5/60)
  • 70%–20/200 in the other eye (6/60)
  • 60%–20/100 in the other eye (6/30)
  • 50%–20/70 in the other eye (6/21)
  • 40%–20/50 in the other eye (6/15)
  • 30%–20/40 in the other eye (6/12)

Vision acuity in one eye 20/70 (66/30) and

  • 30%–20/70 in the other eye (6/21)
  • 20%–20/50 in the other eye (6/15)
  • 10%–20/40 in the other eye (6/12)

Vision acuity in one eye 20/50 (6/15) and

  • 10%–20/50 in the other eye (6/15)

Vision acuity in one eye 20/40 (6/12) and

  • 0%–20/40 in the other eye (6/12)

The above ratings will then correspond to the amount of compensation a veteran can receive for their astigmatism.  As of 2022, the monthly compensation associated with each rating is as follows:

  • Combined 10 Percent Rating–$152.64
  • Combined 20 Percent Rating–$301.74
  • Combined 30 Percent Rating–$467.38
  • Combined 40 Percent Rating–$673.28
  • Combined 50 Percent Rating–$958.43
  • Combined 60 Percent Rating–$1,214.02
  • Combined 70 Percent Rating–$1,529.94
  • Combined 80 Percent Rating–$1,778.43
  • Combined 90 Percent Rating–$1,998.52
  • Combined 100 Percent Rating–$3,332.06

Getting an Accredited Representative to Help with Your Astigmatism Claim

Winning VA disability benefits for astigmatism can be very difficult, especially because of a veteran’s astigmatism must be uncorrectable in order to receive benefits.  If you are a veteran struggling to win VA disability benefits for your astigmatism, help is available to you.  The veterans’ advocates at Chisholm Chisholm & Kilpatrick have successfully helped many veterans with their appeals and we may be able to help you.  Contact our office today for a free case evaluation.