VASRD: The Organs of Special Sense

The Department of Veterans Affairs Schedule for Rating Disabilities, also known as VASRD, contains instructions to VA healthcare professionals and care team members for evaluating medical conditions for possible VA compensation.

There are instructions for each area of the human body that may be affected by injuries, disease, or other medical issues, and one of those areas is described as the “organs of special sense.”

What are the organs of special sense? Evaluations in this area are centered around the eyes and vision in general. The rating criteria include the following sections:

• General Rating Formula for Diseases of the Eye
• Impairment of Central Visual Acuity
• Ratings for Impairment of Visual Fields
• Ratings for Impairment of Muscle Function

Each section has a breakdown of conditions, severity, and other factors that go into determining the disability percentage rating for the individual. Some conditions may warrant high disability percentages while others may not qualify for anything higher than 10% or even 0% regardless of how severe the condition may be.

There are far too many individual medical issues to list comprehensively. What follows are select portions of the VA rating criteria for various eye-related conditions, intended to relate a basic idea of how the VA rates these problems.

This is not an exhaustive list. For specific information about specific medical conditions you should contact your primary care provider or call the VA directly for assistance at 1-800-827-1000.

The VA General Rating Formula for Diseases of the Eye

The VA has general and specific guidelines for rating medical conditions of the eye. The general VA rating formula includes a requirement for evaluators to, “Evaluate on the basis of either visual impairment due to the particular condition or on incapacitating episodes” with the VA noting that a disability rating given should be for whichever condition rates highest.

The VA describes “incapacitating episodes” as “an eye condition severe enough to require a clinic visit to a provider” specifically to be treated for the condition.

Rating Medical Conditions Of The Eye

VA disability ratings for medical issues of the “organs of special sense” will depend partly on the nature of the medical issue itself as well as how the issue affects the patient. Ratings may be assigned based on documented “episodes” as well as the treatment required:

• With documented incapacitating episodes requiring 7 or more treatments in 12 months.
• Documented incapacitating episodes requiring at least 5 but less than 7 treatments in 12 months.
• Episodes requiring at least 3 but less than 5 treatments in 12 months.
• Episodes requiring at least 1 but less than 3 treatments in 12 months.

Ratings in these scenarios range from 60% (the highest in the list) to 10% (the lowest). Note this is the GENERAL rating formula and certain conditions such as tuberculosis of the eye may warrant a 100% disability rating under certain conditions.

Chronic conjunctivitis may only be worth a 10% rating, as are retinal scars and certain glaucomas. But a malignant neoplasm of the eye may be rated at 100%.

Much depends on the individual facts of the medical case and it’s best to remember that VA rating percentages are always subject to change due to regulation, policy, or new medical discoveries depending on circumstances.

The percentages you read here are in effect at the time of this writing but you should always let the VA explain the most up-to-date policies and compensation arrangements.

Conditions Of The Eye

There are a variety of issues the VA anticipates seeing in the screening/rating process. They include:

• Choroidopathy, including uveitis, iritis, cyclitis, or choroiditis
• Keratopathy
• Scleritis
• Retinopathy or maculopathy “not otherwise specified”
• Intraocular hemorrhage
• Detached retina
• Unhealed eye injury (including orbital trauma, penetrating or non-penetrating eye injury)
• Tuberculosis of the eye
• Retinal scars, atrophy, or irregularities
• Angle-closure glaucoma
• Open-angle glaucoma
• Malignant neoplasms of the eye, orbit, and adnexa (excluding skin)

Impairment of Central Visual Acuity

The VA rating information in this section is fairly simple and straightforward. There is a diagnostic code for certain physical issues related to the human eye–the “anatomical loss” of an eye, loss of both eyes, etc.

The VA rates physical conditions of the eye starting with the anatomical loss of both eyes rated at 100%, with certain other medical issues rated as follows:

• No more than light perception in both eyes.
• Anatomical loss of one eye and impaired vision in the other eye on a sliding scale.
• No more than light perception in one eye and impaired vision in the other eye on a sliding scale.
• Vision in one eye.
• Vision in one eye and impaired vision in the other eye on a sliding scale.
• Visual acuity in one eye 10/200 (3/60) or better.
• Visual acuity in one eye 10/200 (3/60) or better and impaired vision in the other eye on a sliding scale.

This is not an exhaustive list, but it gives a good idea of what VA examiners are looking for in this area.

Ratings for Impairment of Visual Fields

The VA list of “visual field defects” is a set of conditions that affect how the patient sees. It’s not a physical loss of an eye, but rather how the human eye is able to function.

For example, the condition hemianopsia is described as a visual field loss on the left or right side of the eye on a vertical plane.

This condition can occur in one eye, or in both. When it affects both eyes it is known as homonymous hemianopsia. The cause of this issue involves damage to the visual pathway to the right or left side of the brain.

In these cases, the VA rates the visual field defect and breaks down the rating based on how much of the visual field is affected. That is the basic approach to most conditions related to the visual field. There are two basic conditions commonly rated by the VA: the previously mentioned homonymous hemianopsia and unilateral scotoma (blind spot). The VA breaks down the rating criteria in part as follows:

Homonymous hemianopsia

Loss of temporal half of visual field:

• Bilateral
• Unilateral
• Or evaluate each affected eye as 20/70 (6/21).

Loss of nasal half of visual field:

• Bilateral
• Unilateral
• Or evaluate each affected eye as 20/50 (6/15).

Loss of inferior half of visual field

• Bilateral
• Unilateral
• Or evaluate each affected eye as 20/70 (6/21).

Loss of superior half of visual field:

• Bilateral
• Unilateral
• Or evaluate each affected eye as 20/50 (6/15)

Scotoma, unilateral

• Minimum, with scotoma affecting at least one-quarter of the visual field (quadrantanopsia) or with centrally located scotoma of any size, OR
• Evaluate based on visual impairment due to scotoma, if that would result in a higher evaluation.

Most of the VA ratings possible in this area are between 10 and 30 percent. There are certain impairments of the visual field that could result in a 50% rating or even 100% but most ratings are lower in this section.

Ratings for Impairment of Muscle Function

There are only two diagnostic codes in this section, one related to double vision (diplopia) and the other, described as a total or partial “adhesion of the palpebral conjunctiva” of the eyelid to the “bulbar conjunctiva of the eyeball” (symblepharon).

Those conditions are rated as follows:

Diplopia (double vision)

(a) Central 20 degrees

(b) 21 degrees to 30 degrees

1. Down
2. Lateral
3. Up

(c) 31 degrees to 40 degrees

1. Down
2. Lateral
3. Up

VA instructions to the rated include a rule that diplopia thought to be “occasional” or correctable with glasses should be rated at zero percent.

Symblepharon

Instructions to the rater include directions to evaluate this condition referring back to the VA General Rating Formula mentioned at the start of this article for diseases of the eye under diagnostic codes for disfigurement, or  lagophthalmos (inability to close the eyes completely).

Joe Wallace is a 13-year veteran of the United States Air Force and a former reporter for Air Force Television News