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6040
§ 4.79 Schedule of ratings—eye.

Diabetic retinopathy

Damage to the blood vessels in the retina caused by diabetes.

What the rating means

Diabetic retinopathy is rated under the General Rating Formula for Diseases of the Eye. VA evaluates it in two ways and uses whichever produces the higher rating: by the visual impairment the condition causes, or by the number of documented incapacitating episodes requiring treatment visits in the past 12 months.

Under the incapacitating-episodes path, a 60% rating requires 7 or more treatment visits in the past 12 months. A 40% rating requires at least 5 but fewer than 7 visits. A 20% rating requires at least 3 but fewer than 5 visits. A 10% rating requires at least 1 but fewer than 3 visits.

An incapacitating episode means your eye condition was severe enough to require a clinic visit specifically for treatment, not just a routine check. Treatment includes things such as intravitreal or periocular injections, laser treatments, surgical interventions, or systemic immunosuppressants or biologic agents.

If visual impairment from diabetic retinopathy produces a higher result, VA rates that impairment using the visual acuity and visual field tables found in 38 CFR 4.75–4.78 and the related diagnostic codes 6061–6091.

Evidence that helps

If you are pursuing a rating based on incapacitating episodes, the most important records are those that document each clinic visit made specifically for treatment of your eye condition within the past 12 months. Treatment records showing intravitreal injections, laser procedures, surgical interventions, or visits for immunosuppressant or biologic therapy directly support the visit count at each level. Dates of each visit matter, because the thresholds are 1, 3, 5, and 7 visits.

If you are pursuing a rating based on visual impairment, records from an ophthalmologist or optometrist showing measured visual acuity and visual field results are central. These measurements are compared against the tables in 38 CFR 4.75–4.78.

Statements from you or people who know you about how reduced vision or treatment visits affect your ability to work, drive, read, or manage daily tasks can help fill in the picture of your functional loss, particularly where clinical records do not fully reflect your day-to-day experience.

Secondary conditions

Conditions that are often caused or made worse by this one. If you have any of these, they may be claimable as secondary service connection.