Jump to content
  • 0

Keratoconus C&p Exam And Service Connection


mayertucker

Question

I recenly completed my C&P exam for Keratoconus a week ago. I was diagnosed in Septer of 2013, with Kerotoconus. During my entrance med exam, my vision was 20/20 in both eys. About 2 years into my service, I started seeing double, and bluriness. I made an appt with the eye doc in 29 stumps, and was diagnosed with asigmatism. At the time of that exam I was 20/40 in my left eye and 20/20 in my right eye. I had two ofher eye exams while in, and while I do not remember what my visual acuity was My perscriptions changed again. During the second exam a

Keratometry was performed. Here are the notes from previous eye exams.

"22 AUG1997
Plan-075 x 178
-050-100 x 041
3 NOV 1998
-025-050 x 180
-050-100 x 045
Keratometry : no comment on quality of mires
41.87/43.25 x 093
42.50/44.87 x 113
14 JAN 2000
Plan -050 x 175
+025-100 x 064".

I didn't go back for any eye exams until 2013, due to lack of money or vision insurance. I just dealt with the double vision and bluriness. Finally I found out I could get my eyes checked through the VA since I was alred 20% service connected for flat feet and my knee, and made an appt. That was when I was given the diagnosis of Keratoconus. I am in the process of getting a contact to help correct my vision, though the C&P doc said I would probably be better off getting the corneal transplant. I applied for service connection in November 2014, and am awaiting the decision. I wanted to know what the board thinks of it being granted since from my perspective, it started during my time in service and was never diagnosed until my visit in 2013. Thanks for any help in this.

I am including the relevant notes from the exam below if anyone can make sense of them.

"Describe the history (including onset and course) of the Veteran's
current
eye condition(s) (brief summary): history of astigmatism. No one used the
word "keratoconus" while in the service. Never turned down for
refractive
surgery. Dx of keratoconus first used at VA in 2013. No family history
Last eye exam at VA by Mar 27, 2015. Patient not dilated at this visit.
SECTION III: PHYSICAL EXAMINATION
---------------------------------
1. Visual acuity
----------------
a. Uncorrected distance:
Right: [ ] 5/200 [ ] 10/200 [ ] 15/200 [ ] 20/200
[ ] 20/100 [ ] 20/70 [ ] 20/50 [X] 20/40 or better
Left: [ ] 5/200 [ ] 10/200 [ ] 15/200 [X] 20/200
[ ] 20/100 [ ] 20/70 [ ] 20/50 [ ] 20/40 or better
b. Uncorrected near:
Right: [ ] 5/200 [ ] 10/200 [ ] 15/200 [ ] 20/200
[ ] 20/100 [X] 20/70 [ ] 20/50 [ ] 20/40 or better
Left: [ ] 5/200 [ ] 10/200 [ ] 15/200 [ ] 20/200
[ ] 20/100 [X] 20/70 [ ] 20/50 [ ] 20/40 or better
c. Corrected distance:
Right: [ ] 5/200 [ ] 10/200 [ ] 15/200 [ ] 20/200
[ ] 20/100 [ ] 20/70 [ ] 20/50 [X] 20/40 or better
Left: [ ] 5/200 [ ] 10/200 [ ] 15/200 [X] 20/200
[ ] 20/100 [ ] 20/70 [ ] 20/50 [ ] 20/40 or better
d. Corrected near:
Right: [ ] 5/200 [ ] 10/200 [ ] 15/200 [ ] 20/200
[ ] 20/100 [ ] 20/70 [ ] 20/50 [X] 20/40 or better
Left: [ ] 5/200 [ ] 10/200 [ ] 15/200 [ ] 20/200
[ ] 20/100 [X] 20/70 [ ] 20/50 [ ] 20/40 or better
2. Difference in corrected visual acuity for distance and near vision
---------------------------------------------------------------------
Does the Veteran have a difference equal to two or more lines on the Snellen
test type chart or its equivalent between distance and near corrected
vision,
with the near vision being worse?
[ ] Yes [X] No
3. Pupils
---------
a. Pupil diameter: Right: 4 mm Left: 4 mm
b. [X] Pupils are round and reactive to light
c. Is an afferent pupillary defect present?
[ ] Yes [X] No
d. [ ] Other, describe:
No answer provided
4. Anatomical loss, light perception only, extremely poor vision or
blindness
-----------------------------------------------------------------------------
Does the Veteran have anatomical loss, light perception only, extremely poor
vision or blindness of either eye?
[ ] Yes [X] No
5. Astigmatism
--------------
Does the Veteran have a corneal irregularity that results in severe
irregular
astigmatism?
[X] Yes [ ] No
If yes, complete the following section:
a. Does the Veteran customarily wear contact lenses to correct the above
corneal irregularity?
[ ] Yes [X] No
b. Was the corrected visual acuity determined using contact lenses?
[ ] Yes [X] No
If no, explain: patient not a contact lens wearer, has been referred
for RGP fit through fee basis
6. Diplopia
-----------
Does the Veteran have diplopia (double vision)?
[X] Yes [ ] No
a. Provide etiology (such as traumatic injury, thyroid eye disease,
myasthenia gravis, etc.): Monocular double vision in left eye
b. The areas of diplopia must be documented on a Goldmann perimeter chart
that identifies the four major quadrants (upward, downward, left lateral
and right lateral) and the central field (20 degrees or less). Include
the
chart with this Questionnaire.
Report the results from the Goldmann perimeter chart below:
Indicate the areas where diplopia is present (the fields in which the
Veteran sees double using binocular vision):
[X] Central 20 degrees
[ ] 21 to 30 degrees
[ ] 31 to 40 degrees
[ ] Greater than 40 degrees
c. Indicate frequency of the diplopia:
[ ] Constant [X] Occasional
If occasional, indicate frequency of diplopia and most recent
occurrence: No answer provided
d. Is the diplopia correctable with standard spectacle correction?
[ ] Yes [X] No
If no, is the diplopia correctable with standard spectacle
correction
that includes a special prismatic correction?
[ ] Yes [X] No
7. Tonometry
------------
a. If tonometry was performed, provide results:
Right eye pressure: 9 Left eye pressure: 9
b. Tonometry method used:
[ ] Goldmann applanation
[X] Other, describe:
NCT
8. Slit lamp and external eye exam
----------------------------------
a. External exam/lids/lashes:
Right [X] Normal [ ] Other, describe:
Left [X] Normal [ ] Other, describe:
b. Conjunctiva/sclera:
Right [X] Normal [ ] Other, describe:
Left [X] Normal [ ] Other, describe:
c. Cornea:
Right [X] Normal [ ] Other, describe:
Left [ ] Normal [X] Other, describe: thinning
d. Anterior chamber:
Right [X] Normal [ ] Other, describe:
Left [X] Normal [ ] Other, describe:
e. Iris:
Right [X] Normal [ ] Other, describe:
Left [X] Normal [ ] Other, describe:
f. Lens:
Right [X] Normal [ ] Other, describe:
Left [X] Normal [ ] Other, describe:
9. Internal eye exam (fundus)
--------------------
Fundus:
[X] Normal bilaterally
[ ] Abnormal
10. Visual fields
-----------------
Does the Veteran have a visual field defect (or a condition that may result
in visual field defect)?
[ ] Yes [X] No
a. Was visual field testing performed?
[ ] Yes [X] No
b. Does the Veteran have contraction of a visual field?
No answer provided
c. Does the Veteran have loss of a visual field?
No answer provided
d. Does the Veteran have a scotoma?
No answer provided
e. Does the Veteran have legal (statutory) blindness (visual field diameter
of 20 degrees or less in the better eye, even if the corrected visual
acuity is 20/20) based upon visual field loss?
No answer provided
SECTION IV: Eye conditions
---------------------------
1. Conditions
-------------
Does the Veteran have any of the following eye conditions?
[X] Yes [ ] No
If yes, check all that apply:
[X] Corneal conditions
6. Corneal conditions
---------------------
a. Has the Veteran had a corneal transplant?
[ ] Yes [X] No
b. Does the Veteran have keratoconus?
[X] Yes [ ] No
If yes, indicate eye affected: [ ] Right [ ] Left [X] Both
c. Does the Veteran have a pterygium?
[ ] Yes [X] No
d. Does the Veteran have another corneal condition that may result in an
irregular cornea? (For example, pellucid marginal degeneration,
irregular
astigmatism from corneal scar, post-laser refractive surgery, acne
rosacea
keratopathy, etc.)
[ ] Yes [X] No
e. Is the Veteran's decrease in visual acuity or other visual
impairment, if
present, attributable to keratoconus or another corneal condition, if
present?
[X] Yes [ ] No [ ] There is no decrease in visual acuity or other
visual impairment
If yes, specify corneal condition responsible for visual impairment:
irregular astigmatism
f. Does any eye condition identified in this section cause scarring or
disfigurement?
No answer provided
14. Other eye conditions, pertinent physical findings, complications,
conditions, signs and/or symptoms
---------------------------------------------------------------------
Does the Veteran have any other eye conditions, pertinent physical findings,
complications, conditions, signs and/or symptoms related to the condition at
hand?
[ ] Yes [X] No
SECTION V: Scarring and disfigurement
--------------------------------------
Does the Veteran have scarring or disfigurement attributable to any eye
condition?
[ ] Yes [X] No
SECTION VI: Incapacitating episodes
------------------------------------
During the past 12 months, has the Veteran had any incapacitating episodes
attributable to any eye conditions?
[ ] Yes [X] No
SECTION VII
-----------
1. Functional impact
--------------------
Does the Veteran's eye condition(s) impact his or her ability to work?
[X] Yes [ ] No
If yes, describe the impact of each of the Veteran's eye
condition(s),
providing one or more examples: poor vision in left eye: Unable to do
work
involving fine depth perception
2. Remarks, if any: The question is asked if the patient has keratoconus
that
is as least as likely as not incurred in or caused by double vision or
blurred vision during service.
Keratoconus is a degeneration of the cornea which leads to distortion and
thinning of the front of the eye. As a result, the cornea steepens (this is
measured by keratometry or corneal topography)
Keratoconus is not caused by blurred vision or double vision. It is instead
a
degeneration. Review of the STR reveals no diagnosis of keratoconus. The
three refractions done over the course of three years were consistent.
Keratoconus patients will often fluctuate. Keratometry done in 1998 was not
indicative of keratoconus. The cover test done at the visit with the
complaint of double vision revealed no motion and no further workup.
At Mr. Mayer-Tucker's first visit to the Cheyenne VA in Sep 2013, he
reported
monocular double vision (overlapping images in one eye) and that he had
good
vision with previous glasses. The exam previous to that had been three years
earlier.
VA Records
Sep 2013
OD: plano-1.00x175 20/20-2 push
OS: -1.25-2.25x020 20/40+2 NO IMPROVEMENT WITH PINHOLE
Corneal topography
OD:
steep K: 46.60D @97
Flat K : 42.44D @7
Astigmatism: 4.16D
OS:
steep K: 48.93D @99
Flat K : 42.26D @9
Astigmatism 4.67D
Mar 2014
OD: -0.75sphere 20/25-+
OS: -1.25-2.25x020 20/50- ph 20/40-
Corneal topography
OD:
steep K: 46.35D @99
Flat K : 42.37D @9
Astigmatism: 3.98D
OS:
steep K: 49.01D @96
Flat K : 44.64D @6
Astigmatism 4.37D
Prescription history from STR
22 AUG1997
Plan-075 x 178
-050-100 x 041
3 NOV 1998
-025-050 x 180
-050-100 x 045
Keratometry : no comment on quality of mires
41.87/43.25 x 093
42.50/44.87 x 113
14 JAN 2000
Plan -050 x 175
+025-100 x 064
Cover test was ortho. Patient did not bring glasses to that visit.

Link to comment
Share on other sites

  • Answers 0
  • Created
  • Last Reply

Top Posters For This Question

Popular Days

Top Posters For This Question

Popular Days

0 answers to this question

Recommended Posts

There have been no answers to this question yet

Join the conversation

You can post now and register later. If you have an account, sign in now to post with your account.
Note: Your post will require moderator approval before it will be visible.

Guest
Answer this question...

×   Pasted as rich text.   Paste as plain text instead

  Only 75 emoji are allowed.

×   Your link has been automatically embedded.   Display as a link instead

×   Your previous content has been restored.   Clear editor

×   You cannot paste images directly. Upload or insert images from URL.

  • Ads

  • Ads

  • Ads

  • Our picks

    • I already get compensation for bladder cancer for Camp Lejeune Water issue, now that it is added to Agent Orange does it mean that the VA should pay me the difference between Camp Lejeune and 1992 when I retired from the Marine Corps or do I have to re-apply for it for Agent Orange, or will the VA look at at current cases already receiving bladder cancer compensation. I’m considered 100% Disabled Permanently 
      • 20 replies
    • 5,10, 20 Rule
      The 5, 10, 20 year rules...



      Five Year Rule) If you have had the same rating for five or more years, the VA cannot reduce your rating unless your condition has improved on a sustained basis. All the medical evidence, not just the reexamination report, must support the conclusion that your improvement is more than temporary.



      Ten Year Rule) The 10 year rule is after 10 years, the service connection is protected from being dropped.



      Twenty Year Rule) If your disability has been continuously rated at or above a certain rating level for 20 or more years, the VA cannot reduce your rating unless it finds the rating was based on fraud. This is a very high standard and it's unlikely the rating would get reduced.



      If you are 100% for 20 years (Either 100% schedular or 100% TDIU - Total Disability based on Individual Unemployability or IU), you are automatically Permanent & Total (P&T). And, that after 20 years the total disability (100% or IU) is protected from reduction for the remainder of the person's life. "M-21-1-IX.ii.2.1.j. When a P&T Disability Exists"



      At 55, P&T (Permanent & Total) or a few other reasons the VBA will not initiate a review. Here is the graphic below for that. However if the Veteran files a new compensation claim or files for an increase, then it is YOU that initiated to possible review.



      NOTE: Until a percentage is in place for 10 years, the service connection can be removed. After that, the service connection is protected.



      ------



      Example for 2020 using the same disability rating



      1998 - Initially Service Connected @ 10%



      RESULT: Service Connection Protected in 2008



      RESULT: 10% Protected from reduction in 2018 (20 years)



      2020 - Service Connection Increased @ 30%



      RESULT: 30% is Protected from reduction in 2040 (20 years)
        • Like
      • 58 replies
    • Post in New BVA Grants
      While the BVA has some discretion here, often they "chop up claims".  For example, BVA will order SERVICE CONNECTION, and leave it up to the VARO the disability percent and effective date.  

      I hate that its that way.  The board should "render a decision", to include service connection, disability percentage AND effective date, so we dont have to appeal "each" of those issues over then next 15 years on a hamster wheel.  
        • Like
    • Finally heard back that I received my 100% Overall rating and a 100% PTSD rating Following my long appeal process!

      My question is this, given the fact that my appeal was on the advanced docket and is an “Expedited” appeal, what happens now and how long(ish) is the process from here on out with retro and so forth? I’ve read a million things but nothing with an expedited appeal status.

      Anyone deal with this situation before? My jump is from 50 to 100 over the course of 2 years if that helps some. I only am asking because as happy as I am, I would be much happier to pay some of these bills off!
        • Like
      • 18 replies
    • I told reviewer that I had a bad C&P, and that all I wanted was a fair shake, and she even said, that was what she was all ready viewed for herself. The first C&P don't even  reflect my Treatment in the VA PTSD clinic. In my new C&P I was only asked about symptoms, seeing shit, rituals, nightmares, paying bills and about childhood, but didn't ask about details of it. Just about twenty question, and  nothing about stressor,
  • Ads

  • Popular Contributors

  • Ad

  • Latest News


  • veteranscrisisline-badge-chat-1.gif

  • Fund HadIt.com

    406%
    $6,103.00 of $1,500.00 Donate Now
  • Advertisemnt

  • 14 Questions about VA Disability Compensation Benefits Claims

    questions-001@3x.png

    When a Veteran starts considering whether or not to file a VA Disability Claim, there are a lot of questions that he or she tends to ask. Over the last 10 years, the following are the 14 most common basic questions I am asked about ...
    Continue Reading
     
  • Most Common VA Disabilities Claimed for Compensation:   

    tinnitus-005.pngptsd-005.pnglumbosacral-005.pngscars-005.pnglimitation-flexion-knee-005.pngdiabetes-005.pnglimitation-motion-ankle-005.pngparalysis-005.pngdegenerative-arthitis-spine-005.pngtbi-traumatic-brain-injury-005.png

  • Advertisemnt

  • VA Watchdog

  • Advertisemnt

  • Ads

  • Can a 100 percent Disabled Veteran Work and Earn an Income?

    employment 2.jpeg

    You’ve just been rated 100% disabled by the Veterans Affairs. After the excitement of finally having the rating you deserve wears off, you start asking questions. One of the first questions that you might ask is this: It’s a legitimate question – rare is the Veteran that finds themselves sitting on the couch eating bon-bons … Continue reading

×
×
  • Create New...

Important Information

{terms] and Guidelines