Keratoconus

[Beeps]

I am currently rated 10% for keratoconus with a visual acuity of 20/70 in my right eye and 20/40 in my left.  The DVA decision letter states a higher evaluation is not warranted unless there is documented incapacitating episodes requiring treatment visits for my eye condition.  My question is whether immunotherapy (allergy shots) would be considered treatment visits.  I've been receiving 5 allergy injections weekly for the past several years to reduce my eye allergies so I can wear medically necessary sclera lenses for keratoconus.  I have no other allergy symptoms except for my eyes.  If I don't get the weekly shots my eye allergy symptoms become severe and I can't wear my contacts.  Would this be considered an incapacitating episode?  My medical records dating back 7 plus years confirm I have been diagnosed with allergic conjunctivitis.  If I could wear glasses my eye allergy symptoms would be less severe since anything in the eye increases the irritation and redness.  I have been documenting my eye allergy flare ups with photographs.   On a side note, I was recently diagnosed with pingueculas in both eyes.  Pinguecula (code 6037) further complicates the fitting of sclera lenses, but there is no scaring on my eyes from them.  My non-VA eye doctor is great, but I have been to his office 10+ times in the past 12 months while he tries to fit contacts for me that work around my other eye complications.  Thank you in advance for any advice.

[GBArmy]

Beeps I don't know anything about your disabilities but a few facts should hold constant. Know your diagnostic code and what is required in way of symptoms to get to the next level of disability rating. The second thing, and you already hint at knowing it is you should get a qualified specialist to state that the what your treatments are and that they constitute treatment for incapacitating episodes. If you don't have the episodes, seems to me that you wouldn't meet the higher rating criteria, whether there are qualifying treatments or not. But I'm no eye doc either. You need a statement from that doc that says so.

[Beeps]

Thank you for your response

[broncovet]

You are asking we "interpret" what is a "incapacitating episode" or if allergy shots are considered "treatement visits".  

While I wont attempt to interpret the regulations, I do know that 38 CFR 3.102 requires the Veteran be given the benefit of the doubt.  

My advice:  If you think you deserve a higher rating GO FOR IT.  

Quote

§ 3.102 Reasonable doubt.

It is the defined and consistently applied policy of the Department of Veterans Affairs to administer the law under a broad interpretation, consistent, however, with the facts shown in every case. When, after careful consideration of all procurable and assembled data, a reasonable doubt arises regarding service origin, the degree of disability, or any other point, such doubt will be resolved in favor of the claimant. By reasonable doubt is meant one which exists because of an approximate balance of positive and negative evidence which does not satisfactorily prove or disprove the claim. It is a substantial doubt and one within the range of probability as distinguished from pure speculation or remote possibility. It is not a means of reconciling actual conflict or a contradiction in the evidence. Mere suspicion or doubt as to the truth of any statements submitted, as distinguished from impeachment or contradiction by evidence or known facts, is not justifiable basis for denying the application of the reasonable doubt doctrine if the entire, complete record otherwise warrants invoking this doctrine. The reasonable doubt doctrine is also applicable even in the absence of official records, particularly if the basic incident allegedly arose under combat, or similarly strenuous conditions, and is consistent with the probable results of such known hardships.

 

[flow1972]

Usually the VA lists what the definition for "Incapacitating Episodes" is for the evaluation of the specific condition in their documentation.  I'd look up the rating schedule for the condition and read how they define it.

 

Based on this though, I'd say it fits the definition:

Note (1): For the purposes of evaluation under 38 CFR 4.79, an incapacitating episode is an eye condition severe enough to require a clinic visit to a provider specifically for treatment purposes.

Note (2): Examples of treatment may include but are not limited to: Systemic immunosuppressants or biologic agents; intravitreal or periocular injections; laser treatments; or other surgical interventions

Note (3): For the purposes of evaluating visual impairment due to the particular condition, refer to 38 CFR 4.75-4.78 and to §4.79, diagnostic codes 6061-6091