VASDR 6035 Compensation for Keratoconus

[MilvetHD]

Hello, 

Does anyone know how the VA rates keratoconus currently? The diagnostic code is 6035. I am new to all this and have been unsuccessful in finding the specifics using the VASDR. I have been diagnosed with bilateral keratoeonus and would like to better inform myself on how it is rated. I am awaiting a decision back from the VA but my case and evidence is overwhelming. To date, I have found only one article dating back to 2008 that appeared to show the  minimum rating use to be 30% but I am unable to gauge the accuracy. Any assistance is helpful. 

[brokensoldier244th]

That is the basic rating, with correction, if you require singular or bilateral correction. Is that what you are asking? 

Keratoconus uses a combined diagnostic code (6035-6077)- meaning that the base condition- Keratoconus has a minimum rating. Depending on the individualized effects to you, under other associated codes (whether they apply or not only you/your doctor know- it's based on actual effects to 'you') can be used to determine if a higher rating is needed. 

 

https://www.va.gov/vetapp16/Files4/1628301.txt

 

CAS

[Buck52]

The Veteran's keratoconus is rated under Diagnostic Code 6035. 38 C.F.R. § 4.84a. Keratoconus is a noninflammatory, usually bilateral protrusion of the cornea. See Dorland's Illustrated Medical Dictionary 973 (30th ed. 2003). Evaluation of keratoconus under applicable criteria of the VA Schedule for Rating Disabilities provides for keratoconus to be evaluated based on impairment of corrected visual acuity using contact lenses. See 38 C.F.R. § 4.84a, Diagnostic Code 6035. If contact lenses are medically required, the minimum rating is 30 percent.

The severity of visual acuity loss is determined by applying the criteria set forth at 38 C.F.R. § 4.84a (2008). Under these criteria, impairment of central visual acuity is evaluated from noncompensable (0 percent) to 100 percent based on the degree of the resulting impairment of visual acuity. 38 C.F.R. § 4.84a, Diagnostic Codes 6061 to 6079 (2008). The percentage evaluation will be found from Table V by intersecting the horizontal row appropriate for the Snellen index for one eye and the vertical column appropriate to the Snellen index of the other eye. 38 C.F.R. § 4.83a (2008). Visual acuity is rated based upon the best distant vision obtainable after correction by glasses. 38 C.F.R. § 4.75 (2008).

Source BVA Nr:102-9110

 Case  No.Docket#6-27 598

[Buck52]

After Reading some keratoconus Cases from the BVA It's obvious these cases are hard to win they have the criteria placed as to make it hard for veterans to win, to many changes in the rating criteria that makes it hard

example  in the case about the Veteran was denied due in part  because he had two Dr to opine their medical opinion   on the 21-4142  because two Dr's gave there medical opinion   this was knock down  because in the criteria for rating  it only ALLOWS ONE Dr (specialist)  to  give his/her Opine  so they denied in part of that reason,, you can get two seperate 21-4142 and have a Dr Opine on each form and it is acceptable   things like this will cause them to deny.

I suggest read up on some past BVA Cases  that Adjudicated what your claiming   this is a hard claim  TO WIN  its unfortunate , but these claims can be won  but they are really picky about the criteria  so you need to follow it to the T.

opposed to in most claims if we have two medical specialist opine in our favour  works very well of what were claiming.

[MilvetHD]

4 hours ago, brokensoldier244th said:

That is the basic rating, with correction, if you require singular or bilateral correction. Is that what you are asking? 

Keratoconus uses a combined diagnostic code (6035-6077)- meaning that the base condition- Keratoconus has a minimum rating. Depending on the individualized effects to you, under other associated codes (whether they apply or not only you/your doctor know- it's based on actual effects to 'you') can be used to determine if a higher rating is needed. 

 

https://www.va.gov/vetapp16/Files4/1628301.txt

 

CAS

Yes, I was wondering if the base minimum still applied. I can tell by the totality of the responses there is not a singular answer per se.  Your response has been extremely insightful...pun intended. Thank you 

[MilvetHD]

3 hours ago, Buck52 said:

After Reading some keratoconus Cases from the BVA It's obvious these cases are hard to win they have the criteria placed as to make it hard for veterans to win, to many changes in the rating criteria that makes it hard

example  in the case about the Veteran was denied due in part  because he had two Dr to opine their medical opinion   on the 21-4142  because two Dr's gave there medical opinion   this was knock down  because in the criteria for rating  it only ALLOWS ONE Dr (specialist)  to  give his/her Opine  so they denied in part of that reason,, you can get two seperate 21-4142 and have a Dr Opine on each form and it is acceptable   things like this will cause them to deny.

I suggest read up on some past BVA Cases  that Adjudicated what your claiming   this is a hard claim  TO WIN  its unfortunate , but these claims can be won  but they are really picky about the criteria  so you need to follow it to the T.

opposed to in most claims if we have two medical specialist opine in our favour  works very well of what were claiming.

In preparing my case, we heavily reviewed previous BVA decisions. And although they are non binding they provided a mount of information. It is less than desirable in my opinion how the VA tries to make it hard to claim compensation. Thank you 

[MilvetHD]

4 hours ago, Buck52 said:

The Veteran's keratoconus is rated under Diagnostic Code 6035. 38 C.F.R. § 4.84a. Keratoconus is a noninflammatory, usually bilateral protrusion of the cornea. See Dorland's Illustrated Medical Dictionary 973 (30th ed. 2003). Evaluation of keratoconus under applicable criteria of the VA Schedule for Rating Disabilities provides for keratoconus to be evaluated based on impairment of corrected visual acuity using contact lenses. See 38 C.F.R. § 4.84a, Diagnostic Code 6035. If contact lenses are medically required, the minimum rating is 30 percent.

The severity of visual acuity loss is determined by applying the criteria set forth at 38 C.F.R. § 4.84a (2008). Under these criteria, impairment of central visual acuity is evaluated from noncompensable (0 percent) to 100 percent based on the degree of the resulting impairment of visual acuity. 38 C.F.R. § 4.84a, Diagnostic Codes 6061 to 6079 (2008). The percentage evaluation will be found from Table V by intersecting the horizontal row appropriate for the Snellen index for one eye and the vertical column appropriate to the Snellen index of the other eye. 38 C.F.R. § 4.83a (2008). Visual acuity is rated based upon the best distant vision obtainable after correction by glasses. 38 C.F.R. § 4.75 (2008).

Source BVA Nr:102-9110

 Case  No.Docket#6-27 598

Thank you, every bit helps