Eye Conditions C&P Exam Prep

Best-Corrected Visual Acuity (BCVA) - Distance

What it measures: How well you see at 20 feet (6 meters) with your optimal correction (glasses or contacts). This is the primary driver of the DC 6066 rating percentage.

What to expect: You will be asked to read a Snellen or LogMAR eye chart one eye at a time. The examiner will refract your eye (determine the optimal lens prescription) before recording BCVA. Both the right eye (OD) and left eye (OS) will be tested.

Pain considerations: Eye pain or headache that occurs during visual tasks or in bright light can contribute to functional impairment even when acuity is preserved. Always describe any ocular pain associated with visual tasks.

Best-Corrected Visual Acuity (BCVA) - Near

What it measures: How well you read up close with optimal correction. Near vision is tested separately and may differ from distance acuity, especially after cataract surgery, with accommodative disorders, or with macular conditions.

What to expect: You will read a near-vision card (Jaeger or equivalent) at approximately 14 inches (35 cm). The examiner may also note a significant difference between distance and near acuity.

Pain considerations: Sustained near work may trigger headaches, eye strain, or photophobia in conditions like keratoconus or corneal disease. Describe these symptoms accurately.

Uncorrected Visual Acuity (UCVA)

What it measures: How well you see without any glasses or contact lenses. This is documented for both eyes but the rating is primarily based on best-corrected acuity under DC 6066.

What to expect: Same Snellen chart procedure but without your glasses on. This test is performed first, before refraction.

Pain considerations: N/A for uncorrected acuity testing specifically.

Visual Field Testing (Perimetry)

What it measures: The complete extent of your peripheral and central vision in each eye. Visual field loss can result in significant disability ratings independent of or in addition to acuity ratings under 38 CFR 4.79.

What to expect: You will place your chin in a device (perimeter) and focus on a central fixation target. Lights or moving targets will appear in your peripheral vision and you must respond (press a button or say 'now') when you see them. The Goldmann kinetic perimeter uses a moving light; the Humphrey automated perimeter (Model 750 or later) uses a stationary flashing light. The test takes approximately 5-10 minutes per eye. Per M21-1 IV.i.3.B.1.a, when a visual field defect is perceived, examiners must use Goldmann kinetic perimetry or automated perimetry using Humphrey Model 750, Octopus Model 101, or later versions with simulated kinetic Goldmann testing capability.

Pain considerations: Photophobia or light sensitivity during perimetry testing should be reported, as it may indicate active inflammatory pathology affecting the rating.

Intraocular Pressure (IOP) Measurement

What it measures: The fluid pressure inside your eye. Elevated IOP is a key indicator of glaucoma and is required for rating glaucoma conditions. Normal IOP is approximately 10-21 mmHg.

What to expect: Anesthetic eye drops will be instilled. The examiner will touch a small probe (Goldmann applanation tonometer attached to the slit lamp) or a handheld device briefly to the surface of your eye. This is generally painless with the anesthetic drops.

Pain considerations: Chronic elevated IOP can cause a dull aching pressure sensation. Acute spikes cause severe eye pain. Describe any pressure-type pain or aching in or around the eye.

Slit-Lamp Examination

What it measures: Microscopic evaluation of the anterior segment of the eye: eyelids, lashes, conjunctiva, cornea, anterior chamber, iris, and lens. Identifies conditions such as keratoconus, corneal scars, cataracts, anterior uveitis, pterygium, dry eye changes, and more.

What to expect: You rest your chin on a chin-rest and look straight ahead while the examiner uses a bright slit of light and microscope to examine the front of your eye. The room is darkened. You may be asked to look in different directions.

Pain considerations: Describe any episodes of acute red eye, painful photophobia, foreign body sensation, or watering - these symptoms suggest active pathology that affects the rating.

Fundus (Retinal) Examination

What it measures: Evaluation of the posterior segment: optic disc, retina, macula, and vitreous. Identifies diabetic retinopathy, macular degeneration, retinal detachment, optic neuropathy, chorioretinal scars, and vitreous hemorrhage.

What to expect: Dilation drops (mydriatics) are instilled 20-30 minutes before this exam. The examiner uses an indirect ophthalmoscope, slit-lamp with a fundus lens, or both to examine the back of your eye. Your vision will be temporarily blurred and you will be light-sensitive for 2-4 hours afterward. Arrange a driver.

Pain considerations: Deep aching pain behind the eye may indicate optic neuritis or orbital inflammatory disease. Mention this to the examiner.

Extraocular Motility / Diplopia Assessment

What it measures: Assesses the alignment and movement of both eyes together. Diplopia (double vision) is rated separately under 38 CFR 4.79 and can significantly increase the overall evaluation.

What to expect: The examiner will have you follow a moving target (pen light or finger) in multiple directions of gaze (up, down, left, right, diagonals). You will be asked if you see double at any point. A cover-uncover test may be performed to detect misalignment (strabismus).

Pain considerations: Pain on eye movement (especially painful eye movement) is a hallmark of optic neuritis and should be explicitly described.

0%

Best-corrected visual acuity of 20/40 (6/12) or better in the affected eye. No ratable visual impairment. Note: refractive error alone without underlying pathology does not support a compensable evaluation under DC 6066.

From 38 CFR: 20/40 (6/12) = 0% per the DC 6066 visual acuity conversion table. Review for entitlement to Special Monthly Compensation under 38 CFR 3.350 is noted if the fellow eye also has impairment.

10%

Best-corrected visual acuity in the affected eye combined with the fellow eye's acuity produces a combined table value of 10% per 38 CFR 4.79. Typically corresponds to moderate impairment in one eye with normal or near-normal fellow eye.

From 38 CFR: Combined table entries where one eye has BCVA in the 20/50-20/70 range and the fellow eye is near-normal produce ratings in the 10% tier.

20%

Combined visual acuity table value of 20% based on the BCVA of both eyes. Represents moderate functional visual impairment affecting daily activities.

From 38 CFR: BCVA approximately 20/100 in one eye combined with normal or mildly impaired fellow eye per the 38 CFR 4.79 visual acuity table produces a 20% combined rating.

30%

Combined table value of 30%. Significant monocular impairment affecting functional tasks. May also arise from incapacitating episodes of eye disease per General Rating Formula Notes 1 and 2.

From 38 CFR: Higher acuity loss in one eye with the other eye remaining functional, per table; also consider incapacitating episodes requiring treatment.

40%

Combined table value of 40%. Severe functional impairment in the worse eye producing measurable bilateral functional limitation. Alternatively, incapacitating episodes of sufficient frequency and duration.

From 38 CFR: BCVA in one eye approaching 20/200 combined with mild-to-moderate impairment in the other, per combined table.

50%

Combined table value of 50%. Significant bilateral functional impairment or one eye with BCVA approaching 20/200 and meaningful impairment in the fellow eye.

From 38 CFR: Combined table entries reflecting 20/200 or worse in one eye with intermediate loss in the other, per 38 CFR 4.79 table.

60%

Combined table value of 60%. Severe monocular loss with additional impairment in the fellow eye, or both eyes with moderate-to-severe acuity loss.

From 38 CFR: BCVA at 20/400 or worse in one eye combined with moderate impairment in the fellow eye per the 38 CFR 4.79 combined acuity table.

70%

Combined table value of 70%. Near-total impairment in one eye combined with significant impairment in the fellow eye as reflected in the combined acuity table.

From 38 CFR: CF, HM, or LP in one eye combined with reduced acuity in the fellow eye per the 38 CFR 4.79 combined table.

80%

Combined table value of 80%. Extremely severe impairment in one or both eyes; one eye may have no light perception (NLP) with significant loss in the fellow eye.

From 38 CFR: NLP in one eye combined with moderate-to-severe acuity loss in the fellow eye per the combined table under 38 CFR 4.79.

90%

Combined table value of 90%. Near-total functional blindness. One eye with NLP and significant impairment in the fellow eye, or both eyes with near-total loss.

From 38 CFR: Extreme bilateral impairment per 38 CFR 4.79 combined acuity table; review for SMC under 38 CFR 3.350 is required.

100%

Combined table value of 100%. Total blindness (NLP) in both eyes, or any combination that produces the maximum table entry under 38 CFR 4.79. Entitlement to Special Monthly Compensation (SMC) must be reviewed under 38 CFR 3.350.

From 38 CFR: NLP bilaterally or any combined table entry reaching 100% under 38 CFR 4.79. Per DC 6066 note: 'Review for entitlement to special monthly compensation under 38 CFR 3.350.'

Visual Acuity Loss

How to describe it: Describe your vision with your best glasses on during your worst days. Use concrete functional terms: 'I cannot read the highway exit signs until I am 50 feet away.' 'I cannot recognize my neighbor's face from across the street.' 'I can no longer read a book, even with reading glasses.'

Example: On my worst days, my right eye vision is so blurry that even with my glasses I can only make out large shapes. I cannot read anything, and I have to hold text within 4 inches of my left eye to see it. I have mistaken strangers for family members because I cannot see faces clearly. I gave up driving 8 months ago because I felt unsafe.

Examiner listens for: Specific functional limitations tied to visual tasks; consistency with objective acuity findings; description of fluctuation and worst-day severity; impact on driving, reading, work, and daily independence.

Avoid: Do not say 'my vision is OK with glasses' if you still have functional limitations even with correction. Do not minimize night vision problems, glare, or halos - these are ratable symptoms.

Visual Field Loss

How to describe it: Describe specific areas where your vision is absent or dimmed. 'There is a dark spot just to the left of wherever I look - I have to look around it to read.' 'I keep bumping into things on my right side because I don't see them coming.' 'I can only see straight ahead - my peripheral vision is gone on both sides.'

Example: I have a large dark area in the lower-left portion of my vision in my left eye. When I walk, I trip over curbs and steps on my left side because I don't see them. I've fallen twice in the past year because of this. Reading is extremely difficult because the missing area falls right over text.

Examiner listens for: Location of field loss (superior, inferior, nasal, temporal, central), impact on mobility and fall risk, any compensatory head-tilting or turning, consistency with perimetry results.

Avoid: Do not omit describing areas where vision seems 'washed out,' 'faded,' or 'missing' - these may be subtle scotomas. Do not attribute bumping into objects only to clumsiness when field loss is the cause.

Pain and Photophobia

How to describe it: Describe eye pain by type, location, frequency, triggers, and severity on a 0-10 scale. 'I have a sharp, stabbing pain behind my right eye that rates 8/10 and lasts 2-4 hours when I am in bright sunlight or fluorescent lighting.' 'I have a constant dull ache (5/10) in my left eye every day.'

Example: On my worst days I cannot tolerate any light. I wear sunglasses indoors and even then have to sit in a dark room. The pain behind my eyes is a constant 7/10 throbbing that gets worse with any light exposure. I've missed work 4-5 days per month because of this.

Examiner listens for: Frequency and duration of painful episodes; association with light exposure, movement, or specific tasks; impact on work attendance and daily function; medications used to manage pain.

Avoid: Do not describe photophobia as only 'annoying' - if it forces you to limit activities, wear sunglasses indoors, or miss work, say so explicitly. Do not omit pain on eye movement, which is a key sign of optic neuritis.

Incapacitating Episodes

How to describe it: An incapacitating episode is a period of 'inability to work and perform usual activities' per 38 CFR 4.79 General Rating Formula Note 1. Treatments that qualify include systemic corticosteroids or immunosuppressive drugs. Document specific dates, duration, and treatments.

Example: In the past 12 months I had 3 episodes where my eye inflammation flared so severely I could not work or care for myself for 3-7 days each time. Each episode required prednisone (oral steroids) from my eye doctor. The total days incapacitated over the past year was approximately 15-21 days.

Examiner listens for: Number of incapacitating episodes, duration of each episode, treatments required (especially systemic steroids or immunosuppressants), impact on ability to work and perform daily activities.

Avoid: Do not forget to report flare-ups that did not result in an ER visit if they still prevented you from working. Bring medication records or pharmacy printouts showing systemic treatment.

Glare Sensitivity and Night Vision

How to describe it: Describe whether glare or night vision problems limit your activities. 'I cannot drive at night because oncoming headlights blind me for 10-15 seconds - I've had 2 near-accidents.' 'Fluorescent lights at work cause me to lose visual focus repeatedly throughout the day.'

Example: At night I cannot see curbs, steps, or obstacles because my vision drops significantly in low light. I stopped attending evening events because I cannot safely navigate. Lights at night appear as large starbursts rather than point sources of light.

Examiner listens for: Functional activities given up due to glare or night vision loss; documentation of halos, starbursts, or glare as objective symptoms; correlation with lens opacity, corneal irregularity, or retinal dysfunction.

Avoid: Do not omit night driving cessation - this is a significant functional loss. Do not attribute halos/starbursts solely to 'needing glasses' if you also have cataracts or corneal disease.

Impact on Occupation and Daily Activities

How to describe it: The examiner will complete a functional impact section of the DBQ. Be specific about how your eye condition limits work-related tasks. 'I work as a welder and can no longer safely distinguish fine measurements.' 'As an administrative assistant I cannot read a computer screen for more than 20 minutes before needing to stop due to pain and blurring.'

Example: Because of my vision loss I had to stop working as a truck driver. I can no longer safely read fine print on medication bottles, which has caused me to take incorrect doses. I require my wife to drive me to all appointments. I have given up hobbies including woodworking and fishing because I cannot see well enough to participate safely.

Examiner listens for: Specific occupational tasks no longer performable; compensatory strategies employed; activities of daily living affected; need for adaptive devices or assistance.

Avoid: Do not say 'I manage OK' if you have given up activities, changed jobs, or require assistance. List every specific task that has become impossible or dangerous due to your vision.