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C&P Exam Prep: Eye Conditions
DBQ Overview
Interview + Physical- Form Name
- Eye_Conditions
- Form Code
- Eye_Conditions
- Page Count
- 14
- Examiner Type
- Ophthalmologist or Optometrist
- Estimated Duration
- 30-45 minutes
- Exam Format
- Interview + Physical
What to Expect During Your Exam
Exam Overview
To document the current severity of your eye condition affecting visual acuity in one eye under DC 6066, establish the degree of visual impairment for rating purposes under 38 CFR 4.79, and determine how the condition affects your daily functioning and employability.
What the examiner evaluates:
- Best-corrected and uncorrected visual acuity in each eye (distance and near)
- Visual field defects using Goldmann kinetic perimetry or Humphrey automated perimetry (Model 750 or later)
- Intraocular pressure (IOP) measured via Goldmann applanation tonometry
- Slit-lamp biomicroscopy findings (anterior segment structures)
- Fundus/retinal examination (posterior segment structures)
- Extraocular muscle function and diplopia assessment
- Eyelid, lacrimal, and external ocular structures
- Lens status (phakic, pseudophakic, aphakic)
- Presence of corneal, uveal, retinal, macular, optic nerve, or neuro-ophthalmic pathology
- Incapacitating episodes requiring treatment in the past 12 months
- Functional impact on occupational and daily activities
- Current treatments (medications, surgical procedures, injections, laser)
- Residuals of any prior ocular surgeries or trauma
Conducted in a clinical ophthalmology or optometry suite. Bring your current glasses or contact lenses. Wear your habitual correction and bring your contact lens prescription if applicable. Dilation drops may be administered; arrange transportation if needed as your vision may be blurred afterward. Do NOT wear contact lenses on the day of the exam unless instructed - most examiners prefer glasses to ensure accurate refraction data.
Typical duration: 30-45 minutes
Best-Corrected Visual Acuity (BCVA) - Distance
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.
Key thresholds:
- 20/20 to 20/40 (6/6 to 6/12) — 0% - no ratable impairment at this level under DC 6066
- 20/50 to 20/70 (6/15 to 6/21) — 10% for one eye with BCVA in this range combined with specific contra-lateral acuity
- 20/100 to 20/200 (6/30 to 6/60) — Significant rating impact; combined table entry used with fellow eye acuity
- 20/400 (6/120) — Near-maximum impairment for a single eye; check eligibility for Special Monthly Compensation (SMC)
- Counting fingers (CF), hand motion (HM), light perception (LP), no light perception (NLP) — Maximum impairment of that eye; SMC review required under 38 CFR 3.350
Tips:
- Read the chart slowly and accurately - do not guess letters you cannot see, but do not refuse to attempt the smaller lines either.
- If the chart is blurry at any line, say so clearly: 'The bottom three letters of that line are blurry to me.'
- Inform the examiner if you have a lazy eye (amblyopia) so it is documented as pre-existing or separate from the claimed condition.
- Report if your vision fluctuates during the day - for example, worse after prolonged screen use or upon awakening.
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
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.
Key thresholds:
- Jaeger 1 (J1) or N5 — Normal near acuity - no additional impairment
- Jaeger 10 or worse (J10+/N14+) — Significant near impairment; may support higher overall rating or special rating considerations
Tips:
- If you notice a significant difference between how well you see distance versus near, mention this to the examiner.
- Report if you need magnification aids (e.g., +3.00 or stronger readers) to perform near tasks.
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)
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.
Key thresholds:
- Any acuity worse than 20/20 without correction — Documents the degree of refractive error; rating still based on BCVA per 38 CFR 4.79 Note 1
Tips:
- Remove glasses before this portion. If you cannot safely navigate the room without them, inform the examiner.
- Note: refractive error alone (needing glasses) does not typically generate a compensable rating - an underlying pathology is required.
Pain considerations: N/A for uncorrected acuity testing specifically.
Visual Field Testing (Perimetry)
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.
Key thresholds:
- Central 20-degree field retained — Less severe field loss
- Field restricted to 21-30 degrees — Significant field loss - maps to higher rating tier
- Field restricted to 31-40 degrees — Moderate-to-severe field restriction
- Field restricted to greater than 40 degrees — Severe field constriction; may warrant maximum rating or SMC review
- Homonymous hemianopsia — Half-field loss; rated separately and may substantially increase combined evaluation
- Scotoma affecting at least 1/4 of visual field — Centrally located scotoma or large peripheral scotoma affects rating significantly
- Loss of nasal, temporal, superior, or inferior half of visual field — Each type of hemianopsia is rated according to specific criteria in 38 CFR 4.79
Tips:
- Do not try to 'hunt' for the test light - fixate centrally and respond only when you genuinely perceive the target.
- If your eye wanders or you lose fixation, tell the technician; most machines have fixation monitoring.
- Describe any areas where your vision seems 'missing,' 'foggy,' 'dark,' or 'washed out' before the test begins.
- If you notice a dark or blank spot in your central vision, explicitly describe it to the examiner as a 'central scotoma.'
- Inform the examiner if you have noticed tunnel vision, difficulty seeing on one side, or bumping into objects on one side.
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
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.
Key thresholds:
- IOP > 21 mmHg — Elevated; relevant to glaucoma rating under 38 CFR 4.79 DCs 6012/6013
- IOP > 30 mmHg despite treatment — Significant; may support higher glaucoma disability rating
Tips:
- Tell the examiner if you are currently using glaucoma eye drops (e.g., latanoprost, timolol, brimonidine) - list all eye medications.
- If your pressure is well-controlled on medication, mention whether it was previously elevated without treatment.
- Report any episodes of acute angle-closure glaucoma attacks (severe eye pain, blurred vision, halos, nausea).
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
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.
Key thresholds:
- Corneal scar or opacity affecting the visual axis — Directly reduces BCVA - significant rating impact
- Significant cataract (PSC, nuclear, cortical) — Reduces BCVA; rated pre-operative or post-operative (aphakia/pseudophakia)
- Active anterior uveitis (cells and flare) — Supports chronic iritis/uveitis diagnosis, which has its own rating pathway
Tips:
- Inform the examiner of any history of corneal transplants, LASIK, PRK, or other refractive surgeries.
- Report if you experience halos, starbursts, or glare around lights, especially at night (common after refractive surgery or with cataracts).
- Mention any history of chemical splash, foreign body injuries, or arc-eye (welding flash) from service.
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
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.
Key thresholds:
- Macular involvement (central scar, edema, atrophy) — Direct cause of central vision loss; major impact on BCVA and field
- Optic disc pallor or cupping >0.6 C:D ratio — Suggests optic nerve damage (glaucomatous or neuropathic)
- Proliferative diabetic retinopathy (PDR) with neovascularization — Active progressive disease; supports DC 6006 or 6008
- Retinal detachment (history or current) — Rated under DC 6000; significant impairment possible
Tips:
- Bring your current glasses prescription. If you have been told you have 'holes,' 'tears,' or 'scars' in your retina, mention this.
- Report any history of flashes of light, floaters (sudden increase), or a 'curtain' across your vision - these are retinal detachment symptoms.
- Describe any 'missing spot' in the center of your vision (metamorphopsia, central scotoma) as these indicate macular disease.
- If you have diabetes, bring documentation of your HbA1c and duration of diabetes for context.
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
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).
Key thresholds:
- Diplopia in any field of gaze — Rated under DC 6090 or 6091; constant diplopia in primary gaze is rated more severely than occasional or peripheral diplopia
- Constant diplopia in primary (straight-ahead) gaze — Significant ratable finding
Tips:
- If you experience double vision, describe exactly when it occurs (all the time, only looking to the left, only looking down, only when tired).
- Report if you have started tilting or turning your head to avoid double vision - this is an adaptive sign the examiner should document.
- Mention if you wear a prism in your glasses prescription to correct diplopia.
Pain considerations: Pain on eye movement (especially painful eye movement) is a hallmark of optic neuritis and should be explicitly described.
Rating Criteria Breakdown
| Rating % | Criteria | Key Symptoms |
|---|---|---|
| 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. |
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.' |
| 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. |
CFR: Extreme bilateral impairment per 38 CFR 4.79 combined acuity table; review for SMC under 38 CFR 3.350 is required. |
| 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. |
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. |
| 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. |
CFR: CF, HM, or LP in one eye combined with reduced acuity in the fellow eye per the 38 CFR 4.79 combined 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. |
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. |
| 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. |
CFR: Combined table entries reflecting 20/200 or worse in one eye with intermediate loss in the other, per 38 CFR 4.79 table. |
| 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. |
CFR: BCVA in one eye approaching 20/200 combined with mild-to-moderate impairment in the other, per combined table. |
| 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. |
CFR: Higher acuity loss in one eye with the other eye remaining functional, per table; also consider incapacitating episodes requiring treatment. |
| 20% | Combined visual acuity table value of 20% based on the BCVA of both eyes. Represents moderate functional visual impairment affecting daily activities. |
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. |
| 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. |
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. |
| 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. |
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. |
100% Combined table value of 100%. Total blindness (NLP) in both ...
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.
Key Symptoms
- No light perception in both eyes
- Total blindness
- Complete dependence on others for all visual tasks
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.'
90% Combined table value of 90%. Near-total functional blindness ...
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.
Key Symptoms
- Effectively non-functional vision bilaterally
- Requires full-time adaptive assistance for most activities
- Cannot read even with optical aids
- Cannot recognize faces at any distance
CFR: Extreme bilateral impairment per 38 CFR 4.79 combined acuity table; review for SMC under 38 CFR 3.350 is required.
80% Combined table value of 80%. Extremely severe impairment in ...
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.
Key Symptoms
- No light perception (NLP) in one eye
- Hand motion (HM) or worse in one eye with significant fellow eye loss
- Legally blind in both eyes
- Total dependence on adaptive devices for any visual task
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.
70% Combined table value of 70%. Near-total impairment in one ey ...
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.
Key Symptoms
- Counting fingers (CF) or worse in one eye
- Severely limited functional vision bilaterally
- Cannot safely ambulate independently in unfamiliar settings
- Requires low-vision rehabilitation
CFR: CF, HM, or LP in one eye combined with reduced acuity in the fellow eye per the 38 CFR 4.79 combined table.
60% Combined table value of 60%. Severe monocular loss with addi ...
Combined table value of 60%. Severe monocular loss with additional impairment in the fellow eye, or both eyes with moderate-to-severe acuity loss.
Key Symptoms
- Functional monocular status in everyday life
- Unable to read standard text
- Significant travel and mobility limitations
- Frequent need for adaptive devices
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.
50% Combined table value of 50%. Significant bilateral functiona ...
Combined table value of 50%. Significant bilateral functional impairment or one eye with BCVA approaching 20/200 and meaningful impairment in the fellow eye.
Key Symptoms
- Legal blindness level impairment in the affected eye
- Cannot read standard print without significant magnification
- Impaired mobility in unfamiliar environments
- Difficulty recognizing faces
CFR: Combined table entries reflecting 20/200 or worse in one eye with intermediate loss in the other, per 38 CFR 4.79 table.
40% Combined table value of 40%. Severe functional impairment in ...
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.
Key Symptoms
- Inability to perform fine detail work
- Loss of functional driving ability
- Requires assistance with visual tasks
- Multiple incapacitating episodes per year requiring treatment
CFR: BCVA in one eye approaching 20/200 combined with mild-to-moderate impairment in the other, per combined table.
30% Combined table value of 30%. Significant monocular impairmen ...
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.
Key Symptoms
- Inability to drive without corrective aids
- Significant limitation in reading and detailed visual tasks
- Depth perception impairment (monocular effect)
- Increased risk of falls due to limited field or depth perception
CFR: Higher acuity loss in one eye with the other eye remaining functional, per table; also consider incapacitating episodes requiring treatment.
20% Combined visual acuity table value of 20% based on the BCVA ...
Combined visual acuity table value of 20% based on the BCVA of both eyes. Represents moderate functional visual impairment affecting daily activities.
Key Symptoms
- Difficulty with tasks requiring detailed near vision
- Reduced driving ability, especially at night
- Frequent use of magnification aids
- Increased errors with fine visual tasks
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.
10% Best-corrected visual acuity in the affected eye combined wi ...
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.
Key Symptoms
- Difficulty reading fine print even with glasses
- Reduced contrast sensitivity
- Night vision difficulties
- Mild glare sensitivity
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.
0% Best-corrected visual acuity of 20/40 (6/12) or better in th ...
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.
Key Symptoms
- Visual acuity 20/40 or better with correction
- Minimal or no functional visual limitation
- May have mild symptoms (dryness, mild glare sensitivity) not yet meeting higher criteria
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.
How to Describe Your Symptoms
Visual Acuity Loss
How to describe:
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.'
Worst-day 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.”
What the 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.
Understatements to 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:
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.'
Worst-day 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.”
What the 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.
Understatements to 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:
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.'
Worst-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.”
What the 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.
Understatements to 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:
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.
Worst-day 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.”
What the 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.
Understatements to 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:
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.'
Worst-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.”
What the 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.
Understatements to 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:
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.'
Worst-day 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.”
What the examiner listens for:
Specific occupational tasks no longer performable; compensatory strategies employed; activities of daily living affected; need for adaptive devices or assistance.
Understatements to 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.
Common Mistakes to Avoid
Wearing contact lenses to the exam without informing the examiner
Contact lenses may artificially improve BCVA readings and can distort refraction measurements, potentially leading to a lower-than-accurate acuity finding on the exam day.
Instead: Wear your glasses to the exam. If you must wear contacts, inform the examiner before any testing begins so the lens type and prescription can be documented.
Impact: All levels - particularly 10%-40%
Reporting only your best days instead of your typical or worst days
VA rating is based on the disability as it exists on the worst or most representative days. Many eye conditions fluctuate (uveitis, keratoconus, macular conditions). Reporting only good days results in an artificially low rating.
Instead: Per M21-1 guidance, describe your condition as it affects you on your worst days. State: 'On my worst days my vision is...' and provide a specific example.
Impact: All levels
Failing to report all functional limitations beyond just the acuity number
The DBQ has specific fields for functional impact on daily activities, occupation, and quality of life. If you only answer the eye chart test and say nothing more, the examiner may document minimal impact.
Instead: Before the exam, prepare a written list of every activity you have stopped or modified due to your eye condition. Bring this list and ask the examiner to document it.
Impact: 0%-30% - functional impact can push borderline cases to a higher tier
Not mentioning incapacitating episodes
The General Rating Formula for Diseases of the Eye (38 CFR 4.79 Notes 1 and 2) allows ratings based on incapacitating episodes requiring specific treatments. Failing to report flare-ups misses this rating pathway entirely.
Instead: Count and document all episodes in the past 12 months where you were unable to work or perform usual activities, and what treatment (especially systemic steroids) was required. Bring pharmacy records.
Impact: 10%-60%
Attributing visual symptoms only to 'needing stronger glasses'
Refractive error alone does not support a compensable rating under DC 6066 - actual underlying pathology is required. If you dismiss symptoms as 'just glasses issues,' the examiner may not investigate the underlying pathology.
Instead: Describe symptoms clearly and let the examiner determine their cause. Do not pre-diagnose yourself. Report ALL symptoms: blurring, distortion, halos, pain, photophobia, field loss, and night vision problems.
Impact: 0%-10% - prevents establishment of a compensable evaluation
Not disclosing all current eye medications
Medications (especially glaucoma drops, anti-VEGF injections, or systemic immunosuppressants) document the severity of your condition. Failing to disclose them may make your condition appear less severe than it is.
Instead: Bring a complete medication list including eye drops, including over-the-counter artificial tears, prescription eye drops, oral medications for eye conditions, and any injection treatments.
Impact: All levels - especially glaucoma and uveitis ratings
Not requesting that the visual field test be performed if you have a perceived field defect
Per M21-1 IV.i.3.B.1.a, when a visual field defect is perceived, Goldmann or qualifying automated perimetry MUST be performed. If you do not report field symptoms, this required test may be skipped.
Instead: If you notice any area of missing, dark, blurry, or washed-out vision outside of your central fixation point, explicitly report this to the examiner before testing begins.
Impact: All levels - visual field ratings can independently increase the overall evaluation significantly
Failing to arrange transportation post-dilation
If dilation drops are given and you did not arrange a driver, you may refuse dilation - resulting in an incomplete fundus exam. An incomplete exam can be returned or used for a lower rating.
Instead: Arrange a driver for the appointment. If dilation is refused, the examiner notes it and the DBQ may be incomplete, which can delay your claim.
Impact: Any condition requiring fundus evaluation (retinal, macular, optic nerve conditions)
Prep Checklist
Before Your Exam
Day Of
During the Exam
After the Exam
Your Rights During a C&P Exam
- You have the right to record your C&P examination in most states (verify your state's recording consent laws - some require both-party consent). Inform the examiner at the start of the exam if you plan to record.
- You are entitled to receive a copy of the completed Disability Benefits Questionnaire (DBQ) and examination report. Request it through your VA Regional Office, VA.gov, or eBenefits.
- You have the right to submit a personal statement (VA Form 21-4138) to supplement or clarify the DBQ if you believe the examiner's findings are incomplete or inaccurate.
- If you believe the C&P examination was inadequate, you may request a new examination. VA must provide an adequate examination; an examination that fails to consider all relevant evidence or fails to perform required testing (e.g., qualifying perimetry when a field defect is perceived) may be returned as insufficient.
- You have the right to submit buddy statements (VA Form 21-10210) from family members, friends, or coworkers who can attest to the functional impact of your eye condition on your daily life.
- You have the right to bring your own private ophthalmologist's opinion (nexus letter, DBQ completed by your treating provider) as supporting evidence in your claim.
- Per M21-1, when a visual field defect is perceived, the examiner is required to perform Goldmann kinetic perimetry or qualifying automated perimetry (Humphrey Model 750, Octopus Model 101, or later versions). If this testing is not performed when you reported field symptoms, the examination may be deficient.
- You have the right to have all service treatment records, VA medical records, and private medical records considered by the rating decision. Ensure all relevant records are associated with your claims file (C-file) before your rating decision.
- Under the PACT Act and related provisions, certain veterans with toxic exposure (burn pits, Agent Orange, radiation, etc.) may have presumptive service connection for certain eye conditions - discuss this with your VSO or accredited claims agent.
- If your evaluation reaches 100% due to bilateral blindness, you may be entitled to Special Monthly Compensation (SMC) under 38 CFR 3.350. The DC 6066 rating note explicitly requires review for SMC eligibility at maximum ratings.
- You are not required to attend a C&P examination conducted by a physician who is not appropriately qualified (e.g., an ophthalmology exam should be conducted by an ophthalmologist or optometrist, not a general practitioner). You may raise a concern to your VSO if the examiner appears unqualified.
- You have the right to be treated with dignity during your examination. If the examiner is dismissive, cuts the interview short, or refuses to document symptoms you report, note this in a subsequent personal statement submitted to your VARO.
Related Conditions
- Glaucoma Glaucoma causes progressive optic nerve damage leading to visual field loss and, ultimately, visual acuity loss that is rated under DC 6066 combined with field defect ratings under 38 CFR 4.79.
- Diabetic Retinopathy Diabetic retinopathy is a common cause of visual acuity loss and macular edema. If service connected diabetes caused retinopathy, the eye condition is rated as secondary to the diabetes. Visual acuity is rated under DC 6066 combined with DC 6006 for retinopathy/maculopathy.
- Retinal Detachment Retinal detachment causes sudden visual field and acuity loss. Traumatic retinal detachment has direct service connection potential. Residual acuity loss is rated under DC 6066.
- Cataracts Cataracts are rated pre operatively and post operatively (aphakia/pseudophakia) under 38 CFR 4.79. Post operative visual acuity is rated under DC 6066. Traumatic or radiation induced cataracts may have direct service connection.
- Keratoconus Keratoconus causes progressive corneal thinning and distortion, leading to BCVA loss that is rated under DC 6066. Veterans with occupational corneal trauma or chronic eye rubbing may have a service connection basis.
- Optic Neuropathy Optic neuropathy (DC 6026) directly causes visual acuity and field loss rated under DC 6066. Traumatic, toxic (e.g., methanol, certain antibiotics), or ischemic optic neuropathy may have service connection.
- Dry Eye Syndrome Dry eye syndrome can secondarily reduce BCVA through corneal surface irregularity and may cause significant photophobia and functional limitations. Per M21 1, it may be rated under DC 6013, 6018, or 6025 depending on symptomatology.
- Traumatic Brain Injury (TBI) TBI is a common cause of neuro ophthalmic visual impairment including post chiasmal visual field defects, optic nerve damage, convergence insufficiency, and ptosis all of which affect the eye DBQ and can be rated concurrently with the TBI rating.
- Post-Traumatic Stress Disorder (PTSD) PTSD and associated hypervigilance may worsen subjective visual symptoms and photophobia. Veterans with both PTSD and eye conditions should ensure each is rated separately and that neither is pyramided.
- Uveitis / Iritis / Choroidopathy Chronic or recurrent uveitis causes visual acuity loss and incapacitating episodes that drive the eye rating. The incapacitating episode rating pathway under 38 CFR 4.79 General Rating Formula is particularly relevant here.
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This C&P exam preparation guide is for educational purposes only and does not constitute legal, medical, or claims advice. Always consult with a qualified Veterans Service Organization (VSO) representative or VA-accredited attorney for guidance specific to your claim. Never exaggerate, minimize, or fabricate symptoms during a C&P examination.