Diabetic retinopathy VA Rating

Diabetic retinopathy is rated under diagnostic code 6040. In the VA Schedule for Rating Disabilities it appears as Diabetic retinopathy, within the Organs of Special Sense section of 38 CFR Part 4.

The essentials

What evidence decides the rating

For organs of special sense conditions, these are the findings VA weighs when assigning a percentage. If your examination did not address them, the examination may be inadequate for rating purposes — which is itself an argument on appeal.

• Corrected and uncorrected central visual acuity
• Visual field testing where field loss is claimed
• Whether there is incapacitating episode activity requiring treatment

Why these claims get denied or under-rated

These are the failure patterns we see most often on diabetic retinopathy and related organs of special sense claims:

• Visual field testing was not performed despite field loss being claimed
• The rating used corrected acuity where the criteria called for a different measure

If your claim was denied or under-rated

A denial is not the end of the claim. Which route is right depends on why VA decided the way it did:

• Higher-Level Review — when the evidence already in the file supports a grant and VA got the decision wrong, or the examination was inadequate.
• Supplemental Claim — when you have new and relevant evidence, such as a private nexus opinion.
• Board Appeal — when you need a Veterans Law Judge to decide, or want a hearing.
• Clear and Unmistakable Error — when a decision more than a year old contains an undebatable error, which can recover retroactive pay.

Effective dates matter as much as the percentage. See effective dates and back pay for how far back an award can reach.

Sources

• 38 CFR Part 4 rating criteria on eCFR
• VA Disability Benefits Questionnaires (DBQ) index

Related conditions

• Accommodation paralysis (DC 6030)
• Cataract (DC 6027)
• Open-angle glaucoma (DC 6013)
• Visual field defects (DC 6080)