Body system: EyeRegulation: 38 CFR § 4.79DBQ: DBQ OPHTH Eyes
Diabetic retinopathy is damage to the blood vessels in the retina (the light-sensing tissue at the back of the eye) caused by long-term high blood sugar from diabetes. The VA rates this condition under the General Rating Formula for Diseases of the Eye (38 CFR § 4.79), using whichever path yields the higher evaluation: visual impairment (acuity, field, or muscle function) OR the Incapacitating Episodes ladder (10% for 1-2 treatment visits per year, up to 60% for 7 or more visits, common treatments include anti-VEGF injections and laser photocoagulation). The underlying diabetes mellitus is rated separately under DC 7913.
Rating levels
- -1% — DC 6040 diabetic retinopathy is rated under 38 CFR § 4.79. PATH 1: visual impairment, the VA measures your visual acuity, visual field defects, or eye-muscle function and rates under the standard chart codes (DCs 6066-6081 acuity, DC 6080 field, DC 6090 muscle). PATH 2: the Incapacitating Episodes ladder shown below, which counts how many clinic visits your retinopathy required for treatment during the past 12 months (typical treatments include intravitreal anti-VEGF injections, panretinal laser photocoagulation, or vitrectomy). Whichever path yields the higher evaluation is what the VA assigns. The underlying diabetes mellitus is rated SEPARATELY under DC 7913, the 6040 rating only covers the eye effects.
- 60% — You qualify for 60% if your diabetic retinopathy required 7 or more clinic visits specifically for treatment during the past 12 months (intravitreal or periocular injections, laser treatments, systemic immunosuppressants or biologic agents, or other surgical interventions). This is the highest tier on the Incapacitating Episodes path of the General Rating Formula for Diseases of the Eye (38 CFR § 4.79). Visual impairment may yield a higher rating in some cases, in which case the higher value applies.
- 40% — You qualify for 40% if your diabetic retinopathy required at least 5 but fewer than 7 clinic visits specifically for treatment during the past 12 months. This rating applies under the Incapacitating Episodes path of the General Eye Formula when it yields a higher evaluation than the visual impairment path.
- 20% — You qualify for 20% if your diabetic retinopathy required at least 3 but fewer than 5 clinic visits specifically for treatment during the past 12 months. This rating applies under the Incapacitating Episodes path of the General Eye Formula when it yields a higher evaluation than the visual impairment path.
- 10% — You qualify for 10% if your diabetic retinopathy required at least 1 but fewer than 3 clinic visits specifically for treatment during the past 12 months. This rating applies under the Incapacitating Episodes path of the General Eye Formula when it yields a higher evaluation than the visual impairment path.