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![]() New Table of DisabilitiesApril 2006 EditionChapter 8
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Table 8.1 | Loss of Function – Visual Acuity | This table is used to rate impairment from loss of visual acuity. |
Table 8.2 | Loss of Function – Visual Field | This table is used to rate impairment from loss of visual field. |
Table 8.3 | Loss of Function – Miscellaneous Visual | This table is used to rate impairment from miscellaneous visual conditions. |
Table 8.4 | Other Impairment – Ocular | This table is used to rate impairment from ocular conditions. |
Figure 8A | Esterman Grid – Left Eye | This figure is used to rate impairment from visual field loss in the left eye. |
Figure 8B | Esterman Grid – Right Eye | This figure is used to rate impairment from visual field loss in the right eye. |
Table 8.1 is used to rate impairment from eye conditions which result in a loss of visual acuity.
Visual acuity describes the ability of the eye to perceive details in the environment. Visual acuity is measured for near and distance but for the purposes of Table 8.1 and for further discussion in this Chapter, visual acuity will refer only to best corrected distance acuity. This is measured when wearing glasses or contact lenses, if required. No additional rating is given for wearing corrective lenses.
All visual acuity within the chapter will be expressed in Snellen Notation (i.e. 6/6; 20/20).
A chart for converting Snellen Notation from metric to standard measurement is found with Table 8.1.
Visual acuity at the 20/200 level is sometimes referred to as "legal blindness". This term is a misnomer because ninety percent of persons who are said to be "legally blind" are not totally blind, but have what should be described as severe vision loss.
Normal vision is a binocular function meaning that both eyes contribute to the function of sight. If an entitled condition affects only one eye the visual impairment is said to be monocular. However, for the purposes of assessment in this Table, all visual impairments are expressed in terms of binocular visual impairment by assuming the vision in the non-entitled eye is normal (i.e. 6/6 or 20/20).
Impairment of entitled amblyopia is rated on the best corrected distance visual acuity at service discharge.
A medical impairment of 35 is given for enucleation of the eye. A medical impairment of 26 for the total loss of vision in the eye and a medical impairment of 9 for the loss of the eye.
Table 8.2 is used to rate impairment from eye conditions which result in loss of visual field.
Visual field testing measures the functional ability of the eye to detect objects in the periphery of the visual environment. Visual fields can be affected in entitled conditions such as glaucoma, optic atrophy, retrobulbar neuritis, and retinitis pigmentosa.
Clinically, most field tests are limited to the central 30 degrees of vision as this is the most important area for diagnostic purposes. For VAC pension/award purposes, this may disadvantage certain Members/Veterans/Clients. Whenever possible, a 60 degree visual field test will be used.
The preferred method for measuring visual field defects is the Esterman Monocular Functional Test. This test determines a result which corresponds to the monocular field loss assessment. Other manual or automated field tests may be used (e.g. Goldman Visual Field Plots, Bjerrum Screen, Allergan Humphrey Computerized Method or Tangent Screen Testing).
If a method other than those identified above is used to determine visual field loss, the case will be rated on individual merits.
Table 8.1 is used to rate impairment where the loss of function relates to visual acuity. Only one rating may be selected. If more than one rating is applicable the ratings are compared and the highest selected.
If more than one condition with visual acuity effects is to be rated from Table 8.1, the conditions are bracketed for assessment purposes.
When both eyes have an entitled decrease in visual acuity, the monocular visual acuity rating for the better eye is plotted on the horizontal axis and the monocular visual acuity rating for the worse eye is plotted on the vertical axis of Table 8.1. The value at the intersection point is the binocular visual acuity impairment rating.When only one eye has an entitled decrease in visual acuity, the monocular visual acuity rating in that eye is converted to a binocular visual acuity rating using Table 8.1. The monocular visual acuity rating for the non-entitled eye is assumed to be normal (i.e. "6/6" or "20/20" ) even if there is a loss of visual acuity in that eye. This value is plotted along the horizontal axis of Table 8.1. The monocular visual acuity rating for the entitled eye is plotted on Table 8.1 along the vertical axis. The value at the intersection point is the binocular visual acuity impairment rating.
When entitled visual acuity conditions result in permanent impairment of other organ systems, a consequential entitlement decision is required. If awarded, the resulting impairment of that organ system(s) will be rated using the applicable body system specific table(s).
If non-entitled conditions or conditions rated within another chapter/table of the Table of Disabilities are contributing to the overall impairment, then the Partially Contributing Table (PCT) must be applied to arrive at the rating which is due to the entitled condition(s) rated within this table.
Table 8.2 is used to rate impairment where the loss of function relates to visual field. Only one rating may be selected. If more than one rating is applicable the ratings are compared and the highest selected.
If more than one condition with visual field effects is to be rated from Table 8.2, the conditions are bracketed for assessment purposes.
When both eyes have an entitled decrease in visual field, the monocular field loss assessment for the better eye is plotted on the horizontal axis and the monocular field loss assessment for the worse eye is plotted on the vertical axis of Table 8.2. The value at the intersection point is the binocular visual field impairment rating.
When only one eye has an entitled decrease in visual field, the monocular field loss assessment for that eye is converted to a binocular visual field rating using Table 8.2. The monocular field loss assessment for the non-entitled eye is assumed to be normal (i.e. "0") even if there is a loss of visual field in that eye. This value is plotted along the horizontal axis of Table 8.2. The monocular field loss assessment for the entitled eye is plotted on Table 8.2 along the vertical axis. The value at the intersection point is the binocular visual field impairment rating.
When entitled visual field conditions result in permanent impairment of other organ systems, a consequential entitlement decision is required. If awarded, the resulting impairment of that organ system(s) will be rated using the applicable body system specific table(s).
If non-entitled conditions or conditions rated within another chapter/table of the Table of Disabilities are contributing to the overall impairment, then the Partially Contributing Table (PCT) must be applied to arrive at the rating which is due to the entitled condition(s) rated within this table.
Table 8.3 is used to rate impairment from miscellaneous eye conditions. Only one rating may be selected for each entitled condition. If more than one rating is applicable for an entitled condition, the ratings are compared and the highest selected.
When entitled miscellaneous visual conditions result in permanent impairment of other organ systems, a consequential entitlement decision is required. If awarded, the resulting impairment of that organ system(s) will be rated using the applicable body system specific table(s).
If non-entitled conditions or conditions rated within another chapter/table of the Table of Disabilities are contributing to the overall impairment, then the Partially Contributing Table (PCT) must be applied to arrive at the rating which is due to the entitled condition(s) rated within this table.
Table 8.4 is used to rate impairment from ocular conditions. Only one rating may be selected for each entitled condition. If more than one rating is applicable for an entitled condition, the ratings are compared and the highest selected.
Any impairment for disfigurement caused by enucleation is included in the impairment rating. No additional impairment rating is considered from the Chapter 22, Skin Impairment.
When entitled ocular conditions result in permanent impairment of other organ systems, a consequential entitlement decision is required. If awarded, the resulting impairment of that organ system(s) will be rated using the applicable body system specific table(s).
If non-entitled conditions or conditions rated within another chapter/table of the Table of Disabilities are contributing to the overall impairment, then the Partially Contributing Table (PCT) must be applied to arrive at the rating which is due to the entitled condition(s) rated within this table.
When both eyes have an entitled decrease in visual acuity, the monocular visual acuity rating for the better eye is plotted on the horizontal axis and the monocular visual acuity rating for the worse eye is plotted on the vertical axis of Table 8.1. The value at the intersection point is the binocular visual acuity impairment rating.
When only one eye has an entitled decrease in visual acuity, the monocular visual acuity rating in that eye is converted to a binocular visual acuity rating using Table 8.1. The monocular visual acuity rating for the non-entitled eye is assumed to be normal (i.e. "6/6" or "20/20" ) even if there is a loss of visual acuity in that eye. This value is plotted along the horizontal axis of Table 8.1. The monocular visual acuity rating for the entitled eye is plotted on Table 8.1 along the vertical axis. The value at the intersection point is the binocular visual acuity impairment rating.
Table 8.1 – Loss of Function – Visual Activity
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Step 1: | Determine the rating from
Table 8.1
(Loss of Function – Visual Acuity).
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Note: | If only one eye is entitled or if only one eye has a visual acuity impairment then the monocular impairment for the second eye is determined to be normal (i.e.6/6 or 20/20) even if there is a loss of visual acuity in that eye. |
Step 2: | Does the Partially Contributing Table apply? If yes, apply to the rating at Step 1. |
Step 3: | Determine the Quality of Life rating. |
Step 4: | Add the ratings at Step 2 and Step 3. |
Step 5: | If partial entitlement exists, apply to the rating at Step 4. |
This is the Disability Assessment. |
When both eyes have an entitled decrease in visual field, the monocular field loss assessment for the better eye is plotted on the horizontal axis and the monocular field loss assessment for the worse eye is plotted on the vertical axis of Table 8.2. The value at the intersection point is the binocular visual field impairment rating.
When only one eye has an entitled decrease in visual field, the monocular field loss assessment for that eye is converted to a binocular visual field rating using Table 8.2. The monocular field loss assessment for the non-entitled eye is assumed to be normal (i.e. "0") even if there is a loss of visual field in that eye. This value is plotted along the horizontal axis of Table 8.2. The monocular field loss assessment for the entitled eye is plotted on Table 8.2 along the vertical axis. The value at the intersection point is the binocular visual field impairment rating.
Central scotoma is rated on individual merits.
Table 8.2 – Loss of Function – Visual Field
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Step 1: | Determine the rating from
Table 8.2
(Loss of Function – Visual Field).
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Note: | If only one eye is entitled or if only one eye has a visual field impairment then the monocular impairment for the second eye is determined to be normal (i.e. "0") even if there is a loss of visual field in that eye. |
Step 2: | Does the Partially Contributing Table apply? If yes, apply to the rating at Step 1. |
Step 3: | Determine the Quality of Life rating. |
Step 4: | Add the ratings at Step 2 and Step 3. |
Step 5: | If partial entitlement exists, apply to the rating at Step 4. |
This is the Disability Assessment. |
Only one rating may be given for each entitled condition. If more than one rating is applicable for an entitled condition, the ratings are compared and the highest selected.
Each bullet () represents one criterion. In order for a rating to be established, all criteria designated at that rating level must be met.
Table 8.3 – Loss of Function – Miscellaneous
Visual Disturbance Criteria | Rating |
Nystagmus without diplopia | 0 |
Cataract with no loss of visual acuity | 0 |
Glaucoma (unilateral or bilateral) without loss of visual fields | 2 |
Bilateral or Unilateral intraocular lens | 0 |
Bilateral aphakia | 5 |
Unilateral aphakia | 10 |
Diplopia* one direction of sideways gaze | 10 |
Diplopia* all directions of upward gaze | 10 |
Diplopia* all directions of downward gaze | 15 |
Diplopia* both directions of sideways gaze | 15 |
Diplopia* all directions of gaze | 25 |
* Diplopia in the above table refers to a diplopia that is not fully correctable with prism.
One rating is selected from Table 8.4 for each entitled condition. If more than one rating is applicable, the ratings are compared and the highest rating is selected as the Table 8.4 rating.
Each bullet () represents one criterion. In order for a rating to be established, all criteria designated at that rating level must be met.
Table 8.4 – Other Impairment – Ocular
Rating | Criteria |
Nil |
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Two |
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Four |
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Nine |
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Step 1: | Determine the rating from Table 8.3 (Loss of Function – Miscellaneous). |
Step 2: | Does the Partially Contributing Table apply? If yes, apply to the rating at Step 1. |
Step 3: | Determine the Quality of Life rating. |
Step 4: | Add the ratings at Step 2 and Step 3. |
Step 5: | If partial entitlement exists, apply to the rating at Step 4. |
This is the Disability
Assessment for miscellaneous conditions of the eye. |
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Step 6: | Determine the rating from Table 8.4 (Other Impairment – Ocular). |
Step 7: | Does the Partially Contributing Table apply? If yes, apply to the rating at Step 1. |
Step 8: | Determine the Quality of Life rating. |
Step 9: | Add the ratings at Step 2 and Step 3. |
Step 10: | If partial entitlement exists, apply to the rating at Step 4. |
This is the Disability Assessment for ocular conditions. |
Click here to open an HTML version of "Figure 8A – Esterman Grid: Left Eye"
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Click here to open an HTML version of "Figure 8B – Esterman Grid: Right Eye"
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