As a member of the U.S. military who sustained an orbital trauma injury while on active duty, you should be entitled to receive benefits, including financial support, for your condition. If you applied for orbital trauma veterans’ benefits but received a denial, do not give up hope.
A VA disability advocate can help you determine why the U.S. Department of Veterans Affairs (VA) denied your claim for orbital trauma veterans benefits and file an appeal on your behalf.
Call (888) 373-4722 today for more information.
How VA Rates Visual Orbital Trauma to Determine Benefits
The U.S. Department of Veterans Affairs (VA) categorizes orbital trauma as an “unhealed eye injury” (38 CFR § 4.79 – Schedule of ratings – eye). VA rates your orbital trauma condition using its general rating formula for diseases of the eye.
This schedule of ratings evaluates your injury based on “visual impairment due to the particular condition or on incapacitating episodes, whichever result in a higher evaluation.”
For this evaluation, the VA defines an incapacitating episode as “an eye condition severe enough to require a clinic visit to a provider specifically for treatment purposes.”
Incapacitating Episodes: General Rating Formula for Diseases of the Eye
The following list includes the general rating formula for diseases of the eye:
- 60% disability rating: “With documented incapacitating episodes requiring seven or more treatment visits for an eye condition during the past 12 months”
- 40% disability rating: “With documented incapacitating episodes requiring at least five but less than seven treatment visits for an eye condition during the past 12 months”
- 20% disability rating: “With documented incapacitating episodes requiring at least three but less than five treatment visits for an eye condition during the past 12 months”
- 10% disability rating: “With documented incapacitating episodes requiring at least one but less than three treatment visits for an eye condition during the past 12 months”
Visual Impairment: Rating Schedule
Because the VA will consider both visual impairment and incapacitating episodes, use the higher of the two ratings.
VA will rate the extent of your visual impairment based on the following set of characteristics:
Impairment of Central Visual Acuity
- Anatomical loss of both eyes
- No more than light perception in both eyes
- Anatomical loss of one eye
- No more than light perception in one eye
- Vision in one eye 5/200 (1.5/60)
- Visual acuity in one eye 10/200 (3/60) or better
- Vision in one eye 10/200 (3/60)
- Vision in one eye 15/200 (4.5/60)
- Vision in one eye 20/200 (6/60)
- Vision in one eye 20/100 (6/30)
- Vision in one eye 20/70 (6/21)
- Vision in one eye 20/50 (6/15)
- Vision in one eye 20/40 (6/12)
Impairment of Visual Field
- Visual field defects
- Loss of temporal half of the visual field
- Loss of nasal half of visual field
- Loss of the inferior half of the visual field
- Loss of the superior half of the visual field
- Concentric contraction of the visual field
- With a remaining field of 6 to 15 degrees
- With a remaining field of 16 to 30 degrees
- With a remaining field of 31 to 45 degrees
- With a remaining field of 46 to 60 degrees
- Scotoma, unilateral
Impairment of Muscle Function
- Diplopia (double vision)
Visual Impairment: Rating Formula for Visual Impairment Veterans Benefits
Based on how your vision performs about the above characteristics, VA will rate your impairment. This rating, specified as a percentage, correlates to a table of monthly benefits to which you are entitled.
For example, if your visual impairment consists of a central visual acuity “vision in one eye,” VA tests your specific condition about this characteristic, then makes a rating based on your vision in the other eye.
Example Rating Criteria for Visual Impairment
The following is the Code of Federal Regulations rating criteria for 10/200 vision in one eye:
- 90% disability rating: “In the other eye 10/200 (3/60)”
- 80% disability rating: “In the other eye 15/200 (4.5/60)”
- 70% disability rating: “In the other eye 20/200 (6/60)”
- 60% disability rating: “In the other eye 20/100 (6/30)”
- 50% disability rating: “In the other eye 20/70 (6/21)”
- 40% disability rating: “In the other eye 20/50 (6/15)”
- 30% disability rating: “In the other eye 20/40 (6/12)”
The corresponding pay schedule as of December 2019 is as follows for a single veteran with no dependents:
- 10%: $142.29 per month
- 20%: $281.27 per month
- 30%: $435.69 per month
- 40%: $627.61 per month
- 50%: $893.43 per month
- 60%: $1,131.68 per month
- 70%: $1,426.17 per month
- 80%: $1,657.80 per month
- 90%: $1,862.96 per month
- 100%: $3,106.04 per month
Evaluating your orbital trauma, incapacitating episodes, and visual impairment can be a complicated undertaking, and accurate evaluation is critical to your receiving the orbital trauma benefits you deserve.
An orbital trauma veterans’ benefits advocate can help you execute this step of your benefits appeal process accurately so you can get the appropriate compensation for your injury.
How to Appeal Your Denied Claim for Optical Trauma Benefits
VA looks for three essential criteria when considering an optical trauma veteran benefits appeal. If your initial claim did not meet all three criteria—perhaps you did not include documentation, for example—it could explain why the VA denied your claim. A veterans’ disability advocate will assist you with satisfying the appeal criteria.
Essential Criteria for a Successful Orbital Trauma Appeal
- A current diagnosis of orbital trauma
- A specific event you experienced while on active duty in the U.S. military that resulted in injury or trauma
- A “nexus” (direct “cause and effect” connection) between the event and your orbital trauma diagnosis
How to Appeal a Denied Claim for Visual Impairment Veterans Benefits
Now that you know the VA’s approach to orbital trauma benefits, you should be ready to start your appeals process.
Filing an appeal is difficult. Enlist the help of a veterans’ disability advocate.
Call (888) 373-4722 to Learn How a Veterans’ Disability Advocate Can Help You
Now that you are ready to appeal your orbital trauma veterans’ benefits claim denial, you should call a disability advocate today. Get help from a veterans’ disability advocate today by calling (888) 373-4722.
