The VA rates keratoconus under Diagnostic Code 6035, and since May 13, 2018, it has been evaluated under the General Rating Formula for Diseases of the Eye. Your keratoconus VA disability rating can range from 0% to 100%, and the VA applies whichever produces the higher rating: your corrected visual acuity, or the number of qualifying treatment visits you had in the past 12 months.1Federal Register. Schedule for Rating Disabilities; The Organs of Special Sense and Schedule of Ratings-Eye Getting to that rating, though, usually depends first on proving service connection, which is where keratoconus claims tend to get complicated.
The Two Rating Pathways
Corrected Visual Acuity
The VA compares the best corrected distance vision in each eye against a standardized table in 38 CFR 4.79. If you customarily wear contact lenses and they give you the best corrected acuity, that measurement is used.2VA Board of Veterans’ Appeals. BVA Decision, Citation Nr. 19119103 The percentage depends on the combination of acuity in both eyes. Corrected vision of 20/70 in both eyes produces a 30% rating; 20/200 in both eyes produces 70%.3eCFR. 38 CFR 4.79 – Schedule of Ratings – Eye Bilateral vision of 20/40 or better yields 0%. At the most severe end, anatomical loss of both eyes or bilateral vision of 5/200 or worse results in 100%.
Treatment Visits in the Past 12 Months
If your corrected acuity is relatively preserved but you still lose significant time to treatment, the VA offers an alternative rating based on qualifying visits in the preceding 12 months:1Federal Register. Schedule for Rating Disabilities; The Organs of Special Sense and Schedule of Ratings-Eye
- 60% for seven or more treatment visits
- 40% for at least five but fewer than seven
- 20% for at least three but fewer than five
- 10% for at least one but fewer than three
Only visits specifically for treatment count. The VA defines an incapacitating episode as an eye condition severe enough to require a clinic visit for treatment purposes, such as injections, laser treatments, or surgery. Routine diagnostic, monitoring, or screening visits do not qualify.1Federal Register. Schedule for Rating Disabilities; The Organs of Special Sense and Schedule of Ratings-Eye That distinction is important to document carefully when you gather records.
If You Had a Corneal Transplant
A keratoplasty is rated under Diagnostic Code 6036, which covers corneal transplants regardless of the underlying cause. A minimum 10% evaluation is assigned when the transplant is accompanied by pain, photophobia, and glare sensitivity. Higher evaluations up to 30% may be warranted when further visual impairment is present.1Federal Register. Schedule for Rating Disabilities; The Organs of Special Sense and Schedule of Ratings-Eye
Establishing Service Connection
Before any rating attaches, the VA has to accept that your keratoconus is connected to service. This is legally complicated because keratoconus has a genetic component and often develops in a person’s late teens or twenties, overlapping with the age of military service.
Congenital Defect vs. Congenital Disease
Under VA General Counsel Precedent Opinion 82-90, a congenital defect is structural and more or less stationary, while a congenital disease is capable of improving or deteriorating.4VA Board of Veterans’ Appeals. BVA Decision, Citation Nr. 19126221 The distinction matters. Congenital defects cannot be service-connected on their own under 38 CFR 3.303(c); you would have to prove a superimposed in-service injury or disease caused additional disability on top of the underlying defect. A congenital disease, by contrast, can be service-connected if the evidence shows service aggravated it beyond its natural progression.5VA Board of Veterans’ Appeals. BVA Decision, Citation Nr. 22000762
Because keratoconus is progressive, the Board of Veterans’ Appeals has in some cases classified it as a congenital disease rather than a static defect.5VA Board of Veterans’ Appeals. BVA Decision, Citation Nr. 22000762 The classification is not automatic, though. The BVA has remanded cases specifically because VA examiners failed to address whether the veteran’s keratoconus was a defect or a disease, treating it as a threshold question that has to be answered before the claim can proceed.4VA Board of Veterans’ Appeals. BVA Decision, Citation Nr. 19126221
Presumption of Soundness
If your entrance examination did not note keratoconus, you are entitled to a presumption of soundness. To rebut it, the VA must produce clear and unmistakable evidence of two things: that the condition existed before service, and that it was not aggravated by service. If the VA fails on either prong, the presumption stands and the condition is treated as incurred in service. The burden is entirely on the VA. You do not have to prove the condition worsened during service.6Federal Register. Presumption of Sound Condition; Aggravation of a Disability by Active Service
In a 1994 decision, the BVA denied service connection where the veteran’s own statement placed his diagnosis in his teens and medical experts opined that corneal changes found shortly after enlistment were consistent with a preexisting condition. The Board also found no aggravation beyond natural progression, noting the veteran’s visual acuity at separation matched his acuity at enlistment.7VA Board of Veterans’ Appeals. BVA Decision, Citation Nr. 9419098
Nexus Arguments That Have Worked
Veterans pursuing direct service connection generally point to in-service events or exposures that caused or worsened the condition. Board decisions and medical literature recognize several theories:
- Chronic, vigorous eye rubbing is a known risk factor, and medical literature has found that between 44.8% and 83% of keratoconus patients report a history of eye rubbing, frequently driven by allergies or environmental irritation.8National Library of Medicine. The Correlation Between Keratoconus and Eye Rubbing: A Review
- Dust, sand, and wind during deployment have been accepted as aggravation factors. In one successful claim, a VHA medical expert opined that a veteran’s bilateral keratoconus was “at least as likely as not” a direct result of environmental exposures in Southwest Asia, where constant dust caused continuous eye rubbing.9VA Board of Veterans’ Appeals. BVA Decision, Citation Nr. 1541086
- Exposure to substances such as oleoresin capsicum (pepper spray) during training has been cited as a potential trigger.10VA Board of Veterans’ Appeals. BVA Decision, Citation Nr. 1233615
An in-service diagnosis is not strictly required. The Board recognizes that keratoconus may go undiagnosed during service, and it must consider lay testimony about worsening symptoms or specific in-service events even without contemporaneous medical records.10VA Board of Veterans’ Appeals. BVA Decision, Citation Nr. 1233615
Secondary Service Connection
If you already have a service-connected condition linked to inflammation or chronic eye rubbing, you can pursue keratoconus as a secondary disability under 38 CFR 3.310. You will need medical evidence that the service-connected condition caused or aggravated the keratoconus. Conditions commonly cited in secondary claims include atopic dermatitis, allergic rhinitis, asthma, rheumatoid arthritis, irritable bowel disease, and ulcerative colitis.11VA Board of Veterans’ Appeals. BVA Decision, Citation Nr. 1735320 If secondary service connection is granted on an aggravation theory, you are compensated only for the degree of worsening above the pre-aggravation baseline.
What the C&P Exam Covers
After you file, the VA typically schedules a Compensation and Pension exam following the Disability Benefits Questionnaire for eye conditions.12VA Benefits. Disability Benefits Questionnaire – Eye Conditions Expect the examiner to:
- Record uncorrected and corrected distance and near vision on a Snellen chart.
- Perform a slit lamp exam and specifically identify keratoconus, noting whether it is unilateral or bilateral.
- Ask whether you have severe irregular astigmatism, whether you customarily wear contact lenses, whether contacts correct better than glasses, and whether corrected acuity was measured with contacts in place.
- Conduct visual field testing over at least 16 meridians using Goldmann kinetic or automated perimetry if a field defect is documented.
- Document qualifying treatment visits within the past 12 months.
- State whether the condition affects your ability to work and give specific examples.
The contact lens question is particularly relevant for keratoconus, because glasses alone often cannot correct the irregular corneal shape.
TDIU and Special Monthly Compensation
If keratoconus prevents you from maintaining substantially gainful employment, you may be eligible for Total Disability Based on Individual Unemployability. In one BVA case, a veteran raised TDIU after keratoconus symptoms, including blurred vision, light sensitivity, migraines, distorted vision, and eye strain, caused him to resign from two jobs within a single year. The Board found the TDIU issue inextricably intertwined with the pending increased rating claim and remanded both for further development.13VA Board of Veterans’ Appeals. BVA Decision, Citation Nr. 21002295
Veterans with keratoconus who become legally blind may qualify for Special Monthly Compensation. A veteran is considered in need of regular aid and attendance if blind in both eyes with visual acuity of 5/200 or worse. The determination considers whether the veteran can perform basic personal functions such as dressing, staying clean, feeding themselves, and navigating their environment safely.14VA Board of Veterans’ Appeals. BVA Decision, Citation Nr. 19177510 In one case, a veteran with keratoconus-related blindness was granted SMC on that basis, which the Board noted provides a greater benefit than the housebound rate.
How to File
File using VA Form 21-526EZ, online, by mail, in person at a regional office, or through an accredited representative or Veterans Service Organization. Before filing, gather medical records documenting the diagnosis and progression of your keratoconus, records of treatment visits (particularly ones that qualify as incapacitating episodes), and personal or buddy statements describing when symptoms began or worsened during service. If you file on paper, submit an intent-to-file form to lock in an effective date while you gather evidence; online filers get an automatic effective date when they begin the application.15VA. How to File a VA Disability Claim As of early 2026, the VA’s average processing time for disability claims is roughly 77 days, and decisions issued on or after February 19, 2019 carry three review options if you disagree with the outcome.16VA. After You File Your VA Disability Claim