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WEEK FIVE
Visual Impairment 38CFR 4.75(a)
The term “visual impairment” refers to a result
of an eye disorder or condition.
The evaluations for visual impairment are
based on:
• Impairment of visual acuity (va)
• Impairment of visual field, and
• Impairment of muscle function.
2
Visual Acuity 38CFR 4.76
(b) Base visual acuity evaluations on corrected,
distance vision
3
Examinations 38CFR 4.75
• Exams must be conducted by licensed
optometrists and ophthalmologists.
• A diagnosis is required for abnormal
findings.
• Exams of visual fields and muscle function
are needed only when medically indicated or
when specially requested, such as in BVA
remand.
4
Eye complications due to
diabetes and hypertension

Most common: retinopathy, glaucoma,
cataract

Retinopathy is a general term that refers to
some form of non-inflammatory damage to the
retina. It is frequently a manifestation of
systemic disease.

Two types: background diabetic retinopathy
and proliferative diabetic retinopathy.
5
Glaucoma 6012 and 6013

Glaucoma is a general term for a group of
diseases that produce damage to the optic
nerve and decreased peripheral vision.

Secondary glaucoma: diabetic retinopathy,
retinal vein occlusion, steroids …
6
Cataracts and Aphakia 6027, 6029
• Cataract – opacity or cloudiness in lens.
To evaluate: use visual impairment for
either preoperative or post operative
cataracts with replacement lens.
• Aphakia – absence of the lens.
To evaluate: use visual impairment
elevated by one step but assign a minimum
30%, unilateral or bilateral.
7
Paired Organs 38CFR 3.383
IF one eye is SC and not the other, and
each eye is at a visual acuity of 20/200, or
each eye peripheral field is 20 degrees or less,
and the NSC problem is not due to
misconduct,
THEN compensation is payable “as if” both eyes
were service connected.
8
HEARING LOSS
Service Connection and
Evaluation of Ratings
SERVICE CONNECTION
REQUIREMENTS
(1)
Medical evidence of a current disability
(2)
Medical or, in certain circumstances, lay
evidence, of in-service incurrence or
aggravation of a disease or injury
(3)
Medical evidence (opinion) of a nexus
between the claimed in-service disease or
injury and the current disability
Hearing Loss – 38 CFR 3.385

Any threshold loss of 40 decibels or greater in
the 500 – 4000 hertz frequency range, or

Thresholds for at least three of the frequencies
in this range being 26 decibels or greater, or

Speech Recognition score of less than 94
percent in accordance with the Maryland CNC
Test.
CAVC - Hensley v. West, (1993)
 Establishes
that a hearing loss under 38
C.F.R. § 3.385 does not have to be shown
during service to establish service
connection (38 C.F.R. § 3.303(d))
Presumptive Service Connection

October 1995 VHA Memorandum: “it would be
appropriate to consider high frequency sensorineural
hearing loss an organic disease of the nervous system
and therefore a presumptive disability.”

Tinnitus has not been conceded in such manner;
however, a finding of tinnitus within one year after
discharge typically cannot be dissociated from service.
VA physicians have been instructed to opine that
tinnitus “at least as likely as not” due to service if
claimed or diagnosed within a year after separation.
Overcoming Adverse Decisions
38 U.S.C. § 1154(b); 38 C.F.R. § 3.304(d)
 VA General Counsel Precedent Opinion 12-99
(October 18, 1999) – provides definition of
when the status of “combat veteran” is
conferred. Combat status not wholly
contingent upon awards or citations, but all
evidence will be considered and resolved on a
case-by-case basis with all reasonable doubt
applied.

Overcoming Adverse Decisions

Lay evidence – buddy statements, letters from
friends and family, etc … See 38 C.F.R. §
3.159(a)(2).

Medical treatises – may be used to corroborate
veteran’s claims of service incurrence of audio
disability and, in some cases, support a nexus
between current disability and service. Most
effective when submitted in conjunction with a
medical opinion.
Supportive Medical Opinions

Include audiometric findings and results of any other clinical
tests. Physician should identify specialty and note treatment
history with veteran. Have physician review SMRs and other
pertinent records and note in the report that such records have
been reviewed. If negative VA opinion has been rendered,
physician should review this and comment as well. Opinion
should be in as definitive language as possible and written in
clear prose with a succinct, but thorough rationale. Inclusion
of as many of these elements as possible will heighten the
probative value of the evidence and increase the veteran’s
prospects for a successful claim.

VHA Directive 2000-029 clearly provides authority for treating
VA physicians to render opinions on behalf of veteran patients’
claims for VA disability benefits.
Rating Hearing Loss


Tables VI, VIA, and VII of 38 C.F.R. § 4.85.
Examiner must be state-certified audiologist.
Examination must include speech
discrimination and audiometric testing.
Testing will be conducted without hearing aids.
 Hearing loss ratings typically predicated upon
the average threshold loss of 1000-4000 hertz
frequencies combined with the percentage of
speech discrimination in Table VI for each ear.
Hearing Loss Ratings

If only one ear is service connected, the non serviceconnected ear will be assigned a Roman Numeral of 1
in order to determine percentage of evaluation in
Table VII. 38 C.F.R. § 4.85(f)

Notable exception to this rule is that if a 10 percent
rating, Roman Numeral X, is shown in the serviceconnected ear. This will allow the non serviceconnected ear to be rated as if service connected in
conjunction with the service-connected ear for rating
purposes. 38 U.S.C. § 1160(a)(3).
Exercise #1: Is there an audio
impairment per 38 CFR 3.385?
Maryland CNC: 95 right ear, 93 left ear.
Thresholds: Right ear Left ear
500
30
20
1000
25
20
2000
30
30
3000
25
25
4000
30
25
6000
40
40
Exercise #1 Answer
 Yes,
there is audio impairment in both
ears.
The right ear because 3 decibel losses are
30.
The left ear because the speech
recognition score is less than 94.
Exercise #2:
Find the pure tone averages
500
15
15
1000
25
45
2000
30
45
3000
30
- inconsistent
4000
45
70
6000
60
90
Average: Right __ Left __
Exercise #2
Answers
 Right
ear puretone average is 33
25+30+30+45 = 130 ÷ 4 = 32.50
 Left
ear puretone average is 53.
45+45+70 = 160 ÷ 3 = 53.33
Exercise #3: What is the Numeric Designation of
Hearing Impairment?
Maryland CNC: 95 right ear, 90 left ear.
Thresholds:
500
1000
2000
3000
4000
Average:
ND:
Right
Left
30
25
30
25
30
___
___
20
30
35
40
65
___
___
Exercise #3
Answers
 Right
Ear
Pure tone average is 27.5 = 28.
CNC 95. The ND is I.
 Left
Ear
Pure tone average is 42.5 = 43.
CNC 90. The ND is II.
Exercise #4: What is the Percentage Evaluation?
Both ears are SC.
Maryland CNC: 88 right ear, 74 left ear.
Thresholds: Right ear
1000
35
2000
50
3000
65
4000
75
Average:
56
Left ear
40
60
70
85
64
Exercise #4
Answer: 10%
Right ear numeric designation is II.
Left ear numeric designation is V.
Using Table VII, the better ear is II and
the poorer ear is V. These numbers
intersect at 10.
PAIRED ORGANS
38 CFR 3.383(a)(3)
 When only one ear is service connected, the
non-service connected ear will be considered
service connected, if
 the hearing loss in that ear meets the
definition of hearing loss as defined by 38 CFR
3.385, AND
 the service connected ear hearing loss is
evaluated 10% or more.
TINNITUS Dx. code 6260

Tinnitus is the perception of sound in the absence
of an acoustic stimulus.

It is subjective only.

It may occur as a symptom of nearly all ear
disorders; ototoxicity due to medicines and other
agents; anemia; cardiovascular disease; acoustic
trauma; hypothyroidism; and head trauma.

Maximum evaluation = 10%
Q U E S T I O N S ??
??
??
Special Monthly Compensation
and Ancillary Benefits
• 38 U.S.C.1114(k), (l), (m), (m), (o), (p)
• (38 CFR 3.350)
• §3.808 Automobiles or other conveyances
• §3.809 Specially adapted housing
• §3.809a Special home adaptation grants
30
Special Monthly Compensation
VA can pay additional compensation to a
veteran who, as a result of military
service, incurred the loss or loss of use of
specific organs or extremities.
38CFR 3.350
What Is Considered Loss or Loss of
Use?
Loss, or loss of use, is described as
either an amputation or, having no
effective remaining function of an
extremity or organ.
The disabilities VA can consider for
SMC include:
•loss, or loss of use, of a hand or foot
•immobility of a joint or paralysis
•loss of sight of an eye (having only light
perception)
•loss, or loss of use, of a reproductive organ
•complete loss, or loss of use, of both buttocks
•deafness of both ears (having absence of air and
bone conduction)
•inability to communicate by speech (complete
organic aphonia)
•loss of a percentage of tissue from a single
breast, or both breasts, from mastectomy or
radiation treatment
The VA will pay higher rates for combinations of
these disabilities such as loss or loss of use of the
feet, legs, hands, and arms, in specific monetary
increments, based on the particular combination
of the disabilities.
There are also higher payments for various
combinations of severe deafness with bilateral
blindness.
Additional SMC is available if a veteran is
service connected for paraplegia, with complete
loss of bowel and bladder control.
If a veteran is service connected at the
100% rate and is housebound, bedridden,
or is so helpless to need the aid and
attendance of another person, then
consideration of payment of additional
SMC can be considered.
The amount of SMC will vary depending
on the level of aid and attendance needed.
ANCILLARY
RATING DECISIONS
ANCILLARY (MEMORANDUM)
RATINGS
Ratings of Entitlement

Memorandum rating decisions are ratings for
specific purposes.
 Determining basic entitlement to ancillary
benefits
– Providing information to other services and
agencies
Definition Ancillary Benefits
Ancillary benefits are:
 Secondary benefits that are considered when
evaluating claims for:
– Compensation
or
– Dependency and Indemnity
Compensation (DIC)
Eligibility for ancillary benefits is contingent on the
type of disability entitlement the veteran has or
the circumstances of the veteran’s death.
ANCILLARY RATINGS
–
–
–
–
–
–
–
–
–
–
–
–
Clothing Allowance
Vocational Rehabilitation
Dependents Educational Assistance (DEA)
CHAMPVA
Loan Guaranty Mortgage Insurance or Survivor
Automobile Allowance
Adaptive Equipment Allowance
Specially Adapted Housing (SAH) Grant
Special Housing Adaptation (SHA) Grant
Competency/Incompetency
Homicide
Veterans Civil Service Preference
Adult Helpless Child
ANCILLARY RATINGS
Clothing Allowance
38 CFR 3.810
Vocational Rehabilitation
38 CFR Part 21
Dependents Educational Assistance (DEA)
38 CFR 3.807
CHAMPVA
38 CFR 17.270 – 17.278
Loan Guaranty
38 CFR 3.805
Automobile Allowance
38 CFR 3.808
Adaptive Equipment Allowance
38 CFR 3.808
Specially Adapted Housing (SAH) Grant
38 CFR 3.809
Special Housing Adaptation (SHA) Grant
38 CFR 3.809a
Competency/Incompetency
38 CFR 3.353
Homicide
38 CFR Part 3 Subpart A 3.11
Veterans Civil Service Preference
38 CFR 3.357
Adult Helpless Child
38 CFR 3.356
VOC REHABILITATION - CH 31

Service connected condition must be:
10 percent with a serious handicap, or
 20 percent with an employment handicap,
and
 be discharged or released from military
service under other than dishonorable
conditions.
 Service member pending medical separation from
active duty may apply, but the disability rating
must be at least 20 percent.

VOC REHABILITATION CONT:

Period of Eligibility:
– 12 years from the latter of the following:
– date separated from active military service,
or
– date veteran was notified of a qualifying
service-connected disability rating.
– NOTE: Eligibility period may be extended if
Vocational Rehabilitation determines the
veteran has a Serious Employment
Handicap
VOC REHABILITATION CONT:
•
•
•
•
•
•
•
BENEFITS:
maximum of 48 months
VA pays cost of services
training at a college, vocational, technical or
business school
subsistence allowance for participate
On-The-Job Training, apprenticeships, and nonpaid work experiences
work study with VA
VOC REHABILITATION CONT:








Benefits (Cont):
evaluation to determine abilities, skills, interests, and needs
counseling and rehabilitation planning
employment services
use of special employer incentives
case management, counseling, and referral
independent living services
Application: VA Form 28-1990, Disabled Veterans
Application for Vocational Rehabilitation
CLOTHING ALLOWANCE

Eligibility:
 service-connected disability that
requires a prosthetic or
orthopedic device that wears out
clothing.
or
 veteran uses medication for a skin condition
that causes damage to outer garments.
CLOTHING ALLOWANCE CONT:

Benefit:
 Annual Payment
 Payment $741.00
 Benefit effective August 1 annually
 Payment date September 1st
 VA Form 10-8678, Application for
Annual Clothing Allowance
AUTOMOBILE ALLOWANCE
– Eligibility :
– Anatomical loss, or permanent loss of use, of one or
both feet, or
– Anatomical loss, or permanent loss of use, of one or
both hands, or
– Permanent impairment of vision of both eyes under
with central visual acuity of 20/200 or less in the
better eye w/corrective lenses, or central visual acuity
of more than 20/200 if there is qualifying visual field
defect.
AUTO ALLOWANCE CONT:
Eligibility:
To purchase a new/used automobile:

disability must be result of injury/disease incurred
or aggravated by activity military,
OR
 result of medical treatment, examination, voc rehab
or compensated work therapy provided by the VA
AUTO ALLOWANCE CONT:
•
Benefit:
The grant is paid directly to the seller of the
automobile for the total price (up to $18,900) of
the automobile. The veteran or service
member may only receive the automobile grant
once in his/her lifetime.
•
Application:
VA Form 21-4502, Application for Automobile
or Other Conveyance and Adaptive Equipment
•
ADAPTIVE AUTO EQUIPMENT

Eligibility:
 Veterans eligible for Automobile Allowance
are also eligible for Adaptive Equipment
Allowance.
 Eligible for Adaptive Equipment Allowance
but not for Automobile Allowance:
 SC ankylosis of one or both knees or hips
ADAPTIVE AUTO EQUIPMENT CONT:
Benefit:
 adaptive equipment includes, but is not limited to
 power steering
 power brakes
 power window lifts
 power seats
 special equipment necessary to assist veteran into /
out of automobile or other conveyance.

Application: VA Form 21-4502, Application for
Automobile or Other Conveyance and Adaptive
Equipment

SPECIALLY ADAPTED HOUSING (SAH)
GRANT
Eligibility:
 Qualifying Conditions must have:
 incurred in active military, or
 aggravated by active military, or
 result of hospital care, medical, surgical
treatment or examination at a VA medical
facility, or
 participation in compensated work therapy
program, or
 pursuing course of vocational training
SPECIALLY ADAPTED HOUSING
(SAH) GRANT CONT:

Eligibility (Cont.):
 Qualifying Conditions:
 permanently & totally disabled, and
– “preclude locomotion” without braces, crutches,
canes, or wheelchair due to loss, or loss of use of
– both lower extremities, or
– one lower extremity & residuals of organic disease /
injury, that affects balance / propulsion, or
– one lower extremity, & one upper extremity, that
affects balance / propulsion
SPECIALLY ADAPTED HOUSING
(SAH) GRANT CONT:

Qualifying conditions continued:

loss, or loss of use, of both upper extremities at
or above the elbow, OR
 blindness in both eyes, light perception only, &
loss or loss of use of one lower extremity.

Note: "Preclude locomotion" necessity for
regular, use of wheelchair, braces, crutches or
canes as normal mode of locomotion, although
occasional locomotion by other methods may
be possible.
SPECIALLY ADAPTED HOUSING
(SAH) GRANT CONT:
Benefits:
 To help provide a barrier-free living
environment that affords the individual a level
of independent living they may not otherwise
enjoy
 Grant for the purpose of constructing or
modifying a home to meet adaptive needs
currently limited to $60,000.
Application: VA Form 26-4555d, Veterans Application
for Assistance in Acquiring Special Housing
Adaptations
SPECIAL HOUSING ADAPTATION
(SHA) GRANT

Eligibility:
– P&T SC disability of:
– blindness in both eyes with
5/200 visual acuity or less, or
– anatomical loss or loss of use of both hands.
– The permanent and total disability is due to
a severe burn injury (as so determined)
SPECIAL HOUSING ADAPTATION
(SHA) GRANT CONT:
Benefit:
• Modify an existing home to meet adaptive needs,
such as assistance with mobility throughout
the home
• Grant currently limited to $12,756
Application:
• VA Form 26-4555d, Veterans Application for
Assistance in Acquiring Special housing
Adaptations
HOME IMPROVEMENT &
STRUCTURAL ALTERATION
(HISA) PROGRAM
HISA AUTHORITY

a. Title 38 USC Section 1717 is the authority
for the Secretary of Veterans Affairs to
provide HISA grants to eligible veterans.

b. The HISA benefit is limited to
improvement & structural alterations
necessary to assure the continuation of
treatment and/or provide access to the home
or to essential lavatory & sanitary facilities
HISA GRANTS






A. HISA grants provide for medically necessary
improvements and/or structural changes to the veteran’s
residence for the following purposes:
(1) Allowing entrance & exit from the veteran’s
residence.
(2) Use of essential lavatory & sanitary facilities.
(3) Allowing accessibility to kitchen or bathroom sinks or
counters.
(4) Improving entrance paths or driveways in immediate
area of the home facilitate access to the home by the
veteran.
(5) Improving plumbing or electrical systems made
necessary due to installation of dialysis equipment in the
home.
HISA ELIGIBILITY

Veterans receiving treatment from the DVA under
the auspices of 38 USC 1710 are eligible for HISA
benefits as follows:
 (1) $6,800.00 lifetime HISA benefits for:
– (a) Service connected condition.
– (b) NSC conditions of a veteran rated 50% or
more SC.
– (c) NSC condition of veteran in receipt of 1151
benefits.

2. $2,000.00 lifetime HISA benefit when necessary
for treatment of a NSC condition of veterans who
are:
– (a) Rated less than 50% SC.
– (b) Discharged or released from active duty for
a disability incurred or aggravated in the line of
duty.
– (c) Former POW’s, veterans of the Mexican
Border period or WWI.

(d) Unable to defray the expenses of
necessary care as determined under 38 USC
1722(a), ie., veterans who qualify through
means testing, as determined via Medical
Care Cost Fund.
 (e) Eligible for benefits under 38 USC
1710(a)(f) and (e), due to exposure to a toxic
substance, radiation, or an environmental
hazard. (priority group 6)
VA Life Insurance

Veterans Group Life Insurance (VGLI)

Veterans Disability Life Insurance (RH)
QUIZ