Diagnostic Code 6040 · 38 CFR §4.79
Diabetic retinopathy is damage to the blood vessels in the retina caused by diabetes mellitus. It is one of the most common secondary conditions claimed by veterans with service-connected diabetes. High blood sugar over time weakens and damages the tiny blood vessels in the retina, causing them to leak fluid, bleed, or grow abnormally. It progresses from mild non-proliferative (background) retinopathy to severe proliferative retinopathy that can cause blindness if untreated. For veterans with service-connected Type 2 diabetes, this is almost always filed as a secondary condition.
| Rating | Criteria |
|---|---|
| 10% | Mild non-proliferative diabetic retinopathy with minimal visual impact, or rate based on incapacitating episodes lasting at least 1 week in the past 12 months. |
| 20% | Moderate non-proliferative retinopathy with visual acuity changes meeting the 20 percent threshold, or incapacitating episodes of 2 to 4 weeks total duration in the past year. |
| 30% | Visual acuity loss meeting the 30 percent level, or significant macular edema requiring treatment. |
| 40% | Incapacitating episodes lasting 4 to 6 weeks total in the past 12 months, or visual acuity loss at the 40 percent level. |
| 60% | Incapacitating episodes lasting more than 6 weeks total in the past year, or severe visual impairment in both eyes from advanced retinopathy. |
| 100% | Blindness or near-total vision loss in both eyes from end-stage diabetic retinopathy. |
Retinal examination with dilated fundoscopy, retinal photographs or OCT imaging showing vessel damage and macular changes, fluorescein angiography if performed, visual acuity testing, documentation of laser treatments or anti-VEGF injections, hemoglobin A1c levels showing diabetes control history, and a nexus statement connecting the retinopathy to service-connected diabetes.
Yes. Diabetic retinopathy is rated separately from diabetes mellitus under its own diagnostic code. Your diabetes rating and retinopathy rating combine to produce a higher overall disability percentage.
An incapacitating episode is a period requiring bed rest and treatment prescribed by a physician. This includes recovery periods after laser photocoagulation or anti-VEGF injection procedures where your doctor restricts your activity.
Yes. Filing early establishes the service connection and a baseline rating. As retinopathy typically progresses over time, having the condition already service-connected makes it much easier to claim increased ratings later without needing to re-establish the connection.
At minimum annually, as recommended for all diabetics. More frequent exams (every 6 months) are appropriate if retinopathy is already present. Each exam creates a medical record documenting progression that supports future increased rating claims.