Keratoconus and Pterygium VA Rating

Keratoconus and pterygium sit in the same corner of the rating schedule: diseases of the cornea and the conjunctiva, the clear front of the eye and the thin layer over it. Neither has a table of its own. Both are rated under a general formula that gives you whichever is higher, the vision you lost or the treatment you needed. Knowing which of those two routes fits your case is most of the work.

This page walks through the eye formula word for word, how keratoconus and pterygium fit it, the contact lens rule that catches keratoconus claims, corneal transplants, how to prove these conditions are service connected, and why claims are denied. The Board section further down shows how appeals on cornea and conjunctiva conditions, including chronic conjunctivitis, have ended. Chronic conjunctivitis has its own page: conjunctivitis.

Keratoconus and pterygium VA rating criteria

38 CFR § 4.79 lists keratoconus as DC 6035 and pterygium as DC 6034. Keratoconus has no criteria of its own, so it rates under the General Rating Formula for Diseases of the Eye. Pterygium's entry reads:

6034 Pterygium: Evaluate under the General Rating Formula for Diseases of the Eye, disfigurement (diagnostic code 7800), conjunctivitis (diagnostic code 6018), etc., depending on the particular findings, and combine in accordance with § 4.25

The general formula starts with a choice: "Evaluate on the basis of either visual impairment due to the particular condition or on incapacitating episodes, whichever results in a higher evaluation." The episode route reads:

The notes define the terms. An incapacitating episode is "an eye condition severe enough to require a clinic visit to a provider specifically for treatment purposes." Treatment examples "include but are not limited to: Systemic immunosuppressants or biologic agents; intravitreal or periocular injections; laser treatments; or other surgical interventions."

Two related codes round out the group:

Rated on treatment visits: what counts

The episode route counts visits for treatment, not for checkups. A routine exam to measure your cornea is not an incapacitating episode. A visit where you get corneal crosslinking, a transplant, a pterygium excision, laser treatment or a fitting procedure done to treat the disease can be.

That makes your eye records the evidence. For each visit in the 12 months before the exam or your claim, the record should say what was done and that it was treatment. A pterygium that came back and needed a second surgery, or keratoconus that needed crosslinking in both eyes on separate days, can add up quickly. Under § 4.79's note (3), the vision route uses the rules in §§ 4.75 to 4.78, covered on the vision loss page.

The contact lens rule for keratoconus

Keratoconus thins and bulges the cornea into a cone, which warps vision in a way glasses often cannot fix. Rigid or scleral contact lenses often correct it better than glasses do, and 38 CFR § 4.76(b)(2) uses that against the rating:

Provided that he or she customarily wears contact lenses, evaluate the visual acuity of any individual affected by a corneal disorder that results in severe irregular astigmatism that can be improved more by contact lenses than by eyeglass lenses, as corrected by contact lenses.

So a veteran who sees 20/200 in glasses but 20/30 in scleral lenses, and wears the lenses most days, is rated on 20/30. Two things follow:

• The treatment route may pay more. If contacts give you good vision, the visit count under the general formula is often the better path.
• Tell the examiner why you cannot wear lenses, if you cannot. The rule applies only when you "customarily" wear contacts. Intolerance, scarring that prevents fitting, or lens-related infections are facts the examiner should record.

Remember the one-eye limits from § 4.75 as well: when only one eye is service connected, the other eye counts as 20/40, and one eye's vision rating cannot pass 30 percent unless the eye is lost.

Corneal transplants

A corneal transplant rates under DC 6036, on the general formula, with a 10 percent minimum "if there is pain, photophobia, and glare sensitivity." The transplant surgery itself is a treatment visit, and so is a visit where a rejection episode is treated. Whether a follow-up visit counts depends on whether treatment was given at that visit.

How much VA pays

At VA's rates effective December 1, 2025, a veteran alone receives $180.42 a month at 10 percent, $356.66 at 20 percent, $795.84 at 40 percent and $1,435.02 at 60 percent. Pterygium ratings for disfigurement or conjunctivitis combine with the eye formula rating under § 4.25; the combined rating calculator shows the result.

How to prove keratoconus or pterygium is service connected

Pterygium and sun exposure

A pterygium is a wing-shaped growth of the conjunctiva onto the cornea. A Cochrane review notes that "evidence suggests that ultraviolet light is a major contributor in the formation of pterygia," and that after simple excision the growth comes back in upwards of 80 percent of cases, less often when a tissue graft is used (Clearfield and colleagues, 2016). Years of sun and glare at sea, on flight lines, in the desert or in training ranges are the in-service exposure a pterygium claim rests on. Your personnel records and your own description of where you served and how much time you spent outdoors are evidence; an eye doctor's opinion links the two.

Keratoconus that began or worsened in service

Keratoconus slowly deforms the cornea in young people (Sahebjada and colleagues, 2021), the same years most people serve. A meta-analysis of 29 studies found it in about 1.4 per 1,000 people overall and linked it to eye rubbing (odds ratio 3.09), family history (6.42), allergy (1.42), asthma (1.94) and eczema (2.95) (Hashemi and colleagues, 2020). A diagnosis in service, or a diagnosis soon after with symptoms charted in service, supports a direct claim.

If keratoconus was noted on your entrance exam, the claim is about aggravation: under 38 CFR § 3.306, a condition that worsened during service is presumed aggravated unless VA shows the worsening was natural progress. If it was not noted at entry, the presumption of soundness in 38 CFR § 3.304(b) applies.

Corneal ectasia after PRK or LASIK in service

Laser vision surgery can rarely leave the cornea weak enough to bulge the way keratoconus does, a complication called ectasia. A systematic review estimated it in about 20 per 100,000 eyes after PRK and 90 per 100,000 after LASIK, among eyes without known risk factors before surgery (Moshirfar and colleagues, 2021). If you had refractive surgery in the military and later developed ectasia, the surgery record is the in-service event.

Secondary claims

Under 38 CFR § 3.310, a condition caused or aggravated by a service-connected condition is service connected. The allergy, asthma and eczema associations above make a secondary theory possible when one of those conditions is service connected and has driven chronic eye rubbing. Such a claim needs a medical opinion that addresses your history; an opinion that skips aggravation, meaning the keratoconus would be less severe but for the service-connected condition, is inadequate under El-Amin v. Shinseki, 26 Vet. App. 136 (2013).

The eye exam and the Eye Conditions DBQ

VA uses the Eye Conditions DBQ, done by a licensed optometrist or ophthalmologist under § 4.75(b). For these conditions, make sure the exam records:

• Every treatment visit in the past 12 months, with what was done. Bring the procedure notes.
• Vision with and without contacts, and whether you customarily wear them.
• Pain, light sensitivity and glare after a transplant, for the DC 6036 minimum.
• Visible changes to the eye from a pterygium, for a disfigurement rating under DC 7800.

Raven Scan reads your medical records and pulls out each eye procedure and its date, which is exactly what the visit count needs.

Why VA denies keratoconus and pterygium claims

The Board section below shows what the Board found missing in denied cornea and conjunctiva appeals and why it sent others back. These are the patterns behind those numbers.

No link to service. Most denied claims fail on the medical link. Keratoconus runs in families, and pterygium is tied to sunlight in general, not only to service. A favorable opinion has to tie your diagnosis to your service: the exposure, the timing, the surgery.

No current disability. A pterygium removed years ago with no recurrence, or keratoconus well controlled in lenses with no treatment visits, can leave nothing to rate. A 0 percent rating still keeps the condition service connected for later.

Visits that are not treatment. Routine checks do not count as incapacitating episodes. The records need to show treatment.

Rated with the wrong vision. Rating keratoconus on glasses vision when you customarily wear contacts, or on contact vision when you cannot tolerate them, are both errors worth raising.

An inadequate exam. An inadequate VA exam is the most common reason the Board sends these claims back; the remand reasons below show how often.

Questions veterans ask about keratoconus and pterygium

What is the VA rating for keratoconus?

Keratoconus rates under the General Rating Formula for Diseases of the Eye: 10, 20, 40 or 60 percent for 1, 3, 5 or 7 or more treatment visits in the past 12 months, or on lost vision if that rates higher. If you customarily wear contacts that correct it better than glasses, VA rates vision with the contacts.

What is the VA rating for pterygium?

Pterygium rates under the same eye formula, plus disfigurement under DC 7800 and chronic conjunctivitis under DC 6018 when those findings are present, combined under § 4.25. An inactive pterygium with no vision loss or visible change can rate 0 percent.

What VA rating does a corneal transplant get?

At least 10 percent under DC 6036 when there is pain, light sensitivity and glare, and more under the eye formula when vision loss or treatment visits support it.

Does corneal crosslinking count as a treatment visit?

It is a procedure done to treat keratoconus, and the formula's examples of treatment include surgical interventions. Make sure the procedure note is in your file with its date.

Is keratoconus considered refractive error?

No. Refractive error, such as nearsightedness, is not a disability under 38 CFR § 3.303(c), but keratoconus is a disease of the cornea with its own diagnostic code, DC 6035.

Can pterygium from sun exposure in service be service connected?

Yes, with a medical opinion that ties it to your exposure. Ultraviolet light is considered a major contributor to pterygium, so long outdoor duty, sea duty and desert deployments are the facts to document.

Sources

• 38 CFR § 4.79, eye ratings, DCs 6018 and 6034 to 6037 (opens in a new tab), eCFR text as of October 2, 2026
• 38 CFR § 4.75 and § 4.76, visual impairment and the contact lens rule (opens in a new tab)
• 38 CFR § 3.304 and § 3.306, soundness and aggravation (opens in a new tab)
• 38 CFR § 3.310, secondary service connection (opens in a new tab)
• El-Amin v. Shinseki, 26 Vet. App. 136 (2013)
• Clearfield E, Muthappan V, Wang X, Kuo IC. Conjunctival autograft for pterygium. Cochrane Database Syst Rev. 2016;2(2):CD011349. doi:10.1002/14651858.CD011349.pub2 (opens in a new tab)
• Hashemi H, Heydarian S, Hooshmand E, and colleagues. The prevalence and risk factors for keratoconus: a systematic review and meta-analysis. Cornea. 2020;39(2):263-270. doi:10.1097/ICO.0000000000002150 (opens in a new tab)
• Sahebjada S, Al-Mahrouqi HH, Moshegov S, and colleagues. Eye rubbing in the aetiology of keratoconus: a systematic review and meta-analysis. Graefes Arch Clin Exp Ophthalmol. 2021;259(8):2057-2067. doi:10.1007/s00417-021-05081-8 (opens in a new tab)
• Moshirfar M, Tukan AN, Bundogji N, and colleagues. Ectasia after corneal refractive surgery: a systematic review. Ophthalmol Ther. 2021;10(4):753-776. doi:10.1007/s40123-021-00383-w (opens in a new tab)
• VA disability compensation rates (opens in a new tab), effective December 1, 2025
• Eye Conditions DBQ guide