Claim Raven explanation
What this means
This section addresses evaluation of eye-muscle function, including diplopia, or double vision. The location and extent of double vision affect how the rule translates it into an evaluation.
The section contains specific instructions and exceptions, including how muscle-function findings relate to other visual impairment. Having occasional double vision does not by itself identify the applicable rating.
How this helps your claim
This helps you look for the detailed examination findings behind a double-vision decision. The symptom's position, persistence, and correction need to be described in the medical record.
What to check in your records
Use your decision, examination reports, and relevant records to check the following points.
- Find the diplopia chart and affected ranges of gaze.
- Review whether symptoms are occasional, persistent, or correctable as the rule addresses.
- Check how VA handled other visual impairment in the same eye.
Identify where double vision occurs
An eye-muscle examination can describe the direction and extent of diplopia, not simply whether double vision occurs at all. Those findings matter because the regulation translates particular patterns into the evaluation framework. Keep the full examination rather than only a symptom summary.
The relationship to other visual impairment also needs consideration under the section's instructions. Do not independently add a muscle-function value to an acuity or field evaluation without checking the combination rules. The record should show which findings are being evaluated and how the prescribed method handles them.
Does occasional double vision establish a compensable evaluation?
Not automatically. Frequency, correction and the specified examination findings can affect the applicable treatment under this rule. A symptom should be accurately reported, but the evaluation requires the complete clinical pattern and instructions, not just the existence of one episode.
Official regulatory text
38 CFR § 4.78
eCFR snapshot: September 3, 2026. Layout and spacing are adapted for reading. The full section and its tables are included below.
§ 4.78 Muscle function.
(a) Examination of muscle function. The examiner must use a Goldmann perimeter chart or the Tangent Screen method that identifies the four major quadrants (upward, downward, left, and right lateral) and the central field (20 degrees or less) (see Figure 2). The examiner must document the results of muscle function testing by identifying the quadrant(s) and range(s) of degrees in which diplopia exists.
(b) Evaluation of muscle function.
(1) An evaluation for diplopia will be assigned to only one eye. When a claimant has both diplopia and decreased visual acuity or visual field defect, assign a level of corrected visual acuity for the poorer eye (or the affected eye, if disability of only one eye is service-connected) that is: one step poorer than it would otherwise warrant if the evaluation for diplopia under diagnostic code 6090 is 20/70 or 20/100; two steps poorer if the evaluation under diagnostic code 6090 is 20/200 or 15/200; or three steps poorer if the evaluation under diagnostic code 6090 is 5/200. This adjusted level of corrected visual acuity, however, must not exceed a level of 5/200. Use the adjusted visual acuity for the poorer eye (or the affected eye, if disability of only one eye is service-connected), and the corrected visual acuity for the better eye (or visual acuity of 20/40 for the other eye, if only one eye is service-connected) to determine the percentage evaluation for visual impairment under diagnostic codes 6065 through 6066.
(2) When diplopia extends beyond more than one quadrant or range of degrees, evaluate diplopia based on the quadrant and degree range that provides the highest evaluation.
(3) When diplopia exists in two separate areas of the same eye, increase the equivalent visual acuity under diagnostic code 6090 to the next poorer level of visual acuity, not to exceed 5/200.
(Authority: 38 U.S.C. 1155)
[73 FR 66550, Nov. 10, 2008, as amended at 83 FR 15321, Apr. 10, 2018]
Related references
- 38 USC § 1155: The law behind VA disability rating percentages
- 38 CFR § 4.1: What a VA disability rating measures
- 38 CFR § 3.159: VA duty to assist: records and examinations
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