Malignant new growths of eye, orbit, and adnexa (excluding skin) are discernible by uncontrolled spread of abnormal cells. Cancers may be lethal by invading adjacent normal tissues or by spreading to sites distant from the original place. Malignant melanoma is the most common primary tumor seen in the eye. It is found only in the uveal tract, and it is usually confined to one side with 85% of cases appearing in the choroid.

Unregulated, disordered production of cells, into malignant, new growths, may be caused by chemicals, viruses, radiation, familial predisposition, and lifestyle, or a combination of the etiologic factors.

Until the macula is involved in the tumor, signs and symptoms may be absent. Tumor growth may lead to loss of visual field, retinal detachment and blindness. The pupil may become deformed, and the iris changes color if involved. Pain may be present when glaucoma, inflammation, or detachment occur.

When a retinal detachment without a tear (nonrhegmatogenous) appears, then a tumor may be suspected. Malignant melanomas can be seen with an ophthalmoscope. Ultrasonography may also be used to detect these tumors.

Traditionally, removal of an eye (enucleation) was done for choroidal melanoma. Recently, for small tumors (less than 10mm), radiotherapy or local resection has been used with good outcomes. Small growths on the iris that have not invaded the iris root can be safely observed until growth is documented by a series of photographs or ultrasound. Following this procedure, the removal of the iris (iridectomy) can then be performed.

Patients with metastatic disease have a median survival time of less than one year. Chemotherapy is not very effective. In contrast, patients with iris melanomas have an excellent prognosis with a mortality rate of less than 1%.

• Consider service connection on a presumptive basis as a chronic condition (38 CFR 3.307; 38 CFR 3.309(a)).

• Consider service connection on a presumptive basis as a condition associated with ionizing radiation exposure (38 CFR 3.307; 38 CFR 3.309(d); 38 CFR 3.311).

• Consider entitlement to Auto and auto adaptive equipment under 38 CFR 3.308 if there is permanent impairment of vision in both eyes consisting of central visual acuity of 20/200 or less in the better eye, with corrective glasses, or central visual acuity of more than 20/200 if there is a field defect in which the peripheral field has contracted to such an extent that the widest diameter of visual field subtends an angular distance no greater than 20° in the better eye.

• Consider entitlement to specially adapted housing under 38 U.S.C. 2101(a)(2)(A)(i) if there is visual impairment to the degree specified in 38 CFR 3.809(b)(2).

• Review for potential entitlement to special monthly compensation under 38 CFR 3.350 when there is loss/loss of use of one or both eyes, light perception only; visual acuity 5/200 or less; the vision field is reduced to 5 degree concentric contraction in both eyes; or blindness with no light perception in one or both eye.

• May be entitled to special monthly compensation where the Veteran has a single service-connected disability rated as 100% with additional service-connected disability or disabilities independently ratable at 60% or more, which are separate and distinct from the 100% service-connected disability and involves different anatomical segments or bodily systems. See  38 CFR 3.350(i)(1) – Special Monthly Compensation (SMC).

• Continue the 100 percent rating beyond the cessation of any surgical, X-ray, antineoplastic chemotherapy, or other therapeutic procedure. Six months after discontinuance of such treatment, the appropriate disability rating will be determined by mandatory VA examination. Any change in evaluation based upon that or any subsequent examination will be subject to the provisions of 38 CFR 3.105(e) of this chapter. If there has been no local recurrence or metastasis, evaluate based on residuals.