6026 - Optic neuropathy
DBQ: Link to Index of DBQ/Exams by Disability for DC 6026
Definition
Optic neuropathy describes abnormalities or damage of the optic nerve that occur as a result of ischemia, toxins, vascular and blood pressure abnormalities (such as blocked blood flow), and compression within the orbit.
Etiology
Optic neuropathy refers to damage to the optic nerve from any cause. Optic neuropathy may be caused from:
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Optic neuritis
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Ischemic optic neuropathy
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Compressive optic neuropathy
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Infiltrative optic neuropathy
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Traumatic optic neuropathy
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Mitochondrial optic neuropathies: nutritional, toxic or hereditary.
Signs & Symptoms
The main symptom is loss of vision, with colors appearing subtly washed out in the affected eye. In many cases, only one eye is affected and patients may not be aware of the loss of color vision until the doctor asks them to cover the healthy eye.
Tests
Tests may include: visual acuity; visual fields; pupillary light reflex; ophthalmoscopy; visual evoked response (VER); computed tomography (CT) scan; magnetic resonance imaging (MRI); and erythrocyte sedimentation rate (ESR).
Vision and visual field are tested with an eye chart and by testing the point at which a person first sees an object (finger) moving into their visual field; inside of the eye is viewed with an ophthalmoscope to observe blood vessels of eye interior the optic nerve head.
Treatment
Currently, there are limited treatments that can be offered to directly treat the optic nerve. Many doctors place the patient on drugs that lower the intraocular pressure, and that may provide some neuro-protection to the nerve. Lowering intraocular pressure may improve the blood flow to and through the optic nerve. Smoking should be discontinued, and while high blood pressure is a risk factor, the sudden lowering of blood pressure should be avoided. Corticosteroids or glaucoma medications may be used for treatment of optic neuropathy. Specific treatments will depend on the direct cause of the optic neuropathy.
Residuals
It is possible for vision to improve with proper treatment, at least partially. However, results vary widely and cannot be predicted in advance of treatment.
Special Considerations
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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).
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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).
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The veteran, spouse, surviving spouse or parent will be considered in need of regular aid and attendance if he or she is blind or so nearly blind as to have corrected visual acuity of 5/200 or less, in both eyes, or concentric contraction of the visual field to 5 degrees or less (38 CFR 3.351(c)(1)).
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Consider entitlement to automobile allowance and/or automobile adaptive equipment if there is visual impairment to the degree specified in 38 CFR 3.808(b)(3).
Notes
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Review for entitlement to special monthly compensation under 38 CFR 3.350.
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For the purposes of evaluation under 38 CFR 4.79, an incapacitating episode is an eye condition severe enough to require a clinic visit to a provider specifically for treatment purposes.
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Examples of treatment may include but are not limited to: Systemic immunosuppressants or biologic agents; intravitreal or periocular injections; laser treatments; or other surgical interventions.
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For the purposes of evaluating visual impairment due to the particular condition, refer to 38 CFR 4.75, 38 CFR 4.76, 38 CFR 4.77, 38 CFR 4.78, and 38 CFR 4.79, diagnostic codes 6061-6091.