★ Vision & Eye
Dry Eye Syndrome VA Rating
38 CFR § 4.79, Diagnostic Code 6018 (analogous)
Overview
Dry eye is common after deployment exposure to dust, smoke, or burn pits and after refractive surgery.
Rating considers symptoms (pain, redness, foreign body sensation), objective findings, and any visual impairment.
Severe cases requiring punctal plugs or scleral lenses support compensable ratings.
In Depth
Dry eye disease (keratoconjunctivitis sicca) is rated under 38 CFR § 4.79 by analogy, most commonly to Diagnostic Code 6018 (chronic conjunctivitis). Active disease with objective findings (conjunctival injection, decreased Schirmer test, reduced tear breakup time) rates 10%. Severe corneal damage producing visual impairment is rated under DC 6066 (visual acuity) and DC 6080 (visual fields).
Dry eye is one of the highest-incidence ocular conditions in post-9/11 veterans. Documented contributors include: airborne particulate exposure (burn pits, dust storms, sand), JP-8 jet fuel and engine exhaust, LASIK/PRK performed under DoD-funded refractive surgery programs, prolonged contact lens wear in austere environments, and the dry environment of military aviation cabins.
Service connection paths: (1) direct, with documented in-service onset or exposure plus current diagnosis and nexus; (2) secondary to autoimmune disease such as Sjögren syndrome, rheumatoid arthritis, or lupus when those are service-connected; (3) secondary to medications taken for a service-connected condition (antihistamines, SSRIs, isotretinoin); (4) secondary to seventh-nerve dysfunction (Bell's palsy, post-traumatic facial nerve injury).
PACT Act framework: dry eye itself is NOT a listed PACT Act presumptive, but documented service in a covered location during a qualifying period strengthens the in-service exposure element for direct service connection.
How to Establish Service Connection
- Direct: documented in-service onset or burn pit/dust exposure (PACT Act framework).
- Secondary to autoimmune conditions, medications, or seventh nerve dysfunction.
Rating Criteria
Paraphrased from 38 CFR § 4.79, Diagnostic Code 6018 (analogous)
| Rating | Criteria |
|---|---|
| 10% | Active chronic conjunctivitis with objective findings (DC 6018). |
| 0–100% | Based on resulting visual impairment if severe corneal damage develops. |
See what each percentage pays in 2026 and how it combines with your current rating →
Evidence Checklist
- Ophthalmology notes including Schirmer test and tear breakup time.
- Treatment records (artificial tears, cyclosporine, punctal plugs).
- Documentation of in-service environmental exposures.
Evidence Templates
Common formats of evidence the VA looks for in this type of claim. These describe what the documents typically include — they are not legal forms or medical opinions, and Oakridge Claims does not draft them.
Ophthalmology Notes
Comprehensive eye exam including Schirmer test, tear breakup time, corneal staining (fluorescein/lissamine green), and meibomian gland evaluation.
Treatment Records
Documentation of artificial tears, prescription drops (cyclosporine, lifitegrast), punctal plugs, autologous serum tears, or scleral lens prescriptions.
Exposure Documentation
Burn Pit Registry enrollment, deployment records, DD-214 reflecting service in covered location.
Operative Records (if applicable)
DoD refractive surgery (LASIK/PRK) operative report and post-op follow-up documenting persistent dry eye.
Evidence VA Commonly Cites in These Claims
Descriptive summary of evidence types frequently referenced in rating decisions for this condition. Not a checklist of actions to take — every claim is decided on its own facts.
- ★Request a Schirmer test and tear breakup time (TBUT) measurement at the C&P exam — these are the standard objective tests for dry eye and many examiners skip them unless specifically requested.
- ★Document the full treatment ladder: artificial tears (over-the-counter), prescription cyclosporine (Restasis) or lifitegrast (Xiidra), punctal plugs, autologous serum tears, and scleral lenses. Higher treatment intensity supports more severe findings.
- ★For burn pit / airborne hazard cases, enroll in the VA Airborne Hazards and Open Burn Pit Registry and submit the questionnaire results.
- ★If LASIK/PRK was performed under a DoD program, request the operative records — post-LASIK dry eye is well-documented in ophthalmology literature and supports direct service connection.
- ★Severe cases with corneal scarring should be rated by visual impairment in addition to (or instead of) the DC 6018 analogy.
Illustrative Scenarios
These are hypothetical educational examples — not actual case results, predictions, or guarantees of outcomes.
Post-9/11 deployment dry eye
Marine veteran with two Iraq deployments developed persistent foreign-body sensation and burning two years after discharge. Ophthalmology documented Schirmer < 5mm and TBUT < 5 seconds. Direct service connection granted citing documented burn pit and dust exposure; rated 10% under DC 6018 analogy.
Post-LASIK dry eye from DoD refractive program
Naval aviator underwent PRK under the Navy's refractive surgery program in 2015. Persistent dry eye requiring punctal plugs and Restasis. Direct service connection granted with operative records; 10% rating.
Secondary to service-connected Sjögren syndrome
Veteran with service-connected Sjögren syndrome developed severe dry eye requiring scleral lenses and autologous serum tears. Secondary service connection granted; rated 10% under DC 6018, with consideration for higher visual-impairment ratings if corneal scarring develops.
Common pitfalls VA sees
- Accepting a C&P exam without Schirmer test or TBUT measurement — without objective findings, VA frequently denies or rates 0%.
- Failing to enroll in the VA Airborne Hazards and Open Burn Pit Registry, which is a low-cost step that strengthens exposure documentation.
- Not separately claiming visual impairment when severe dry eye has produced corneal scarring or persistent vision changes.
- Missing secondary pathways — dry eye from a service-connected autoimmune disease or medication is often more straightforward than direct service connection.
Common Secondary Conditions
Conditions frequently service-connected as secondary to Dry Eye Syndrome:
Frequently Asked Questions
Have a Dry Eye Syndrome claim or denial?
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Requesting a consultation does not create representation and is not a guarantee of any outcome. Representation begins only after a written fee agreement and VA Form 21-22a are signed.
Educational content only — not legal advice and not medical advice. Rating criteria on this page are summarized in plain English from 38 CFR Part 4; consult VA.gov or the current Code of Federal Regulations for official criteria. This page provides general education about how the VA rates this condition; it is not individualized advice, does not establish a representation relationship, and should not be used to self-diagnose, self-treat, or decide a course of action without speaking to a qualified clinician and a VA-accredited representative. Outcomes depend on each veteran's individual facts, evidence, and the adjudicator's judgment; no specific rating, effective date, or other result is guaranteed. Oakridge Claims is a private business and is not affiliated with, endorsed by, or operated by the US Department of Veterans Affairs.