38 CFR Part 4 — 38 CFR § 4.79
Diplopia
dc-6090-diplopia
Eye
Diagnostic code
6090
Why your DC matters: DC 6090 is the exact code the VA uses to rate this condition. It determines which symptoms unlock which percentage, what evidence the rater looks for, and which secondaries are most likely to be approved.
Last verified against 38 CFR (eCFR Part 4):
Rating criteria (38 CFR Part 4)
Diagnostic code 6090 — Diplopia — is listed under 38 CFR § 4.79 in 38 CFR Part 4. The paragraphs below summarize how this code is used; the official schedule text controls exact percentages, formulas, and notes.
Schedule summary (educational, not a substitute for the regulation): Educational index row from the rating schedule naming convention; confirm exact diagnostic code, effective date, and criteria in the current eCFR Part 4.
Exact rating criteria: Open Part 4 in the eCFR (link under “Official source” below). Locate your diagnostic code number (6090) in the correct body-system subpart, or use Find in Page (Ctrl+F / ⌘F) for “6090”. Copy the verbatim rating table, including any parenthetical notes, exceptions, and cross-references, for the version of Part 4 that applies to your effective date.
Effective dates & which schedule version applies
Which diagnostic code, percentage, and effective date apply depends on the facts of your claim and the version of the rating schedule in force for the period being decided. Generally, VA applies the schedule in effect at the specified time under 38 U.S.C. § 5110 and implementing rules, subject to exceptions (e.g., protected ratings, liberalizing law changes—see regulation and VA manual policy as applicable).
For older claims, the **current** eCFR may not match the text that applied years ago. If your decision references a prior percentage or code, compare against the Part 4 text **as of** your claim’s relevant dates; historical Federal Register / CFR snapshots may be needed for precise comparison.
The “Last verified” date on this page is when we last checked this educational summary against the electronic CFR—not the date of any VA policy or your personal claim decision.
Notes for your claim
Evidence: Show that your diagnosis and severity match the factors the schedule names for DC 6090 (e.g., measurements, frequency, treatment, functional loss), with medical and lay evidence as appropriate.
C&P exams: Results should reflect the schedule’s requirements (correct joints measured, correct formulas). If the exam omits required findings, consider submitting records or requesting clarification.
If you disagree with the DC, percentage, or effective date, review the Part 4 text for your period and consider a supplemental claim or appeal with a VA-accredited representative.
This site does not provide legal advice.
Official source
38 CFR Part 4 (eCFR) — locate diagnostic code 6090 in the subpart for your body system (use Find in Page if needed).
DC 6090 (diplopia) is one of the most-missed post-TBI secondaries in the entire schedule. Diplopia rates by translating the affected gaze field to an equivalent visual acuity for the worse eye, then combining with the better eye under the General Rating Formula for Diseases of the Eye. The schedule's quirk: diplopia is assigned to only ONE eye, and the equivalent acuity adjustment is applied to that eye. The TBI link matters — post-TBI cranial nerve palsies (CN III, IV, VI) frequently cause diplopia, but examiners often classify it as 'cosmetic' and don't rate it. Veterans with documented TBI (DC 8045) should specifically audit for unrecognized diplopia. The other massive miss: post-cataract / post-eye-surgery diplopia.
Rating Tiers — What Each Percentage Requires
| Rating | What It Takes | Evidence That Supports It |
|---|---|---|
| 30% | Diplopia equivalent to visual acuity of 5/200 in the affected eye (severe — central 20° of gaze field). | Goldmann perimetry or comparable mapping of diplopic field; central gaze diplopia documented. |
| 20% | Diplopia equivalent to visual acuity of 20/200 or 15/200 (moderate — central 21°-30° of gaze field). | Field mapping showing diplopia in central 21°-30° zone. |
| 10% | Diplopia equivalent to visual acuity of 20/100 or 20/70 (mild — peripheral 31°-40° of gaze field). | Field mapping showing diplopia in 31°-40° zone. |
| 0% | Diplopia in extreme peripheral gaze only (> 40°) — no compensable rating. | Diplopia present only in extreme peripheral gaze, not affecting functional gaze fields. |
What Qualifies as 'Diplopia' Under DC 6090?
Persistent double vision in at least one gaze field
Two separate visual images perceived simultaneously — distinct from blurred vision (single, unclear image). Caused by ocular misalignment from cranial nerve palsy, muscle dysfunction, or refractive cause.
Objective field mapping required
Goldmann perimetry, red-glass test, Maddox rod, or equivalent mapping. Subjective report alone doesn't support rating; the diplopic gaze field must be objectively documented.
Assigned to only one eye for rating
The schedule explicitly limits diplopia rating to a single (worse / affected) eye. The diplopia-equivalent acuity is applied to that eye and combined with the fellow eye's actual acuity under the General Rating Formula.
Tier based on central vs. peripheral zone
30% = central 20°. 20% = 21°-30°. 10% = 31°-40°. > 40° = noncompensable. Central diplopia is most functionally impairing.
Language Your Rater Needs to See
These are the exact (or near-exact) regulatory phrases that unlock specific tiers. If your DBQ or C&P report doesn't use this vocabulary, the rater may default to a lower percentage even when symptoms qualify.
“Assigned to only one eye (worse / affected eye)”
The schedule explicitly limits diplopia to a single eye for rating purposes. The diplopia-equivalent acuity is applied to the worse / affected eye; the other eye uses its actual corrected acuity. Don't let an examiner double-count or split diplopia bilaterally — it doesn't work that way.
“Central 20° of gaze field (equivalent acuity 5/200)”
30% gate. Central gaze diplopia is the most functionally impairing — affects reading, driving, daily tasks. Field mapping is the objective evidence.
“Combined with visual acuity of fellow eye under General Rating Formula”
Diplopia rating uses the diplopia-equivalent acuity for the affected eye + the actual acuity for the fellow eye, then applies the General Rating Formula tier matrix. Single-eye diplopia + good fellow eye = lower tier than the equivalent acuity alone would suggest.
Evidence Checklist — Specific to This Condition
Ophthalmology / neuro-ophthalmology exam with diplopia mapping
CRITICALGoldmann perimetry, red-glass test, Maddox rod, or equivalent. Maps the gaze field where diplopia occurs.
TBI / cranial nerve evaluation (if post-TBI)
CRITICALCN III, IV, VI palsies cause diplopia. Documents the etiology and supports SC nexus to underlying TBI (DC 8045).
Best-corrected visual acuity in both eyes
CRITICALFellow eye's actual acuity matters for the combined tier under the General Rating Formula.
Patient symptom diary documenting functional impact
IMPORTANTDriving, reading, gait disturbance, head tilt compensation. Supports the qualitative element of central vs. peripheral diplopia.
Imaging (MRI brain / orbits if structural cause)
IMPORTANTLocalizes the lesion (TBI, mass, vascular). Supports SC nexus.
Prism prescription records
SUPPORTINGPrism glasses prescribed for diplopia correction = objective evidence of clinically significant diplopia.
C&P Exam Tips
Demand explicit diplopia mapping, not just 'patient reports double vision'
Goldmann or red-glass mapping is the objective evidence. Without it, the rater defaults to lowest tier or noncompensable.
Describe the functional impact concretely
'Can't drive — double vision when looking right at intersections.' 'Have to close one eye to read.' Functional descriptions support the central-gaze element.
Bring prism glasses if prescribed
Physical evidence of clinically significant diplopia. Don't take them off for the exam.
Don't conflate diplopia with blurred vision
Blurred vision = visual acuity issue. Diplopia = SEPARATE images. Be precise so the examiner codes correctly under DC 6090.
Common Mistakes That Cost Veterans Points
Not pursuing diplopia as a TBI secondary
Post-TBI cranial nerve palsies cause diplopia in a significant subset of patients. If you have SC TBI (DC 8045), audit for unrecognized diplopia — it's one of the most-missed secondaries.
Letting the rater treat diplopia as 'cosmetic'
Diplopia rates under DC 6090 based on objective gaze-field mapping. 'Cosmetic' or 'subjective only' is NOT a basis for denial when field mapping documents the diplopic zone.
Filing without Goldmann or red-glass mapping
Field mapping is the objective evidence. Without it, the rater defaults to lowest tier or noncompensable. Demand neuro-ophthalmology evaluation with explicit mapping.
Confusing diplopia tier with raw visual acuity tier
Diplopia translates to EQUIVALENT acuity for the worse eye, then combines with the FELLOW eye's actual acuity under the General Rating Formula. The combined rating is often lower than the equivalent-acuity number alone.
Tactical Plays
⚡ Audit your TBI rating for unrecognized diplopia
Post-TBI cranial nerve palsies (CN III, IV, VI) cause diplopia in a significant fraction of TBI patients — but examiners often classify the symptom as 'cosmetic' and don't pursue DC 6090. If you have SC TBI (DC 8045), get a neuro-ophthalmology evaluation with explicit Goldmann field mapping. If diplopia is present in any functional gaze field, file DC 6090 as a TBI secondary. This is one of the highest-yield missed plays in the catalog.
⚡ Demand objective gaze-field mapping
Diplopia rates entirely on objective field mapping (Goldmann, red-glass, Maddox rod). 'Patient reports double vision' is not enough — the rater defaults to noncompensable. Demand neuro-ophthalmology evaluation with explicit mapping of the diplopic gaze field, and make sure the report classifies the zone as central, intermediate, or peripheral.
⚡ Calculate the combined tier — not just the equivalent acuity
Diplopia translates to equivalent visual acuity for the worse / affected eye (5/200, 20/200, 20/100, etc.), then combines with the FELLOW eye's actual best-corrected acuity under the General Rating Formula tier matrix. Single-eye diplopia + good fellow eye yields a lower combined tier than the equivalent-acuity number alone would suggest. Run the matrix yourself before filing.
⚡ Stack with visual acuity loss in fellow eye if applicable
If the fellow eye also has reduced visual acuity (from cataract, glaucoma, macular degeneration), it rates separately under DC 6066. The combined visual impairment matters under the General Rating Formula.
Secondary Conditions to File With This One
TBI (causal)
STRONGDC 8045
Post-TBI cranial nerve III, IV, VI palsies cause diplopia. Direct presumptive secondary if TBI is SC. Most-missed TBI secondary.
Stroke (causal)
STRONGDC 8008
Brainstem stroke involving CN III/IV/VI nuclei causes diplopia. Secondary pathway if stroke is SC.
Diabetic cranial neuropathy
MODERATEDC 8210
Diabetic vasculopathy can cause isolated CN VI or CN III palsy with diplopia. Secondary to SC diabetes.
Multiple sclerosis (when SC)
MODERATEDC 8018
MS causes internuclear ophthalmoplegia and other diplopic syndromes. Secondary if MS is SC.
Post-surgical eye trauma
SITUATIONALPost-cataract, post-strabismus surgery, or post-orbital trauma can cause persistent diplopia. Secondary to documented in-service or post-service procedure related to SC condition.
Visual acuity loss (separate path)
MODERATEDC 6066
Visual acuity loss in fellow eye rates separately from diplopia under the General Rating Formula.
Compensation Scenarios
2026 rates (effective Dec 1, 2025, per va.gov)
10% — single, no dependents
Base rating
$180.42
TOTAL
$180.42/mo
Diplopia in 31°-40° gaze zone (equivalent 20/100 or 20/70).
20% — single, no dependents
Base rating
$356.66
TOTAL
$356.66/mo
Diplopia in 21°-30° gaze zone (equivalent 20/200 or 15/200).
30% — single, no dependents
Base rating
$552.47
TOTAL
$552.47/mo
Diplopia in central 20° gaze zone (equivalent 5/200).
30% DC 6090 diplopia + 40% DC 8045 TBI
Base rating
$1,435.02
TOTAL
$1,435.02/mo
Diplopia as TBI secondary — combined ~58% rounds to 60%. Common post-TBI presentation.
Note: Amounts are approximations rounded to nearest dollar. Actual comp varies with effective date, dependents (spouse, children, parents — each adds), Aid & Attendance, and additional disabilities. Combined ratings use VA Math (§ 4.25), not simple addition.
Key Definitions
👁️What is Diplopia?
Diplopia = double vision. Two separate visual images perceived simultaneously, typically from misalignment of the eyes. Distinct from blurred vision (a single, unclear image). Can be monocular (within one eye) or binocular (when both eyes are open).
📐What's the Difference Between Central and Peripheral Diplopia?
Central diplopia (within 20° of straight-ahead gaze) is most functionally impairing — affects reading, driving, daily tasks. Peripheral diplopia (> 40°) typically doesn't impair function and isn't compensable. The schedule tiers diplopia by the zone of the gaze field affected.
🔀Why is Diplopia 'Assigned to Only One Eye'?
Binocular diplopia is by definition a problem of alignment between the two eyes — it doesn't make conceptual sense to rate it bilaterally. The schedule resolves this by assigning the diplopia-equivalent acuity to the worse / affected eye, then combining with the fellow eye's actual acuity under the General Rating Formula.
🧠Why is Diplopia a TBI Secondary?
Post-TBI cranial nerve palsies (CN III oculomotor, CN IV trochlear, CN VI abducens) cause diplopia in a significant fraction of TBI patients. These cranial nerves are vulnerable to shear injury during head trauma. If TBI (DC 8045) is SC, diplopia rates as a recognized secondary.
How to File Your Claim
Get neuro-ophthalmology evaluation with explicit diplopia mapping
Goldmann or red-glass mapping documents the diplopic gaze field objectively.
Document underlying etiology
TBI (DC 8045), stroke (DC 8008), diabetic neuropathy (DC 8210), MS (DC 8018), post-surgical trauma. Anchors secondary pathway.
Pull best-corrected Snellen for fellow eye
Fellow eye's actual acuity matters for the combined General Rating Formula tier.
File 21-526EZ specifying 'diplopia (DC 6090)' as secondary to underlying SC condition
Specify the etiology (TBI, stroke, diabetes, MS) in the claim narrative.
Stack visual acuity loss in fellow eye separately if applicable
DC 6066 rates the fellow eye's acuity independently of diplopia.
Typical Claim Timeline
File initial claim
Day 0–7: Submit VA Form 21-526EZ with all medical evidence on file
VA acknowledges claim
Week 1–2: Receive confirmation letter and claim tracking number
C&P examination scheduled
Month 1–3: VA contracts an exam vendor and sends you appointment notice
Attend C&P exam
Bring your full evidence package; describe symptoms on your worst days, not your best
Decision & rating notice
Month 3–6: Decision letter with rating percentage and effective date
First payment & retro back pay
Within 15 days of decision; retroactive to claim date (or effective date if earlier)
Timeline varies by case complexity and VA regional office workload. Some claims resolve faster; others take longer.
Important Considerations
Diplopia is one of the most-missed TBI secondaries
Post-TBI cranial nerve palsies cause diplopia in a significant fraction of patients — but examiners often classify it as 'cosmetic.' If you have SC TBI, audit for unrecognized diplopia.
Demand objective field mapping
Goldmann or red-glass mapping is the objective evidence. Without it, the rater defaults to noncompensable.
Assigned to one eye — single-eye combined with fellow eye acuity
Diplopia translates to equivalent acuity for the worse eye + actual acuity for the fellow eye, under the General Rating Formula. Run the combined tier matrix.
Stack with fellow-eye acuity loss separately
If the fellow eye has reduced acuity from independent cause (cataract, glaucoma, macular degeneration), it rates separately under DC 6066.
Related Tools & Resources
Frequently Asked Questions
Can I claim diplopia as a TBI secondary?
Yes — post-TBI cranial nerve III/IV/VI palsies cause diplopia in a significant fraction of TBI patients. If TBI (DC 8045) is SC, diplopia rates as a direct secondary. Most often missed because examiners classify the symptom as 'cosmetic' rather than pursuing DC 6090 evaluation. Demand neuro-ophthalmology with Goldmann field mapping.
How is diplopia rated if it affects both eyes?
The schedule explicitly assigns diplopia to only one eye for rating — the diplopia-equivalent acuity is applied to the worse / affected eye, then combined with the fellow eye's actual best-corrected acuity under the General Rating Formula. Binocular diplopia is by definition a single-eye-assigned rating; it can't be doubled.
What's the highest possible DC 6090 rating?
30%, when diplopia affects the central 20° of gaze (equivalent acuity 5/200 in the worse eye). Higher overall ratings require combining with fellow-eye visual acuity loss under the General Rating Formula.
Does prism correction affect the rating?
Prism glasses are a workaround, not a cure. Diplopia rating is based on the underlying gaze-field abnormality (Goldmann mapping), not whether prism partially compensates. Prism prescription is actually objective evidence of clinically significant diplopia.
Can monocular diplopia rate under DC 6090?
Monocular diplopia (double vision in one eye, persisting when fellow eye is closed) is typically refractive or lens-related (cataract, irregular astigmatism). DC 6090 is primarily structured for binocular diplopia (gaze misalignment). Monocular diplopia may rate under the underlying cause's DC (e.g., DC 6027 cataract).
Official Regulatory Source
Diplopia is rated under 38 CFR § 4.79, DC 6090 — equivalent visual acuity assigned to one eye, combined with fellow eye under General Rating Formula.
38 CFR § 4.79 — Eye (eCFR) →Scroll to DC 6090. Cross-reference the General Rating Formula tier matrix and § 4.78 (muscle function of the eye) for related ocular motility codes.
Next Steps
If your rating decision lists DC 6090, compare your current symptoms and documentation against the criteria above. Consider:
- Requesting a copy of your rating decision and C&P exam report from the VA
- Gathering all relevant medical records (VA and private providers)
- Documenting functional limitations and how they impact work and daily activities
- Obtaining a nexus letter if needed to establish or strengthen service connection
- Filing for secondary conditions that may be related to this primary condition
- Contacting a VA-accredited VSO, claims agent, or attorney to review your file
This is general educational information only — not legal or medical advice.
Also: DC code lookup (tools) lists the same index in a compact layout.
Source: 38 CFR Part 4, Diagnostic Code 6090 • va.gov
⚠️ Important Disclaimer
This page provides general educational information only based on public VA regulations (38 CFR) and va.gov resources. It is not legal, medical, or claims assistance. Ratings and service connections are decided case-by-case by the VA based on the individual veteran’s evidence. We do not prepare claims, generate documents, or provide personalized advice. Always consult a VA-accredited Veterans Service Organization (VSO), attorney, or your physician for help with your specific situation. Verify the latest rules on va.gov.