Diabetic Retinopathy and Disability Rating — What Actually Counts

A person with diabetes who receives a diagnosis of diabetic retinopathy arrives at the committee holding a document that sounds serious, and sometimes leaves with nothing. That is surprising, but it is not arbitrary: the National Insurance schedule does not rate diagnoses, it rates consequences. Retinopathy is in the schedule, at clause 68, and it is expressly assigned 0% — in one eye and in both.

That does not mean there is nothing to claim. It means the percentage comes from somewhere else, and that a file built around the diagnosis rather than around the measurements has lost before the committee has sat. The figures here are drawn from the same schedules that underlie the eye disability calculator — the same clauses, the same numbers.

What the schedule says about retinopathy

Clause 68 at the National Insurance Institute — the clause headed “retina” — contains only three items:

• Status after successful treatment of retinal detachment — 0% in one eye, 0% in both.
• Retinopathy of any type — 0% in one eye, 0% in both.
• Night blindness, proven by electrophysiological testing — 10%, for both eyes only.

The principle behind this recurs throughout the eye chapter: a retinal finding with no dedicated clause — macular degeneration or dystrophy, a retinal scar, a coloboma — is rated by its effect on visual acuity and on the visual field, not as a standalone item. Diabetic retinopathy is the most conspicuous case of that principle, because it is common, it sounds serious, and it genuinely can be serious — but only through what it causes.

Where the percentage actually comes from

The overwhelming majority of the percentage in retinopathy files comes from the visual acuity table: a grid that cross-references corrected acuity in both eyes and returns a figure. Some points from the table, with the other eye normal (6/6):

• a fall to 6/18 — 10%
• a fall to 6/60 — 20%
• a fall to 3/60 — 25%
• a fall to 1/60 or below — 30%

And where both eyes are affected the numbers climb quickly: 6/36 in both — 50%; 6/60 in both — 70%.

Two points are worth knowing. First, the table measures corrected acuity, that is with the best available spectacles or lenses. Second, where separate impairments combine they are weighted from the remainder rather than added — 10% plus 10% gives 19%, and 20% plus 10% gives 28%. This is the most frequent calculation error in eye files, and it is visible in the decision document itself.

The visual field after laser treatment — the clause that gets forgotten

This is the most important point on this page, and it is specific to diabetic retinopathy.

Panretinal photocoagulation (PRP) is an effective and well-established treatment, and it acts precisely where visual acuity is not measured — in the peripheral retina. The consequence is that after extensive treatment there may be a measurable narrowing of the visual field while central acuity is fully preserved. Such a patient will read 6/6 on the chart, receive 0% for the diagnosis, and leave without anyone having examined the place where the impairment actually is.

The visual field is rated under a separate clause — 52(2) at the National Insurance Institute, 52(b) under the Disabled Persons regulations — and it is measured by perimetry, not by a letter chart. If the test was not done, the impairment does not exist as far as the file is concerned. The detail of how it is rated, including the definition of “diameter of the visual field” as the average of the vertical and horizontal diameter, is set out in Visual Field Loss.

Night blindness — the only item that is not zero

The same panretinal treatment also impairs dark adaptation, and patients sometimes describe real difficulty with night driving or on entering a dark room long before they complain about acuity.

In clause 68 at the National Insurance Institute this is the only item carrying a percentage: night blindness, proven by electrophysiological testing — 10%. The two decisive words are “proven” and “electrophysiological”: a complaint is not enough, and a description in a discharge letter is not enough. An objective test is required. The item is also defined for both eyes only — there is no one-eye version.

In practice this is the clause almost nobody claims, not because the condition is rare but because the test that proves it is almost never obtained on the claimant’s initiative.

The Ministry of Defence — where retinopathy carries its own percentage

Under the Disabled Persons regulations the structure is entirely different. Clause 68 there has three tiers, each with a figure for one eye and for both:

• (a) Status after successful treatment of retinal detachment — 1% / 2%
• (b) Retinopathies requiring treatment, and retinal detachment — 5% / 10%
• (c) Other retinopathies not requiring treatment — 1% / 2%

The note in the regulations makes clear that the accompanying impairment to vision and to the visual field attracts additional disability under the appropriate clauses — meaning the clause 68 percentage does not stand in place of the functional impairment but alongside it.

The difference between (b) and (c) is the only material gap in the clause: 5% against 1% for one eye, 10% against 2% for both. It rests on a question that can be documented — whether the retinopathy required treatment. Laser photocoagulation, a series of intravitreal injections, or a documented clinical decision to treat is exactly the material that settles it, and it is almost always in the record even when it was never attached to the file.

It is also worth knowing that the Ministry of Defence applies a ceiling on each eye’s total contribution (regulation 10(c)(3)), which the calculator applies automatically — so the clause 68 figure is not always added in full on top of normal acuity.

What actually decides retinopathy cases

• Stability versus fluctuation. Macular oedema treated by injections is a moving state: vision rises after the injection and falls towards the next. A single measurement is unrepresentative, and the choice of date determines the result. A documented series over time is what allows the level the condition returns to be identified.
• Corrected acuity, not acuity on a bad day. The table measures with optimal optical correction. A current refraction before the committee is worth more than any argument.
• The visual field, if there has been PRP. See above — this is the most common gap.
• A stable state versus a temporary degree. Active retinopathy under treatment is not a stable state. A temporary degree sometimes reflects reality better than a permanent determination made too early, which fixes a figure set at the height of treatment.
• Accompanying impairments. Early cataract, intraocular pressure, status after vitrectomy — each is rated under its own clause, and all are weighted from the remainder. The detail on how cataract is rated is in Cataract and Disability Rating.
• General disability applies a further filter. A combination of clauses 52(1)–(2) not exceeding 25%, where no eye is at 3/60 or worse, is filtered out in general disability. The calculator checks this automatically and displays a warning — worth knowing in advance rather than discovering in a decision.

If the retinopathy was discovered or worsened in an occupational context, see Eye Injury at Work. And if a decision has already been given and an appeal is under consideration, the deadlines and procedure are set out in Appealing a Medical Committee Decision.

What an ophthalmic opinion adds

• Identifies which of the existing measurements are reliable and which reflects a stable state.
• Maps the finding to the correct clause in each schedule relevant to the file.
• Points to a missing test — perimetry, electrophysiology — without which an existing impairment goes uncounted.
• Separates damage caused by the retinopathy from a pre-existing impairment or an age-related change.
• Applies the weighting rules and ceilings correctly.
• Addresses whether the condition is genuinely stable, or whether a temporary degree fits better.

And what an opinion does not do: it does not replace the committee’s examination, does not bind it and does not guarantee an outcome.

How to get in touch

Examinations and assessments take place in Haifa and Herzliya, by prior arrangement. There is no need to send a full medical file with the first enquiry — a brief description of the finding, the stage the process has reached and the date that has been set is enough to establish whether the case is suited to an assessment within this field of expertise. Every enquiry is considered on its own merits, with no undertaking as to a conclusion or to the outcome of the proceedings.

Get in touch to check suitability for an assessment