This page explains, from an ophthalmologist’s point of view, how a vision disability claim proceeds before the Rehabilitation Department of the Ministry of Defence, how it differs from the National Insurance route, and what an organised eye opinion can contribute at each of its stages.
For a numerical comparison between the two books, the starting point is the eye disability calculator, which computes under the National Insurance tests and the Ministry of Defence tests in parallel. For a general explanation of an ophthalmic expert opinion, see Expert Medical Opinion in Ophthalmology, and for the parallel route see Ophthalmic Opinion for Bituach Leumi.
Two stages, two decision-makers
A claim before the Rehabilitation Department divides into two stages that do not mix, and most of the disappointment arises from treating them as one.
The recognition stage. Here the decision belongs to the Compensation Officer, and the question is not how many percent but whether the injury or illness is connected to service. A file rejected here never reaches the question of degree. This is the stage at which documentation close in time to the event — a unit record, a clinic visit, an emergency room, an image — weighs more than any later account.
The degree stage. Only after recognition does a district medical board convene and determine the disability degree under the Ministry of Defence tests, which are a separate book and not identical to the National Insurance book of tests.
Consequential, aggravated, and the practical difference
Two terms recur in every file and are almost always confused.
An aggravated impairment is a condition that existed before service and was worsened by it. In such a case the Compensation Officer determines which part of the disability arises from service and which part does not, and only the service-attributable part is counted. The medical implication is clear: the better the documentation of the state before enlistment and of the change that followed, the more precisely the aggravation can be described.
A consequential impairment, under Regulation 9, is a new impairment that developed on the basis of an already recognised disability — in ophthalmology, for example, a complication arising from a previously recognised trauma. Here the question is not what happened during service but whether a medical connection exists between the recognised disability and the new impairment.
In both cases this is a medical question that must be described in medical terms. The explanation on this page is general and is not legal advice.
How the tests differ from the National Insurance book
The logic is similar — best corrected visual acuity, visual field, the state of the cornea and the lens — but the tables are not identical, and the gap widened after the amendment that took effect in National Insurance on 1 January 2012. Three practical points:
- Clause 59 was repealed in the National Insurance book of tests, but still exists in the Ministry of Defence tests.
- Cataract is rated in the Ministry of Defence tests in the 5%–10% range.
- Minimal findings receive 1% at the Ministry of Defence rather than 0% — a difference that sounds negligible, but in a route where several impairments accumulate it changes the weighting.
This is precisely why the calculator on this site runs both books in parallel: the same file can produce two different results, and there is no way to guess which is relevant without knowing which route is involved.
What is actually examined in eye files
The injuries that recur in Rehabilitation Department files are largely anterior segment injuries: ocular trauma, a foreign body, a chemical or thermal burn, a corneal scar, infection, and damage following exposure. In each of them the decisive documentation is similar:
- Best corrected visual acuity, preferably from more than one date, to show a stable state rather than a good or bad day.
- A reliable visual field test where the impairment concerns the field — the most common weak point in eye files.
- Corneal documentation: imaging, topography, and a located description of the scar and its relation to the visual axis.
- A chronological sequence from the event to the present, not only a single up-to-date examination.
Supreme Medical Board and aggravation
Appeal. An appeal against a medical board decision is filed with the Supreme Medical Board within 45 days of receiving the Compensation Officer’s notice. The chairman of the Supreme Board may extend the period by a further 60 days, following an explicit written request. A decision of the Supreme Board may be appealed to the District Court — on a question of law only.
Aggravation. A request for aggravation is filed only if at least six months have passed since the last board for that injury, and it rests on a documented change: a fall in visual acuity, a narrowing of the visual field, or a new finding that was not present before. A feeling that the degree is too low is not aggravation.
What an ophthalmic opinion adds
In a Rehabilitation Department file an opinion is asked to do two different things at the two stages. At the recognition stage it describes the medical connection — the mechanism of injury, the fit between the finding and the documented event, and whether the picture is consistent over time. At the degree stage it maps the findings to the correct test, addresses the reliability of the examinations, and applies the weighting rules correctly.
What an opinion does not do matters just as much: it does not replace the board’s own examination, it does not bind the board and it does not guarantee a result.
How to make contact
Examinations and assessments take place in Haifa and Herzliya by prior appointment. There is no need to send a full medical file at first contact — a short description of the injury, the stage the proceeding has reached and the question at issue is enough to check whether the case fits an assessment within the field of expertise. Every enquiry is considered on its merits, with no undertaking as to a conclusion or to the outcome of the proceeding.
Get in touch to check suitability for an assessment
Frequently asked questions
What is the difference between the recognition stage and the degree stage?
They are two separate proceedings with different decision-makers. At the first stage the Compensation Officer decides whether the injury or illness is connected to service; only after recognition does the second stage follow, in which a district medical board determines the disability degree under the Ministry of Defence tests. A file rejected at the recognition stage never reaches the question of percentages, which is why medical documentation close in time to the event matters most at that first stage.
What is an aggravated impairment and how does it differ from a consequential one?
An aggravated impairment is a medical condition that existed before service and was worsened by it; the Compensation Officer determines which part of the disability arises from service and which part does not, and only the service-attributable part is counted. A consequential impairment, under Regulation 9, is a new impairment that developed on the basis of an already recognised disability — for example an ocular complication arising from a previously recognised injury. The distinction is medical in nature and depends on documentation of the state before service and after it.
How do the Ministry of Defence eye tests differ from the National Insurance book of tests?
Both bodies rate vision on similar logic but not on identical tables, and the gap widened after the amendment that took effect in National Insurance on 1 January 2012. Three practical examples: clause 59 was repealed in the National Insurance book but still exists in the Ministry of Defence tests; cataract is rated by the Ministry of Defence in the 5%–10% range; and minimal findings receive 1% at the Ministry of Defence rather than 0%. The calculator on this site computes under both books in parallel and shows the difference.
How long is there to appeal to the Supreme Medical Board?
An appeal is filed within 45 days of receiving the Compensation Officer's notice of the medical board's decision. The chairman of the Supreme Medical Board may extend that period by a further 60 days, following an explicit written request. A decision of the Supreme Medical Board may be appealed to the District Court, but on a question of law only and not on a medical question.
When can a request for aggravation be filed?
A request for aggravation may be filed only if at least six months have passed since the last board for that injury. The request rests on a documented change in the medical condition, not on a feeling that the degree awarded is too low; in eye files that means a documented fall in visual acuity or visual field, or a new finding that was not present at the previous examination.
Does a private opinion bind the medical board?
No. The board examines independently, weighs the file and is not bound by an opinion submitted on behalf of the claimant. The role of an opinion is to present the findings in the language of the relevant tests, to address the reliability of the examinations and to explain the medical connection — not to promise a result. There is no undertaking as to a particular conclusion or as to the outcome of the proceeding.