This page explains, from an ophthalmologist’s point of view, how a National Insurance Institute medical board actually rates visual impairment — what a properly written eye opinion can add to such a file, and what it cannot do.
If you are at an early stage and want to understand which range is even relevant to your situation, the practical starting point is the eye disability calculator, which computes from the clauses themselves and compares National Insurance with the Ministry of Defence. For a general explanation of what an ophthalmic expert opinion is and when it is needed, see Expert Medical Opinion in Ophthalmology.
Two separate tracks, one book of tests
National Insurance rates eye impairment under the same chapter of the book of tests in two different tracks, and confusing them is a common source of disappointment.
Work injury. Here the first question is not how many percent, but whether the event is recognised as a work injury and whether the eye impairment arises from it. Only after recognition is a degree determined, and it covers the impairment traceable to that injury. Regulation 15 also lives in this track.
General disability. Here the whole medical picture is assessed, independent of cause, alongside a separately examined question of reduced earning capacity. A screening rule applies in this track: visual impairment not exceeding 25% is not counted in the calculation, unless acuity in one eye is 3/60 or worse.
That difference explains why the same patient, with the same file and the same tests, can receive an entirely different outcome in the two tracks.
How vision is measured at a board
Visual impairment is rated under clause 52, and its logic is simpler than it looks: a two-dimensional table where the acuity of the right eye meets the acuity of the left. There is no addition between eyes and no separate score per eye.
Three principles decide almost every file:
- Best corrected visual acuity. The table refers to vision with the best available optical correction. Uncorrected vision is not the measure, and an acuity recorded without correction does not reflect what the board will weigh.
- The one-eye ceiling. Where one eye is injured and the fellow eye is normal, the rating stops within a defined range: 6/60 gives 20%, 3/60 gives 25%, and 1/60 or no light perception gives 30%. Loss of the eye itself — enucleation or phthisis — adds 5% arithmetically.
- Weighting from the remainder. Where several separate impairments exist, percentages are not added but weighted from what remains: 10% plus 10% is 19%, 20% plus 10% is 28%, 30% plus 10% is 37%. This is where most of the calculation errors I see in files are made.
The clauses that recur in eye files
Beyond clause 52, a handful of clauses appear in almost every eye file — and they are where the misunderstandings concentrate.
- Clause 55(d) — dry eye. A mild condition controlled with drops is rated 0%. A persistent condition with an objective finding is rated in the 10%–15% range. The distinction rests on documentation over time, not on symptom intensity on the day of the examination. More: dry eye and disability percentage.
- Clause 56 — tear drainage. Impairment without discharge is rated 0%; constant tearing or purulent discharge is rated 5%–10%.
- Clause 61 — corneal opacities. 5% or 10%, but only where there is no visual impairment that itself confers a disability degree. The point is to prevent double counting: the same scar is not rated twice, once as an opacity and once as reduced vision.
- Clause 62 — the lens. The current text, in force since 1 January 2012: accommodation disturbance 5% with the over-45 bar; pseudophakia 0% in one eye and in both; lens subluxation 5% or 10%; aphakia or full dislocation 10% or 15%; and cataract rated by actual visual capacity. Older tables still in circulation show pseudophakia at 5% and 10% — that is the pre-amendment text. More: cataract and disability percentage.
- Clause 59. Repealed in the National Insurance book by the 2012 amendment, but still present in the Ministry of Defence tests. This is one of the more consequential practical differences between the two bodies.
- Keratoconus. It has no clause of its own — the term does not appear even once in the eye chapter. It is rated through the visual result under clause 52 and through corneal opacities under clause 61, which makes the decisive question whether vision corrects in glasses or only in a rigid lens. More: keratoconus and disability percentage.
Regulation 15 — work injury track only
Regulation 15 allows the determined disability degree to be increased by up to half, where the injured person cannot return to the work they were doing and their income has fallen substantially. The decision is taken by the medical board after review by an authority committee, and it turns on an occupational and economic question rather than a purely medical one.
In eye files it becomes relevant mainly where the occupation demands binocular vision, a full visual field, or work at height, with machinery or in professional driving. A medical opinion does not decide the question, but it can describe precisely what the visual limitation permits and what it does not. This explanation is general only and is not legal advice.
What an ophthalmic opinion adds to a National Insurance file
The gap I see repeatedly is not between a strong file and a weak one, but between a file written in the language of treatment and one written in the language of the book of tests. A visit summary records a complaint, a finding and a recommendation. A disability opinion does something else:
- It maps the findings to the correct clause and reasons why that clause and not another.
- It addresses the reliability of the tests — particularly visual fields, the most common weak point in eye files.
- It separates a pre-existing state from new damage where that distinction matters.
- It applies the weighting, ceiling and screening rules correctly, which is where calculation errors accumulate.
- It demonstrates stability over time rather than a snapshot.
Equally important is what an opinion does not do: it does not replace the board’s own examination, it does not bind the board, and it does not guarantee an outcome. The board examines independently, and on appeal it may also lower the degree. The appeal deadlines and rules are set out on Expert Medical Opinion in Ophthalmology.
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 impairment, the type of proceeding and the stage it has reached 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 a general disability board and a work injury board?
Both work from the same book of tests, but they ask a different question. In the work injury track the event must first be recognised as a work injury, and the rating covers only the impairment arising from it. In general disability the whole medical picture is assessed regardless of cause. The surrounding rules differ too: Regulation 15 exists only in the work injury track, and in general disability a screening rule can exclude a low visual impairment from the calculation altogether.
Do glasses or contact lenses affect the disability percentage?
Decisively. The table in clause 52 refers to best corrected visual acuity — vision with the best possible optical correction, not vision without glasses. Someone with a high prescription who reads 6/6 in glasses has no visual impairment for the purposes of the table. In practice this means a measurement recorded without correction, or with an outdated correction, can misrepresent the case in either direction.
I have impairment in both eyes — do the percentages add up?
Not by simple addition. Clause 52 uses a two-dimensional table where the acuity of the right eye meets the acuity of the left, so a combination of two impairments is never their sum. Where separate impairments exist — say reduced acuity alongside an ocular surface disease — the law weights from the remainder rather than adding: 10% plus 10% gives 19%, 20% plus 10% gives 28%, and 30% plus 10% gives 37%.
Does an intraocular lens after cataract surgery earn a disability percentage?
Under the current text of clause 62, pseudophakia — an eye with an implanted intraocular lens — is rated 0%, in one eye and in both eyes alike. This is one of the most common errors: older tables still circulating online show 5% and 10%, but those figures predate the amendment that took effect on 1 January 2012. What is assessed instead is the actual visual acuity after surgery, under the table in clause 52.
What is Regulation 15 and is it relevant to an eye file?
Regulation 15 exists only in the work injury track. It allows the determined disability degree to be increased by up to half, where the injured person cannot return to the work they were doing and their income has fallen substantially. The decision is made by the medical board following review by an authority committee. This is an occupational and economic question rather than a purely medical one, so a medical opinion does not decide it — though an accurate description of what the visual limitation permits is part of the picture. This explanation is general and is not legal advice.
How long is there to appeal a medical board decision?
In the general disability track an appeal must be filed within 60 days of the written notice, and only where the medical disability degree is below 80%. In the work injury track the period is 30 days, the appeal must state reasons and is filed on Form 247, and a further 30-day extension may be requested. It is worth knowing that the appeals committee may also lower the degree, not only raise it.