Two questions, two sets of rules
Getting scleral lenses through VA depends on two things:
- Are you eligible for VA eyeglasses and contact lenses? This is set by federal regulation.
- Does your eye condition meet VA’s prescribing criteria for contact lenses? This is set by a VA directive and decided by a VA eye care provider.
You need both.
Question 1: eligibility for contact lenses
Being enrolled in VA health care makes you eligible for diagnostic and preventive eye care. That’s separate from VA providing eyeglasses, contact lenses, and hearing aids, which VA calls sensori-neural aids.[2]
Under 38 CFR 17.149, VA furnishes these aids only to veterans who are otherwise receiving VA care, and only to those in listed groups, including veterans:[1]
- with a compensable service-connected disability
- who are former prisoners of war
- who were awarded a Purple Heart
- receiving benefits under 38 U.S.C. 1151
- receiving increased pension based on the need for regular aid and attendance or being permanently housebound
- with a visual or hearing impairment that resulted from another medical condition VA is treating, or from its treatment
- with a significant functional or cognitive impairment shown by difficulty with activities of daily living, not counting normally occurring vision or hearing loss
- whose vision or hearing impairment is so severe that the aid is needed for them to take an active part in their own medical treatment
VA.gov’s vision care page summarizes, in plain language, who qualifies for VA-paid eyeglasses, and says to contact the prosthetic representative at your nearest VA medical center for more information.[3]
Question 2: the prescribing criteria
VHA Directive 1034, Prescribing and Providing Eyeglasses, Contact Lenses, and Hearing Aids, dated October 24, 2019, sets VA’s criteria. Its transmittal sheet says it was due to be recertified by the end of October 2024 and continues as national policy until it is recertified or rescinded.[2]
The directive says contact lenses are provided to eligible veterans who meet these criteria, subject to evaluation by, or the recommendation, prescription, and approval of, a VA eye care provider:[2]
- Vision conditions: aphakia, severe astigmatism, pathologic myopia, keratoconus, aniseikonia, significant corneal pathology or deformity, corneal transplant, significant post-surgical anisometropia or irregular astigmatism, conditions in which glasses can’t be used or contact lenses give a significant improvement in visual or medical function, and similar conditions.
- Bandage lenses: to manage traumatic corneal injuries, corneal diseases and dystrophies, post-surgical corneal conditions, significant corneal abrasions, displaced corneal flaps, severe dry eye, or similar conditions.
- Specialty lenses: for conditions such as severe corneal scarring, ocular cicatricial pemphigoid or Stevens-Johnson syndrome, severe dry eye, light sensitivity and glare, and others.
The directive doesn’t name lens designs. Whether a scleral lens is the right tool is the VA eye care provider’s call. If you have keratoconus, a corneal transplant, severe dry eye, or Stevens-Johnson syndrome, those are all named in the criteria.
Replacements and spares
- Replacement contact lenses are provided on the recommendation, prescription, and approval of a VA eye care provider, but are not normally provided unless medically necessary.[2]
- A second lens or pair may be provided when losing or destroying a lens creates a severe hardship or a compelling medical need.[2]
Because a lost scleral lens can leave you unable to see well, ask your VA eye care provider early whether a backup is appropriate for you.
Care outside VA
The directive says these aids are provided at VA expense only when prescribed by a VA or non-VA eye care provider as a result of a VA-authorized appointment and evaluation.[2] If you want to see a community fitter, get VA authorization first. Don’t assume a private practice can bill VA.
Plans and programs differ
VA has its own rules, separate from TRICARE, Medicare, and private plans. If you also have other coverage, ask how it fits together. See our pages on TRICARE and Medicare.
What to ask
Your VA prosthetics representative or eye clinic:
- Am I eligible for contact lenses under 38 CFR 17.149?
- Can I be evaluated for scleral lenses at my VA eye clinic, or referred to one that fits them?
- If VA sends me to a community fitter, what has to be authorized first?
- What’s the process if a lens breaks or is lost?
Write down the date, the name of the person you spoke with, and what they told you.
Common questions
Does the VA cover scleral lenses for keratoconus?
VHA Directive 1034 lists keratoconus among the conditions for which contact lenses are provided to eligible veterans, subject to evaluation and approval by a VA eye care provider. It doesn't name lens types, so whether a scleral lens is the right choice is your VA eye care provider's clinical decision.
I'm enrolled in VA health care. Does that mean I'm eligible for contact lenses?
Not automatically. Enrollment makes you eligible for eye exams, but contact lenses are only provided to veterans in the groups listed in 38 CFR 17.149, such as those with a compensable service-connected disability or a vision problem caused by a condition VA is treating. Ask your VA prosthetics representative whether you qualify.
Will the VA replace a lost or broken scleral lens?
The directive says replacement contact lenses are provided on the recommendation, prescription, and approval of a VA eye care provider, but are not normally provided unless medically necessary. A second lens or pair may be provided when losing or destroying a lens creates a severe hardship or a compelling medical need.
Can I see a fitter outside the VA?
The directive says aids are provided at VA expense only when prescribed by a VA or non-VA eye care provider as a result of a VA-authorized appointment and evaluation. So outside care has to be authorized by VA first. Ask your VA eye clinic before booking.