LASIK (Laser-Assisted in Situ Keratomileusis) is a surgical procedure that uses a laser to reshape the cornea, the clear front part of the eye, to correct common vision problems like nearsightedness, farsightedness, and astigmatism. This reshaping allows light to focus properly onto the retina, reducing or eliminating the need for glasses or contact lenses. The Department of Veterans Affairs (VA) policy regarding coverage for this procedure is not straightforward, leading many veterans to question whether their benefits will pay for the surgery.
VA Policy on Refractive Surgery Coverage
The VA generally classifies LASIK and other similar refractive surgeries as elective procedures that are not covered under standard health benefits. This policy stems from the fact that the vision issues corrected by LASIK can typically be managed effectively with conventional methods like eyeglasses or contact lenses.
Coverage for any form of laser vision correction is strictly limited to rare instances where the procedure is determined to be medically necessary by a VA healthcare provider. This determination means the surgery must be required to treat an underlying medical condition or a service-connected disability. Without this specific designation, the veteran is responsible for the entire cost of the surgery.
Establishing Medical Necessity for LASIK
A veteran may qualify for VA-covered LASIK if the refractive error is directly linked to a service-connected condition or if standard corrective lenses are unusable. For example, coverage is sometimes granted for veterans who suffer from severe intolerance to wearing glasses or contact lenses, particularly if that intolerance is related to a service-connected disability. The physical inability to wear corrective devices, perhaps due to facial trauma or severe dry eye syndrome, can constitute medical necessity.
A significant exception to the general policy involves specific corneal pathologies, such as Keratoconus, a progressive eye disease where the cornea thins and bulges into a cone shape. The VA may cover laser refractive surgery for veterans diagnosed with service-connected Keratoconus. Furthermore, vision changes resulting from a service-related traumatic brain injury (TBI) or other ocular trauma can also be grounds for a medical necessity determination. The VA will consider a procedure necessary when traditional correction is ineffective or harmful, such as in cases of severe corneal irregularities that cannot be corrected with conventional rigid contact lenses.
Navigating the Authorization Process
The first step in seeking authorization for covered LASIK is to schedule an appointment with a VA primary care provider or optometrist to discuss the vision issue. That provider must then make a referral to a VA ophthalmologist, who is a specialist responsible for performing a comprehensive eye examination and determining clinical eligibility. This evaluation is necessary to establish that the condition meets the strict medical necessity criteria.
Once the specialist confirms the need for the surgery, the next phase involves submitting a formal request for pre-approval, which must be accompanied by detailed medical documentation. This paperwork must clearly outline why the veteran cannot be treated with less invasive means and how the surgery will address the service-connected or medically necessary condition. If the request for coverage is denied, the veteran has the right to appeal the decision through the standard VA appeals process, which allows for a further review of the medical evidence.
Where the Procedure is Performed
Even when the VA authorizes LASIK coverage based on a medical necessity determination, the surgery is rarely performed inside a VA medical center (VAMC). Most VAMCs do not have the specialized equipment or staff dedicated to performing elective or conditionally covered refractive procedures.
Instead, the VA typically facilitates the procedure through its Community Care program, which allows veterans to receive care from authorized, non-VA providers in their local area. Under this mechanism, the VA issues a specific referral and authorization for the veteran to see a private ophthalmologist who specializes in laser vision correction. The Community Care program covers the cost of the surgery at the authorized private facility, ensuring the veteran receives the necessary specialized care outside of the VA system.