§4 - Veterans Affairs
Diagnosis #1: ICD code: Date of diagnosis: Diagnosis #2: ICD code: Date of diagnosis: Diagnosis #3: ICD code: Date of diagnosis: 1B. ... rod and/or cone dystrophy) ( Right ( Left ( Both ( Other (Describe): ( Right ( Left ( Both b. Is the Veteran’s decrease in visual acuity or other visual impairment attributable to a retina, macula, or ... ................
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