RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXX	CASE:  PD-2013-01341
BRANCH OF SERVICE:  Army 	BOARD DATE:  20141119
SEPARATION DATE:  20041104

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty SGT/E-5 (88M/Motor Transport Operator) medically separated for optic neuropathy condition.  The condition could not be adequately rehabilitated to meet the physical requirements of his Military Occupational Specialty (MOS) or satisfy physical fitness standards.  He was issued a permanent E3 profile and referred for a Medical Evaluation Board (MEB).  The optic neuropathy condition, characterized as “optic neuropathy, left eye” was forwarded to the Physical Evaluation Board (PEB) IAW AR 40-501.  No other conditions were submitted by the MEB.  The Informal PEB adjudicated “optic neuropathy” as unfitting rated at 10% citing criteria of the Veterans Affairs Schedule for Rating Disabilities (VASRD).  The CI made no appeals and was medically separated.

CI CONTENTION:  “I Received the Injuries In Combat.” 

SCOPE OF REVIEW:  The Board’s scope of review is defined in DoDI 6040.44, Enclosure 3, paragraph 5.e.(2).  It is limited to those conditions determined by the PEB to be unfitting for continued military service and those conditions identified but not determined to be unfitting by the PEB when specifically requested by the CI.  The rating for the unfitting optic neuropathy condition is addressed below and no additional conditions are within the DoDI 6040.44 defined purview of the Board.  Any conditions or contention not requested in this application, or otherwise outside the Board’s defined scope of review, remain eligible for future consideration by the Board for Correction of Military Records.

RATING COMPARISON:  

Service IPEB – Dated 20040825 | VA - (2 Mos. Pre-Separation)
Condition | Code | Rating | Condition | Code | Rating | Exam
Optic Neuropathy | 6026-6079 | 10% | Post-Operative Residuals, Corneal Transplant, Left Eye, With Conduction Disturbance | 6026-6070 | 30% | 20040915
Other x 0  (Not in Scope) | Other x 3
Combined:  10% | Combined:  40%
*Derived from VA Rating Decision (VARD) dated 20041130 (most proximate to date of separation)

ANALYSIS SUMMARY: 

Optic Neuropathy Condition.  Due to a perforated corneal ulcer, the CI underwent a corneal transplant of the left eye in January 1998; that post-operatively the CI’s best corrected visual acuity was 20/20 for the right eye and a 20/30 for the left eye.  

During deployment to Iraq, the CI presented to the optometrist on 25 July 2003, with a complaint of a having the sensation of a foreign body in his left eye for a duration of 2 hours.  During examination the CI’s left eye visual acuity was limited to only hand motion, however the stated that his visual impairment was unchanged from his initial cornea surgery in 1998.  The optometrist noted that this degree of reported visual impairment did not meet criteria for his MOS and was [bemused] that the CI was apparently never considered for an MEB.  The CI was medically evacuated for further evaluation and MEB processing.

During an ophthalmology examination obtained on 21 October 2003, the CI stated the he had a 4 months history of “vision loss” in the left eye, having “light perception only” and indicated that he could see “images” post cornea surgery “up until July 03”.  The examiner noted that despite the subjective complaint of significant vision loss, his stereoscopic vision was intact.  
At the ophthalmology examination performed on 30 October 2003, the CI was unable to count fingers at ten inches in front of his left eye and at following ophthalmology examination dated 3 November 2003; the examiner opined that current objective eye findings, non-physiologic vision loss could be a factor.  An ophthalmology consultation dated 10 December 2003, noted the CI’s subjective complaint of inability to see from the left eye and also that “exams indicate vision of 20/70 or 20/80 to left (L) eye, but only when CI is unaware that he’s being tested for (L) vision”.  For the MEB examination (DD Form 2808) dated 16 December 2003, corrected visual acuity of the left eye was noted to be 20/200; the right eye was 20/20.  However, on the Report of Medical Assessment the CI stated that he had “no lateral vision in left eye”.

An initial MEB ophthalmology addendum summary dated 9 February 2004 (9 months prior to separation), re-iterated the reported vision loss while deployed was unexplained.  The examiner noted that corrected visual acuity measured in the left eye in October 2003 was 20/70 and that visual field testing at that time revealed loss of vision in the entire left visual field.  The addendum examiner’s conclusion was that non-physiologic visual loss was suggested by the testing.  On 3 March 2004, the CI could count fingers at ten inches in front of his left eye.  The following day he could count fingers at six inches.  A medical memorandum to the MEB dated 8 April 2004, states that “likely dust/sand irritation to left eye” occurred while deployed and that the cause of vision loss was unexplainable.  It also notes an October 2003 entry showing corrected left eye visual acuity of 20/70.  Electrophysiologic testing (visual evoked potentials) on 12 July 2004 showed evidence of optic neuropathy in the left eye.

At the VA Compensation and Pension (C&P) evaluation on 27 September 2004 (a month prior to separation), the CI reported that his left eye “became very infected” while in Iraq and since that time he only had light perception.  Examination showed corrected right eye visual acuity of 20/20 and left eye visual acuity of light perception only.  On 28 October 2004, the VA eye clinic attempted visual field testing, but the results were deemed “not reliable”.  During a follow-up VA ophthalmology evaluation dated 25 April 2005, the examiner also noted left visual acuity of light perception only and visual field testing “looks normal but 20% false positives”.  The examiner concluded that the etiology of vision loss was “uncertain”.

The Board directs attention to its rating recommendation based on the above evidence.  The PEB assigned a 10% rating for visual acuity loss under a combination 6026-6079 code (optic neuritis; impaired visual acuity).  Based on best corrected vision of 20/15 in the right eye and 20/70 in the left eye, the PEB use of the 6079 code was appropriate, as was the 10% rating.  The VA assigned a 30% rating under a 6026-6070 code.  Based on best corrected vision of 20/20 in the right eye and light perception only in the left noted by the VA examiner, the VA’s determination was also correct.

There are disparities between examinations in the service treatment records which had implications for the Board's rating recommendation.  The Board deliberated the probative value of these conflicting evaluations and carefully reviewed the entire file for corroborating evidence from the period preceding separation.  In this regard, inconsistent reports were considered.  For example, the CI indicated at his first evaluation in Iraq that his visual impairment since cornea surgery in 1998 was “hand motion only,” but the STR clearly showed that best corrected visual acuity after the cornea surgery was well beyond this.  It was also noted that this reportedly long-standing near-absence of vision preceding deployment was later characterized as worsened during deployment.  Regarding visual testing, while the visual evoked potentials showed evidence of left optic neuropathy, the degree of visual impairment appeared to be quite variable.  Visual field testing prior to separation reportedly showed loss of vision in the entire left visual field, while the CI claimed he only had difficulty in the lateral left visual field.  Testing by the VA noted initial unreliable field results, but this was followed by an apparently normal visual fields.  Meanwhile, visual acuity of the left eye was reported at various encounters as light perception only, hand motion only, unable to count fingers at 10 inches, able to count fingers at 10 inches, 20/70 and 20/200.  The Board ultimately agreed with the PEB that the visual acuity for rating purposes was best characterized as 20/70 in the left eye and better than 20/40 in the right.  Therefore, the PEB’s 10% rating was warranted.  The Board also considered if rating under the 6080 code (field vision, impairment of) was appropriate, given reports of some visual field difficulties.  However, actual perimetry data necessary to ascertain a rating was not in evidence and as previously elaborated the VA concluded that visual fields were normal.  Therefore, this rating option was not supported.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board concluded that there was insufficient cause to recommend a change in the PEB adjudication for the left optic neuropathy condition.

BOARD FINDINGS:  IAW DoDI 6040.44, provisions of DoD or Military Department regulations or guidelines relied upon by the PEB will not be considered by the Board to the extent they were inconsistent with the VASRD in effect at the time of the adjudication.  The Board did not surmise from the record or PEB ruling in this case that any prerogatives outside the VASRD were exercised.  In the matter of the left eye optic neuropathy condition and IAW VASRD §4.84a, the Board unanimously recommends no change in the PEB adjudication.  There were no other conditions within the Board’s scope of review for consideration.

RECOMMENDATION:  The Board, therefore, recommends that there be no recharacterization of the CI’s disability and separation determination.  

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20130929, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs’ Treatment Record

		
XXXXXXXXXXXXXXXXX
President
Physical Disability Board of Review

SAMR-RB									

MEMORANDUM FOR Commander, US Army Physical Disability Agency 
(AHRC-DO), 2900 Crystal Drive, Suite 300, Arlington, VA  22202-3557

SUBJECT:  Department of Defense Physical Disability Board of Review Recommendation for XXXXXXXXXXXXXXXXX, AR20150002971 (PD201301341)

I have reviewed the enclosed Department of Defense Physical Disability Board of Review (DoD PDBR) recommendation and record of proceedings pertaining to the subject individual.  Under the authority of Title 10, United States Code, section 1554a,   I accept the Board’s recommendation and hereby deny the individual’s application.  
This decision is final.  The individual concerned, counsel (if any), and any Members of Congress who have shown interest in this application have been notified of this decision by mail.

 BY ORDER OF THE SECRETARY OF THE ARMY:

Encl						     XXXXXXXXXXXXXXXXX
						     Deputy Assistant Secretary of the Army
						          (Review Boards)
						         
CF: 
(  ) DoD PDBR
(  ) DVA

PD-2013-01341