RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX			CASE:  PD-2014-00857
BRANCH OF SERVICE:  Army	 SEPARATION DATE:  20081227

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E-4, Canon Crewmember, medically separated by the Informal Physical Evaluation Board for “bilateral uveitis” with a disability rating of 0%.

CI CONTENTION:  The CI made no specific contention in his application.  His complete submission is at Exhibit A.

SCOPE OF REVIEW:  The Board’s scope of review is defined in DoDI 6040.44.  It is limited to those conditions determined by the PEB to be unfitting for continued military service and when specifically requested by the CI, those conditions identified by the PEB, but determined to be not unfitting.  Any conditions outside the Board’s defined scope of review and any contention not requested in this application may remain eligible for future consideration by the Board for Correction of Military Records.  Furthermore, the Board’s authority is limited to assessing the fairness and accuracy of PEB rating determinations and recommending corrections, where appropriate.  The Board’s assessment of the PEB rating determinations is confined to review of medical records and all available evidence for application of the Veterans Affairs Schedule for Rating Disabilities (VASRD) standards to the unfitting medical condition at the time of separation.  The Board has neither the role nor the authority to compensate for post-separation progression or complications of service-connected conditions.  That role and authority is granted by Congress to the Department of Veterans Affairs, operating under a different set of laws.  The Board gives consideration to VA evidence, particularly within 12 months of separation, but only to the extent that it reasonably reflects the severity of the disability at the time of separation.

RATING COMPARISON:  

SERVICE PEB - 20080827	VARD - 20090902	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Bilateral Uveitis	6000	0%	Idiopathic Recurrent Uveitis in Both Eyes	6000-6027	0%	STR	
COMBINED RATING:  0%	COMBINED RATING FOR ALL VA CONDITIONS:  0%	

ANALYSIS SUMMARY:  

Bilateral Uveitis.  The service treatment record (STR) and narrative summary (NARSUM) documented an initial flare of uveitis in June 2007 (18 months pre-separation) and a second flare in May 2008 (7 months pre-separation), that required return from the field and medevac from Iraq.  During flares, there was reduced visual acuity at 20/40 bilaterally with correction, moderate anterior chamber inflammation (uveitis), bilateral synechiae (scarring due to inflammation), and clumps of brown pigment in the left anterior lens capsule.  Both flares of uveitis resolved with medical therapy.  There was no STR documentation of physician prescribed bed rest during either flare episode.  On the MEB DD Form 2697, Report of Medical Assessment, and the MEB DD Form 2807-1, Report of Medical History, both dated 30 May 2008 (7 months pre-separation), the CI reported having preglaucoma, iritis, uveitis treated by multiple medications and cataracts after steroid injections.  On the MEB DD Form 2808, Report of Medical Examination, dated 4 June 2008 (6 months pre-separation), the examiner documented the diagnosis of uveitis, cataract and preglaucoma.  Distant visual acuity was 20/200 bilaterally, that corrected to 20/20 bilaterally.  Near vision was 20/40 bilaterally, corrected to 20/30 bilaterally.

The ophthalmology MEB NARSUM exam was performed on 18 July 2008 (5 months pre-separation).  The examiner documented no signs of uveitis (no inflammation in the anterior chamber and vitreous, and absence of iris synechiae) and described the disease as “quiescent.”  Visual acuity was 20/30 on the right and 20/20 on the left.  At an ophthalmology visit in October 2008 (2 months pre-separation), the examiner performed extended visual fields testing and documented “scattered faint peripheral spot loss bilaterally, but no visual filed loss consistent with glaucoma.”  At an ophthalmology visit in November 2008 (2 month pre-separation), the examiner documented high intraocular pressures (IOPs) and diagnosed “preglaucoma ocular hypertension” bilaterally and a cataract.  At an ophthalmology visit in December 2008 (2 weeks before separation), the IOPs were improved and the diagnosis remained “pre-glaucoma” and cataract.  No other associated systemic diseases were found.  
Cataracts were removed from both eyes in February and April 2009 (2 and 4 months post-separation).  At an ophthalmology visit in July 2009 (7 months post-separation), the examiner documented 20/30 and 20/20 vision with normal intraocular pressures and normal visual fields.  There was no conjunctivitis and no evidence of uveitis (clear bilateral corneas without opacities, “quiet” anterior chamber, and normal macula, optic nerve, and vessels).

At the VA Compensation and Pension (C&P) exam dated 18 November 2009 (11 months post-separation), the CI reported wearing glasses only at night to drive.  The examiner documented corrected distance vision on the right as 20/30.  His uncorrected distance vision on the left was 20/20.  His near vision was within normal limits.  There was no evidence of uveitis (clear cornea, normal retina, and normal blood vessels) with “rare cells” in the anterior chamber bilaterally, that were attributed to the topical medications used for a “post dilation” exam.

The Board directed attention to the rating recommendation based on the above evidence.  The PEB adjudicated the “bilateral uveitis with two flares (2007 and 2008)” as unfitting and rated 0% coded 6000 (uveitis).  The VA rated 0% for the “idiopathic recurrent uveitis…with bilateral cataracts…and glaucoma” analogously coded 6000-6027 (uveitis; post-operative cataract).  

The Board considered the evidence for a higher rating.  The VASRD states to evaluate uveitis on the basis of either visual impairment …or incapacitating episodes.  Corrected visual acuities were documented as 20/30 on the right and 20/20 on the left, therefore a rating for visual impairment cannot be given, as the minimum required for a 10% rating is 20/50 in the worse eye and 20/40 in the better eye.  A 10% rating can be granted for “incapacitating episodes having a total duration of at least 1 week, but less than 2 weeks, during the past 12 months.”  The VASRD further describes an incapacitating episode as a “period of acute symptoms severe enough to require prescribed bed rest and treatment by a physician….”  There was one documented flare in May 2008 that resolved with physician prescribed therapies.  However, the episode did not required physician prescribed bed rest, as necessitated by the VASRD for a 10% rating.  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 bilateral uveitis condition.

BOARD FINDINGS:  In the matter of the bilateral uveitis 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.

The Board, therefore, recommends that there be no re-characterization of the CI’s disability and separation determination.

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20140219, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

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 XXXXXXXXXXXXXXXXXX, AR20160005440 (PD201400857)

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:

Enclosure

CF: 
(  ) DoD PDBR
(  ) DVA