RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXX	CASE:  PD-2014-01076
BRANCH OF SERVICE:  MARINE CORPS	BOARD DATE:  20150512
Separation Date:  20050531

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E-3 (Basic Rifleman) medically separated for a left eye condition.  The left eye condition could not be adequately rehabilitated to meet the physical requirements of his Military Occupational Specialty (MOS) or satisfy physical fitness standards.  He was placed on limited duty [LIMDU] and referred for a Medical Evaluation Board (MEB).  “Unspecified histoplasmosis without mention of manifestation,” was forwarded to the Physical Evaluation Board (PEB) IAW SECNAVINST 1850.4E.  No other conditions were submitted by the MEB.  The Informal PEB adjudicated “histoplasmosis scar, left macula” as unfitting, rated 20%, with likely application of the Veterans Affairs Schedule for Rating Disabilities (VASRD).  The CI made no appeals and was medically separated.

CI CONTENTION:  “Rating too low at time of discharge as stated by correspondence recently received by applicant from VA.”

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 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/Naval 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 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 IPEB – Dated 20050325	VA - (1 Mos. Pre-Separation)	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Histoplasmosis Scar, Left Macula	6011-6077	20%	Ocular Histoplasmosis with Macular Involvement, Left Eye	6074	30%	20050426	
Other x 0	Other x 4	
Rating:  20%	Combined:  30%	
Derived from VA Rating Decision (VARD) dated 20051122 (most proximate to date of separation)

ANALYSIS SUMMARY:  
Histoplasmosis Scar, Left Macula.  The CI noticed decreased vision in his left eye in October 2003.  He was seen by primary care for warped vision in the left eye with a headache that persisted for 14 days.  The CI denied any history of recent eye trauma.  A cursory eye exam was done and did not show any obvious trauma and a funduscopic exam was not done.  The examiner referred the CI to Optometry.  The Optometrist noted decreased vision in the left eye with macular edema and 20/400 vision as tested on the Snellen chart.  The examiner referred the CI to Ophthalmology who performed Intravenous Fluorescein Angiography (IVFA) testing to evaluate the eye internal blood circulation.  The examiner diagnosed histoplasmosis scar, left macula.  The left eye vision testing on 2 December 2003 was 20/200 (normal 20/20-means a person can read the same line of letters at 20 feet on a Snellen chart that a “normal” person can read at 20 feet).  The CI underwent a macular thickness scan and photodynamic therapy.  In 2004 the CI underwent a second macular thickness scan.  The Ophthalmologist documented left eye vision at 20/400 with decreased vision and a scotoma (blind spot).  The CI underwent two laser photodynamic therapy procedures, the first one in December 2003 and the second one in March 2004 with poor results.  
The MEB narrative summary (NARSUM) exam prepared approximately 5 months prior to separation documented that the CI had very poor vision in the left eye.  He noticed that when he tried to look around corners to the affected side (left side) that his visual acuity was not sufficient.  He had problems with depth perception, grabbing things, catching and moving in the field.  Since the onset of his eye disability, he was unable to concentrate on the computer or television without developing a headache.  The pertinent physical exam findings were uncorrected right eye visual acuity of 20/20 and left eye visual acuity of “count fingers” at 2 feet.  The pupils were normal as was the ocular pressures.  The macula was normal in the right eye; however, the left eye had an inactive but significant central dense macular scar with punched out lesions (indicative of retinal and choroidal atrophy).  The examiner opined that the histoplasmosis scar of the left macula with decreased visual acuity and depth perception interfered with the CI’s MOS as an infantryman.  The non-medical assessment indicated that the CI had a permanent left eye blind spot and he was non-deployable.  
The VA Compensation and Pension (C&P) exam 36 days prior to separation documented that the CI reported warped vision in his left eye with much of the central vision gone in his left eye due to the ocular histoplasmosis.  There were physical exam findings of 20/20 visual acuity in the right eye and count fingers at eight feet in the left eye with corrected reading vision to 20/800 in the left eye.  The pupillary exam was normal.  The funduscopic exam showed a central macular scar.  The examiner diagnosed ocular histoplasmosis with macular involvement, left eye resulting in severe central vision loss, left eye.

The Board directed attention to its rating recommendation based on the above evidence.  The PEB coded the histoplasmosis scar, left macula condition as 6011 (localized scars of the Retina…) with 6077 (central vision 10/200 with vision in the other eye 20/40) and rated at 20%.  The VA coded the ocular histoplasmosis with macular involvement, left eye condition as 6074 (central vision 20/800 with vision in the other eye 20/40) and rated at 30%.  The left eye central visual acuity at the MEB exam was count fingers at two feet while the best corrected visual acuity at the C&P exam was 20/800 in the left eye.  The PEB’s application of 6077 corresponds to a central visual acuity of 20/400.  The evidence present for review documents a central visual acuity much worse than 20/400.  The Board considered the coding and rating schema of 6074, as applied by the VA, as the most accurate rating recommendation supported by the evidence.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board recommends a disability rating of 30% for the histoplasmosis scar, left macula condition coded 6074.
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 histoplasmosis scar, left macula condition, the Board unanimously recommends a disability rating of 30%, coded 6011-6074 IAW VASRD §4.84a.  There were no other conditions within the Board’s scope of review for consideration.

RECOMMENDATION:  The Board recommends that the CI’s prior determination be modified as follows; and, that the discharge with severance pay be recharacterized to reflect permanent disability retirement, effective as of the date of his prior medical separation:

UNFITTING CONDITION	VASRD CODE	RATING	
Histoplasmosis Scar, Left Macula	6011-6074	30%	
RATING	30%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20140227, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans’ Affairs Treatment Record

MEMORANDUM FOR COMMANDER, NAVY PERSONNEL COMMAND
		   DEPUTY COMMANDANT, MANPOWER & RESERVE AFFAIRS
	                          
Subj:  PHYSICAL DISABILITY BOARD OF REVIEW (PDBR) RECOMMENDATIONS

Ref:   (a) DoDI 6040.44
       (b) PDBR ltr dtd 31 Jul 15 ICO XXXXXXXXXXXXXXX
       (c) PDBR ltr dtd 31 Jul 15 ICO XXXXXXXXXXXXXXX
	 (d) PDBR ltr dtd 24 Jul 15 ICO XXXXXXXXXXXXXXX
	 (e) PDBR ltr dtd 31 Jul 15 ICO XXXXXXXXXXXXXXX
	 (f) PDBR ltr dtd 11 Aug 15 ICO XXXXXXXXXXXXXXX
	 (g) PDBR ltr dtd 27 Jul 15 ICO XXXXXXXXXXXXXXX
	 (h) PDBR ltr dtd 14 Aug 15 ICO XXXXXXXXXXXXXXX

1.  Pursuant to reference (a) I approve the recommendations of the Physical Disability Board of Review set forth in references (b) through (h).

2.  The official records of the following individuals are to be corrected to reflect the stated disposition:

     a. XXXXXXXXXXXXXXX, former USN: Placement on the Permanent Disability Retired List with a 30 percent disability rating (increased from 10 percent) effective date of discharge. 

     b. XXXXXXXXXXXXXXX, former USN: Placement on the Permanent Disability Retired List with a 40 percent disability rating (increased from 20 percent) effective date of discharge.

     c. XXXXXXXXXXXXXXX, former USN: Placement on the Permanent Disability Retired List with a 40 percent disability rating (increased from 20 percent) effective date of discharge.

     d. XXXXXXXXXXXXXXX, former USMC: Placement on the Permanent Disability Retired List with a 30 percent disability rating (increased from 10 percent) effective date of discharge.

     e. XXXXXXXXXXXXXXX, former USMC: Placement on the Permanent Disability Retired List with a 30 percent disability rating (increased from 20 percent) effective date of discharge.

     f. XXXXXXXXXXXXXXX, former USN: Placement on the Permanent Disability Retired List with a 30 percent disability rating (increased from 10 percent) effective date of discharge.

     g. XXXXXXXXXXXXXXX, former USN: Placement on the Temporary Disability Retired List (TDRL) for six months at time of discharge with a 60 percent disability rating; following the TDRL period, placement on the Permanent Disability Retired List with a 40 percent disability rating. 

3.  Please ensure all necessary actions are taken to implement these decisions, including the recoupment of disability severance pay, if warranted, and notification to the subject members once those actions are complete.