RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2014-01369
BRANCH OF SERVICE:  Marine Corps 	SEPARATION DATE:  20090130

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E5, Infantry Rifleman, medically separated for “herpes simplex epithelial keratitis,” with a disability rating of 10%. 

CI CONTENTION:  The CI’s condition continues to worsen and negatively impacts daily living.  The CI’s 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 Physical Evaluation Board (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 - 2008102	VARD - 20081210	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Herpes Simplex Epithelial Keratitis	6001	10%	Cornea Dystrophy, Chronic Open-Angle Glaucoma, Legal Blindness, Right Eye 	6013-6077	20%	20080805	
Recurrent Iritis	Category II					
Secondary Glaucoma						
Herpes Simplex Stromal Keratitis						
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS: 50%	

ANALYSIS SUMMARY:  

Herpes Simplex Epithelial Keratitis.  According to service treatment record (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI was diagnosed with chronic herpetic keratouveitis (severe inflammatory eye condition) in 2005 which developed after blunt trauma to his right eye.  He was placed on four separate LIMDU status boards as to ensure close follow-up and trials of multiple treatment regimes.  Pursuant to steroid eye drops used to treat the original condition, the CI developed secondary glaucoma as well.  In April 2008, he underwent a glaucoma-stabilizing surgical procedure on his right eye.  Several months after surgery, his condition was noted to be “…relatively stable.”  Overall, his chronic ocular condition had the propensity and history of abruptly going from near normal vision to severely limiting and painful vision in a single day.  Eventually, he was referred to the MEB which met on 24 July 2008.  At the MEB examination dated July 2008, 6 months prior to separation, the CI reported unpredictable flare-ups of his right eye condition.  His clinical examination revealed fluctuating visual acuity between 20/30 and 20/70.  The examiner noted, “[The CI’s] intraocular pressure remains significantly low.”  At the VA Compensation and Pension (C&P) examination dated August 2008, 6 months prior to separation and 2 weeks after the MEB NARSUM, the CI stated, “I am legally blind and lost most of my peripheral vision at the right eye.”  

The VA ocular examination was extensive and performed under a slit lamp with corneal dilation.  There was evidence of ocular haze with disc pallor noting indistinct disc margins.  Intraocular pressure of both eyes were normal.  The eye disease/injury was described as: “chronic open-angle glaucoma at the right eye and central cornea scarring, opacities, and dystrophy at the right eye secondary to an ulcer.”  His visual acuity examination revealed uncorrected and corrected far vision on the right as 20/200 and both near vision tests were ‘count fingers’.  All tested parameters on the left eye were 20/20.  There were no definitive periods of VASRD-defined incapacitating episodes.    

The Board directed attention to its rating recommendation based on the above evidence.  The PEB assigned a 10% rating utilizing VASRD code 6001 (keratopathy) without citing specific reasoning.  The VA assigned a 20% rating using a dual code of 6013-6077 (open angle glaucoma-visual acuity) based on the VA C&P examination 6 months before separation, citing objective testing of visual acuity.  Board members first considered the medical diagnoses in association with the VASRD codes to determine proper associations.  Keratitis (CI’s original condition) is defined as an inflammation of the cornea of the eye and can be caused by infectious or noninfectious agents or actions.  The PEB’s 6001 VASRD code is for keratopathy, which is a broad based term use to indicate any non-inflammatory disease of the eye.  In this case, the primary herpetic viral ocular infection was appropriately treated with anti-virals as well as ocular steroids and that the 6001 code appropriately captured the combined entities of the eye trauma and the resulting invading herpetic virus.

According to VASRD §4.79 Guidelines for code 6001, rating parameters are to be assessed on the basis of visual impairment (visual acuity) or on incapacitating episodes.  Absent the evidence of specific incapacitating episodes, Board members focused their attention to the CI’s visual impairment.  All VASRD visual acuity impairment criteria is based upon the affected eye as compared with the unaffected eye with the minimum positive compensation being at the level of 20/40 in the unaffected eye.  In this case, the visual acuity of the unaffected eye was 20/20 and not in support of a positive impairment rating.  Therefore, 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’s adjudication for the keratitis condition of the right eye.     
 
Contended PEB Conditions.  The Board’s main charge is to assess the fairness of the PEB’s determination that recurrent iritis (inflammation of the iris [colored portion of the eye]), secondary glaucoma, and the herpes simplex stromal keratitis were not unfitting.  The Board’s threshold for countering fitness determinations requires a preponderance of evidence, but remains adherent to the DoDI 6040.44 “fair and equitable” standard.  All three conditions as a group were noted on the CI’s LIMDU and “his eyes” were implicated in the commander’s non-medical assessment.  All were reviewed and considered by the Board.  

All Board members agreed that the inflamed iris (listed as recurrent iritis) and the herpes stromal keratitis were appropriately classified as Category II conditions that either contributed to or were identifying features (stromal keratitis) of the primary ocular condition.  There were no performance-based evidence from the record that either of these conditions/findings significantly interfered with satisfactory duty performance near separation.  After due deliberation, and in consideration of the preponderance of the evidence, the Board concluded that there was insufficient cause to recommend a change in the PEB’s fitness determination and categorization for either of these contended conditions and so no additional disability ratings are recommended.  

As for the glaucoma condition, all Board members agreed that it was ‘secondary’ and a ‘residual’ consequence from the steroid treatment of the primary condition as noted in the NARSUM.  Board members then carefully considered if the secondary glaucoma condition was separately unfitting and therefore, ratable.  All Board members agreed that the frequent specialty monitoring and calculated treatment regime of a glaucoma condition would attribute to the CI’s functional impairment and therefore favors its recommendation as an additional unfitting condition for disability rating.  The single code and rating for open-angle glaucoma is 6013 at 10% if medication is required.  After due deliberation, and in consideration of the preponderance of the evidence, the Board concluded that the CI’s continued use of ocular medication in conjunction with the residual glaucoma diagnosis clearly supported the additional 10% rating.  

BOARD FINDINGS:  In the matter of the herpes simplex epithelial keratitis condition and IAW VASRD §4.79, the Board unanimously recommends no change in the PEB adjudication.  In the matter of the contended secondary glaucoma condition, the Board unanimously agrees that it was unfitting and unanimously recommends a disability rating of 10%, coded 6013 IAW VASRD §4.79.  In the matter of the contended recurrent iritis and herpes simplex stromal keratitis conditions, the Board unanimously recommends no change from the PEB determinations as not unfitting.  There were no other conditions within the Board’s scope of review for consideration.  The Board recommends that the CI’s prior determination be modified as follows, effective as of the date of the prior medical separation:  

CONDITION	VASRD CODE	PERMANENT RATING	
Herpes Simplex Epithelial Keratitis	6001	10%	
Secondary Glaucoma	6013	10%	
COMBINED	20%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20140321, 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 15 Apr 16 ICO XXXXXXXXXXXXXXXXXX
	(c) PDBR ltr dtd 23 May 16 ICO XXXXXXXXXXXXXXXXXX  
	(d) PDBR ltr dtd 27 May 16 ICO XXXXXXXXXXXXXXXXXX 
	(e) PDBR ltr dtd 23 May 16 ICO XXXXXXXXXXXXXXXXXX
	(f) PDBR ltr dtd 23 May 16 ICO XXXXXXXXXXXXXXXXXX
	(g) PDBR ltr dtd 09 May 16 ICO XXXXXXXXXXXXXXXXXX 
	(g) PDBR ltr dtd 27 May 16 ICO XXXXXXXXXXXXXXXXXX
	(i) PDBR ltr dtd 22 Jan 16 ICO XXXXXXXXXXXXXXXXXX
	(h) PDBR ltr dtd 29 Apr 16 ICO XXXXXXXXXXXXXXXXXX 
	(i) PDBR ltr dtd 14 Apr 16 ICO XXXXXXXXXXXXXXXXXX

1.  Pursuant to reference (a), the recommendations of the Physical Disability Board of Review set forth in references (b) through (i) are approved.

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

     a. XXXXXXXXXXXXXXXXXX, former USMC: Retroactive placement on the Temporary Disability Retired List for six months with a 50 percent disability rating effective date of discharge followed by transfer to the Permanent Disability Retired List with a final rating of 30 percent (increased from 10 percent).

     b. XXXXXXXXXXXXXXXXXX, former USMC: Entitlement to disability separation pay with a 20 percent disability rating (increased from 10 percent) effective date of discharge.

     c. XXXXXXXXXXXXXXXXXX, former USMC: Entitlement to disability separation pay with a 20 percent disability rating (increased from 10 percent) effective date of discharge.

     d. XXXXXXXXXXXXXXXXXX, former USMC: Retroactive placement on the Temporary Disability Retired List for six months with a 50 percent disability rating effective date of discharge followed by transfer to the Permanent Disability Retired List with a final rating of 30 percent (increased from 10 percent).

     e. XXXXXXXXXXXXXXXXXX, former USN: Retroactive placement on the Permanent Disability Retired List with a 40 percent disability rating (increased from 10 percent) effect date of discharge. 

     f. XXXXXXXXXXXXXXXXXX, former USMC: Retroactive placement on the Permanent Disability Retired List with a 30 percent disability rating (increased from 20 percent) effect date of discharge.

     g. XXXXXXXXXXXXXXXXXX, former USN: Entitlement to disability separation pay with a 20 percent disability rating (increased from 10 percent) effective date of discharge.

     h. XXXXXXXXXXXXXXXXXX, former USN: Retroactive placement on the Permanent Disability Retired List with a 30 percent disability rating (increased from 10 percent) effect date of discharge. 
     
     i. XXXXXXXXXXXXXXXXXX, former USMC: Retroactive placement on the Permanent Disability Retired List with a 70 percent disability rating (increased from 10 percent) effect date of discharge.
 
     j. XXXXXXXXXXXXXXXXXX, former USN: Retroactive placement on the Permanent Disability Retired List with a 30 percent disability rating (increased from 20 percent) effect date of discharge.       

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.

						XXXXXXXXXXXXXXXXXX
						Assistant General Counsel
						(Manpower & Reserve Affairs)