RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME: XXXXXXXXXXXXXXXXXXXX	CASE:  PD-2014-01600
BRANCH OF SERVICE:  NAVY	Date of sepAration:  20090731

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E5, Automatic Gunfire Control Systems Technician, medically separated for “keratoconus” rated at 0%.  

CONTENTION: The CI asks the Board to consider all conditions.  The applicant’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 based upon a 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 - 20090421	VARD - 20100115	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Keratoconus	6035	0%	Keratoconus	6035	0%	20091030	
Obstructive Sleep Apnea, Currently on Continuous Positive Airway Pressure	Category III	Sleep Apnea	6847	50%	20091022	
Atypical Chest Pain, Etiology Unclear	Category III	Chest/Heart Condition	7005	NSC	20091022	
Left Ventricular Hypertrophy	Category III					
Cardiac Valvular Disease	Category III					
Asthma, Moderate, Persistent	Category III	Asthma	6602	0%	20091022	
Gastroesophageal Reflux Disease	Category III	Gastroesophageal Reflux Disease	7399-7346	0%	20091022	
Migraine Cephalgia	Category III	Migraines	8100	30%	20091022	
Migraine Headaches	Category III					
Hypertension	Category III	Hypertension	7101	0%	20091022	
Anxiety Disorder Not Otherwise Specified	Category III	Anxiety Disorder	9413	0%	20091110	
Past History of Syncope	Category III	No VA Placement	
Hyperlipidemia	Category IV	No VA Placement	
Pseudofolliculitis Barbae, Currently Under Treatment	Category IV	Pseudofolliculitis Barbae of the Face and Neck	7806	0%	20091022	
Nicotine Dependence	Category IV	No VA Placement	
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  70%	

ANALYSIS SUMMARY:  

Right Eye Keratoconus.  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s eye condition was first evaluated in November 2005 after having noted a blur in his right eye of several years duration.  At the MEB examination (recorded on DD Form 2808) dated 17 June 2008, 14 months pre-separation, the visual examination showed visual distance acuity of the right eye to be corrected to 20/25 with near vision corrected to 20/40.  The left eye was 20/20 for both distance and near visual acuity.  The optometry addendum was dated 30 March 2009.  The CI reported poor depth perception and inability to drive at night due to poor night vision.  He also reported that the rigid gas-permeable (RGP) contact lens for vision correction occasionally slipped, rendering him temporarily incapacitated, and that the RGP lens was impossible to wear for longer than 3-4 hours as it was rigid and irritated the cornea.  The examiner affirmed the visual acuity of 20/25 when using the RGP lens.  At the VA Compensation and Pension (C&P) examination on 30 October 2009, 3 months after separation, the CI reported that he was no longer wearing the RGP lens, as it was uncomfortable.  Physical examination showed a visual acuity of 20/30 +2 on the right, with spectacle correction.  

The Board directed attention to the rating recommendation based on the above evidence.  The PEB assigned a 0% rating under the 6035 code (Keratoconus), citing the recently modified (December 2008) VA rating scheme that keratoconus be evaluated solely by best corrected visual acuity.  The VA also assigned a 0% rating using the same 6035 code based on the VA C&P examination citing a corrected visual acuity of 20/30 on the right with normal left eye visual acuity, normal fields of vision, and no disability of any eye muscles.  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 keratoconus condition.  

Contended PEB Conditions.  Asthma and atypical chest pain.

Asthma.  The CI was profiled three different times for “shortness of breath” while the pulmonary consultant stated that his condition caused him to be “desk-bound with a completely sedentary job.”  The commander’s statement did not differentiate functional limitations attributable to the asthma condition, stating that he had “consistently performed to the expectation of his rank,” with “multiple conditions that affect his health.”  The last pulmonary function tests in evidence were performed in April 2008 and were considered to be normal.  The asthma condition was forwarded by MEB, and specifically found to be not unfitting by the PEB in June 2008, November 2008 (“fit to continue on active duty”), and again during a Formal PEB in April 2009.  

Atypical Chest Pain.  The CI was profiled two different times for “atypical chest pain.”  The CI was extensively evaluated by the cardiologist, who stated that his condition “was not of cardiac origin.”  The commander’s statement did not differentiate functional limitations attributable to the chest pain condition, stating that he had “consistently performed to the expectation of his rank,” with “multiple conditions that affect his health.”  The atypical chest pain condition was implicated by the NARSUM examiner, forwarded by the MEB, and specifically found to be not unfitting by the PEB in June 2008, November 2008 (“fit to continue on active duty”), and again during a Formal PEB in April 2009.  

With the exception of the atypical chest pain and the asthma conditions as detailed above, the remaining Category III conditions were not profiled or implicated in the commander’s statement and were not judged to fail retention standards.  All were reviewed and considered by the Board.  There was no performance-based evidence from the record that any of the Category III conditions significantly interfered with satisfactory duty performance.  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 fitness determination for any of the other Category III conditions and so no additional disability ratings are recommended.  

BOARD FINDINGS:  In the matter of the keratoconus condition and IAW VASRD §4.71a, the Board unanimously recommends no change in the PEB adjudication.  In the matter of the contended Category III 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, 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 20140409, with attachments
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

MEMORANDUM FOR DIRECTOR, SECRETARY OF THE NAVY COUNCIL OF REVIEW
               BOARDS 

Subj:  PHYSICAL DISABILITY BOARD OF REVIEW (PDBR) RECOMMENDATIONS
 
Ref:   (a) DoDI 6040.44
       (b) CORB ltr dtd 6 Jul 16

      In accordance with reference (a), I have reviewed the cases forwarded by reference (b), and, for the reasons provided in their forwarding memorandums, approve the recommendations of the PDBR that the following individual’s records not be corrected to reflect a change in either characterization of separation or in the disability rating previously assigned by the Department of the Navy’s Physical Evaluation Board:

		- XXXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXXX, former USMC

						  	XXXXXXXXXXXXXXXXXXXX
	     				  		Assistant General Counsel
						  	(Manpower & Reserve Affairs)