RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXX		CASE:  PD-2014-02974
BRANCH OF SERVICE:  Army  	SEPARATION DATE:  20090716

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty O-2, All Source Intelligence, medically separated for bilateral photophobia and glare sensitivity, rated at 20%. 

CI CONTENTION:  “I continue to have extremely dry eyes.  My vision still changes each year.  I still have chronic dislocations of the left shoulder.” 

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 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:  

Recon PEB – Dated 20090415	VA* - (~4 Mos. Pre-Separation)  	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Bilateral Photophobia and Glare Sensitivity.	6099-6036	20%	Corneal Scarring, Status Post Multiple Corneal Procedures of the Right Eye with Blepharitis with Ocular Dryness	6099-6063	10%	20090330	
			Corneal Scarring, Status Post Multiple Corneal Procedures of the Left Eye with Blepharitis with Ocular Dryness	6099-6063	10%	20090330	
Recurrent left shoulder pain… 
	Not Unfitting	Status Post Bankart Surgery of the Left Shoulder	5201	10%	20090305	
Other x 2 (Not In Scope)	Other x 5 	
RATING:  20%	RATING:  50%	
*Derived from VA Rating Decision (VARD) dated 20090723 (most proximate to date of separation (DOS)).  

ANALYSIS SUMMARY:  

Bilateral Photophobia (extreme sensitivity to light) and Glare Sensitivity Conditions.  The service treatment record (STR) confirms the history and clinical course as documented in the narrative summary (NARSUM) dated 20 August 2008.  The earliest note dated 18 May 1981 indicated the CI had bilateral hyperopia (far sighted) and high astigmatism (inability of the optics of the eye to focus sharply).  In July 2005 he had a refraction of +4.50 -5.00 x 015 OD (right eye) and +5.25 -3.75 x 176 OS (left eye) that without correction was 20/80 in both eyes and with correction was 20/20 in the right and 20/25 in the left.  However, he wanted better vision “without glasses.”  While attending college in preparation to be an Army officer, the CI had multiple surgical procedures to correct his visual acuity beginning 22 September 2006 when he underwent an astigmatic keratotomy (AK) (incision(s) in an outer portion of the cornea) bilaterally.  In December 2006, he underwent an additional AK in each eye.  By 9 April 2007, his refraction was +3.50 -3.50 x 014 OD and +4.00 -2.50 x 176 OS with a corrected vision of 20/20 in both eyes and uncorrected vision of 20/30 in both eyes.  On 19 April 2007, the patient underwent hyperopic photo reactive keratotomy (PRK) procedure in the right eye, and on 10 May 2007 underwent hyperopic PRK in the left eye.  By 30 May 2007 his refraction of -0.75 DS (diopters sphere) OD and +0.75 DS OS with a corrected vision of 20/20 in both eyes and an uncorrected vision of 20/20 in the right and 20/25 in the left.  On March 2008, the CI complained of blurry vision after working with a personal computer and it took a while to focus.  There was peripheral haze in both corneas and his refraction was +3.00 -3.25 x 010 OD and +2.25 -1.25 x 003 OS with a corrected vision of 20/20 in the right and 20/25-2 (missed two letters on the 25 line) in left.  As a result of regression and scarring from prior surgical procedures, the CI underwent bilateral de-epithelialization (to remove scar tissue) of the corneas of both eyes on 4 June 2008.  He healed uneventfully and visual acuity without correction was 20/30 OD and 20/40 OS.  He did have halos at night, but denied night blindness. Although vision was satisfactory, he had severe photophobia, sensitivity to the wind, dust, and any of the elements.  His eyes teared severely and he stated his vision was blurred and his eyes were painful in spite of use of Restasis (cyclosporine, for dry eyes), Aqua Tears (for dry eyes), and Refresh Celluvisc (lubricant eye drops) as needed.  As a result of the persistent irritation and blurriness in both eyes, the CI felt that he could not perform his duties.

The CI summarized the surgical procedures he had related to his eye conditions on an undated DD Form 2807-1 for the MEB examination, while the MEB examiner noted the CI was photosensitive to light and summarized the CI’s surgical procedures on DD Form 2808 on 8 September 2008.  The commander’s statement dated 19 September 2008 indicated the CI could not perform his assigned MOS duties in the unit and in the field and could not work outdoors in dry, dusty or windy conditions including working in the desert.  He also noted the CI had trouble looking at maps, working on the computer, and focusing with his eyes.  A permanent E3 profile was issued on 3 February 2009 for chronic eye irritation (bilateral) S/P multiple eye surgeries with photophobia with the aforementioned limitations as well as with wearing a protective mask and chemical defense equipment, but the CI could wear sunglasses.

At the VA Compensation and Pension (C&P) examination dated 30 March 2009, performed approximately 4 months before separation, the CI reported that after corneal de-epithelialization, he noted improvement of his vision, but with worsening of photophobia and irritation; and he also indicated the vision in his left eye was worse than the vision in the right eye.  He began Restasis in May 2009 and had been using artificial tears since September 2006 and he reported his visual symptoms as glare, blurring, photophobia and becoming easily fatigued.  Examination revealed uncorrected vision 20/40 bilaterally and corrected distance vision 20/25 (+0.50 -2.25 x 015) OD and 20/30 (+3.00 -1-00 x 148) OS.  Slit lamp examination revealed bilateral blepharitis (inflammation of the eyelids) and superficial punctate keratitis (inflammation) with perilimbal (around the border of the cornea) scarring from 12:00-4:00 o’clock and nasal isolated scars at 6:00 o’clock and 9:00 o’clock on the right and from 2:00-10:00 o’clock on the left.

The Board directed its attention to its rating recommendation based on the above evidence.  The PEB assigned a 20% rating (10% rating for each eye) using code 6099-6036 (Status post corneal transplant) for bilateral photophobia and glare sensitivity.  The VA assigned 10% for the right eye and 10% for the left eye using code 6099-6036 for each eye for corneal scarring, status post multiple corneal procedures with blepharitis with ocular dryness.  The Board sought a route for a higher rating and noted that a 10% rating is the minimum rating if there is pain, photophobia, and glare sensitivity and a higher rating is based on visual impairment.  However, the CI’s corrected visual acuity noted above, which would have met retention standards according to the PEB, is better than 20/40 in each eye; and with the use of code 6066 would warrant a 0% rating for each eye, if each were unfitting, thereby not affording any advantage to the CI.  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 photophobia and glare sensitivity conditions present at the time of separation.  

Contended PEB Condition-Recurrent Left Shoulder Pain.  The Board’s main charge is to assess the fairness of the PEB’s determination that recurrent left shoulder pain was 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.  The left shoulder pain condition was not profiled proximate to separation, although he did have a temporary profile in 2004, or implicated in the commander’s statement and was not judged to fail retention standards.  The CI sustained a dislocation of his left shoulder when he worked as a vehicle mechanic in December 2001.  Because of recurrent dislocations and subluxations, he had an MRI in February 2004 that revealed an anterior labral (fibrous tissue of the shoulder joint) tear (likely chronic) and a Hill-Sachs deformity (a bony defect of head of the humerus) associated with anterior shoulder instability (likely old). As a result he underwent arthroscopy and a Bankart procedure of his left shoulder in March 2004 followed by physical therapy.  In spite of stiffness and pain when working overhead, which was treated with ibuprofen, he continued physical training and passed his physical fitness test in October 2008.  The NARSUM examiner noted a surgical scar and mild tenderness over the anterior aspect of the left shoulder.  At the VA C&P examination in March 2009 the CI noted that when pain occurred, he limited his activities and he also reported abduction and external rotation were limited.  

The aforementioned was reviewed and considered by the Board.   There was no performance based evidence from the record that the left shoulder condition significantly interfered with satisfactory duty performance.  After due deliberation 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 the left shoulder condition and so no additional disability rating is recommended.

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 bilateral photophobia and glare sensitivity conditions and IAW VASRD §4.79 the Board unanimously recommends no change in the PEB adjudication.  In the matter of the contended recurrent left shoulder pain condition, the Board unanimously recommends no change from the PEB determination 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 20140618, 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 XXXXXXXXXXXXXXXXXXXX, AR20160005469  (PD201402974)

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