RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXX	CASE:  PD-2014-04343
BRANCH OF SERVICE:  Marine Corps 	SEPARATION DATE:  20040831

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was a Reserve E5, Motor Transportation, medically separated for “traumatic optic neuropathy, right eye,” with a disability rating of 10%.

CI CONTENTION:  The CI contends loss of vision in right eye, PSTD and TBI.  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 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 - 20040623	VARD - 20040929  	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Traumatic Optic Neuropathy, Right Eye	6079	10%	Functional Vision Loss, Right Eye with Myopia	6078	20%	20040621	
Superior Right Orbital Rim Fracture	Cat II					
RATING:  10%	RATING:  80%	

ANALYSIS SUMMARY:  

Traumatic Optic Neuropathy, Right Eye.  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s traumatic optic neuropathy, right eye condition began in April 2003 after he detonated an explosion, while wearing eye protection, and sustained shrapnel injuries to the right brow followed immediately by a decrease in vision while deployed.  Fluorescein angiography (to examine retina blood vessels) of the right eye was reported as normal in June 2003.  Computed tomography in June 2003 revealed a comminuted fracture with a 1 cm displacement involving the superior orbital rim on the right with possible extension to involve the right frontal sinus, metallic shrapnel adjacent to the right frontal bone above the orbit, and no evidence of acute hemorrhage within the brain.  On 31 July 2003 visual acuity was 2/200 on the right and 20/20 on the left.  Nerve fiber analysis was bilaterally symmetrical and pupil diameters were 4.4 mm on the left and 3.8/5.1 mm on the right on 13 August 2003.  An ophthalmologist opined in August 2003 that the CI’s visual acuity impairment was likely secondary to commotio [retinae] (shock waves from blunt trauma) and macular puckering.    

The NARSUM examination dated 23 December 2003, 8 months prior to separation, noted a recent eye examination in December 2003 revealed visual acuity in the right eye was 20/80 with a refraction of -0.50 -0.75 x 018 and was 20/20 in the left eye.  The CI had no afferent pupillary defect and the slit-lamp examination was within normal limits.  On color testing he had 0/15 correct responses in the right eye and 13/15 correct responses in the left eye.  With dilation, the retina and optic nerve appeared normal.  At the MEB examination (recorded on DD Form 2807 Report of Medical History and DD Form 2808 Report of Medical Examination) in February 2004, 6 months prior to separation, the CI reported loss of vision as a result of an explosion to the face with shrapnel to the lower eye.  There was a 1 cm scar of the right eyebrow; eye examination was deferred to ophthalmology.  Ophthalmologic evaluation in February 2004 revealed visual acuity finger counting on the right (20/400) and 20/15 on the left.  Optometry examination in April 2004 noted counting fingers at 2 feet on the right with no improvement with lenses and 20/15 on the left.  On the Amsler grid (to monitor the central visual field) the CI reported blurry vision and he was unable to see vertical and horizontal lines.

At the VA Compensation and Pension (C&P) examination on 21 June 2004, performed 2 months before separation, the CI reported loss of vision and optic nerve damage in April 2003.  No surgery was performed specifically on the eye, although facial lacerations were sutured.   On examination visual acuity without correction was to count fingers at one foot in the right eye and 20/20 in the left eye.  Retinoscopy gave a correction of -1.50 +50 x 90 degrees for the right eye; however, there was no improvement in visual acuity using that lens.  Near vision in the left eye without correction was 20/20 and was not recordable in the right eye.  External examination showed scarring from a healed laceration in the right central brow and light touch sensation was decreased over a branch of the fifth cranial nerve on the right.  Versions (eye movements) were full and the pupils reacted from 6.5 to 5.5 mm OU (eyes bilaterally) with no afferent pupillary defect; pupillary actions were normal.  Slit lamp examination showed normal lids, lashes, conjunctivae, sclerae, corneae, irises, anterior chambers and lenses.  Intraocular pressures were 18 mm Hg on the right and 19 mm Hg on the left.  A Goldman visual field test was normal response to the left eye with 50-80 degrees of peripheral vision.  On the right eye despite his low visual acuity the peripheral vision response was variable and overall measured some 30-60 degrees.  A dilated examination showed a cup-to-disc ratio of 0.2 OU with normal optic nerves including good/normal optic nerve color without any pallor in both eyes.  The anatomical components of the retina (maculae, vessels and retinal peripheries) were all normal.  Ocular coherence tomography demonstrated normal and symmetrical retinal nerve fibers in both eyes.  The examiner’s diagnoses were functional vision loss, myopia OD (nearsighted of the left eye), and scarring of the right brow with decreased light touch sensation in the right forehead.  The examiner opined he did not see any objective evidence of any direct or indirect injury to the eye, which argued against any significant injury, although the CI had some myopia of the right eye.  Therefore, he felt the subjective data was not supported by objective evidence, and diagnosed the condition as functional visual loss.  A remote X-ray series of the facial bones in November 2009 demonstrated no abnormality in the facial bones, but for a small radiodense foreign body was above the right superior orbital margin in the frontal region.  

The Board directed its attention to its rating recommendation based on the above evidence.  The PEB assigned a 10% rating under the 6079 code (visual acuity impairment according to the VASRD schedule), citing traumatic optic neuropathy, right eye and determined a superior right orbital rim fracture was a related Navy Category II diagnosis.  The VA assigned a 20% rating using the 6078 code (visual acuity impairment according to the VASRD schedule) based on the VA C&P examination 2 months before separation, citing functional vision loss, right eye with myopia and according to the VA Rating Decision (VARD) concentric contraction of 44 degrees on the right and 60 degrees on the left.  The VA also assigned 10% rating using code 7804 for tender facial scars (not in the scope of review), status post shrapnel injury and a 10% rating using code 8205 for status post shrapnel injury, right forehead with residual hyposensitivity in the V1 trigeminal nerve distribution (not in the scope of review) .  

Board members discussed whether the CI’s rating should consist of the combination of his impaired visual acuity and his visual field contraction rating IAW VASRD §4.77 which states “(c) Combination of visual field defect and decreased visual acuity. To determine the evaluation for visual impairment when both decreased visual acuity and visual field defect are present in one or both eyes and are service connected, separately evaluate the visual acuity and visual field defect (expressed as a level of visual acuity), and combine them under the provisions of §4.25.”  However, neither the NARSUM examination nor the VA examination presented both corrected visual acuity and visual field deficit for the right eye.  Nevertheless since both examinations were prior to separation, Board members determined that use of the visual acuity referenced in the NARSUM and the visual field contraction measured at the VA examination could be considered combinable, although the VA examiner noted that the CI’s visual acuity, which was finger counting at one foot was not correctable with a lens.  Board members were cognizant that the maximum rating for a disability of one eye is 30%.   If the NARSUM visual acuity of the right eye of 20/80 were used with the left eye at 20/20, a 10% rating is warranted.  Using the VA examination where right peripheral vision of 30-60 degrees was noted likewise warrants a 10% rating using code 6080 (visual field defects).  However, more importantly, an ophthalmologist, an optometrist, and the VA examiner all noted that the right eye visual acuity was only finger counting, which in February 2004 VASRD was determined to be 20/400 (10/200) and 20/15 in the left eye.  Therefore, the CI’s visual acuity is more appropriately coded 6077 IAW Table V-Ratings for Central Visual Acuity Impairment and warrants a 30% rating.  Board members took note of the VA examiner’s opinion that the traumatic optic neuropathy represented a functional loss, which Board members determined to have resulted in a very significant visual acuity limitation meriting a 30% rating. 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 traumatic optic neuropathy condition, coded 6077.  Board members determined that the Navy Category II superior right orbital rim fracture condition, which ultimately healed, contributed to the Navy Category I traumatic optic neuropathy condition and was not separately unfitting or compensable. 

BOARD FINDINGS:  In the matter of the traumatic optic neuropathy condition, the Board unanimously recommends a disability rating of 30%, coded 6077 IAW VASRD §4.79.  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; and, that the discharge with severance pay be re-characterized to reflect permanent disability retirement, effective as of the date of the prior medical separation:  

CONDITION	VASRD CODE	PERMANENT RATING	
Traumatic Optic Neuropathy, Right Eye	6077	30%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 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 29 Aug 16 ICO XXXXXXXXXXXXXXXXXXXX  
	(c) PDBR ltr dtd 29 Aug 16 ICO XXXXXXXXXXXXXXXXXXXX
	(d) PDBR ltr dtd 29 Aug 16 ICO XXXXXXXXXXXXXXXXXXXX
	(e) PDBR ltr dtd 29 Jul 16 ICO XXXXXXXXXXXXXXXXXXXX
	(f) PDBR ltr dtd 12 Sep 16 ICO XXXXXXXXXXXXXXXXXXXX
	(g) PDBR ltr dtd 28 Aug 16 ICO XXXXXXXXXXXXXXXXXXXX
	(h) PDBR ltr dtd 29 Aug 16 ICO XXXXXXXXXXXXXXXXXXXX
	(i) PDBR ltr dtd 29 Aug 16 ICO XXXXXXXXXXXXXXXXXXXX
	(j) PDBR ltr dtd 12 Sep 16 ICO XXXXXXXXXXXXXXXXXXXX
	(k) PDBR ltr dtd 12 Sep 16 ICO XXXXXXXXXXXXXXXXXXXX

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

2.  The official records of the following individuals are to be corrected to reflect the stated disposition:
     
     a. former USMC: Retroactive placement on the Permanent Disability Retired List with a 30 percent disability rating (increased from 20 percent) effective date of discharge.  

     b. former USN: Retroactive placement on the Permanent Disability Retired List with a 30 percent disability rating (increased from 20 percent) effective date of discharge.  

     c. former USMC: Retroactive placement on the Permanent Disability Retired List with a 50 percent disability rating (increased from 10 percent) effective date of discharge.  

     c. former USMC: 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 disability rating of 30 percent. 

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

     e. former USMC: 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 disability rating of 30 percent.
Subj:  PHYSICAL DISABILITY BOARD OF REVIEW (PDBR) RECOMMENDATIONS          

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

     g. former USN: Retroactive placement on the Permanent Disability Retired List with a 50 percent disability rating (increased from 10 percent) effective date of discharge.

     h. former USMC: Retroactive placement on the Permanent Disability Retired List with a 30 percent disability rating (increased from 10 percent) effective date of discharge.

     i. former USMC: Retroactive placement on the Permanent Disability Retired List with a 30 percent disability rating (increased from 20 percent) effective 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.