RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2015-00175
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20060914

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E3, Infantryman, medically separated for “chronic eye injury from blast and shrapnel wound to right eye” and “chronic right ankle pain,” rated 10% and 10%, respectively, with a combined disability rating of 20%.

CI CONTENTION:  The CI contends he was given a higher rating for his conditions by the VA.  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 - 20060630	VARD - 20070711	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Eye Injury	6009	10%	Intraorbital Metal Fragment, Partial Optic Atrophy and Anisocoric, Right Eye	6099-6009	10%	20070426	
			Shrapnel Wound Scar, Right Eye	7805	0%		
Chronic Right Ankle Pain	5099-5003	10%	Chronic Right Ankle Strain	5271	10%	STR	
Mood & Anxiety Symptoms	Not Unfitting 	Posttraumatic Stress Disorder (PTSD)	9411	50%	20070420	
COMBINED RATING:  20%	COMBINED RATING OF ALL VA CONDITIONS:  60%	

ANALYSIS SUMMARY: 

Chronic Eye Injury:  According to the service treatment record (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI sustained a traumatic explosive injury on 13 March 2005 which required emergency ocular (eye) surgery.  Despite eye saving (pressure reduction) surgery, a metallic (shrapnel) foreign body remained behind the right eyeball and adjacent to the optic nerve.  The ophthalmologist noted that, “The risks of removing [the metallic shrapnel] significantly outweigh the benefits.”  The CI’s post-surgical rehabilitation left the CI with a permanent refractive error as well as photosensitivity in the right eye.  His stringent profiled restrictions did not allow for unrestricted duty.  The MEB forwarded “right retro-orbital metallic foreign body,” “optic neuropathy right eye,” and “chronic right ankle pain,” for PEB adjudication.  At an ocular MEB NARSUM examination on 19 September 2005, 12 months prior to separation, the CI had normal corrective vision in both eyes as well as light-activated pupil constriction (right more sluggish than the left).  All directional eye muscle movements were intact.  Radiographic imaging revealed the retained metallic shrapnel without other abnormalities.  A follow-up ocular examination on 31 January 2006, 8 months prior to separation, the CI reported his vision as “good with glasses” and “no pain.”  His examination remained unchanged and new prescription (replacement) glasses were issued.  

At the 26 April 2007 VA Compensation and Pension (C&P) evaluation, performed 7 months after separation, the CI reported occasional right eye pain and persistent pain upon far left-sided gaze.  His physical revealed corrected bilateral vision of 20/20.  Pupillary activity was present in both eyes with the right acting more sluggishly than the left…similar to NARSUM findings.  His visual fields, ocular muscles, ocular pressure, lens, and retina were normal. 

The Board directed attention to its rating recommendation based on the above evidence.  Both the PEB and VA rated the right eye condition under the same primary VASRD code of 6009 (unhealed eye injury) at 10%, citing pain and photophobia by the PEB and continuance of active pathology by the VA.  Board members first considered the coding options in this case and agreed that having the retained metallic shrapnel behind the right eye and its associated space-occupying potential danger for sudden vision loss, the 6009 code was most appropriate.  The 6009 code is to be rated on either criteria of visual impairment or incapacitating episodes associated with the eye condition.  Although this case represented significant trauma, the CI’s rehabilitation went well and did not support either VASRD criterion near the time of separation.  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 right eye condition.  

Chronic Right Ankle Pain.  According to the STR and the NARSUM, the CI underwent ligament re-positioning surgery (Brostrom procedure) on his right ankle in August 2005.  Post-operative rehabilitation did not result in improvement sufficient to allow unrestricted duty.  The MEB forwarded “chronic right ankle pain” for PEB adjudication.  At the orthopedic MEB NARSUM examination on 24 February 2006, 7 months prior to separation, the CI reported continued right ankle pain that was aggravated with increased activities.  His physical examination revealed “minimal swelling” and decreased range of motion (ROM) of the right ankle.  Physical therapy measured ROM was conducted on 24 April 2006 (5 months prior to separation) and revealed non-painful decrease in dorsiflexion of 10 degrees (normal 20).  

The Board directed attention to its rating recommendation based on the above evidence.  Utilizing different VASRD codes, both the PEB and VA rated the right ankle condition at 10%.  The PEB analogously rated under 5003 (degenerative arthritis) whereas the VA rated under 5271 (ankle; limited motion).  All Board members agreed that absent the presence of ankylosis, marked limited motion, or bony malunion/deformity, there was no rating scheme that would support a higher rating than the PEB’s current 10%.  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 right ankle condition.
   
Contended PEB Condition:  Mood and Anxiety Symptoms.  The Board’s main charge is to assess the fairness of the PEB’s determination that the contended condition was not unfitting.  The STR revealed that the CI was psychiatrically hospitalized for 21 days (25 August - 15 September 2005), 13 months prior to separation, with a diagnosis of major depressive disorder.  A follow-up psychiatric evaluation performed on 12 December 2005 (9 months prior to separation and 3 months post-hospitalization), the CI’s diagnosis remained unchanged and the provider documented the following: 

“The [CI] has had a history of mood and anxiety symptoms as manifested by depressed mood and anxiety symptoms currently markedly improved and stable on medications.  There have been no significant limitations to duty related to mental health problems.”

Additionally, the mental health contended condition was not profiled or implicated in the commander’s statement or judged to fail retention standards.  All Board members agreed that the above facts combined with the documented comments from the psychiatric provider clearly revealed the there was no performance-based evidence that a mental health condition significantly interfered with satisfactory duty performance at or near separation.  After due deliberation, the Board concluded that there was insufficient cause to recommend a change in the PEB fitness determination for the contended condition and so no additional disability rating is recommended.

BOARD FINDINGS:  In the matter of the right eye condition and IAW VASRD §4.79, the Board unanimously recommends no change in the PEB adjudication.   In the matter of the right ankle condition and IAW VASRD §4.71a, the Board unanimously recommends no change in the PEB adjudication.  In the matter of the contended mood and anxiety 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 modification or re-characterization of the CI’s disability and separation determination. 

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20150210, w/attachments
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 
XXXXXXXXXXXXXXXXXX, AR20160018507 (PD201500175)

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