RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2015-01509
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20050406

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 “iatrogenic nighttime glare and halo following refractive surgery, both eyes,” with a disability rating of 0%.  “Diplopia, intermittent,” was determined to have existed prior to service (EPTS) and was not rated.

CI CONTENTION:  The CI requests review of all conditions, the 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 on 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 - 200500201	VARD - 20050502	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Iatrogenic Nighttime Glare and Halo Following Refractive Surgery, Both Eyes	6099- 6001	0%	Iatrogenic Night Glare and Halo Following Refractive Surgery, Both Eyes	6099- 6001	10%	20041213	
Diplopia, Intermittent	6092	---%	Intermittent Diplopia	6090	NSC	20041213	
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  10%	

ANALYSIS SUMMARY:  

Iatrogenic Nighttime Glare and Halo, and Diplopia.  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI was cleared for accession on the entrance examination dated 12 August 2003.  The CI was seen in optometry on 3 March 2004, 2 weeks after accession, noting double vision with the glasses issued at “reception”.  He also reported that he had prisms to correct his vision.  On 4 March 2004, the entrance standards Board recommended that he be separated for pre-existing diplopia (double vision) which did not meet accession standards.  His commander recommended retention in training as the CI was doing well; this recommendation was supported.  Following basic training, the CI had eye surgery (laser-assisted in situ keratomileusis [LASIK]) to correct his vision on 16 June 2004.  This was in a civilian setting and not sanctioned (approved) by the US Army.  He unfortunately suffered adverse consequences from the surgery which could not be corrected with the technology present at that time.  He reported significant degradation in his vision with glare.  He noted both halos and decreased acuity.  This was confirmed in ophthalmology and the CI was referred to MEB.  The MEB NARSUM was dated 29 October 2004, 5 months prior to separation.  His visual acuity was 20/20 right and 20/25 left with correction.  This decreased to 20/80 bilaterally with reduced contrast (as noted by the civilian ophthalmologist).  A spherical aberration (scarring) of each cornea was present on examination.  He was also noted to have an accommodative esotropia (cross-eyed when looking a close objects) which existed prior to service.  At the VA Compensation and Pension (C&P) evaluation performed on 14 December 2004, 4 months before separation, the CI reported glare and diminished night vision.  He corrected to 20/25 on the right and 20/30 on the left.  His vision decreased to 20/40 and 20/70 with glare.  No comment was made on contrast.  Scarring of the corneas was present on examination.  The MEB forwarded “iatrogenic nighttime glare and halo S/P refractive surgery, both eyes”, and “accommodative esotropia w/ intermittent diplopia” for PEB adjudication.  

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the iatrogenic nighttime glare and halo condition 0%, analogously coded 6001 (keratopathy), citing vision as 20/20 OD, and 20/25 OS.  The PEB did not rate the diplopia, coded 6092 (diplopia, limited muscle function), citing compelling evidence to support a finding that the current condition existed prior to service (EPTS) and was not permanently aggravated beyond natural progression by such service.  The Board noted that the VA also determined that this was an EPTS condition and did not service connect it.  The VA rated the iatrogenic nighttime glare and halo condition 10%, analogously coded 6001, based on the VA C&P examination 4 months before separation, citing evidence of active pathology in both corneas resulting in periods of decreased visual acuity in certain environments and conditions.  The Board first considered the PEB's determination that the esotropia was an EPTS condition.  In the 3rd week of basic training, the CI reported diplopia with the glasses issued at accession.  Once a prism was added (for the esotropia), the double vision cleared.  He reported that his glasses always had a prism correction.  The medical officer observed that this is usually a developmental condition and that this is a typical history for this condition.  There is no evidence in the record that this was acquired in the service or aggravated by it.  The EPTS finding is supported.  The Board then considered the degraded visual acuity.  Both the PEB and VA used the code 6001, keratopathy (pathology of the cornea).  There were no incapacitating episodes recorded to support a rating on that basis.  Visual impairment with glared as noted on the VA examination supports a 10% rating for 20/40 and 20/70 vision (right and left eyes, respectively).  Both the PEB and VA examinations support a 0% rating in a non-glare, normal contrast setting though.  The Board noted that while the CI was restricted from firing weapons at night and from driving military vehicles at night, it did not find restrictions documented which showed restrictions from driving civilian (personal) vehicles at night.  This is more consistent with a 0% rating in a typical civilian occupational setting.  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 eye condition.  

BOARD FINDINGS:  In the matter of the Iatrogenic nighttime glare and halo following refractive surgery, both eyes condition and IAW VASRD §4.75, the Board unanimously recommends no change in the PEB adjudication.  In the matter of the Intermittent Diplopia condition, the Board unanimously recommends no change in the PEB adjudication.  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 20150621, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

AR20170006623, XXXXXXXXXXXXXXXXXX 

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Dear XXXXXXXXXXXXXXXXXX:

	The Department of Defense Physical Disability Board of Review (DoD PDBR) reviewed your application and found your separation disability rating and your separation from the Army for disability with severance pay to be accurate.  I have reviewed the Board’s recommendation and record of proceedings (copy enclosed), and I accept its recommendation.  I regret to inform you that your application to the DoD PDBR is denied.  

	This decision is final.  Recourse within the Department of Defense or the Department of the Army is exhausted; however, you have the option to seek relief by filing suit in a court of appropriate jurisdiction.

Sincerely,					       
						      					
Enclosure