RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXX	CASE:  PD-2015-01611
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20030204

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E4, Intelligence Analyst, medically separated for “monocular diplopia in the left eye,” with a disability rating of 0%.

CI CONTENTION:  The CI made no specific contention.  The complete submission is at Exhibit A.  

SCOPE OF REVIEW:  The panel’s scope of review is defined in DoDI 6040.44.  It is limited to review of disability ratings assigned 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 or non-compensable.  Any conditions outside the panel’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 panel’s authority is limited to assessing the fairness and accuracy of PEB rating determinations and recommending corrections, where appropriate.  The panel’s assessment of the PEB rating determination 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(s) at the time of separation.  The panel 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 panel 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 - 20021104	VARD - 20040105	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Monocular Diplopia in the Left Eye	6099-6008	0%	Blindness In Left Eye	6070	30%	20031001	
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  60%	

ANALYSIS SUMMARY.

Monocular Diplopia in the Left Eye.  According to the service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s left eye condition began in August 2001 following surgery to repair a detached retina.  Post-surgery, the CI developed severe headaches, double images, progressive blurring of vision in the left eye, and a drooping left upper eyelid.  Prior to repair of the retinal surgery, baseline visual acuity was 20/20 in the right eye and 20/30 in the left eye.  There were no findings to explain her double vision in one eye post-surgery despite several tests.  

The 19 March 2002 MEB NARSUM examination, 11 months prior to separation, noted complaints of persisting symptoms as noted above.  Trial frames with different lens combinations and contact lens did not correct the double vision.  Examination of the eyes showed visual acuity of 20/20 in the right eye and 20/100 in the left eye with unequal size of the eyes’ pupils.  The pupil size of the right eye was 3.5 mm in a light room to 5.5 mm in a dark room; the left eye was 4.5 mm which dilated to 6 mm in a dim room.  The lens was clear in both eyes and the nerves were healthy.  There were no structural defects of the cornea or retina.  Neuroimaging was normal.  However, there was depression of the visual field superiorly in the left eye corresponding to the area of the retinal detachment.  The examiner noted no physical finding to support the diagnosis of monocular diplopia, but the CI had persistent eye discomfort and functional disturbances.  

At the 1 October 2003 VA Compensation and Pension (C&P) evaluation, performed 8 months after separation, the CI reported very poor vision in the left eye.  No eye medications were used.  Examination showed uncorrected visual acuity in the right eye of 20/20 and in the left eye she was able to count fingers at one foot.  Intraocular pressure was 16 on the right and 11 on the left.  Visual fields of the left eye showed altitudinal (upper) field loss in the left eye.  Diagnoses of left eye, severe decrease in visual acuity and lattice degeneration in the periphery of the right and left eyes were rendered.  A memorandum from the Chief Consultant to the Surgeon General for Ophthalmology noted the CI had monocular double vision in the left eye based on retinal detachment and subsequent retinal surgery.  Origin of the detachment was unknown but it was incorrect to ascribe her condition to an existing prior to service (EPTS) condition.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the “monocular diplopia in the left eye” condition 0% coded 6099-6008 (analogous to detachment of retina).  The VA rated the “blindness in the left eye, 20/20 in the right eye” condition 30% coded 6070 (blindness in one eye, having only light perception and in the other eye 20/40,) based on the C&P examination 8 months after separation.  The VARD noted that loss of use of one eye with only light perception is granted when the perception of objects, hand movements or counting fingers cannot be accomplished at 3 feet.  

The VASRD coding prior to 2008 noted that consideration of visual acuity was part of the visual impairment rating system.  Several examinations documented declining visual acuity in the left eye post-surgery.  CI was initially able to count fingers at four feet but acuity declined so that she could not count fingers beyond 2 feet by June 2002.  The C&P examination, more proximal to separation than the MEB examination, noted she was not able to count fingers beyond one foot and had upper field loss of the superior half of the visual field unilateral.  This is consistent with the VASRD disability rating of no more than light perception in one eye and in the other eye 20/40, coded 6070.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel recommends a disability rating of 30% for the monocular double vision condition, coded 6070.  

BOARD FINDINGS:  In the matter of the “monocular diplopia in the left eye” condition, the panel unanimously recommends a disability rating of 30%, coded 6070 IAW VASRD §4.75.  There are no other conditions within the panel’s scope of review for consideration.  

The panel recommends that the CI’s prior determination be modified as follows, effective as of the date of the prior medical separation:  

CONDITION	VASRD CODE	PERMANENT RATING	
Monocular Diplopia In The Left Eye	6099-6008	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

AR20170008824, XXXXXXXXXXXXXXXXXXX

XXXXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXXXXXX:

	I accept the recommendation of the Department of Defense Physical Disability Board of Review (DoD PDBR) to re-characterize your separation as a disability retirement with the combined disability rating of 30% effective the date of your medical separation for disability with severance pay.  Enclosed is a copy of the Board’s recommendation and record of proceedings for your information.

	The re-characterization of your separation as a disability retirement will result in an adjustment to your pay providing retirement pay from the date of your original medical separation minus the amount of severance pay you were previously paid at separation.
 
	The accepted DoD PDBR recommendation has been forwarded to the Army Physical Disability Agency for required correction of records and then to the U.S. Defense Finance and Accounting Service to make the necessary adjustment to your pay and allowances.  These agencies will provide you with official notification by mail as soon as the directed corrections have been made and will provide information on your retirement benefits.  Due to the large number of cases in process, please be advised that it may be several months before you receive notification that the corrections are completed and pay adjusted.  Inquiry concerning your correction of records should be addressed to the U.S. Army Physical Disability Agency, (AHRCO-DO), XXXXXXXXXXXXXXXXXXX.

	A copy of this decision has also been provided to the Department of Veterans Affairs.

Sincerely,					      
Enclosure