RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXX	CASE:  PD-2016-00222
BRANCH OF SERVICE:  Air Force 	SEPARATION DATE:  20070724

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E6, Imagery Analysis Craftsman, medically separated for “loss of contrast sensitivity following photorefractive keratectomy”, with a disability rating of 10%.

CI CONTENTION:  The CI suffered from the following additional conditions that were not considered by the PEB; chronic neck pain, upper back pain, left knee problems, left ankle broken, right foot broken, aggravated broken right leg, aggravated broken left leg, depression, and lower back pain.  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 - 20070612	VARD - 20080611	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Loss of Contrast Sensitivity Following Photorefractive Keratectomy 	6099-6009	10%	Post PRK Vision Impairment with Diminished Contrast
Sensitivity	6099-6009	10%	20071012	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  60%	

ANALYSIS SUMMARY:  

Loss of Contrast Sensitivity Following Photorefractive Keratectomy.  According to the service treatment record (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI underwent a photorefractive keratectomy (PRK, a common laser procedure to correct vision) in January 2006 (18 months before separation).  There were no complications and visual acuity was corrected to 20/20 (both eyes); but, a few months after the procedure he began to complain of subjective impairment of contrast sensitivity that interfered with his ability to perform within his specialty as an imagery analyst.  A battery of technically sophisticated ophthalmology tests did not identify any unusual sequelae of the PRK procedure; and, failed to detect any objective pathology in explanation of the subjective complaint.  The symptom did not adequately respond to treatment (ocular steroids, preview lens), and ophthalmology opined that no additional procedure was indicated.  There was ample STR confirmation that visual acuity, visual fields, and ocular muscle function (diplopia, nystagmus, etc.) were not affected.  There was no STR documentation of any period of acute symptoms, prescribed bedrest, or quarters assignment.  The commander’s statement documented that there had been no work loss due to the condition.

The 19 March 2007 NARSUM examination, 4 months prior to separation, detailed the above clinical course and verified the absence of any other VASRD-ratable visual impairment (visual acuity, visual fields, or ocular muscle function) at separation.  The NARSUM ophthalmologist opined, “This is a complex case, made more difficult by a discordance between objective testing, which does not account for the patient's subjective significant reduction in contrast sensitivity, and subjective responses ... maintains he is unable to perform his duties.  I do not predict that will change.”  The NARSUM did not document any periods of incapacitation.  

A 12 October 2007 VA ophthalmology Compensation and Pension (C&P) evaluation, 3 months after separation, documented “problems driving at night and viewing detailed images.”  The examiner noted that the equipment was unavailable for objective testing of contrast sensitivity; but, verified the absence any other VASRD-ratable visual impairment (as specified above); and, did not document any periods of incapacitation.  A general C&P examination of 30 October (2 weeks later) documented that the CI was a full time student (college linguistics), and also did not identify any periods of incapacitation.

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the loss of contrast sensitivity condition 10%, coded analogously as 6009 (unhealed eye injury).  The VA, based on the C&P evidence, conferred the same rating under the same analogous code.  The rating decision stated that “a minimum evaluation of 10 percent is assigned during continuance of active pathology,” although no VASRD underpinning for that criterion could be located.  Except for eye conditions rated under the general formula elaborated above for code 6009, VASRD §4.84a only provides rating criteria for impairment of visual acuity, visual fields, or ocular muscle function.  There was thus no support for a minimum rating under any alternative code.  Even for analogous rating under code 6009, significant latitude must be taken with the criteria to justify the minimum 10% rating, given the absence of available evidence for any incapacitating episodes.  

After due deliberation, considering all of the evidence and conceding VASRD §4.3 (reasonable doubt), the panel concluded that there was insufficient cause to recommend a change in the PEB adjudication of the loss of visual contrast sensitivity. 

BOARD FINDINGS:  In the matter of the loss of visual contrast sensitivity and IAW VASRD §4.84a, the panel unanimously recommends no change in the PEB adjudication.  There are no other conditions within the panel’s scope of review for consideration.  The panel, 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 20160413, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

SAF/MRB
1500 West Perimeter Road, Suite 3700
Joint Base Andrews, MD  20762

XXXXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXXXXXX:

Reference your application submitted under the provisions of DoDI 6040.44 (Section 1554, 10 USC), PDBR Case Number PD-2016-00222.

After careful consideration of your application and treatment records, the Physical Disability Board of Review determined that the rating assigned at the time of final disposition of your disability evaluation system processing was appropriate.  The Board recommended no re-characterization or modification of your separation.

I carefully reviewed the evidence of record and the recommendation of the Board.  I concur with that finding and their conclusion that re-characterization of your separation is not warranted.  I accept their recommendation that your application be denied.

Sincerely,

XXXXXXXXXXXXXXXXXXX
Director
Air Force Review Boards Agency

Attachment:
Record of Proceedings