RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX 	CASE:  PD-2016-01348
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20040415

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E4, Food Service Specialist, medically separated for “chronic bilateral conjunctivitis, with normal visual acuity” with a disability rating of 10%.  

CI CONTENTION:  Wants to file a new claim for her back, neck, depression, bladder pain and thyroid removal.  Also, she continues to get pink eye.  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 (VA), 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 -20040310	VARD - 20041101	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Bilateral Conjunctivitis	6018	10%	Bilateral Conjunctivitis	6013-6018	10%	20040924	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  10%	

ANALYSIS SUMMARY:  

Bilateral Conjunctivitis.  According to the service treatment record (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s conjunctivitis began in May 2000 after experiencing swelling with burning sensations in both eyes and she was treated with an antibiotic and topical steroid.  She deployed to Iraq in April 2003 and the same problem recurred.  Despite treatment with medication, the problem worsened and she was medically evacuated for hospitalization.  The ophthalmologist saw her on 5 June 2003 and both eyes were still injected (redness and irritation suggesting inflammation of the cornea) with swelling of both eyelids.  She was diagnosed with conjunctivitis and glaucoma.  Corneal cultures showed evidence of a bacterial organism but a biopsy was negative with no evidence of trachoma infection.  Despite treatment with various antibiotics and steroids, the bilateral conjunctivitis persisted, symptoms did not fully resolve and she appeared refractory to treatment.  A September 2003 ophthalmology evaluation rendered a diagnosis of chronic bilateral conjunctivitis due to repetitive mechanical irritation, i.e. she was vigorously rubbing her eyes in her sleep.  She was given protective eyeglasses but 2+ conjunctival injection (redness and irritation) remained in both eyes with normal visual acuity.  

The 26 January 2004 MEB NARSUM examination, 3 months prior to separation, noted the CI reported burning in both eyes and swelling.  According to the commander’s statement she was not performing in her military occupational specialty, but was helping in the supply room of her company. She did not participate in training exercises or physical fitness testing and was not using medication for her eyes.  Physical examination showed moderately swollen eyelids and redness of conjunctivae; the remainder of the examination was within normal limits.

At the 24 September 2004 VA Compensation and Pension (C&P) evaluation, 5 months after separation, the CI reported a history of severe conjunctivitis for the past 3 years.  At some point, “her pressure was elevated and she began using glaucoma drops due to the pressure and a wide CD ratio [measures cup-to-disc ratio].”  She took Zilantin (numbing medication) daily in both eyes and wore glasses for a few months.  Physical examination showed visual acuity, right eye corrected: near 20/20 and far 20/25 and left eye corrected: near 20/25 and far 20/25 with myopic and astigmatic corrections.  Visual fields were attached but with “discrepancy in the confrontation field which was larger in both eyes done with peripheral fields.”  Intraocular pressure was 16 and 15, in the right and left eye respectively.  External examination revealed moderately severe conjunctivitis with mucoid exudate.  “After dilatation, slit lamp of the lens [was] clear and funduscopic examination showed a CD ratio of 20.7 with fairly good rims bilaterally.”  She was diagnosed with moderately severe bilateral conjunctivitis, controlled open angle glaucoma and refractive error.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the bilateral conjunctivitis condition 10%, coded 6018 (chronic conjunctivitis), citing normal visual acuity.  The VA rated the conjunctivitis condition 10%, analogously coded 6013-6018 (open angle glaucoma with chronic conjunctivitis), based on the C&P examination 5 months after separation, citing visual acuity of 20/20 in the right eye and 20/25 in the left eye.  

The panel majority noted the PEB rated the bilateral conjunctivitis as a single unfitting condition coded 6018 and rated 10%.  This approach by the PEB not uncommonly reflected its judgment that the constellation of conditions was unfitting, and there was no need for separate fitness adjudications.  The panel’s initial charge in this case was therefore directed at determining if the PEB’s approach of combining the bilateral eye conditions under a single rating was justified in lieu of separate ratings.  When considering a separate rating for each condition, the panel considers each bundled condition to be reasonably justified as separately unfitting unless a preponderance of evidence indicates the condition would not cause the member to be referred into the DES or be found unfit because of physical disability.  The profile, NARSUM and MEB cited both eyes as unfit, so both the right and left eye are reasonably considered unfit.  

Panel members agreed the condition was appropriately coded 6018.  The NARSUM examination showed active pathology in both eyes with bilateral swollen eyelids and redness of conjunctiva.  The glaucoma was treated with eye drops and corrected visual acuity was within normal limits.  There was no evidence of a Chlamydia trachoma infection to achieve a higher rating under the 6017 (trachomatous conjunctivitis.)  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel majority recommends a disability rating of 10% for the left eye condition, coded 6018 and 10% for the right eye condition, coded 6018.  

BOARD FINDINGS:  In the matter of the bilateral conjunctivitis condition, the panel majority recommends a disability rating of 10%, coded 6018 IAW VASRD §4.75 for the left eye condition and 10% for the right eye condition, coded 6018 IAW VASRD §4.75.  The single voter for dissent recommends no change and elected not to submit a minority opinion.  There are no other conditions within the panel’s scope of review for consideration.  

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

CONDITION	VASRD CODE	PERMANENT RATING	
Right Eye Conjunctivitis	6018	10%	
Left Eye Conjunctivitis	6018	10%	
	COMBINED	20%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20160915, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record 

AR20180001665, XXXXXXXXXXXXXXXXXX 

XXXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXXXXX:

The Department of Defense Physical Disability Board of Review (DoD PDBR) reviewed your application and found that your disability rating should be modified but not to the degree that would justify changing your separation for disability with severance pay to a permanent retirement with disability.  I have reviewed the Board’s recommendation and record of proceedings (copy enclosed) and I accept its recommendation.  This will not result in any change to your separation document or the amount of severance pay.  A copy of this decision will be filed with your Physical Evaluation Board records.  I regret that the facts of the case did not provide you with the outcome you may have desired.
  
	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. 

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

Sincerely,					      
						      					
Enclosure