RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXX	CASE:  PD-2017-00838
BRANCH OF SERVICE:  Navy 	SEPARATION DATE:  20070604

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E3, Aviation Boatswain's Mate Fueling, medically separated for “left macular scar due to toxoplasmosis” with a disability rating of 10%.  

CI CONTENTION:  “Totally blind in the left eye as a result of toxoplasmosis from the Navy.”  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 Medical Evaluation Board (MEB), but determined by the PEB 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.  The panel’s authority is limited to assessing the fairness and accuracy of PEB rating determinations and recommending corrections when appropriate.  The panel’s assessment of the PEB rating determination is based on review of medical records and all available evidence relevant to application of the Veterans Affairs Schedule for Rating Disabilities (VASRD) standards for 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, which operates 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 disability at the time of separation.  

RATING COMPARISON:  

SERVICE PEB - 20070323	VARD - 20070919 or NA	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Left Macular Scar due to Toxoplasmosis	6011	10%	Toxoplasmosis, Left Eye	6011	10%	20070823	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  10%	

ANALYSIS SUMMARY:  

Left Macular Scar due to Toxoplasmosis.  According to the service treatment record (STR) and MEB narrative summary (NARSUM), the CI’s left eye condition began gradually in August 2006, with no specific injury or accident.  In September 2006, he was treated for chorioretinitis due to toxoplasmosis and the condition resolved with treatment.  He was evaluated at the ophthalmology clinic on 20 February 2007, with the diagnosis of macular scar left eye secondary to toxoplasmosis.  The CI’s primary complaint was blurred vision.  At the 20 February 2007 ophthalmology visit, the examiner noted the CI’s condition was stable and his vision was unlikely to improve or worsen.
 
The 20 February 2007 MEB NARSUM examination, 4 months prior to separation, noted complaints of decreased left eye vision.  The CI reported gradual onset of blurred vision.  He was found to have a left macular lesion and a positive toxoplasmosis IgG titer.  He was treated with oral steroids and antibiotics.  He had no pain or redness of the eye.  The examiner noted that at the time of initial presentation, the examination of the eye was normal except for a central macular scar in the left eye including fibrous membranes and pigmented areas.  There were no areas of toxoplasmosis activity and his condition remained stable.  Physical examination showed best corrected visual acuity of 20/50 minus 2 in the left eye, and 20/20 uncorrected in the right eye.  Intraocular pressure, optic nerves, vessels and peripheral retina were normal in each eye. No active disease was found in the left retina and the left macular scar was stable with clear vitreous.

At the 23 August 2007 VA Compensation and Pension (C&P) ophthalmology examination, 2 months after separation, the CI reported decreased vision in his left eye.  He was working as a security patrol officer and also as a driver.  Physical examination showed corrected left eye vision of 20/400.  The left eye examination was normal with the exception of macula scar and pigment.

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the left eye condition 10%, coded 6011 (retinal scars, atrophy, or irregularities).  The Navy PEB listed left chorioretinitis due to toxoplasmosis as a related diagnosis (Category II) contributing to the disability in this case.  The panel concluded the Category II diagnosis was not a separate condition which could be reasonably justified as separately unfitting; nor would separate ratings be achievable without violation of VASRD §4.14 (avoidance of pyramiding).  The VA also rated the left eye condition 10%, coded 6011, based on the C&P examination, citing unilateral damage to the retina with irregular, duplicated, enlarged, or diminished image.  Panel members agreed, that a 10% rating and no higher was justified for the left eye condition, and a higher rating under the 6011 code was not possible.  The panel considered alternative VASRD diseases of the eye (choroiditis or retinitis) and analogous codes, but all were less applicable and/or not advantageous to rating.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel concluded there was insufficient cause to recommend a change in the PEB adjudication for the left eye condition.  

BOARD FINDINGS:  In the matter of the left macular scar due to toxoplasmosis and IAW VASRD §4.84a, the panel recommends no change in the PEB adjudication.  There are no other conditions within the panel’s scope of review for consideration.  Therefore, the panel recommends no modification or re-characterization of the CI’s disability and separation determination.   

JAN 1 5 2019
MEMORANDUM FOR DIRECTOR, SECRETARY OF THE NAVY COUNCIL OF REVIEW
BOARDS
Subj: PHYSICAL DISABILITY BOARD OF REVIEW (PDBR) RECOMMENDATIONS
Ref: (a) DoDI 6040. 44
In accordance with reference (a), I have reviewed the cases
listed below and approve the recommendations of the PDBR that the
following individual's records not be corrected to reflect a change
in either characterization of separation or in the disability
rating previously assigned by the Department of the Navy's Physical
Evaluation Board: