RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXX	CASE:  PD-2017-01164
BRANCH OF SERVICE:  Air Force 	SEPARATION DATE:  20051026

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty  E5, Dental Laboratory Apprentice, medically separated for “pressured ocular histoplasmosis syndrome, right eye,” with a disability rating of 20%.   

CI CONTENTION:  Review all conditions.  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 - 20050914	VARD - 20060404	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Pressured Ocular Histoplasmosis Syndrome, Right Eye	6005-6077	20%	Histoplasmosis Syndrome, Macular Degeneration, and Scotomas Affecting Both Eyes	6005-6076	40%	20060309	
COMBINED RATING:  20%	COMBINED RATING OF ALL VA CONDITIONS:  60%	

ANALYSIS SUMMARY:  

Pressured Ocular Histoplasmosis Syndrome, Right Eye.  According to the service treatment record (STR) and MEB narrative summary (NARSUM), the CI’s right eye condition began in September 2002.  The 11 September 2002 ophthalmology examination noted 20/30 visual acuity (normal 20/20) and a scotoma (visual field blind spot).  The 15 December 2003 ophthalmology examiner noted a diagnosis of subfoveal choroidal neovascular membrane (new blood vessel membrane formation) in the right eye secondary to presumed ocular histoplasmosis syndrome.  Physical examination showed right eye vision of 20/70, a grayish subretinal membrane in the center of the macula and subretinal fibrosis.  There was no hemorrhaging.  Fluorescein angiogram showed staining of the subretinal fibrosis in the center of the macula and new choroidal neovascular membrane extending with late leaking seen.  The CI was treated with photodynamic therapy.  The 25 January 2005 follow-up examination showed right visual acuity of 20/100.  

The 23 June 2005 MEB NARSUM examination, 3 months prior to separation, the CI reported a slightly enlarged scotoma.  Physical examination showed 20/200 right eye visual acuity.  The fluorescein angiogram did not show active or a threatening amount of leakage in either eye.  The examiner noted the CI was legally blind in the right eye.  

At the 9 March 2006 VA Compensation and Pension (C&P) examination, 4 months after separation, the CI reported loss of vision in the right eye.  Physical examination showed unaided visual acuity in the right eye of 20/400.  He was able to count fingers at half a meter with the right eye. Refraction in the right eye of -5.00 did not improve vision.  Dilated ophthalmoscopy showed evidence of laser treated chorioretinal lesions and substantial scarred lesion of the macula which included the entire posterior pole.  The examiner noted the CI was legally blind.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the right eye condition 20%, dual coded 6005-6077 (choroiditis-vision in one eye 20/200), citing impaired vision at 20/200.  The VA rated the right eye condition 40%, dual coded 6005-6076 (choroiditis-vision in one eye 10/200), based on the C&P examination, citing left eye corrected visual acuity of 20/50 and right eye corrected visual acuity of 10/200.

The panel noted that only the right eye was adjudicated as unfitting; therefore IAW VASRD 4.75 (c) “visual acuity of the other eye will be considered to be 20/40 for purposes of evaluating the service-connected visual impairment.”  The panel noted that the General Rating Formula for Diagnostic Codes 6000 through 6009 rates on the basis of either visual impairment or incapacitating episodes; whichever results in a higher evaluation.  There was no evidence of incapacitating episodes greater than 4 weeks to support a 40% rating under that formula.  The panel noted that multiple STR treatment notes documented 20/200 right visual acuity, but the post-separation VA examination showed 10/200 visual acuity.  After considering these disparate evaluations, panel members agreed the STR evidence held more probative value than the post-separation VA examination and was more consistent with the CI’s functional impairment at the time of separation.  After due deliberation, considering all 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 pressured ocular histoplasmosis syndrome, right eye condition.  

BOARD FINDINGS:  In the matter of the right eye condition 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.  

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

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Dear XXXXXXXXXX:

		Reference your application submitted under the provisions of DoDI 6040.44 (Section 1554, 10 USC), PDBR Case Number PD-2017-01164.

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.  Accordingly, the Board recommended no re-characterization or modification of your separation.

I have 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.  Accordingly, I accept their recommendation that your application be denied.