RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-02273
BRANCH OF SERVICE:  Air FORCE 	SEPARATION DATE:  20070502

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E4, Tactical Aircraft Maintenance Journeyman, medically separated for “cystoid macular edema and pars planitis left eye” with a disability rating of 10%.  

CI CONTENTION:  No specific contention made.  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 - 20070301	VARD - 20080311	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Cystoid Macular Edema and Pars Planitis Left Eye	6099-6000	10%	Pars Planitis with Secondary Macular Edema…	6000-6078	40%	20080223	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  40%	

ANALYSIS SUMMARY:  

Cystoid Macular Edema and Left Eye Pars Planitis Left Eye.  According to the service treatment record and MEB narrative summary (NARSUM), the CI was diagnosed with bilateral cataracts in September 2004, but failed to schedule an appointment for treatment (his military enlistment physical documented reduced visual acuity in the left eye corrected to 20/70).  On 29 March 2006, he was disqualified for an overseas assignment due to vision of 20/100 in the left eye and 20/40 in the right eye, with no change with correction.  In June 2006, he underwent cataract surgery for both eyes and post-operatively he developed bilateral cystoid macular edema (CME) and was diagnosed with pars planitis (inflammation--uveitis--thought to be an autoimmune disorder) of the left eye.  He recalled a diagnosis of pars planitis in childhood and being told his condition led to the cataracts.  He underwent a left eye vitrectomy (removal clear gel between lens and retina) in December 2006 and he was subsequently prescribed trifocal lenses that corrected his left eye to 20/80 and right eye to 20/20.  The provider advised him to wait at least 2 months for left eye vision improvement and prescribed steroid drops for 6 months with additional steroid injections scheduled.  

The 12 January 2007 MEB NARSUM examination, 4 months prior to separation, cited the ophthalmology treatment notes summarized above.  Visual fields were not measured due to the decreased vision in the left eye post-operatively, but no abnormality of visual fields was expected due to either CME pars planitis.  With the requirement for steroid eye drops and ongoing ophthalmology care, the CI was non-deployable.  The examiner noted possible amblyopia (“lazy eye”) in the left eye due to the longstanding cataract, and indicated that should his vision not improve any further, “he would be a permanent E2 profile fully capable of performing work required of his AFSC provided that he wear glasses.”  

At the 23 February 2008 VA Compensation and Pension (C&P) evaluation, 10 months after separation, the CI reported limited and blurry vision requiring trifocal corrective lenses but denied any incapacitating episodes.  Physical examination showed corrected left eye distance vision of 20/60 and near of 20/30; and corrected right eye distance vision of 20/40 and corrected near of 20/20.  The examiner noted artificial lenses in both eyes along with macular edema, inferior scarring and inflammation.  There was no keratoconus (thinning cornea) and eye pressure was normal with no visual field defects or visual acuity worse than 5/200.

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the left eye condition 10%, analogously coded 6099-6000 (uveitis), citing macular edema and left eye pars planitis, status post vitrectomy.  The VA rated the bilateral eye condition 40%, coded 6000-6078, (uveitis-impairment of central visual acuity), based on the C&P evaluation, citing bilateral aphakia (30%) and active uveitis (10%).  The panel must make its rating recommendation for the unfitting left eye condition based on the VASRD rules in effect on the date of separation.  Under VASRD code 6000 (in 2007), uveitis was rated for impairment of visual acuity or field loss, pain, rest requirements, or episodic incapacity, combining an additional rating of 10% during continuance of active pathology.  In this case, the corrected visual acuity at the MEB NARSUM was 20/80 in the left eye and 20/20 in the right eye, and the CI had ongoing treatment with topical and injected steroids for left eye inflammation. According to VASRD §4.78 (computing aggravation), to determine the effect of aggravation on visual disability, even though the visual impairment for only one eye is being determined, the vision of both eyes prior to aggravation is subtracted from the vision of both eyes after aggravation.  Then the percentage evaluation is found by referring to Table V (ratings for central visual acuity impairment).  During the entrance physical, corrected left eye distance vision was 20/70 and the right eye was 20/30.  By the time of the NARSUM, the right eye vision actually improved to 20/20 and the difference between the left eye after aggravation (20/80) and before (20/70) did not reach the threshold for a 10% rating.  Even if no subtraction of the CI’s vision at enlistment from his vision near separation is performed, the visual acuity impairment at separation does not meet the threshold for a 10% rating.  While the CI’s left eye vision had improved and the right eye had worsened at the C&P evaluation, IAW VASRD §4.78 rating procedures, the vision documented at the examination also did not meet the threshold for a 10% rating.  However, a 10% minimum rating was supported by both the MEB NARSUM and VA examinations for active uveitis as adjudicated by the PEB.  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 cystoid macular edema and pars planitis of the left eye, status post vitrectomy condition and IAW VASRD §4.84a, the 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

The following documentary evidence was considered:  

Exhibit A.  DD Form 294, dated 20170301, w/atchs  
Exhibit B.  Service Treatment Record  
Exhibit C.  Department of Veterans Affairs Record  

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

XXXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXXXXX:

Reference your application submitted under the provisions of DoDI 6040.44 (Section 1554, 10 USC), PDBR Case Number PD-2017-02273.

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.

						Sincerely,

								XXXXXXXXXXXXXXXXXX
								Director
								Air Force Review Boards Agency

Attachment:
Record of Proceedings