RECORD OF PROCEEDINGS PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXX		CASE: PD-2017-04305 BRANCH OF SERVICE: ARMY	SEPARATION DATE: 20090121

SUMMARY OF CASE: Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E4, Motor Transportation Operator, medically separated for “impairment of central visual acuity with left eye 20/70, and right eye 20/50” and “migraine headaches (not ocular migraines),” rated 20% and 0%, respectively, with a combined disability rating of 20%.

CI CONTENTION:  “Vision loss is getting worse.”  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 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 - 20081003	VARD - 20100511	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Impairment of Central Visual Acuity …	6078	20%	Eye Condition Causing Vision Loss	6099-
6066	NSC	20090824	
Migraine Headaches (Not Ocular Migraines)	8100	0%	Chronic Daily Headaches with Intermittent Migraines	8199-
8100	30%	20090615	
COMBINED RATING: 20%	COMBINED RATING OF ALL VA CONDITIONS: 30%	

ANALYSIS SUMMARY:

Central Visual Acuity Impairment. According to the service treatment record (STR) and MEB narrative summary (NARSUM), the CI had a history of a congenital left “lazy eye.” He sought treatment by ophthalmology in mid-2007 for left eye pain, headaches and dizziness with decreased vision, and his glasses were noted to be in disrepair at a few visits. On 13 September 2007, after extensive testing, the ophthalmologist found no physical abnormality to explain the visual field loss, but visual field testing results indicated non-organic causes. A low thiamine level was noted, but correcting this did not improve his vision. A psychiatry consult was recommended, and neuro-ophthalmology evaluation concluded there was a functional overlay to the visual examination. The CI’s corrected visual acuity steadily declined on serial examinations from August 2007 (right 20/30 and left 20/50) to August 2008 (right 20/50 and left 20/70).       In July 2008, the ophthalmologist reiterated that further evaluation of the CI’s visual

complaints would not be productive. The 3 September 2008 MEB NARSUM examination, 4 months prior to separation, cited the information from the ophthalmology evaluations above.

At the 10 June 2009 VA Compensation and Pension (C&P) eye examination, 5 months after separation, the CI reported being nearsighted and trouble with peripheral vision as well as light sensitivity for many years. He denied injury and wore glasses. Physical examination showed visual acuity of the right eye was 20/40 and left eye was 20/60. There was generalized constriction of visual fields to confrontation, and visual field testing was abnormal in both eyes. The ophthalmologist opined that myopia could partially explain the constricted visual fields, but indicated the test results did not explain the symptoms. A second ophthalmologist provided an opinion on 24 August 2009, 8 months after separation, and found that at the C&P examination, the CI’s visual fields were stable, with constricted visual fields and no new diagnoses. An extensive work-up while on active duty was also noted, and the ophthalmologist’s opinion was that it was less likely than not that the CI’s decreased visual acuity and visual field loss were related to a diagnosed eye disease.

The panel directed attention to its rating recommendation based on the above evidence. The PEB rated the right and left eye conditions 20%, coded 6078 (central visual acuity), which appeared to the panel to be a code from the 2008 VASRD. The VA did not service connect the eye conditions, analogously coded 6099-6066 (visual acuity in one eye), based on the C&P eye examination, citing a mere citation of impaired visual acuity without diagnosis of an actual eye disease is not subject to service connection. Panel members agreed that a 20% rating was supported for central visual acuity of 20/70 in one eye and 20/50 in the other eye, coded 6066. 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 visual acuity condition.

Migraine Headaches (Not Ocular Migraines). According to the STR and MEB NARSUM, the CI presented to the emergency room after migraine headaches (HAs) began abruptly in July 2007. He described moderate daily HAs and persistent visual field loss in both eyes, with associated nausea, light sensitivity and vertigo. The HAs usually lasted all day and were present upon awakening and falling asleep. He was evaluated by neurology, but treatment trials of many preventive medications did not relieve the HAs. At the MEB NARSUM examination, the CI reported chronic daily HAs, and that he took a preventive medication (Depakote), as well as abortive medications (Imitrex and Fioranal). Physical and neurological examinations were normal, and the neurologist indicated that while the HAs were not totally disabling and that the CI could function in a sedentary occupation, the condition prevented him from meeting military physical standards.

The 15 June 2009 C&P general examination, 5 months after separation, noted complaints of constant HA’s and flare-ups twice a month which were associated with blurred vision and light sensitivity. The CI was employed as a forklift operator and stated he was able to work with his baseline HAs, and that during flare-ups, he worked a little more slowly. He had not missed any days due to the condition and was not taking any medication or treatment for the HAs. Physical and neurological findings were normal.

The panel directed attention to its rating recommendation based on the above evidence. The PEB rated the migraine condition 0%, coded 8100 (migraine headaches), citing the HAs did not meet the definition of prostrating. The VA rated the migraine condition 30%, analogously coded 8199-8100, based on the C&P general examination, citing characteristic prostrating attacks that occurred on an average of once a month over the last several months. Panel members noted that rating guidance under diagnostic code 8100 is based on the frequency of “prostrating attacks” over the “last several months.” The VASRD does not further define prostrating attacks, however  commonly accepted  definitions  include  “utter physical  exhaustion  or helplessness”

(Webster's New World Dictionary of American English), “complete physical or mental exhaustion” or “extreme exhaustion or powerlessness” (Dorland's Illustrated Medical Dictionary). The panel carefully considered the frequency and nature of the CI’s HAs, and found no objective or corroborating subjective evidence at the MEB NARSUM or VA examinations of prostrating HAs. Thus, panel members agreed that a 0% rating and no higher was supported for the migraine HAs under code 8100. 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 migraine condition.

BOARD FINDINGS: In the matter of the central visual acuity impairment and IAW VASRD §4.79, the panel recommends no change in the PEB adjudication. In the matter of the migraine headaches and IAW VASRD §4.124a, 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.

The following documentary evidence was considered:

PD-2017-04305

AR20200000173, XXXXXXXXXXXXXXXXXXXX 

Dear XXXXXXXXXXXXXXXXXXXXXX

	The Department of Defense Physical Disability Board of Review (DoD PDBR) reviewed your application and found your separation disability rating and your separation from the Army for disability with severance pay to be accurate.  I have reviewed the Board’s recommendation and record of proceedings (copy enclosed), and I accept its recommendation.  I regret to inform you that your application to the DoD PDBR is denied.  

	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.