RECORD OF PROCEEDINGS PHYSICAL DISABILITY BOARD OF REVIEW
NAME:  XXXXXXXXXXXXXXXX	CASE: PD-2017-04718
BRANCH OF SERVICE: NAVY	SEPARATION DATE: 20080613

SUMMARY OF CASE: Data extracted from the available evidence of record reflects this covered individual (CI) was a Reserve E3, Seaman, medically for “left eye subjective pain and photophobia,” “left eye subjective visual field loss,” and “left eye subjective visual acuity loss,” rated for overall effect, with a combined disability rating of 0%.

CI CONTENTION: “I have been diagnosed as legally blind by the VA and rated over 100% service connected disabled.”  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 - 20080507	VARD - 20090113	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Subjective Pain and Photophobia Left Eye	

Overall Effect	

0%	
Hemianopsia, Visual Field Deficit Left Eye with Photophobia and Floaters	
6080	
10%	
20081218	
Subjective Visual Field Loss Left Eye, Inconsistent with Objective Examination							
Subjective Visual Acuity Loss Left Eye, Variable			Dizziness associated with Hemianopsia, Visual Field Deficit Left Eye with Photophobia and Floaters	6299-
6204	10%	20081218	
Borderline Personality Disorder	Cat IV	
No VA Placement	
Adjustment Disorder Unspecified	Cat IV		
COMBINED RATING: 0%	COMBINED RATING OF ALL VA CONDITIONS: 50%	

ANALYSIS SUMMARY:

Left Eye Conditions. The PEB combined the left eye subjective pain and photophobia, left eye subjective visual field loss and left eye subjective variable visual acuity loss conditions under a single disability rating for “overall effect” as permitted by DoDI 1332.38 (E3.P3.4.4). The combination of multiple conditions as a single disability reflects the PEB’s determination that each condition was not separately unfit, but the functional impairment resulting from the conditions when considered together was unfitting. The panel’s initial charge in this case was therefore directed at determining if the PEB’s single overall effect rating was justified in lieu of separate unfit determinations and ratings. When considering a separate rating for each condition, under overall effect standards, the panel considers each bundled condition to be reasonably justified as not separately unfitting unless a preponderance of evidence indicates the condition would cause the member to be referred into the DES or be found unfit because of physical disability. When the panel recommends separate fitness recommendations in this circumstance, its recommendations may not produce a lower combined rating than that of the PEB. The evidence for the left eye subjective pain and photophobia, left eye subjective visual field loss and left eye subjective variable visual acuity loss conditions under a single disability rating for the conditions are presented together; with separate fitness determinations and rating recommendations if indicated.

According to the service treatment record (STR) and MEB narrative summary (NARSUM), the CI’s left eye conditions began in August 2006 after signs and symptoms of a corneal ulcer. The CI reported floaters, loss of peripheral vision, and occasional sharp pain. An April 2007 ophthalmology visit noted complaints of decreased vision, pain with light exposure, and floaters (black or grey spots that drift across the eyes) in the left eye. The ulcer was treated with antibiotics. Topical medication was noted to reduce the level of pain indicating a superficial etiology. Physical examination revealed uncorrected visual acuity of both eyes was worse than 20/200 OU. Corrected visual acuity was 20/20 in the right eye and 20/25 in the left eye. Optometry noted only minimal scarring on the periphery of the left cornea of the previous ulcer area. Otherwise, mild superficial keratitis (inflamed cornea) of both eyes was noted. Anterior and posterior segment examinations of the left eye were normal except for rare small pigment clumps in the retinal periphery. It was noted the CI wore a soft contact lens only in the right eye. Visual field testing of the right eye was not reliable due to fixation losses and the left eye showed a moderately dense temporal field sensitivity loss. Vitreous appeared normal and there were no optic nerve or macular defects noted.  The CI had a history of myopia.

During the 13 November 2007 MEB examination (recorded on DD Forms 2807-1 and 2808), 7 months prior to separation, the CI reported photophobia (light sensitivity) and loss of left eye peripheral vision. Eye examination revealed decreased distance vision bilaterally, left hemianopsia (vision in one half of visual field in that eye), and a dilated left pupil due to medication. The CI was in too much discomfort due to photophobia for an ophthalmologic examination. The examiner noted left eye vision loss, especially peripheral vision. Due to increased intraocular pressure, three ophthalmic medications (homatropine and voltaren for pain, and betimol for high pressure in eyes) were started.

The 4 December 2007 MEB NARSUM examination, 6 months prior to separation, noted complaints of extreme light sensitivity of the left eye and lack of work performance. Command noted the CI was functionally unable to perform any of his military duties, partly due to his eye pain and light sensitivity and partly due to severe swings in his mood. Examinations by ophthalmologists showed little or no objective findings to include fluorescein angiography and MRI of the brain and orbits. One ophthalmology visual field examination showed a hemianopia defect (less vision in half of the visual field) of the left eye but with many false responses. Corrected visual acuity was generally noted to be in the 20/50 range in the left eye. This same examiner  noted  “vitreous  debris”  and  an  atrophic  scar  below  the  disc,  but  this  would  be

inconsistent with a temporal field defect. Testing for vitritis (inflammation of vitreous) was negative. Treatment with medications showed little impact on symptoms at a follow-up in November 2007. Diagnoses were rendered of left eye subjective pain and photophobia, variable subjective visual acuity loss, subjective visual field loss inconsistent with objective examination, and possible conversion disorder. Visual symptoms could not be explained by objective findings. The examiner opined it was likely they were functional/non-organic in origin and noted the CI be found fit for full duty but not suitable for military service.

The 12 December 2007 non-medical assessment (NMA) noted the CI was unable to work, always had a professional demeanor, but misrepresented for 5 months that he was going to medical appointments regarding his vision loss and it was later discovered no appointments had been kept. The CI’s behavior had become erratic and unstable over the past 4 months with admission of severe depression. Due to concerns for his safety while driving, the CI was working daily from his home and unable to perform any driving or work at the base. The 7 May 2008 JDETS noted “this eye business is subjective without organic etiology…ophthalmology evaluations are clear this diagnosis does not exist but he wears sunglasses to all evaluations.” The JDETS summary noted confusing/conflicting medical information.

The 16 June 2008 VA Compensation and Pension (C&P) general examination, one week after separation, noted the CI always wore very dark sunglasses due to photophobia and had been diagnosed with vitreitis with decreased central peripheral vision of the left. The condition was extremely disabling. The CI also reported intermittent dizziness, an ill-defined symptom, and described as a momentary feeling of loss of balance. This was attributed to left temporal hemianopsia with vitreous body floaters.

At the next-day VA C&P ocular examination the CI reported his vision was unchanged from 8 months previously and that he had a dull pain in his left eye but that the right eye was normal. He reported wearing a daily wear soft contact lens in the right eye only and that he could not tolerate any contact lens in the left eye. Medications included homatropine and voltaren in the left eye every 2 hours and betimol in the left eye twice a day.

An ocular examination showed unaided visual acuity at distance; right eye 20/200 at 9 feet and left eye 20/200 at 5 feet. The best corrected visual acuity with astigmatic prescription to each eye at a distance was 20/20. Best corrected visual acuity at near distance was right eye: 20/20 and left eye 20/25. The CI had a full range of eye motility. The confrontation visual fields in the right eye were normal and in the left eye the visual fields appeared constricted. Intraocular pressures in the afternoon were 13 mm in the right eye and 17mm in the left eye (normal 12- 22mm). Slit-lamp evaluation revealed scars in the right eye that were incidental to the claimed condition. The view of the left eye was suboptimal due to the CI’s severe photophobia but there was trace superficial punctate keratitis inferiorly in the left eye. Anterior chambers were normal. There was an atrophic scar with pigment deposition inferior temporally of the left eye and floaters were noted in the left eye.  Cup-to-disk ratio in the right eye was 0.5 and in the left eye
0.3 (generally normal). visual field showed a normal right eye and an ill-defined general contraction of the left eye (some decreased peripheral vision). Diagnoses in the left eye were severe photophobia, a visual field defect, and floaters; also diagnosed was normal vision with a refractive error in each eye.

The 18 December 2008 C&P examination, 6 months post separation, noted complaints of severe transient photophobia and a dull ache in the left eye since August 2006. The CI reported his vision was clear at a distance and near in his right eye using a daily wear soft contact lens. He was no longer able to use the contact lens in his left eye due to the previously described symptoms. The CI reported wearing an eye patch over the left eye. Ocular examination showed left eye 20/40 at a distance and 20/60 near distance using a spectacle correction. Pressure in the right eye was 14 mm HG and 18mm HG in the left eye.  There was no double vision in any   field

and extraocular muscle movements were full. There was normal binocular alignment of the two eyes and a questionable restricted superior field in the left eye, likely as not due to the CI’s squint and otherwise normal visual field. Visual field for the right eye was normal. There was slightly decreased visual acuities in the left eye, likely as not due to pharmacological agents used on a long-term basis in that eye.

The panel directed attention to its rating recommendation based on the above evidence. The PEB rated the multiple left eye conditions 0%, for overall effect. The PEB’s overall effect rating did not specify any §4.79 code or criteria. The PEB also rated borderline personality disorder and adjustment disorder as Category IV conditions which do not constitute a physical disability. The VA rated the left eye conditions 10%, coded 6080 (visual field defects), based on the C&P examination, citing left eye contraction and equivalent visual acuity of 20/70 which is equal to a 10 percent evaluation. A computation of the remaining field vision of 500 degrees (normal) -320 degrees of total vision (found) divided by the 8 meridians results in 22.5 degrees concentric contraction per 38 USC 1155. The VA also rated dizziness associated with left eye hemianopsia 10%, analogously coded 6204 (peripheral vestibular disorders), citing symptoms involving occasional dizziness.

The NARSUM examination noted CI complaints related to the left eye which included photophobia and pain, decreased vision, and floaters. Although ophthalmology examinations found little objective evidence of underlying pathology, the CI’s complaints remained consistent through multiple examinations over an almost 2-year period. There was some objective evidence of left eye pathology reflected by a history of corneal ulceration (often associated with pain, photophobia and eventual loss of vision) with residual scarring, increased intraocular pressure, hemianopia, and abnormal, though confusing findings, in the visual field. Examination of the eye was repeatedly documented as difficult due to light sensitivity and pain and this reasonably interfered with a complete and accurate evaluation.

The commander noted the CI had difficulty performing tasks due to pain in his left eye and refused the use of a contact lens in the left eye but accepted a contact lens in the right eye. The June 2008 C&P general examination noted the CI always wore sunglasses due to photophobia, refused the use of a contact lens in the left eye, while accepting it in the right eye. The panel concluded there was credible clinical evidence of photophobia and pain with decreased vision with floaters despite incomplete confirmation by objective findings.

The panel concluded the most probative examination of the eyes were from the June 2008 C&P examinations one week after separation. The CI’s complaints were unchanged at that time or during the later December 2008 C&P eye examination. The examination noted constricted visual field of the left eye with severe photophobia and floaters. Diagnoses were rendered in June of severe photophobia, visual field defect, and floaters in the left eye. A follow-up C&P examination resulted in similar complaints and findings. The panel majority concluded there were ophthalmology findings to support the CI’s complaints at the time of separation. Visual fields showed concentric contraction in the left eye with an equivalent visual acuity of 20/70 warranting a 10% disability rating. The panel majority agreed there was no evidence of bilateral hemianopsia, other visual field defects, or other eye impairment under other codes to meet criteria for a higher rating. After due deliberation, considering all the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel recommends a disability rating of 10% for hemianopsia, visual field defect with photophobia and floaters coded 6080.

Contended PEB Conditions: Borderline Personality Disorder and Adjustment Disorder Unspecified. In accordance with DoDI 1332.38, E4.13.1.4 and E5, borderline personality disorder and adjustment disorder are conditions that do not constitute a physical disability, are therefore not compensable and thus the panel has no basis for recommending the contended conditions as  unfitting.    After  due  deliberation,  the  panel  concluded  there  was  insufficient  cause   to

recommend a change in the PEB fitness determination for either of the contended conditions, so no additional disability ratings are recommended.

BOARD FINDINGS: In the matter of the hemianopsia, visual field defect condition, the panel majority recommends a disability rating of 10%, coded 6080 IAW VASRD §4.75. In the matter of the contended borderline personality disorder and adjustment disorder unspecified conditions, the panel recommends no change from the PEB determinations as not unfitting. The single voter for dissent recommends no change to the rating and did not elect 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 the date of medical separation:

CONDITION	VASRD CODE	PERMANENT RATING	
Hemianopsia, Visual Field Defect with Photophobia and Floaters	6080	10%	

The following documentary evidence was considered:

DEPARTMENT OF THE NAVY
SECRETARY OF THE NAVY COUNCIL OF REVIEW BOARDS 720 KENNON STREET SE STE 309
WASHINGTON NAVY YARD DC 20374-5023

IN REPLY REFER TO

1850
CORB:003
2 Jun 20

From: Director, Secretary of the Navy Council of Review Boards 

Subj:  PHYSICAL DISABILITY BOARD OF REVIEW (PDBR)

Ref:   (a) DoDI 6040.44
(b) PDBR ltr of 24 Sep 19

1.	Pursuant to reference (a), the PDBR reviewed your case and forwarded its recommendation to the Department of the Navy for appropriate action.

2.	On 27 May 2020, the Assistant Secretary of the Navy (Manpower & Reserve Affairs) took action in your case by accepting the recommendation of the PDBR.  Accordingly, your records will be corrected to reflect an increase in the disability rating awarded by the Department of the Navy Physical Evaluation Board (PEB) from 0% to 10% without re-characterization of your discharge.

3.	For your information, since all disability ratings from 0% to 20% qualify for disability severance pay, the above stated increase will not result in your entitlement to additional compensation.

4.	The Assistant Secretary’s determination, which represents final action in your case by the Department of the Navy, has been forwarded to the Navy Personnel Command for appropriate changes to your personnel records and notification to you upon completion.

Copy to:
PDBR