RECORD OF PROCEEDINGS PHYSICAL DISABILITY BOARD OF REVIEW
NAME: XXXXXXXXXXXXXXXXXXXXXXXX	CASE: PD-2018-00137
BRANCH OF SERVICE: MARINE CORPS	SEPARATION DATE: 20040215

SUMMARY OF CASE: Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E6, Electronics Maintenance Technician, medically separated for “visual field defect right eye, paracentral scotoma” with a disability rating of 10%.

CI CONTENTION: No specific contention was 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 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 – 20031202	VARD - 20040330	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Visual Field Defect Rt Eye, Paracentral Scotoma	6080-
6079	10%	

Diplopia Rt Eye with Retinal Scarring	

6090-
6073	

50%	

20031230	
Presumed Ocular Histoplasmosis Syndrome	

Cat II					
Reduced Visual Acuity Rt Eye to the 20/30 Level						
Symptoms of Diplopia						
Choroidal Neovascular Membrane, Extra Foveal and Classic Rt Eye, Status Post Focal Laser Photocoagulation						
COMBINED RATING: 10%	COMBINED RATING OF ALL VA CONDITIONS: 70%	

ANALYSIS SUMMARY:

Visual Field Defect Right Eye, Paracentral Scotoma. According to the service treatment record (STR) and MEB narrative summary (NARSUM), the CI presented to the ophthalmology department, on January 2003 with a chief complaint of reduced vision and central scotoma right eye. His visual acuity was 20/50 and examination revealed a choroidal neovascular membrane superior temporal to the fovea and signs of presumed ocular histoplasmosis (Histo) syndrome in both eyes. He was referred to a civilian retina specialist and he underwent Fluorescein angiography which showed an extra foveal classic choroidal neovascular membrane with fluid leakage into the fovea. He underwent focal laser photocoagulation of the lesion successfully on 8 January 2003. He subsequently had an uneventful postoperative course and was followed on a monthly basis by the retina specialist. On 12 August 2003 his complaints centered on reduced

vision in the right eye and a paracentral scotoma which interfered with his ability to perform near vision tasks as an electronics technician.

The 30 August 2003 MEB NARSUM examination, 6 months prior to separation, noted complaints of right eye reduced visual acuity, diplopia (double vision) and central scotoma (blind spot). Physical examination revealed a best corrected visual acuity of 20/30 right eye and 20/20 left eye. The pupil examination was normal. Applanation tonometry and anterior segment slit lamp examinations were normal in both eyes. Ocular alignment was normal at distance and near. A trial of horizontal prism both base-in and base-out was unsuccessful in reducing or eliminating his complaints of diplopia. Amsler grid and automated Humphrey visual field 24-2 revealed an inferonasal visual field defect extending into the fovea. Dilated fundus examination revealed healthy optic nerve heads in both eyes. There was peripapillary atrophy with histo spots in both eyes. There was a round darkly pigmented scar temporal to the fovea in the right eye which was the location of the treated neovascular membrane. The peripheral retina was normal except for a rare histo spot.

At the 29 December 2003 VA Compensation and Pension (C&P) examination, 2 months before separation, the CI reported right eye retinal scarring of the macula secondary to histoplasmosis with decreased visual acuity and diplopia. Physical examination revealed uncorrected visual acuity in both eyes to be 20/60, but the right eye was not correctable (left eye was correctable to 20/20). There was a right corneal scar and retinal scarring of the macula area of the right eye. The examiner noted, “There was diplopia in the right eye and it occurs constantly.” It was present at all distances and the Goldman Perimeter Test Chart revealed all visual field sectors in the right eye were affected including central vision at 20 degrees. This was a visual acuity equivalent to 5/200 in the right eye.

The panel directed attention to its rating recommendation based on the above evidence. The PEB rated the right eye condition 10%, analogously coded 6080-6079 (field vision, impairment). The PEB listed presumed Ocular Histoplasmosis Syndrome; reduced visual acuity right eye to the 20/30 level; symptoms of diplopia; and choroidal neovascular membrane, extra foveal and classic right eye, status post focal laser photocoagulation conditions as related Category II diagnoses contributing to the disability in this case. All conditions were related to, and/or intrinsic to, the unfitting right eye condition and are considered together for rating under VASRD §4.84a (schedule of ratings—eye). Separate ratings would not be achievable without violation of VASRD
§4.14 (avoidance of pyramiding). The VA rated the right eye condition 50%, analogously coded 6090-6073 (diplopia [double vision]), based on the C&P examination, citing uncorrected visual acuity in the right eye to 20/60 (left corrected to 20/20), and diplopia in all right eye visual field sectors with central vision of 20 degrees and retinal scarring of the macula. VASRD eye ratings in this case are based on equivalent impairment of central visual acuity and are determined on combinations of direct central corrected visual acuity, field defects (blind spots) and diplopia (double vision). The PEB rating and coding was based on the scotoma (field vision) and did not appear to consider alternative rating for the CI’s significant diplopia (6090), which the STR indicated was not correctable. Additionally, examinations indicated there was some pre- separation worsening of the CI’s right eye condition. Accounting for the visual impairment due to the diplopia in addition to the paracentral scotoma, and using the VA’s pre-separation examination, the CI’s right eye condition was equivalent to 5/200 (with vison in the left eye corrected to normal). IAW VASRD §4.84a and Table V, the CI’s right eye condition warranted a 30% rating coded 6090-6074, for “vision in one eye 5/200; in the other eye 20/40.” After due deliberation, considering all the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel recommends a disability rating of 30% for the right eye condition, coded 6090-6074.

BOARD FINDINGS: In the matter of the right eye condition (including all PEB Category I and II conditions), the panel recommends a disability rating of 30%, coded 6090-6074 IAW VASRD
§4.84a. 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; and, that the discharge with severance pay be re-characterized to reflect permanent disability retirement, effective the date of medical separation:

CONDITION	VASRD CODE	PERMANENT RATING	

Visual Field Defect Right Eye, Paracentral Scotoma; Symptoms of Diplopia; Choroidal Neovascular Membrane, Extra Foveal and Classic Right Eye, Status Post Focal Laser Photocoagulation; Presumed Ocular Histoplasmosis Syndrome; Reduced Visual Acuity Right Eye	

6090-6074	

30%	

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
12 Oct 20

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

Subj:	PHYSICAL DISABILITY BOARD OF REVIEW (PDBR)

Ref:	(a) DoDI 6040.44
(b) PDBR ltr of 15 Mar 20

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

2.	On 7 October 2020, the Assistant Secretary of the Navy took action in your case by accepting the correct recommendation of the PDBR.	Accordingly, your records will be corrected to reflect an increase in the disability rating awarded by the Physical Evaluation Board from 10 to 30 percent with assignment to the Permanent Disability Retired List.

3.	The Assistant Secretary's determination, which represents final action in your case by the Department of the Navy, was sent to the Office of the Deputy Commandant (Manpower and Reserve Affairs), for correction of your records as stated above.	You will be notified once those changes are complete.