RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD1300227
BRANCH OF SERVICE:  Army	BOARD DATE:  20140325
SEPARATION DATE:  20031216

SUMMARY OF CASE: Data extracted from the available evidence of record reflects that this covered individual (CI) was an activated National Guard SGT/E-5 (95B20/Military Policeman) medically separated for diabetes mellitus (DM).  The CI experienced the onset of symptoms in May 2003 while deployed to Iraq and was returned early from deployment.  He started and was maintained on insulin injections.  The condition could not be adequately rehabilitated to meet the physical requirements of his Military Occupational Specialty or satisfy physical fitness standards, primarily due to deployment limitations.  He was issued a permanent P3 and referred for a Medical Evaluation Board (MEB).  The DM, characterized as “diabetes mellitus, insulin-dependent” was forwarded to the Physical Evaluation Board (PEB) IAW AR 40-501.  The MEB also identified and forwarded two other conditions (see rating chart below) judged to meet retention standards.  The Informal PEB adjudicated “insulin dependent diabetes mellitus” as unfitting, rated 20%, and the remaining conditions were determined to be not unfitting.  The CI made no appeals and was medically separated.

CI CONTENTION:  “My diagnosis of diabetes mellitus has been very severe from the time of my discharge and into the continuing years. More specifically, in 2006, 2008, 2009 and 2010 I was treated at and admitted to the hospital due to the worsening of my ability to control my diabetes. I also suffer from hypoglycemic unawareness. This affects my ability to respond appropriately to situations because I am unable to recognize and treat mild hypoglycemia so it quickly becomes severe hypoglycemia where I suddenly become non-responsive. Most recently, in June 2012, I was treated by paramedics after I was found unconscious in my patrol car.  In addition to and directly related to the diabetes mellitus, I have been diagnosed and
rated by the VA for: bilateral diabetic retinopathy and left and right lower extremity peripheral neuropathy associated with diabetes mellitus.  As these diagnoses are directly related to my discharge due to diabetes mellitus, the ratings received for these conditions should be considered in my overall discharge disability rating.”  [sic]

SCOPE OF REVIEW:  The Board’s scope of review is defined in DoDI 6040.44, Enclosure 3, paragraph 5.e.(2).  It is limited to those conditions determined by the PEB to be unfitting for continued military service and those conditions identified but not determined to be unfitting by the PEB when specifically requested by the CI.  The rating for the unfitting DM is addressed below; the knee and cholesterol conditions, identified as not unfitting by the PEB, were not requested for review and thus are not within the defined scope.  Any conditions or contention not requested in this application, or otherwise outside the Board’s defined scope of review, remain eligible for future consideration by the Board for Correction of Military Records.

RATING COMPARISON:

Service IPEB – Dated 20031030	VA - (< 1 Mos. Post-Separation) 	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Insulin Dependent Diabetes Mellitus	7913	20%	Diabetes Mellitus	7913	20%	20040106	
Intermittent Right Knee Pain	Not Unfitting	Right Knee, S/P Meniscal Tear, Surgically Repaired	5259	10%	20040106	
Elevated Cholesterol	Not Unfitting	No VA Entry	
No Additional MEB/PEB Entries	Other x 1	20040106	
Combined:  20%	Combined:  30%	
Derived from VA Rating Decision (VARD) dated 20040308 (most proximate to date of separation [DOS]).

ANALYSIS SUMMARY:  The Disability Evaluation System (DES) is responsible for maintaining a fit and vital fighting force.  While the DES considers all of the member's medical conditions, compensation can only be offered for those medical conditions that cut short a member’s career and then only to the degree of severity present at the time of final disposition.  The DES has neither the role nor the authority to compensate members for anticipated future severity or potential complications of conditions resulting in medical separation nor for conditions determined to be service-connected by the Department of Veterans Affairs (DVA) but not determined to be unfitting by the PEB.  However, the DVA, operating under a different set of laws (Title 38, United States Code), is empowered to compensate all service-connected conditions and to periodically re-evaluate said conditions for the purpose of adjusting the Veteran’s disability rating should the degree of impairment vary over time.  The Board’s role is confined to the review of medical records and all evidence at hand to assess the fairness of PEB rating determinations, compared to VASRD standards, based on severity at the time of separation.

The Board utilizes DVA evidence proximal to separation in arriving at its recommendations; and, DoDI 6040.44 defines a 12-month interval for special consideration to post-separation evidence.  The Board’s authority as defined in DoDI 6044.40, however, resides in evaluating the fairness of DES fitness determinations and rating decisions for disability at the time of separation.  Post-separation evidence therefore is probative only to the extent that it reasonably reflects the disability and fitness implications at the time of separation.

Diabetes Mellitus.  The CI presented with a several week history of abdominal pain while deployed in May 2003.  He was diagnosed with DM and evacuated from theater.  He was treated with Insulin and his glucose brought under control.  An ophthalmological (eye) evaluation on 9 July 2003 found no complications.  The tests for renal (kidney) function were also normal.  At the MEB examination, the CI reported frequent urination at the onset of the DM condition, but did not report complications from it.  On examination, the neurological (nerve) examination was normal.  The narrative summary was dated 2 October 2003, 2 months prior to separation.  The CI reported that he felt well and he had no limitations other than the (normal) vigilance against the signs and symptoms of decreased blood sugar with strenuous exertion.  He was able to run for 1.5 miles before he needed to walk to avoid low blood sugar (hypoglycemia) symptoms.  His fasting blood sugar was well controlled.  His Hemoglobin A1c, a test that measures chronic control, was elevated, but reflected pre-treatment blood sugar levels as well as those post-treatment.  He had minimal limitations in garrison, but was restricted from field duties.  The DM was noted to be well controlled and without complications.  At the VA Compensation and Pension examination performed less than a month after separation, the CI reported good control and feeling fine.  No complications were reported and he denied side effects from the insulin.  The eye and neurological evaluations were normal.

The Board directs attention to its rating recommendation based on the above evidence.  The PEB and VA both coded the condition as 7913, DM, and rated it at 20% for the use of Insulin without regulation of activities.  The Board observed that no limitation on activities was placed other than those levied on all individuals who require insulin.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board concluded that there was insufficient cause to recommend a change in the PEB adjudication for the DM condition.

BOARD FINDINGS:  IAW DoDI 6040.44, provisions of DoD or Military Department regulations or guidelines relied upon by the PEB will not be considered by the Board to the extent they were inconsistent with the VASRD in effect at the time of the adjudication.  The Board did not surmise from the record or PEB ruling in this case that any prerogatives outside the VASRD were exercised.  In the matter of the DM condition and IAW VASRD §4.120, the Board unanimously recommends no change in the PEB adjudication.  There were no other conditions within the Board’s scope of review for consideration.

RECOMMENDATION:  The Board, therefore, recommends that there be no re-characterization of the CI’s disability and separation determination.

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20130429, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans’ Affairs Treatment Record

		
SAMR-RB									

MEMORANDUM FOR Commander, US Army Physical Disability Agency 
(AHRC-DO), 2900 Crystal Drive, Suite 300, Arlington, VA  22202-3557

SUBJECT:  Department of Defense Physical Disability Board of Review Recommendation for XXXXXXXXXXXXXXXXXX, AR20140018969 (PD201300227)

I have reviewed the enclosed Department of Defense Physical Disability Board of Review (DoD PDBR) recommendation and record of proceedings pertaining to the subject individual.  Under the authority of Title 10, United States Code, section 1554a,   I accept the Board’s recommendation and hereby deny the individual’s application.  
This decision is final.  The individual concerned, counsel (if any), and any Members of Congress who have shown interest in this application have been notified of this decision by mail.

 BY ORDER OF THE SECRETARY OF THE ARMY:

Encl						     
						         
CF: 
(  ) DoD PDBR
(  ) DVA