RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXX	CASE:  PD-2013-00912
BRANCH OF SERVICE:  AIR FORCE	BOARD DATE:  20140204
SEPARATION DATE:  20011105

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty SRA/E-4 (2W/Munitions System) medically separated for diabetes mellitus (DM).  The condition could not be adequately rehabilitated to meet the physical requirements of her Air Force Specialty or satisfy physical fitness standards.  She was issued a permanent P4 profile and referred for a Medical Evaluation Board (MEB).  The DM condition was found “medically unacceptable” and was forwarded to the Physical Evaluation Board (PEB) IAW AFI 48-123.  No other conditions were submitted by the MEB.  The PEB adjudicated “diabetes mellitus” as unfitting and rated it 20%, with likely application of the VA Schedule for Rating Disabilities (VASRD).  The CI made no appeals and was medically separated.

CI CONTENTION:  “Diabetes is very difficult to manage, affects mood and general health daily; illness and stress affect management seriously and complications are inevitable.  In addition, patients with one organ-specific autoimmune disease and the presence of thyroid dysfunction may affect diabetes control. (from Thyroid Disease and Diabetes, XXXXXX, http://journal.diabetes.org) I was recently put on thyroid medication and have symptoms of thyroid problems, in joint pains, menstrual problems, evidence of infertility family history, anxiety and depression, and fatigue.  The nature of both autoimmune disorders indicate that these problems will only get worse and need more medication and attention.”

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 diabetes condition is addressed below.  No other conditions are within the DoDI 6040.44 defined purview of the Board.  Any condition outside the Board’s defined scope of review may be eligible for consideration by the Board for Correction of Military Records.

RATING COMPARISON:

Service PEB – dated 20010727	VA – Service Treatment Record (STR)	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Diabetes Mellitus 	7913	20%	Diabetes Mellitus, Type I	7913	20%	STR	
No Additional MEB/PEB Entries	Other x 5		
Combined:  20%	Combined:  40%	
Derived from VA Rating Decision (VARD) dated 20070505 (most proximate to date of separation [DOS])

ANALYSIS SUMMARY:  The Board acknowledges the sentiment expressed by the CI regarding the impairment with which her conditions continue to burden her and the significant impact they have had on her quality of life.  It is noted for the record that the Board is subject to the same laws for disability entitlements as those under which the Disability Evaluation System (DES) operates.  The DES has neither the role nor the authority to compensate members for future severity or potential complications of conditions.  That role and authority is granted to the Department of Veterans Affairs.  The Board evaluates VA evidence in arriving at its recommendations, but its authority resides in evaluating the fairness of DES fitness and rating determinations at the time of separation.  While the DES considers all of the CI's medical conditions, compensation can only be offered for those conditions that cut short a member’s career, and then only to the degree of severity present at the time of separation.  The VA, however, is empowered to compensate for service-connected conditions and to periodically re-evaluate conditions for the purpose of adjusting the Veteran’s disability rating should the degree of impairment change over time.

Diabetes Mellitus (DM).  In November 2000, the CI developed symptoms of polyuria (increased urination), polydipsia (increased thirst) and weight loss.  She was admitted to the hospital and was diagnosed with DM.  Initially she was treated with oral hypoglycemic medications, but was later switched to insulin.  In 2001, the CI underwent MEB and PEB.  The MEB narrative summary dictated on 10 July 2001, noted that her physical examination was normal and blood pressure was 120/72.  A laboratory evaluation had shown that hemoglobin A1C (HgbA1C) was 10%.  Her treatment plan included insulin and restricted diet.  There was no mention of medically prescribed regulation of activities.  As noted above, the CI was separated in November 2001 with a 20% service disability rating.

The Board directs attention to its rating recommendation based on the above evidence.  The PEB and VA both chose the same coding and rating options for the DM condition.  IAW VASRD §4.119, a rating of 20% is appropriate for DM requiring insulin and restricted diet.  A higher rating of 40% would require medically prescribed regulation of activities.  Regulation of activities is when a licensed healthcare provider prescribes or recommends that a diabetic patient avoid strenuous occupational or recreational activities.  In the CI’s treatment record, there was not sufficient evidence that this was the case.  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 diabetes 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 §4.119, 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 recharacterization of the CI’s disability and separation determination, as follows:

UNFITTING CONDITION	VASRD CODE	RATING	
Diabetes Mellitus	7913	20%	
COMBINED	20%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20130624, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans’ Affairs Treatment Record

		

SAF/MRB

Dear XXXXXXXXXXXXXX:

	Reference your application submitted under the provisions of DoDI 6040.44 (Title 10 U.S.C. §  1554a), PDBR Case Number PD-2013-00912.

	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,

Attachment:
Record of Proceedings