RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXX	CASE:  PD 13-01127
BRANCH OF SERVICE:  Army	BOARD DATE:  20140114
SEPARATION DATE:  20030821

SUMMARY OF CASE: Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty SPC/E-4 (98GLQB/Voice Intercept Operator) medically separated for diabetes.  The CI was diagnosed with diabetes mellitus (DM), type I in early 2003.  Due to her requirement for treatment with insulin, she could not deploy although she continued to perform well in garrison.  Accordingly, the condition could not be adequately rehabilitated to meet the physical requirements of her Military Occupational Specialty (MOS).  She was issued a permanent P3 profile and referred for a Medical Evaluation Board (MEB).  The condition, characterized as “diabetes type I requiring insulin” was forwarded to the Physical Evaluation Board (PEB) IAW AR 40-501.  The MEB also identified and forwarded an abnormal pap smear for PEB adjudication as medically acceptable.  The Informal PEB adjudicated “diabetes mellitus type I” as unfitting, rated 20%.  The remaining condition was determined to be not unfitting and not rated.  The CI made no appeals, and was medically separated.

CI CONTENTION: “Type I Diabetes.”

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 Service rating for the unfitting diabetes condition is addressed below; no additional conditions are within the DoDI 6040.44 defined purview of the Board.  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 Army Board for Correction of Military Records.

RATING COMPARISON:

Service IPEB – Dated 20030618	VA* - (3 Mos. Post-Separation)	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Diabetes Mellitus, Type I	7913	20%	Diabetes Mellitus, Type I	7913	40%	20031106	
No Additional MEB/PEB Entries	Other x 9	20031106	
Combined:  20%	Combined:  50%	
*Derived from VA Rating Decision (VARD) dated 20040129 (most proximate to date of separation)

ANALYSIS SUMMARY:  

Diabetes Mellitus, Type I. The CI was evaluated on 16 January 2003 for a one month history of polydipsia (excessive thirst), polyuria (excessive urination), but without polyphagia (increased eating.)  She also reported a five pound weight loss and fatigue.  DM was suspected and a fasting blood sugar was 210, well above normal.  Type I DM, was diagnosed, confirmed by serologic testing, and she was begun on insulin and a diabetic diet and entered into the MEB process.  During the stabilization process, she was excused from physical fitness training.  This is a normal precaution for newly diagnosed diabetics.  Diabetic complications such as retinopathy (damage to the retina of the eye), neuropathy (damage or disease affecting nerves), and nephropathy (damage to or disease of a kidney) were not present.  The narrative summary (NARSUM) noted that the CI had not had any episodes of diabetic ketoacidosis (DKA) or when the human body cannot use sugar (glucose) as a fuel source because there is no insulin or not enough insulin.  On physical examination, the funduscopic (eye exam) and neurological (nervous system) examinations were normal.  Laboratory values, including renal (kidney) function tests, were normal other than a blood sugar of 203.  It was determined that she did not meet retention standards secondary to the use of insulin for control of DM and she was issued a permanent P3 profile.  Restrictions included no operations of heavy machinery, trucks, (and) aircraft (or) working at heights.  No scuba diving.  No formal PT when (her) blood glucose was greater than 250.  At that time, these restrictions were typical of those given to anyone with DM requiring insulin.

At the VA Compensation and Pension (C&P) examination performed just under three months after separation, the CI reported that she had never been hospitalized for DM nor had there been a history of DKA.  She had hypoglycemic (abnormally low levels of blood sugar) episodes several times a week.  She did not have a caloric restriction and denied complications.  No regulation of activities was documented.  On examination, her funduscopic and neurological examinations were unremarkable.  The Board did note that on an 8 November 2012 DM questionnaire, the examiner specifically answered “no” to the question of regulation of activities.  The Board directed attention to its rating recommendation based on the above evidence.  The PEB and VA both coded the condition as 7913, diabetes mellitus, and rated it at 20% and 40%, respectively.  The difference between the two ratings hinges upon “regulation of activities.”  The Board found no evidence that any activities were limited beyond those limitations given to anyone on insulin.  Hence, the criteria for the higher 40% rating were determined by the Board to have not been met.  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 §4.119, 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, Type I	7913	20%	
COMBINED	20%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20130813, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans’ Affairs Treatment Record

SFMR-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 XXXXXXXXXXXXXXXXXXXXXXXXX, AR20140005197 (PD201301127)

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