RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXX                                                                            CASE:  PD-2013-01648
BRANCH OF SERVICE:  AIR FORCE                                                               BOARD DATE:  20140716
Separation Date:  20040608

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty A1C/E-3 (2W051/Munitions Specialist) medically separated for Diabetes Mellitus, Type II.  The condition could not be adequately rehabilitated to meet the physical requirements of his Air Force Specialty (AFS) or satisfy physical fitness standards.  He was issued a P4 profile and referred for a Medical Evaluation Board (MEB).  No other conditions were submitted by the MEB.  The informal PEB adjudicated the Diabetes Mellitus, Type II requiring insulin, condition as unfitting and rated it at 20% citing the Veterans Affairs Schedule for Rating Disabilities (VASRD).  The PEB adjudicated obesity as a Category III condition, not separately unfitting and not compensable.  The CI made no appeals and was medically separated.

CI CONTENTION:  The CI elaborated no specific contention in his application.

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 Mellitus, Type II condition is addressed below; no additional conditions are within the Board’s defined DoDI 6040.44 purview.  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 20040408	VA - (Exam ~ 1 Mo. Pre-Separation)	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Diabetes Mellitus, Type II …	7913	20%	Type II Diabetes with Diabetic Retinopathy	7913	20%	20040510	
Obesity	Category III	Other x2	20040510 	
No Additional MEB/PEB Entries			
Combined:  20%	Combined:  30%	
Derived from VA Rating Decision (VARD) dated 20040820 (most proximate to date of separation)

ANALYSIS SUMMARY:

Diabetes Mellitus, Type II Condition.  The CI had a long history of Diabetes Type II as evidenced by the numerous notes in the service treatment record.  He was first diagnosed with diabetes in 2001 and was initially controlled by diet and exercise.  He was seen by endocrinology because he had his first failure on the weight management program.  He started on a modified Atkins diet in June and was seen in follow up by endocrinology in July 2002 who noted that the blood sugars were less than 100 in the morning and less than 110 in the evening.  The endocrinologist documented that the CI had lost 5 pounds, from 210 pound to 205 pounds, with the glycosylated hemoglobin (HgbA1C) at 6.3 and blood glucose 103 (normal 75-110) and he was advised to continue the Atkins diet and check his finger sticks after each meal.  The CI had an 8 pound weight gain because he stopped the Atkins diet 2 weeks prior to this appointment.  The endocrinologist started him on an oral hypoglycemic (Metformin).  The finger sticks before dinner were 70 to 80.  The CI’s diabetes was poorly controlled in August 2003 with fasting glucose 160 and ranges from 160 to 180 in the evening.  A diabetic group checklist documented an HgbA1C on 25 July 2002 at 6.3 (normal 4-6%) and on 6 August 2003 at 8.8.  The internal medicine provider documented that the diabetes was poorly controlled and changed the oral hypoglycemic to Glipizide as the CI could not tolerate the Metformin or the Avandia.  The HgbA1C was 10.0 on 18 November 2003 and the provider started insulin therapy.  The CI continued to have a poor response to insulin with finger sticks in the 200’s and required additional insulin titration.  He was seen by a nutritionist and attended, which noted that although the CI was a highly competent person and a valuable asset to the flight, his diabetes interfered with him fulfilling his wartime and peacetime requirements as he could not deploy.  The CI was given a temporary P4 Profile.  The MEB narrative summary exam approximately 2 months prior to separation documented that the CI had an HgbA1C of 10.0 and because the diabetes was poorly controlled, the CI would require larger doses of insulin to control his diabetes resulting in even more weight gain.  The VA Compensation and Pension exam approximately a month prior to separation documented that the CI’s diabetes required an oral hypoglycemic twice a day, insulin daily and a novo pen 3 times a day.  The examiner opined that the CI had no restriction of activity from the diabetes and there was no functional impairment from the condition.  The CI had no episodes of ketoacidosis and no complications of diabetes such as problems with vision, kidneys, skin, neuropathy, impotence or arterial disease.

The Board directs attention to its rating recommendation based on the above evidence.  The PEB coded the Diabetes Mellitus, Type II condition as 7913 and rated at 20%.  The VA coded the Type II Diabetes with Diabetic Retinopathy as 7913 and rated at 20%.  The CI had poorly controlled diabetes and required combination therapy of oral hypoglycemic, insulin and a novo pen.  The CI had no episodes of ketoacidosis.  The VA examiner documented there was no restriction of activity from the diabetes.  The Board considered the 20% rating criteria (requiring insulin and restricted diet, or; oral hypoglycemic agent and restricted diet) versus 40% criteria (requiring insulin, restricted diet, and regulation of activities).  While the CI required insulin and a restricted diet, there was no regulation of activities.  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 Mellitus, Type II 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 Diabetes Mellitus, Type II condition and IAW VASRD §4.121, 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 20130927, 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-2013-01648

	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.

							

Attachment:
Record of Proceedings