RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXX	CASE:  PD-2014-00151
BRANCH OF SERVICE:  Army	BOARD DATE:  20150225
Separation Date:  20071009

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was a National Guard E-7 (Human Resources Specialist) medically separated for diabetes.  The condition could not be adequately rehabilitated to meet the physical requirements of his Military Occupational Specialty.  He was issued a permanent P3 profile and referred for a Medical Evaluation Board (MEB).  The MEB forwarded “Adult onset diabetes mellitus, on Insulin” to the Physical Evaluation Board (PEB) IAW AR 40-501.  The MEB also forwarded five other conditions as meeting retention standards, for further consideration by the PEB.  The PEB adjudicated “Diabetes Mellitus Type II requiring insulin” as unfitting, rated 20%, with likely application of the Veterans Affairs Schedule for Rating Disabilities (VASRD).  The remaining conditions were determined to be not unfitting.  The CI made no appeals and was medically separated.

CI CONTENTION:  On his application, the CI elaborated a lengthy contention for his diabetes condition, including specific requests for medical retirement and to be permitted to complete 20 years of active duty service.  His complete submission is at Exhibit A.

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 when specifically requested by the CI, those conditions identified by the PEB, but determined to be not unfitting.  Any conditions outside the Board’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/Naval Records.  Furthermore, the Board’s authority is limited to assessing the fairness and accuracy of PEB rating determinations and recommending corrections, where appropriate.  The Board’s assessment of the PEB rating determinations is confined to review of medical records and all available evidence for application of the Veterans Affairs Schedule for Rating Disabilities (VASRD) standards to the unfitting medical condition at the time of separation.  The Board has neither the role nor the authority to compensate for post-separation progression or complications of service-connected conditions.  That role and authority is granted by Congress to the Department of Veterans Affairs, operating under a different set of laws.  The Board gives consideration to VA evidence, particularly within 12 months of separation, but only to the extent that it reasonably reflects the severity of the disability at the time of separation.

RATING COMPARISON:

Service IPEB – Dated 20070524	VA - (~2Mos. Post-Separation)	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Diabetes Mellitus Type II	7913	20%	Diabetes Mellitus Type II	7913	20%	20071220	
Other x5 (Not In Scope)	Other X 11	
Combined:  20%	Combined 80%	
Derived from VA Rating Decision (VARD) dated 20080201 (most proximate to date of separation [DOS])

ANALYSIS SUMMARY:

Diabetes Mellitus (DM) Type II Condition.  The CI presented with elevated fasting blood sugars of 117 and 120 (normal blood sugar 70-110) in 1996.  The examiner documented that the CI initially had two elevated blood sugars on glucose tolerance testing; however, his fasting blood sugars has since normalized.  Based on that, the examiner opined that his results most likely represented a glucose intolerance and not diabetes.  He recommended that the glucose intolerance could be completely controlled by diet and exercise.  Over the next 6 years, the CI’s blood sugar control worsened, he was diagnosed with diabetes and worsened to the point that he required insulin.  The finger stick log for the month of June-July 2005 showed morning finger sticks that ranged from 41-214.  The primary care provider (PCP) documented a fasting blood sugar of 103 and the CI reported feeling much better.  The PCP changed the insulin, ordered a carbohydrate count and continued the finger stick log.  The CI was reevaluated in May 2006 and the PCP noted glycosolated hemoglobin (HgbA1C) of 8.1 (normal 4.6-6.4).  The PCP changed the insulin and recommended finger sticks four times daily.  The CI’s commander documented that the CI maintained a rigorous fitness routine stating, “[Applicant] is a physically fit NCO who maintains a rigorous fitness routine which includes daily basketball games during lunch periods and normal physical fitness three times a week.”  The MEB narrative summary exam approximately 5 months prior to separation documented that the CI had an HgbA1c that ranged from 8% to 13% with multiple urinalyses positive for glycosuria and a glucose as high as 279.  According to the examiner, the CI did not have significant protein at this time.  The CI was compliant with his insulin medication regime.  The examiner further noted that the CI should not do a 2-mile run as part of the Army physical fitness test; however, he could do sit-ups, and push-ups; running at own pace and distance and unlimited walking, biking and swimming.  The VA Compensation and Pension exam 2 months after separation documented that the CI was continued on insulin and he had no hospitalizations for hypoglycemia or ketoacidosis within the past year.  The HgbA1C was 9.5 which indicated poor diabetes control.  The examiner notified the CI who agreed to follow-up with his PCP for further management.

The Board directed attention to its rating recommendation based on the above evidence.  The PEB coded the condition using VASRD code 7913 (DM Type II) and rated the condition at 20% consistent with requiring insulin and restricted diet, or; oral hypoglycemic agent and restricted diet.  The VA used the same coding and rating for the DM Type II condition.  There was ample documentation in the treatment record that the CI was using insulin medication as directed and following a restricted diet.  The MEB examiner documented that the CI required “reasonable flexibility with his diet” as he could not eat MRE’s (meals ready to eat) for more than 7 days.  The Board considered the 40% rating criteria of requiring insulin, restricted diet, and regulation of activities; however, the MEB examiner documented that although the CI should not do unlimited running, he could do unlimited walking, biking, swimming; sit-ups, and push-ups; and running at own pace and distance.  Additionally, the CI’s commander indicated that the CI “…maintained a rigorous fitness routine…” which indicated there was no regulation of activities.  Regulation of activities is required for the next higher 40% rating under code 7913.  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 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 DM Type II condition and IAW VASRD §4.121a, 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 20131231, 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 XXXXXXXXXXXXXXXXXXXX, AR20150014343 (PD201400151)

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