RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME: XXXXXXXXXXXXXXXXXXX	CASE:  PD-2014-00524
BRANCH OF SERVICE:  navy	SEPARATION DATE:  20071123

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E-5 (Gas Turbine Systems Technician) medically separated for Diabetes Mellitus, Type II.  The condition could not be adequately rehabilitated to meet the physical requirements of his Rating.  He was placed on limited duty (LIMDU) and referred for a Medical Evaluation Board (MEB).  The “diabetes mellitus without mention of complication, type II…uncontrolled” condition was forwarded to the Physical Evaluation Board (PEB) IAW SECNAVINST 1850.4E.  No other condition was submitted by the MEB.  The Informal PEB (IPEB) met on 13 July 2007 and adjudicated “diabetes mellitus, type II, uncontrolled” as a category I condition (unit and ratable) unfitting, rated 20% with application of the Veterans Affairs Schedule for Rating Disabilities (VASRD).  The IPEB also added three additional conditions (allergic rhinitis, obstructive sleep apnea [OSA], and hypertension) as category III conditions (conditions that are not separately unfitting and not contributing to the unfitting condition).  The CI submitted a rebuttal and a second Reconsideration IPEB met on 8 August 2007 and affirmed the initial IPEB rating.  The CI made no further appeals and was medically separated.  

CI CONTENTION:  The CI contended that his VA rating was higher than his Navy PEB rating and he requests 100% and medical retirement.  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 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:  

Recon IPEB - Dated 20070808	VA* - (~1 Mo. Pre-Separation)  	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Diabetes Mellitus, Type II,  Uncontrolled	7913	20%	Diabetes Mellitus, Type I2	7913	20%	20071012	
Allergic Rhinitis	Not Unfitting
Category III	Allergic Rhinitis	6522	10%	20071012	
OSA	Not Unfitting
Category III	Sleep Apnea as Primary Snoring and Sleep Apnea with CPAP	6847	50%	20071012	
Hypertension	Not Unfitting
Category III	Hypertension	7101	0%	20071012	
Other MEB/PEB Conditions x 0 (Not in Scope)	Other x 10	
RATING:  20%	RATING:  80%	
*Derived from VA Rating Decision (VARD) dated 20080324 (most proximate to date of separation (DOS)).  Code 7101 increased to 10% by VARD dated 20120518, effective 20071124, based on Service records.  

ANALYSIS SUMMARY:  

Diabetes Mellitus, Type II Condition.  The narrative summary (NARSUM) and treatment records noted that the CI was diagnosed with diabetes mellitus in 2006.  The CI was started on oral hypoglycemic medication and long acting insulin, which did not adequately control his blood glucose levels.  Additional oral hypoglycemic agents and addition of “sliding scale” regular insulin along with diet and nutritional management did not lead to consistent good control.  The MEB physical exam noted that the CI was healthy appearing with a blood pressure well controlled and a normal cardiovascular and lung exam with all other systems normal.  In the CI’s PEB rebuttal statement he complained of restricted activities, easy fatigability, hypoglycemic episodes, complications from his diabetes, and frequent medical visits to try to control his diabetes.  

At the VA Compensation and Pension (C&P) exam performed a month before separation, the CI reported two hospitalizations in the past year for high blood sugar, 12 times of low blood sugar requiring possible treatment and seeing his doctor about 30 times a year.  Symptoms included loss of strength, numbness and tingling, abnormal sensation, itching skin, and headaches.  He reported urinating twice an hour during the day and night.  Heart and extremity exams were normal without evidence of any focal neurologic or vascular deficit.  Glucose was 159 (high).  The examiner indicated that there was no effect “on the eyes, heart, skin, arteries, kidneys, neurologic system, and no impotency,” and no restriction of activities due to diabetes.  

The Board directed its attention to its rating recommendation based on the above evidence.  Both the PEB and VA rated the CI at 20% coded 7913 (diabetes mellitus).  There were no hospital admissions or emergency department visits for diabetic ketoacidosis or hypoglycemia located in the record.  There was no evidence of prescribed regulation of activity related to diabetes.  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 condition.  

Contended PEB Conditions.  The Board’s main charge is to assess the fairness of the PEB’s determination that allergic rhinitis, OSA, and hypertension were not unfitting.  The Board’s threshold for countering fitness determinations requires a preponderance of evidence, but remains adherent to the DoDI 6040.44 “fair and equitable” standard.  None of the contended conditions were mentioned on LIMDUs, implicated in the NMA commander’s statement, or referred by the MEB.  All contended conditions were reviewed and considered by the Board.  The CI was taking prescribed allergy medications for allergic rhinitis, and medications for hypertension with fairly good control.  The CI was initially seen for snoring and daytime sleepiness in May 2007 and OSA was diagnosed by a sleep study in June 2007 and treated with CPAP (continuous positive airway pressure).  A repeat sleep study demonstrated a good response to CPAP.  Routinely OSA is not considered unfitting solely on the basis of field and operational impediments to the use of CPAP.  The CI did complain of continued day time sleepiness and use of naps even following use of CPAP, however, there was no evidence in this case that there was any functionally significant impairment.  There was no performance based evidence from the record that any of these conditions significantly interfered with satisfactory duty performance.  After due deliberation in consideration of the preponderance of the evidence, the Board concluded that there was insufficient cause to recommend a change in the PEB fitness determination for the any of the contended conditions and so no additional disability ratings are recommended.  

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 condition and IAW VASRD §4.119, the Board unanimously recommends no change in the PEB adjudication.  In the matter of the contended allergic rhinitis, OSA, and hypertension conditions, the Board unanimously recommends no change from the PEB determinations as not unfitting.  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 20140102, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

MEMORANDUM FOR DIRECTOR, SECRETARY OF THE NAVY COUNCIL OF REVIEW
               BOARDS 

Subj:  PHYSICAL DISABILITY BOARD OF REVIEW (PDBR) RECOMMENDATIONS
 
Ref:   (a) DoDI 6040.44
       (b) CORB ltr dtd 22 Dec 15

      In accordance with reference (a), I have reviewed the cases forwarded by reference (b), and, for the reasons provided in their forwarding memorandums, approve the recommendations of the PDBR that the following individual’s records not be corrected to reflect a change in either characterization of separation or in the disability rating previously assigned by the Department of the Navy’s Physical Evaluation Board:

- XXXXXXXXXXXXXXXXXXXX former USN
- XXXXXXXXXXXXXXXXXXXX former USN
- XXXXXXXXXXXXXXXXXXXX former USN  
- XXXXXXXXXXXXXXXXXXXX former USN
- XXXXXXXXXXXXXXXXXXXX former USN
- XXXXXXXXXXXXXXXXXXXX former USN 
- XXXXXXXXXXXXXXXXXXXX former USN

						  XXXXXXXXXXXXXXXXXXXX
	     				  Assistant General Counsel
						  (Manpower & Reserve Affairs)