RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXX	CASE:  PD-2014-00897
BRANCH OF SERVICE:  AIR FORCE 	SEPARATION DATE:  20080815

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E-3 (Maintenance Management Analysis Journeyman) medically separated by the Informal Physical Evaluation Board (PEB) for “diabetes mellitus, type II, not requiring insulin” with a disability rating of 20%.  

CI CONTENTION:  The applicant makes no specific contention in her application.  Her 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 PEB - 20080612	VARD - 20090903	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Diabetes Mellitus, Type II, not Requiring Insulin	7913	20%	Diabetes Mellitus Type II	7913	20%	20090421	
RATING:  20%	COMBINED RATING OF ALL VA CONDITIONS:  30%	

ANALYSIS SUMMARY:  

Diabetes Mellitus, Type II.  The CI developed type II diabetes mellitus in 2007 which ultimately required treatment with oral antidiabetic medication and dietary restriction (without requirement for insulin).  According to the MEB evaluation on 11 April 2008, 4 months prior to separation, the examiner noted that the CI was doing well on two oral medications (Metformin and Januvla), and her daily fasting blood sugar levels had declined to an average of 115, and an average of 185 after meals (acceptable levels).  Her hemoglobin A1c had declined to 7.1 by February 2008 (indicating adequate longer-term glucose control).  The CI had lost about 8 pounds with diet and exercise, and the diagnosis did not limit her duty performance in any way.  The examiner did not indicate that avoidance of strenuous occupational and recreational activities was medically necessary.  At the VA Compensation and Pension examination on 21 April 2009, 8 months after separation, the examiner noted that the CI had no episodes of ketoacidosis or hypoglycemic reactions requiring hospitalization, and did not follow a restricted diet.  She had no restrictions related to her diabetes.  Oral medications included Glipizide and Byetta.  Review of the service treatment record showed no hospitalizations for treatment of ketoacidosis or hypoglycemia.  There was also no evidence of twice monthly visits to a diabetic care provider and no diabetic complications.  

The Board directed attention to its rating recommendation based on the above evidence.  The PEB assigned a 20% rating under the 7913 code (diabetes mellitus) citing risk of diabetic complications, and limited ability to deploy.  The VA also assigned a 20% rating using the 7913 code (diabetes mellitus) based on the VA C&P examination 8 months after separation, citing use of an oral hypoglycemic agent for control.  The Board agreed that the requirement for an oral hypoglycemic agent and restricted diet justified a 20% rating.  Because there was no evidence of medically prescribed regulation of activities, no higher rating was supported.  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.  

BOARD FINDINGS:  In the matter of the diabetes mellitus 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.  

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 20140221, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

SAF/MRB
1500 West Perimeter Road, Suite 3700
Joint Base Andrews, MD  20762

Dear XXXXXXXXXXXXXXX:

Reference your application submitted under the provisions of DoDI 6040.44 (Section 1554, 10 USC), PDBR Case Number PD-2014-00897.

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