RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXX		                                                                 CASE:  PD-2014-01062
BRANCH OF SERVICE:  AIR FORCE 	SEPARATION DATE:  20081001

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E-4 (Security Forces Journeyman) medically separated for diabetes mellitus (DM).  The condition could not be adequately rehabilitated to meet the physical requirements of his Air Force Specialty (AFS).  He was issued a temporary P4 profile and referred for a Medical Evaluation Board (MEB).  The “type 1 diabetes mellitus”  was forwarded to the Physical Evaluation Board (PEB) IAW AFI 48-123.  No other condition was submitted by the MEB.  The Informal PEB adjudicated “diabetes mellitus, Type I, requiring insulin and insulin pump” as unfitting, rated 20%, citing application of the Department of Defense Instruction (DoDI) 1332.39 and the Veterans Affairs Schedule for Rating Disabilities (VASRD).  The CI made no appeals and was medically separated.  

CI CONTENTION:  His condition continues to worsen and negatively impact his daily activities.  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:  

IPEB - Dated 20080730	VA* - (~3 Mos. Pre-Separation)  	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Diabetes Mellitus, Type I, Requiring Insulin and Insulin Pump	7913	20%	Type 1 Diabetes Mellitus	7913	20%	20080624	
Other MEB/PEB Conditions x 0  (Not in Scope)	Other x 2	
RATING:  20%	RATING:  30%	
*Derived from VA Rating Decision (VARD) dated 20090106 (most proximate to date of separation [DOS]).  

ANALYSIS SUMMARY:  

Diabetes Mellitus, Type I, Requiring Insulin and Insulin Pump.  The CI presented on 29 August 2007 with a history of a 55-pound weight loss as well as increased hunger (polyphagia), thirst (polydipsia), and urination (polyuria).  His random blood sugar was elevated and ketones were present in his urine.  He was diagnosed with Type I DM and begun on insulin.  Over the course of the next year, he was stabilized on insulin and his laboratory values improved.  He was never hospitalized for his DM nor did he ever have ketoacidosis although he was ketotic at initial presentation prior to therapy.  The narrative summary (NARSUM) was dated 9 May 2008, 5 months prior to separation.  His HbA1C was 7.5%, indicative of less than optimal control, but reduced from his presentation which was 10.7%.  In February it had been 6.4%.  Less than 6.0% is considered normal.  He showed no complications from diabetes including examinations of the eyes, nerves, kidneys, and cardiovascular system.  Regulation of activities was not recommended.  The final profile allowed him to exercise at his own pace and distance, but did limit him from duties in which sudden incapacitation could be hazardous.  At the VA Compensation and Pension (C&P) examination performed ton 24 June 2008, 3 months before separation, the CI reported hypoglycemia (low blood sugar) about once a week if his meal was delayed and he had taken his insulin.  He denied end organ complications (eyes, nerves, kidneys, and cardiovascular system), but endorsed being more cautious.  His physical examination remained negative for complications from DM.  Regulation of activities was not recorded.  

The Board directed attention to its rating recommendation based on the above evidence.  The PEB and VA both rated the CI at 20%, coded 7913 (diabetes mellitus).  The evidence did not show either regulation of activities or complications from the DM to support a higher rating.  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 Type I DM condition and IAW VASRD §4.120, 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 20140228, 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 XXXXXXXXXXXX:

Reference your application submitted under the provisions of DoDI 6040.44 (Section 1554, 10 USC), PDBR Case Number PD-2014-01062.

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,

XXXXXXXXXXXX
Director
Air Force Review Boards Agency

Attachment:
Record of Proceedings