RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXX	CASE:  PD-2014-01354
BRANCH OF SERVICE:  Air Force 	SEPARATION DATE:  20091229

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E4, Health Service Management Journeyman, medically separated for “diabetes mellitus (DM) type I” with a disability rating of 20%.  

CI CONTENTION:  “I have developed secondary diagnoses of Hyperthyroidism and Hyperlipidemia related to my type I diabetes.  I am currently taking medications 5-7 times daily due to these diagnoses.” The CI’s complete submission is at Exhibit A.  

SCOPE OF REVIEW:  The Board’s scope of review is defined in DoDI 6040.44.  It is limited to those conditions determined by the Physical Evaluation Board (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 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 - 20090914	VARD - 20100225	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Diabetes Mellitus (DM) Type I	7913	20%	Diabetes Mellitus I	7913	20%	20090609	
COMBINED RATING:  20%	COMBINED RATING OF ALL VA CONDITIONS:  30%	

ANALYSIS SUMMARY:  

Diabetes Mellitus Type I Condition.   The CI developed type I diabetes mellitus in October 2008.  The CI initially went to the emergency department in early October 2008 with complaints of excessive thirst and hunger, passage of large volumes of dilute urine, nausea, and blurred vision.  He was hydrated intravenously and started on insulin.  The CI continued insulin treatment and was referred to nutritional medicine for dietary regulation.  Despite treatment, the diabetes condition could not be adequately rehabilitated to meet the physical requirements of the CI’s military specialty, so he was referred for a Medical Evaluation Board (MEB).  The MEB forwarded “diabetes mellitus, type I” for PEB adjudication.  The MEB narrative summary (NARSUM) examination on 22 December 2008, 12 months prior to separation, noted that the CI had been prescribed insulin.  The examiner did not indicate that avoidance of strenuous occupational and recreational activities was medically necessary.  Review of the service treatment record (STR) showed no hospitalizations for treatment of ketoacidosis or hypoglycemia.  There was also no evidence of twice monthly visits to a diabetic care provider and diabetic complications.  The VA Compensation and Pension (C&P) evaluation on 9 June 2009 (6 months before separation) reported that the CI was taking insulin.  The CI reported a history of ketoacidosis, but no episodes of ketoacidosis or hypoglycemic reaction that required treatment in the previous year.  Additionally, the CI indicated the diabetes did not cause any functional impairment. The examiner indicated that avoidance of strenuous occupational and recreational activities was not medically necessary. Physical examination was normal showing no evidence of retinopathy, neuropathy, or other complications of diabetes.  At an endocrine evaluation on 15 July 2009 the CI reported dizziness with exercise, especially running. He reported post exercise blood sugar levels (hypoglycemia) in the 80s and 90s.  The endocrinologist recommend no running or exercises during the day due to increased risk of hypoglycemia.  

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the diabetes condition 20% (coded 7913) citing treatment with insulin and restricted diet, with no regulation of activities.  The VA rated the diabetes condition 20% (coded 7913) citing the same criteria as the PEB.  The Board agreed that the requirement for treatment with insulin and restricted diet justified a 20% rating.  The Board noted the recommendation for exercise restriction due to increased risk of hypoglycemia; however, there was no evidence of medically prescribed regulation of activities; therefore, the next higher 40% rating was not justified.  Furthermore, there was no evidence of episodes of ketoacidosis or hypoglycemic reactions requiring hospitalizations or frequent visits to a diabetic care provider; or diabetic complications that support higher ratings.  

BOARD FINDINGS:  In the matter of the diabetes type I 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 20141205, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

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

Dear XXXXXXXXXX:

Reference your application submitted under the provisions of DoDI 6040.44 (Section 1554, 10 USC), PDBR Case Number PD-2014-01354.

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