RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXX	CASE:  PD-2014-01466
BRANCH OF SERVICE:  AIR FORCE	BOARD DATE:  20141003
SEPARATION DATE:  20090426

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty Air Force SSgt/E-5 (1C072/Aviation Resource Management Craftsman) medically separated for diabetes mellitus (DM), Type II, uncontrolled.  The condition could not be adequately rehabilitated to meet the physical requirements of her Air Force Specialty or satisfy physical fitness standards.  She was issued a P4 profile and referred for a Medical Evaluation Board (MEB).  The DM, Type II, uncontrolled condition characterized as “Diabetes Mellitus Type II” and was forwarded to the Physical Evaluation Board (PEB) IAW AFI 48-123.  No other conditions were submitted by the MEB.  The Informal PEB adjudicated “diabetes Type II” as unfitting, rated 20%, referencing the Veterans Affairs Schedule for Rating Disabilities (VASRD).  The CI appealed to the Formal PEB (FPEB), which affirmed the IPEB finding(s) and rating(s), and the CI was medically separated.

CI CONTENTION:  “Diabetes is a progressive disease.  I was diagnosed with Sleep Apnea about six months ago by Dr. XXXXX at the Brain Institute of XXXXXXXXX.  He has suggested that I must have had on active duty.  Sleep apnea can have a huge impact on fluctuating blood sugars.  I have also suffered through depression since discharge.  I would have given my life for my country.  Please allow me to at least have my retirement.” 

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 those conditions identified but not determined to be unfitting by the PEB when specifically requested by the CI.  The rating for the unfitting DM, Type II, uncontrolled condition is addressed below; and, no additional conditions are within the DoDI 6040.44 defined purview of the Board.  Any conditions or contention not requested in this application, or otherwise outside the Board’s defined scope of review, remain eligible for future consideration by the Board for Correction of Military Records.

RATING COMPARISON:

Service FPEB – Dated 20090123	VA - (3 Mos. Post-Separation)  	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Diabetes Mellitus, Type II, Uncontrolled	7913	20%	Type II Diabetes Mellitus	7913	20%	20090609	
Other x 0 (Not in Scope)	Other x 12 	20090609	
Combined:  20%	Combined:  60%	
Derived from VA Rating Decision (VARD) dated 20091022; correction of VARD dated 20090710 most proximate to date of separation [DOS].

ANALYSIS SUMMARY:

Diabetes Mellitus, Type II, Uncontrolled, Condition:  The narrative summary (NARSUM) and record indicated that the CI had a history of Type II DM in 2004 since April 2004 and was tolerating oral medications well.  She had been on duty limitations (ALC-C – AF Form 469, Duty Limiting Condition Report [DLC]) for multiple years with multiple follow-ups.  The DLC dated July 2008 was ALC-C3 and required specialty consultation reports.  The CI was still taking oral medications only (no injected insulin) and had undergone surgery in March 2008 (Abdominoplasty) with continued high blood sugar levels (glucose 262 with normal 74-106) and high Glycosolated hemoglobin levels (A1C 9.5 with normal 4.2-7.0).  She sometimes had mid-afternoon episodes of hypoglycemia (low sugar), which went away after eating a snack.  She had not needed hospital visits due to those episodes.  She was able to accomplish her normal duties, was not deployable and her prognosis was considered to be good.  The treatment plan was “considering the likely need for the addition of lantus (insulin) injections …”

At the MEB exam, the CI reported no DM-related symptoms and exam demonstrated consistent high glucose and A1C levels.  There was no diabetic retinopathy (eye findings), no peripheral nerve abnormalities and all other tests for significant DM-related end organ damage were negative.  The CI had no restrictions from fitness testing or unit physical training.  The CI was found unfit for duty due to DM with “chronically poor control of your diabetes in spite of near maximum dosages of medications, inability to consistently lower your weight to ideal levels …: be stationed near a facility with emergency services to prevent aggravation of symptoms … and … increased risk of complications.”  The supporting documents for the FPEB noted the CI’s desire and supervisory and commander’s support for continuation on duty.

At the VA Compensation and Pension exam performed 2 months after separation, the CI reported taking oral DM medications without prior DM-related hospitalizations.  The examiner noted the high glucose and A1C levels and noted no other DM-related physical findings.  The CI included a memo from her physician dated 26 March 2014 which indicated that her DM “has proven difficult to control using multiple medication regimens including large amounts of insulin.  Due to consistently elevated blood sugars she is having symptoms of paresthesias, pain, fatigue, and gastrointestinal problems that are getting progressively worse …”

The Board directs attention to its rating recommendation based on the above evidence.  The FPEB rated the DM condition at 20% and the VA final DM rating was also 20%.  The CI had restricted diet and required oral hypoglycemic agents.  The Board considered that even if the CI’s chronically high glucose and A1C levels were interpreted as “required insulin,” that would not warrant a rating higher than 20%.  There was no indication in the record for required regulation of activities, multiple hospitalizations, frequent visits to a diabetic care provider, or significant diabetic residuals to warrant any rating higher than 20% proximate to separation.  The CI’s medical condition in 2014, nearly 5 years after separation, was considered post-separation worsening and not indicative of her disability level at the time of separation.

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, uncontrolled condition.  The Board concluded therefore that this condition could not be recommended for additional disability rating.

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, Uncontrolled 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.

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 20140325, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans’ Affairs Treatment Record

		
XXXXXXXXXXXXXX
President
Physical Disability Board of Review

SAF/MRB

Dear XXXXXXXXXXXXXX:

Reference your application submitted under the provisions of DoDI 6040.44 (Title 10 U.S.C. § 1554a), PDBR Case Number PD-2014-01466.

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,

XXXXXXXXXXXXXX
Director
Air Force Review Boards Agency

Attachment:
Record of Proceedings