RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXXX	CASE:  PD-2014-01734
BRANCH OF SERVICE:  Army	SEPARATION DATE:  20080311

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty, E4, Bradley Fighting Vehicle Systems Maintainer, medically separated for “diabetes type I, on insulin therapy” with a disability rating of 20%.  

CI CONTENTION:  The applicant contends he should have received 40% disability rating “due to uncontrolled diabetes and hospitalization.”  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:  

PDA Admin Correction - 20090227	VARD - 20080715	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Diabetes Type I, on Insulin Therapy	7913	20%	Diabetes Mellitus Type I	7913	20%	20080409	
RATING:  20%	COMBINED RATING OF ALL VA CONDITIONS:  70%	

ANALYSIS SUMMARY:  

Diabetes Type I.  According to the service treatment record and Medical Evaluation Board narrative summary (NARSUM) the CI developed diabetes mellitus in 2004 and was treated with oral medication.  Insulin and additional regulation of diet were started with an April 2007 hospitalization for ketoacidosis (very high glucose levels).  The NARSUM dated 27 August 2007 (6 months prior to separation) indicated that the CI was on short-acting and ultra-long acting insulin.  There had been one episode of loss of consciousness due to unawareness of hypoglycemia.  The CI had not reached his glycosylated hemoglobin target (HgbA1C indicated longer term glucose control), but was considered stable for rating.  The CI was reported to be performing 3-4 hours of cardiovascular exercise per week and was allowed to walk or run at own pace.  The examiner indicated there was no evidence of diabetic complication and did not indicate that the CI had to regulate his physical activities.  

At the VA Compensation and Pension exam performed 9 April 2008, a month after separation, the CI reported hospitalization in 2007 for regulation of diabetes, and 1-2 hospitalizations per year due to episodes of hypoglycemia or ketoacidosis.  The CI was on a restricted diet and using insulin.  The CI reported symptoms of shortness of breath, syncope, dizziness, visual field loss, dizzy spells, paresthesia’s, pain, dysesthesia, skin rash on arms and body and decreased libido.  Exam documented normal cardiac, ocular, peripheral nerve and skin exams.  The examiner indicated that poor distance vision was due to diabetes when out of control, and was considered a complication of diabetes.  There was no indication of regulation of activities.  

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 insulin therapy and diet restriction.  The VA also assigned a 20% rating using the 7913 code, citing restricted diet and insulin.  The Board agreed that the requirement for insulin 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.  

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 20140422, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

MEMORANDUM FOR Commander, US Army Physical Disability Agency 
(AHRC-DO), 2900 Crystal Drive, Suite 300, Arlington, VA  22202-3557

SUBJECT:  Department of Defense Physical Disability Board of Review Recommendation for XXXXXXXXXXXXXXXXXXXXX AR20160006822  (PD201401734)

I have reviewed the enclosed Department of Defense Physical Disability Board of Review (DoD PDBR) recommendation and record of proceedings pertaining to the subject individual.  Under the authority of Title 10, United States Code, section 1554a, I accept the Board’s recommendation and hereby deny the individual’s application.  
This decision is final.  The individual concerned, counsel (if any), and any Members of Congress who have shown interest in this application have been notified of this decision by mail.

 BY ORDER OF THE SECRETARY OF THE ARMY:

Enclosure

CF: 
(  ) DoD PDBR
(  ) DVA