RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXX	CASE:  PD-2014-01834
BRANCH OF SERVICE:  AIR FORCE	BOARD DATE:  20150521
SEPARATION DATE:  20050105

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an activated Air National Guard E-5 (Security Forces Journeyman) medically separated for diabetes.  The condition could not be adequately rehabilitated to meet the physical requirements of his Air Force Specialty.  He was issued a temporary P4 profile and referred for a Medical Evaluation Board (MEB).  The “Type II Diabetes Mellitus” was forwarded to the Physical Evaluation Board (PEB) IAW AFI 48-123.  The MEB also identified and forwarded two other conditions (hypertension and hyperlipidemia) for PEB adjudication.  The Informal PEB (IPEB) adjudicated the diabetes condition as unfitting, rated 20%, citing application of the Department of Defense Instruction (DoDI) 1332.39 and Veterans Affairs Schedule for Rating Disabilities (VASRD).  The remaining conditions were determined to be Category II, a condition that can be unfitting but is not currently compensable or ratable and the remaining hyperlipidemia condition was determined to be Category III, a condition that is not separately unfitting and not compensable or ratable.  The CI made no appeals and was medically separated.

CI CONTENTION:  “Please Consider all Conditions.”

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 20041007	VA* - (~6 Mos. Post-Separation)	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Diabetes Mellitus Type ll	7913	20%	Diabetes Mellitus Type II	7913	20%	20050629	
Hypertension	Cat II	Diabetic Nephropathy with HTN and Arteriosclerotic Heart Disease	7913-7541	30%		
Hyperlipidemia	Cat III	No VA Placement	
Other x0	Other x3	
RATING:  20%	RATING:  70%	
*Derived from VA Rating Decision (VARD) dated 20050927 (most proximate to date of separation)

ANALYSIS SUMMARY:  IAW DoDI 6040.44, the Board’s authority is limited to making recommendations on correcting disability determinations.  The Board reviews medical records and other available evidence to assess the fairness of PEB rating determinations, using the VASRD standards, based on ratable severity at the time of separation; and, to review those fitness determinations within its scope (as elaborated above) consistent with performance-based criteria in evidence at separation.

Diabetes Mellitus Type II.  The CI was found to have diabetes mellitus (DM) during a routine pre-deployment exam in March 2002.  He was initially treated with a two medication combination that was ultimately changed to a different single anti-diabetic medication that seemed to work better.  Over a 2-year period, his diabetic control waxed and waned.  In April 2004 he had an exercise tolerance test that was normal as the CI had “excellent exercise tolerance” and reached >100% of his maximum heart rate.  He was given a profile that allowed him to exercise at his own pace and distance.  The narrative summary prepared almost 4 months prior to separation noted a diagnosis of Type II DM uncontrolled with oral medications.  At the time, the CI was in the Georgia ANG and there was no recent test for long term blood sugar control in the record present for review and there was no evidence of neuropathy.  At the VA Compensation and Pension exam performed 6 months after separation, the CI reported symptoms of neuropathy and other potential complications of DM.  There were no episodes of ketoacidosis noted and no lost time from work caused by his DM.  The pertinent physical exam findings were normal neurologic and vascular exams.  His blood sugar was elevated, his echocardiogram was essentially normal, and his urinalysis showed protein and sugar.  He was diagnosed with Type II DM.

The Board directed attention to its rating recommendation based on the above evidence.  The PEB adjudicated the Type II DM by applying VASRD code 7913 (Diabetes mellitus) and rated it 20% consistent with “requiring insulin and restricted diet, or; oral hypoglycemic agent and restricted diet.”  The VA applied the same coding and rating scheme.  The Board reviewed the VASRD requirements for the next higher 40% rating level in considering its rating recommendation.  That 40% level also requires a “regulation of activities” in addition to the requirements of the 20% level.  The evidence present for review does not support that the CI’s activity was regulated, as he was given a profile for exercise at his own distance and pace.  Considering the totality of the evidence and mindful of VASRD §4.3 (reasonable doubt), Board members agreed that a disability rating of 20% for the DM Type II uncontrolled on oral medications condition was appropriately recommended in this case.

Contended Hypertension and Hyperlipidemia Conditions.  The Board’s main charge is to assess the fairness of the PEB’s determination that the contended hypertension and hyperlipidemia conditions were not unfitting.  The Board’s threshold for countering fitness determinations requires a preponderance of evidence, but remains adherent to the DoDI 6040.44 “fair and equitable” standard.  The contended conditions were not profiled or implicated in the commander’s statement and were not judged to fail retention standards.  All were reviewed and considered by the Board.  There was no performance based evidence from the record that any of these conditions significantly interfered with satisfactory duty performance.  After due deliberation in consideration of the preponderance of the evidence, the Board concluded that there was insufficient cause to recommend a change in the PEB fitness determination for the contended hypertension and hyperlipidemia conditions and so no additional disability ratings are recommended.

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.  As discussed above, PEB reliance on DoDI 1332.39 for rating DM was operant in this case and the condition was adjudicated independently of that instruction by this Board.  In the matter of the DM Type II uncontrolled on oral medications condition and IAW VASRD §4.119, the Board unanimously recommends no change in the PEB adjudication.  In the matter of the contended hypertension and hyperlipidemia conditions, the Board unanimously recommends no change from the PEB determinations as not unfitting.  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 20140428, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

XXXXXXXXXXXXXXXXXXXX
President
Physical Disability Board of Review

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

Dear XXXXXXXXXXXXXXXXXXXX:

Reference your application submitted under the provisions of DoDI 6040.44 (Section 1554, 10 USC), PDBR Case Number PD-2014-01834.

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,

XXXXXXXXXXXXXXXXXXXX
Director
Air Force Review Boards Agency

Attachment:
Record of Proceedings

cc:
SAF/MRBR