RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXX	CASE:  PD-2014-01897
BRANCH OF SERVICE:  Army	BOARD DATE:  20150113
SEPARATION DATE:  20060615

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E-4 (Air and Missile Defense Crewmember) medically separated for diabetes.  The condition could not be adequately rehabilitated to meet the physical requirements of his Military Occupational Specialty (MOS). He was issued a permanent P3 profile and referred for a Medical Evaluation Board (MEB).  The condition, characterized as “insulin dependent diabetes mellitus,” (DM) was forwarded to the Physical Evaluation Board (PEB) IAW AR 40-501.  The MEB also identified and forwarded two other conditions (fatty liver and hyperlipidemia) for PEB adjudication.  The Informal PEB adjudicated his condition as unfitting and rated it at 20%, with application of the VA Schedule for Rating Disabilities (VASRD).  The remaining conditions were determined to be not unfitting.  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 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 IPEB – Dated 20060426	VA - (2 Months Post-Separation)  	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Diabetes Mellitus, Type I	7913	20%	Type 1 Diabetes Mellitus	7913	20%	20060826	
Fatty Liver	Not Unfitting	No VA Entry	
Hyperlipidemia	Not Unfitting	No VA Entry	
Other x 0 (Not In Scope)	Other x 0	
Combined:  20%	Combined:  20%	
Derived from VA Rating Decision (VARD) dated 20060907 (most proximate to date of separation [DOS]).

ANALYSIS SUMMARY:

Diabetes Mellitus, Type I.  The CI developed Type I insulin dependent DM in August/September 2005 and was hospitalized for initial diagnosis and treatment.  His insulin dose was adjusted following release from the hospital to accommodate activity levels.  By the time of the Internal Medicine evaluation on 7 March 2006, his diabetes was controlled with diet and insulin.  He was noted to be exercising regularly.  There were no “significant hypoglycemic episodes” (very low blood sugar with severe symptoms) since the beginning of his treatment, and “none recently.”  The MEB narrative summary (NARSUM) also noted control of diabetes with insulin.  The NARSUM noted there had not been any episodes of hypoglycemia in the record and that he was tolerating a moderate level of physical exertion.  There had been no hospitalizations or emergency department visits since initial diagnosis.  Physical examinations were normal.  Laboratory testing was negative for evidence of diabetic kidney problems and ophthalmology examination was negative for evidence of diabetic retinopathy.  At the VA Compensation and Pension examination on 26 August 2006, 2 months after separation, blood sugars were well controlled with insulin treatment without side-effects.  There was no evidence of neuropathy, nephropathy, or retinopathy.  The CI was recently employed without any occupational activity limitations.

The Board directed attention to its rating recommendation based on the above evidence.  Both the PEB and the VA rated the Type I DM 20% (coded 7913) citing insulin and diet for control.  The determining factor for the next higher rating of 40% is the presence of regulation of activities which is defined as avoidance of strenuous occupational or recreational activities by the VASRD.  There was no evidence that the CI was advised by a physician to avoid strenuous occupational or recreational activities due to his DM diagnosis.  Review of the service medical treatment records indicate that the CI had was responding well to his treatment following his initial hospitalization and there were no subsequent episodes of ketoacidosis, significant hypoglycemic reactions (requiring urgent medical treatment), or hospitalizations documented proximate to the time of separation to meet the criteria of one of the higher ratings under the code 7913.  There were no complications such as diabetic neuropathy, nephropathy or retinopathy for consideration of separately unfitting disability ratings.  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 adjudication for the DM condition.

Contended PEB Conditions.  The Board’s main charge is to assess the fairness of the PEB’s determination that the fatty liver 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.  Laboratory testing disclosed elevated liver enzymes and high cholesterol and triglyceride levels.  The elevated liver enzymes were determined to be due to fatty liver, a condition of increased amounts of fatty tissue within the liver.  There was no impairment of liver function.  The elevated cholesterol and triglycerides were treated with medication.  The fatty liver and hyperlipidemia 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 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.  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 I condition and IAW VASRD §4.119, the Board unanimously recommends no change in the PEB adjudication.  In the matter of the contended fatty liver 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 20140430, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

XXXXXXXXXXXXXXX
President
Physical Disability Board of Review

SAMR-RB									

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 XXXXXXXXXXXXXXX, AR20150009957 (PD201401897)

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:

Encl		     XXXXXXXXXXXXXXX
			     Deputy Assistant Secretary of the Army
			          (Review Boards)
						         
CF: 
(  ) DoD PDBR
(  ) DVA