RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXX	CASE:  PD-2014-01955
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20080528

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E1 (Trainee) medically separated by the Informal Physical Evaluation Board for “diabetes” with a disability rating of 20%. 

CI CONTENTION: The applicant requests the Board consider all conditions.  His complete submission is at Exhibit A.

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 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 – 20080512	VARD – 20081125	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Diabetes Mellitus…	7913	20%	Diabetes Mellitus Type I	7913	10%*	20080821	
Abnormal EKG	Not Unfitting	No VA Placement	
HTN	Not Unfitting	HTN	7913-7101	0%	20080821	
Hyperlipidemia	Not Unfitting	No VA Placement	
Folliculitis	Not Unfitting	No VA Placement	
Flat Foot Condition	Not Unfitting	Pes Planus, Right Foot	5276	0%	20080821	
		Pes Planus, Left Foot	5276	0%	20080821	
RATING:  20%	COMBINED RATING OF ALL VA CONDITIONS:  10%	
*The 20091230 VARD increased the diabetes rating to 20% effective 20080529 based on clear and unmistakable errors.  

ANALYSIS SUMMARY:  

Diabetes Mellitus Type I Condition.  The CI developed type I diabetes in March 2008 which required treatment with oral hypoglycemic medication (Metformin), dietary restriction, and insulin (Lantus, Novolog).  Review of the service treatment record (STR) showed no hospitalizations for treatment of ketoacidosis or hypoglycemia.  Ophthalmology examination showed no diabetic retinopathy.  There were small cataracts which did not cause symptoms.  There was micro-albuminuria present but kidney function was normal.  There was no neuropathy. 

At the MEB Narrative Summary (NARSUM) evaluation on 18 April 2008 approximately 1 month before separation the examiner noted that the CI was on insulin, oral medication and a restricted diet.  Although there were no episodes of hypoglycemia, the examiner reported that the CI should not operate heavy machinery and should not work at heights, however the examiner did not indicate that avoidance of strenuous activities was medically necessary.  He recommended quarterly visits to an internist or endocrinologist. 

According to the Endocrinology clinic visit on 22 April 2008 approximately a month prior to separation the examiner noted that the CI was encouraged to continue to exercise and follow the appropriate diet.  The examiner noted there had been no hypoglycemic episodes.  The examiner did not indicate that avoidance of strenuous occupational and recreational activities was medically necessary.  There was no evidence of diabetic retinopathy, neuropathy or nephropathy.  

At the VA Compensation and Pension evaluation on 21 August 2008, approximately 3 months prior to separation, the examiner noted that the CI was on insulin and a restricted diet.  The examiner did not indicate that avoidance of occupational and strenuous recreational activities was medically necessary. 

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the diabetes condition 20% coded 7913 (diabetes mellitus) citing that the CI required diet and insulin.  The VA rated the diabetes condition 20% coded 7913 citing the required use of insulin, an oral medication and a diabetic diet.  The Board agreed that the requirement for insulin and an oral hypoglycemic agent with a restricted diet justified a 20% rating.  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.  The restriction should be prescribed by a physician and the evidence of the medical records must show the restriction in activity is medically necessary.  Although there were restrictions for working from heights or operating heavy equipment, there was no evidence that the CI was advised by a physician to avoid strenuous occupational or recreational activities due to his diabetes mellitus diagnosis.  Review of the service medical treatment records indicate that the CI was responding well to his treatment and that there were no episodes of hypoglycemia which would require regulation of activities.  Following the initial phase of establishing the treatment regimen, the endocrinologist recommended routine follow-up with a diabetes provider every quarter.  There were no episodes of ketoacidosis or 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.  Therefore, the Board has determined that all evidence considered, the condition did not meet the criteria for a higher rating and that there is not reasonable doubt in the CI’s favor supporting a change from the PEB’s rating decision for the diabetes mellitus condition.  There were no complications such as diabetic neuropathy, nephropathy or retinopathy for consideration of separately unfitting disability ratings.  

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 diabetes mellitus condition.  

Contended PEB Conditions.  The contended conditions adjudicated as not unfitting by the PEB were abnormal EKG, hypertension, hyperlipidemia, folliculitis and flat foot condition.  The Board’s first charge with respect to these conditions is an assessment of the appropriateness of the PEB’s fitness adjudications.  The Board’s threshold for countering fitness determinations is preponderance of the evidence but remains adherent to the DoDI 6040.44 “fair and equitable” standard.  None of these conditions were profiled; none were implicated in the Commander’s Statement; and, none were judged to fail retention standards.  All were reviewed and considered by the Board.  There was no indication 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 abnormal EKG, hypertension, hyperlipidemia, folliculitis and flat foot condition contended conditions and, therefore, no additional disability ratings can be recommended.

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.  In the matter of the contended abnormal EKG, HTN, hyperlipidemia, folliculitis and flat foot 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.  

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 20140501, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

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 XXXXXXXXXXXXXXXXXXXX, AR20160004012 (PD201401955)

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