RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXX	CASE:  PD-2014-02180
BRANCH OF SERVICE:  Army	BOARD DATE:  20141015
SEPARATION DATE:  20080109

SUMMARY OF CASE: Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty SPC/E-4 (11B/Infantry Soldier) medically separated for diabetes mellitus (DM) Type I.  The condition could not be adequately rehabilitated to meet the physical requirements of his Military Occupational Specialty or satisfy physical fitness standards.  He was issued a permanent P3 profile and referred for a Medical Evaluation Board (MEB).  The DM Type I condition was forwarded to the Physical Evaluation Board (PEB) IAW AR 40-501.  The MEB also identified and forwarded two other conditions (toxoplasmosis and anxiety with depressed mood) for PEB adjudication.  The Informal PEB adjudicated “diabetes mellitus type 1” as unfitting, rated 20% with likely 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:  The CI elaborated no specific contention in his application.

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 I condition is addressed below; 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 IPEB – Dated 20071012	VA - (6 Mos. Post -Separation)	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Diabetes Mellitus Type I	7913	20%	Diabetes Mellitus Type I	7913	20%	20080605	
Other x 2  (Not in Scope)	Other x 13 	20080605	
Combined:  20%	Combined:  40%	
Derived from VA Rating Decision (VARD) dated 20080703 (most proximate to date of separation [DOS]).

ANALYSIS SUMMARY:

Diabetes Mellitus Type I Condition.  The CI was admitted for the treatment and evaluation of DM after he presented with a 2-month history of weight loss (50 pounds), excessive thirst, eating and urination (polydipsia, polyphagia, and polyuria, respectively).  All are indications of DM.  He was begun on insulin and instructed in dietary and lifestyle changes to manage his DM.  His compliance was not optimal, but he did still show improvement in both the fasting blood sugar (indicative of short term control) and blood markers for chronic blood sugar levels (Hemoglobin A1C, indicating average levels the prior 120 days).  At an endocrinology evaluation on 10 May 2007, his medication was changed and he was again counseled on appropriate lifestyle changes.  No complications of DM were noted and regulation of activities was not prescribed.  At the VA Compensation and Pension (C&P) examination performed 7 months prior to separation; the CI reported episodes of hypoglycemia.  These were not recorded in the service treatment record and it is not clear upon what this was based.  No complications of DM were reported nor were any found on the examination.  The narrative summary was dated 8 August 2007, 5 months prior to separation and noted that the use of insulin for control of DM was not medically acceptable.  Complications from DM were not documented; neither was regulation of activities.  At the VA C&P exam performed 5 months after separation, the CI reported that his condition was stable and response to treatment good.  Hypoglycemia was not recorded.  On examination, the evaluation of his eyes, nervous system, and renal (kidney) system was normal.  No hospitalizations were recorded after the initial 3-day hospitalization for evaluation and stabilization.  The PEB and VA both used code 7913 (DM) and rated it at 20%.  To support a higher rating, there must be regulation of activities, hospitalizations or complications present.  None was in evidence at the time of separation.  The CI was later determined to have a neuropathy (nerve damage) secondary to DM, but at an examination almost 2 years after 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 condition.

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 condition and IAW VASRD §4.120, 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 20180703, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans’ Affairs Treatment Record

XXXXXXXXXXXXXXX
President
DoD 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, AR20150008213 (PD201402180)

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