RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2014-02475
BRANCH OF SERVICE:  Air Force 	SEPARATION DATE:  20091127

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an Reserve, E6, Air Transportation, medically separated for “diabetes mellitus,” with a disability rating of 20%.  

CI CONTENTION:  The applicant requests an increase and makes no specific contention in their application.  The applicant’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:  

SERVICE PEB - 20090728	VARD - 20100405	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Diabetes Mellitus	7913	20%	Diabetes Mellitus with Peripheral Neuropathy Right Upper Extremity, Left Upper Extremity, Right Lower Extremity, and Left Lower Extremity	7913	20%	20100111	
			Diabetic Dermatitis Associated with Diabetes Mellitus…	7806	10%	20100111	
COMBINED RATING:  20%	COMBINED RATING OF ALL VA CONDITIONS:  30%	

ANALYSIS SUMMARY:  

Diabetes Mellitus (DM).  According to service treatment records and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s DM began in September 2008 when he was admitted to the Intensive Care Unit for diabetic ketoacidosis with a new diagnosis of DM, Type II.  At the time of admission he was in acute renal failure and was hypertensive.  Following acute treatment, the kidney failure resolved, the CI’s blood pressure came under control and oral antihypertensive medication was continued.  Review of the STR showed no hospitalizations for treatment of ketoacidosis or hypoglycemia except for the initial hospitalization which led to the diagnosis of DM.  There was also no evidence of twice monthly visits (or more frequent) to a diabetic care provider and diabetic complications.  No evidence of diabetic retinopathy was found on exam by optometry.  The CI’s DM, Type II required treatment with dietary restrictions and insulin.  The CI was referred for an MEB due to a new diagnosis of DM.

According to the NARSUM evaluation which was undated, but occurred between 19 November and 1 January 2009 (date of PEB), the examiner noted that the CI was on Novolog (insulin).  The examiner did not indicate that avoidance of strenuous occupational and recreational activities was medically necessary.  Strength was reported as 5/5 and sensation was intact throughout.  The MEB examiner indicated that the CI had been under intensive care for management of his DM for the approximately 3 months following his diagnosis, however, stated that the CI was “now doing rather well.”  He further indicated that he would be hesitant to clear the CI for deployment so soon after his DM came under control, but thought “over time he should be able to return to deployment status with some restrictions.”

At the VA Compensation and Pension (C&P) examination on 11 January 2010, performed a month after separation, the CI reported one hospitalization for ketoacidosis in September 2008 (initial hospitalization).  He described tingling and numbness in his fingers, but denied other neurological symptoms or weakness.  He reported a rash on his legs for the past week.  He reportedly treated his condition with low fat, low carbohydrate and sugar free foods and used insulin two times a day.  The VA examiner noted there was no history of cardiovascular or kidney complications due to the diabetes.  Physical exam noted well controlled blood pressure on medication.  Examination of both eyes was normal.  The examiner indicated there was “diabetic dermatitis” on the bilateral lower extremities described as ulceration exfoliation, crusting, induration, hyperpigmentation and abnormal texture of more than 6 square inches.  The examiner noted sensory function was reported as abnormal, with sensory dysfunction demonstrated by reported tingling in the fingertips.  The exam of both the upper and lower extremities noted no motor or sensory deficits to light touch.  Reflexes and peripheral pulses were also normal.

The Board directed attention to its rating recommendation based on the above evidence.  The PEB assigned a 20% rating under code 7913 (diabetes mellitus), citing daily insulin use and dietary restrictions.  The VA also assigned a 20% rating using the same code (7913) based on the VA C&P examination a month after separation, citing a requirement for insulin and restricted diet.  The VA also determined peripheral neuropathy was “at least as likely as not” a complication of diabetes, however could not assign a rating for this non-compensable complication.  The VA also assigned a 10% rating using code 7806 (dermatitis or eczema), citing dermatitis involving at least 5 percent, but less than 20% of the entire body.   

The Board agreed that the requirement for an insulin and restricted diet justified a 20% rating.  Because there was no evidence of medically prescribed regulation of activities, no higher rating was supported.  Although the CI was diagnosed with diabetic dermatitis at the post-separation C&P exam, there was no dermatitis mentioned on exams prior to separation and there was no evidence of any complication due to the DM that could be considered separately unfitting at the time of separation and therefore eligible for separate Service rating.  Also, as noted above, there was no evidence of medically prescribed regulation of activities or severe DM requiring sufficiently frequent visits for DM management/recurrent hospitalizations, both of which are required in addition to associated complications to support the higher ratings of 60% or 100%.  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.  

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 20140528, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

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

Dear XXXXXXXXXX:

Reference your application submitted under the provisions of DoDI 6040.44 (Section 1554, 10 USC), PDBR Case Number PD-2014-02475.

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,

Attachment:
Record of Proceedings