RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  jXXXXXXXXXXXXXXXXXXXX	CASE:  PD-2014-02787
BRANCH OF SERVICE:  AIR FORCE	BOARD DATE:  20141231
SEPARATION DATE:  20030912

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E-4 (Intel Applications Journeyman) medically separated for Type I 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 diabetes condition, characterized as, “diabetes mellitus” was forwarded to the Physical Evaluation Board (PEB) IAW AFI 48-123.  The Informal PEB adjudicated “diabetes mellitus, type I, requires insulin” rated 20% with likely application of VA Schedule for Rating Disabilities (VASRD).  The CI appealed to the Formal PEB, which affirmed the PEB’s finding and rating.  The CI made no further appeal 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 FPEB – Dated 20030716	VA* - (~7 Mos. Post-Separation)	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Diabetes Mellitus, Type I…	7913	20%	Diabetes Mellitus Type I	7913	20%	20040402	
Other x 0 (Not In Scope)	Other x 4	
Combined:  20%	Combined:  20%	
*Derived from VA Rating Decision (VARD) dated 20040528 (most proximate to date of separation [DOS])

ANALYSIS SUMMARY:

Type I Diabetes Mellitus.  The service treatment record (STR) indicated the CI’s diabetes mellitus (DM) condition was abruptly diagnosed after hospitalization for an uncomplicated ketoacidosis condition in January 2003.  After hospital discharge, he continued to receive daily insulin supplementation and dietary counsel.  The STR did not reveal any history of significant complications of DM other than the original hospitalization as stated above.  At the MEB narrative summary examination on 4 April 2003; 5 months prior to separation, the CI reported no subjective complaints and his “review of systems” were unremarkable.  A thorough physical examination (PE) was completely normal.  His only profile for the DM condition was a temporary one issued shortly after his initial hospitalization which restricted temporary duty assignments, cross-training, re-enlistments and deployments.  The case file contained many letters from leadership all lauding the CI’s duty performance and advocating for his necessary retention.

The VA C&P examination in evidence was performed on 2 April 2004; approximately 7 months after separation.  It was submitted as a request to increase the previous rating (20%) on his DM condition from the original (missing) examination of 4 November 2003 (a month after separation).  The CI reported no current DM complaints or persistent adverse symptoms and continued taking insulin four times a day.  His PE was normal.  The examiner listed the diagnosis as type I diabetes mellitus requiring daily diet and exercise manipulations along with multiple-dose insulin injections.

The Board directed attention to its rating recommendation based on the above evidence.  Neither the MEB nor VA examiner noted adverse findings on the PE that pertain to the VASRD rating of the diabetes condition.  The clinical evidence of requiring insulin at the time of separation was consistent with a 20% rating IAW VASRD §4.120 as determined by the PEB.  There was no laboratory evidence that ketoacidosis or hypoglycemia were manifested at any time since his original diagnosis.  Neither the profiled restrictions nor leadership statements/comments provided evidence that any “regulation of routine activities” were imposed by the DM condition in support of a higher rating.  Upon deliberation, Board members agreed that the 40% rating criteria under 7913 were not reasonably supported by the evidence at hand and there was not reasonable doubt in the CI’s favor, therefore, to justify a Board recommendation for other than the 20% rating assigned by the PEB for the diabetes 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 20140528, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans’ Affairs Treatment Record

		
XXXXXXXXXXXXXXXXXXXX
President
DoD 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 (Title 10 U.S.C. § 1554a), PDBR Case Number PD-2014-02787.

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