RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXXXXX	CASE:  PD-2014-03225
BRANCH OF SERVICE:  army	SEPARATION DATE:  20070326

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was a traditional drilling National Guard E-4 (Counterintelligence Agent) medically separated for diabetes mellitus (DM), rated at 20%.

CI CONTENTION:  The applicant had asked for consideration of all conditions.  His 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 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 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:

IPEB – Dated 20070209	VA* - (~3 to 4 Mos. Pre-Separation)	
Condition	Code	Rating	Condition	Code	Rating	Exam	
DM Type I	7913	20%	DM	7913	20%	20061128	
Nontropical Sprue	Not Unfitting	Celiac Disease	7307	0%	20061128	
Hyperlipidemia	Not Unfitting	No VA Placement	
Adjustment DO with Anxiety	Not Unfitting	General Anxiety DO	9400	10%	20061221	
Asperger’s DO	Not Unfitting					
Chronic Low Back Pain…	Not Unfitting	Degenerative Changes L5-S1…	5242	10%	20061128	
Other MEB/PEB Conditions x 0 (Not In Scope)	Other x 3	
RATING:  20%	RATING:  40%	
*Derived from VA Rating Decision (VARD) dated 20070306 (most proximate to date of separation (DOS))

ANALYSIS SUMMARY:  

Diabetes Mellitus Type I.  The record and MEB narrative summary (NARSUM) indicated the CI was diagnosed with DM in September 2005. He had presented with symptoms of diabetic ketoacidosis and hospitalized with transition from IV to injected insulin.  At the narrative summary (NARSUM) examination, approximately 2 months before separation, the CI reported continued mild generalized weakness/easy fatigability and irritability.  He was taking two types of injected insulin with multiple injections per day.  The examiner indicated that the CI was achieving excellent control of his diabetes, and had infrequent and only mild hypoglycemia on his treatment.  There were no required ER visits for hypo or hyperglycemia since his initial diagnosis.  Exam documented normal neurologic and motor exams, with “no clinically detectable signs of complications secondary to diabetes….”  Laboratory on 5 December 2005 documented normal urinalysis with random blood glucose of 173 (high) and HbA1c 6.5% (normal 4.5-5.7%).  PEB noted September 2006 fasting glucose of 167 (high) and HbA1c of 6.9% (high).  On 28 December 2006 the HbA1c was 7.3% (high).  

At the VA Compensation and Pension (C&P) exam approximately 4 months before separation the CI presented a similar history of one episode of ketoacidosis (on diagnosis) with no hypoglycemia.  He was on a regular gluten free diet with a stable weight.  He was taking injected insulin and “diabetes does not interfere with his regular activities.”  He was seen for his diabetes every 3 months and denied other symptoms or residuals from his diabetes.  

The Board directed its attention to its rating recommendation based on the above evidence.  Both the PEB and VA rated the CI’s DM at 20% coded 7913 (diabetes mellitus).  The CI was taking insulin and was on a restricted diet which met the 20% rating criteria of code 7913.  There was no evidence for regulation of activities, multiple hospitalizations, or diabetic complication that would warrant any rating over 20%.  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.  

Contended PEB Conditions.  The Board’s main charge is to assess the fairness of the PEB’s determination that nontropical sprue, hyperlipidemia, adjustment disorder with anxiety, Asperger’s disorder, and chronic low back pain 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.  All contended conditions were reviewed and considered by the Board.  

Nontropical sprue (celiac disease - gluten intolerance) was diagnosed by a gastroenterologist and the NARSUM examiner indicated:  “Since MREs are not gluten free, he is non-deployable and I would therefore recommend to his command that he be considered for a MEB…”  Nontropical sprue was judged to fail retention standards, but was not profiled or implicated in the commander’s statement.  The PEB wording for their not unfitting determination for nontropical sprue indicated likely application of DoDI 1332.38, E3.P3.3.3. (“Adequate Performance Until Referral”) which appeared supported by the record.  

The hyperlipidemia, adjustment disorder, and Asperger’s disorder are conditions or circumstances that do not constitute a physical disability IAW DODI 1332.38, Enclosure 5, in effect at the time, and are therefore not compensable.  

The low back pain condition had prior episodes of temporary profile restriction and radiographic evidence of degenerative changes.  There was no acute trauma and the CI complained of tenderness and pain radiating down the back of the left thigh to above the knee.  He took Motrin (nonsteroidal anti-inflammatory medication) and “when he does not take it, the pain goes down left leg.”  He was seen in physical therapy and a left heel lift was prescribed without benefit.  NARSUM exam documented normal lumbosacral spine range-of-motion with normal strength, reflexes, and sensory exams.  Proximate to the time of separation the back condition was profiled as L2, was not implicated in the commander’s statement and was not judged to fail retention standards.  

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 any of the contended conditions and so no additional disability ratings are 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 nontropical sprue, hyperlipidemia, adjustment disorder with anxiety, Asperger’s disorder, and chronic low back pain 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 20140620, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans’ Affairs Treatment Record

MEMORANDUM FOR Commander, US Army Physical Disability Agency
(AHRC-00), 

SUBJECT: Department of Defense Physical Disability Board of Review Recommendation
for XXXXXXXXXXXXXXXXXXXXXXX AR20160004407 (PD201403225)

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