RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2014-03739
BRANCH OF SERVICE:  Army	BOARD DATE:  20150623
SEPARATION DATE:  20021102

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E-2 (Petroleum Supply Specialist) medically separated for Diabetes Mellitus (DM), Type I.  The condition could not be adequately rehabilitated to meet the physical requirements of her Military Occupational Specialty but was authorized to perform an alternate physical fitness test (per PROFILE).  She was issued a permanent P3 profile and referred for a Medical Evaluation Board (MEB).  The MEB forwarded “type I diabetes mellitus” was forwarded to the Physical Evaluation Board (PEB) IAW AR 40-501.  The MEB also identified and forwarded obesity and supraventricular tachycardia (SVT), non-sustained symptomatic for PEB adjudication.  The Informal PEB adjudicated “type I diabetes mellitus” as unfitting, rated 20% with likely application of Veterans Affairs Schedule for Rating Disabilities (VASRD).  The obesity and the SVT conditions were determined to be not unfitting and not rated. The CI made no appeals 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 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 20020613	VA* - (~2 Mos. Pre-Separation)  	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Type I Diabetes Mellitus	7913	20%	Diabetes Mellitus, Type I	7913	20%	20020902	
Obesity	Not Unfitting	No VA Placement	
SVT	Not Unfitting	SVT	7099-7010	NSC	
Other MEB/PEB Conditions x 0 (Not In Scope)	Other x 6	
RATING:  20%	RATING:  20%	
*Derived from VA Rating Decision (VARD) dated 20021106 (most proximate to date of separation [DOS]).

ANALYSIS SUMMARY:

Diabetes Mellitus, Type I Condition.  The CI presented acutely on 11 May 2001 with a 2-week history of weight loss and excessive urination and thirst.  She was hospitalized and begun on insulin and dietary restrictions.  Evaluation for complications showed no evidence of renal, neurological, or ophthalmological effects from the diabetes.  She was non-compliant with treatment and actually gained over 50 pounds the first two months after diagnosis.  An endocrinology evaluation on 5 March 2002 documented that the CI had an irregular work schedule and did not eat on time; therefore, she did not always take her insulin.  Her glucose levels were typically high.  She remained overweight, but without complications from her DM.  Compliance and poor control remained issues up through separation.  The narrative summary was dated 10 June 2002 and referred back to an examination performed on 11 March 2002.  It noted that the CI had no complications from her diabetes or a recurrence of ketoacidosis since the initial presentation.  Her blood sugar averaged 241 (high) as did the Hemoglobin A1C (a marker of the average blood sugar the previous 120 days).  At the VA Compensation and Pension examination performed on 2 September 2002, 2 months prior to separation, the CI reported hypoglycemia (low blood sugar) once every 2 weeks.  On examination, she was overweight at 202 pounds (70 pound gain since diagnosis), but without evidence of eye or nerve complications.  Regulation of activities was not documented.

The Board directed attention to its rating recommendation based on the above evidence.  The PEB and VA both rated the DM condition at 20%, coded 7913 (diabetes mellitus).  Absent complications from the DM, a recurrence of the ketoacidosis, regulation of activities or more frequent outpatient visits, the Board found no route to a rating higher than the 20% adjudicated by both the PEB and VA.  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 DM condition.

Contended PEB Conditions.  The Board’s main charge is to assess the fairness of the PEB’s determination that the SVT and obesity 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.  Neither condition was profiled or implicated in the commander’s statement.  Neither was judged to fail retention standards.  Both were reviewed and considered by the Board.  There was no performance based evidence from the record that either condition significantly interfered with satisfactory duty performance.  The SVT was a single event which spontaneously resolved.  The obesity complicated the control of the DM, but there is no evidence that it impaired duty separately.  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 either of the contended conditions and so no additional disability ratings are recommended.

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.  In the matter of the contended SVT and obesity 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.

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 20140714, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

DEPARTMENT OFTHE ARMY
ARMY REVIEW BOARDS AGENCY
251 18TH STREET SOUTH, SUITE 385
ARLINGTON, VA 22202-3531

SAMR-RB

MEMORANDUM FOR Commander, US Army Physical Disability Agency
(AHRC-DO), 2900 Crystal Drive, Suite 300, Arlington, VA 22202-3557

06 JUL 2016

SUBJECT: Department of Defense Physical Disability Board of Review Recommendation
for XXXXXXXXXX, AR2016003336 (PD201403739)

I have reviewed the enclosed Department of Defense Physical Disability Board of
Review (000 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:
( ) 000 PDBR
( ) OVA