RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXX	CASE:  PD-2014-03773
BRANCH OF SERVICE:  Navy 	SEPARATION DATE:  20081114

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E5, Interior Communications Electrician, medically separated for “type 2 diabetes mellitus, ” rated 20%.

CI CONTENTION:  The CI requests that all conditions be considered.  The CI’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 based on 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 – 20081001	VARD - 20081202	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Type 2 Diabetes	7913	20%	Diabetes Mellitus	7913	20%	20080723	
Hyperlipidemia	Cat IV	No VA Placement	
COMBINED RATING:  20%	COMBINED RATING OF ALL VA CONDITIONS:  30%	

ANALYSIS SUMMARY:  

Diabetes Mellitus.  The CI was diagnosed with type 2 diabetes mellitus, characterized by variable insulin (hormone that regulates blood glucose) resistance/deficiency and hyperglycemia (high blood glucose), in February 2005.  He ultimately required treatment with a restricted diet, an oral hypoglycemic medication, and insulin.  Despite treatment, the diabetes mellitus condition could not be adequately rehabilitated to meet the physical requirements of the CI’s military specialty and the CI was referred for a Medical Evaluation Board (MEB).  The MEB forwarded “diabetes…” for PEB adjudication.  The MEB narrative summary (NARSUM) examination by endocrinology on 24 April 2008, 7 months prior to separation, noted that the CI had been prescribed an oral hypoglycemic medication and insulin.  Surveillance for complications of diabetes mellitus was negative for retinopathy (retinal blood vessel damage), nephropathy (kidney structural and functional damage), or neuropathy (vascular and metabolic nerve damage).  The examiner did not indicate that avoidance of strenuous occupational and recreational activities was medically necessary.  According to the MEB examination (recorded on DD Forms 2807 and 2808) dated 2 June 2008, 5 months prior to separation, the examiner noted that the CI was on an oral hypoglycemic medication.  The examiner did not indicate that avoidance of strenuous occupational and recreational activities was medically necessary.  The service treatment record contained no evidence of episodes of ketoacidosis (life threatening elevated ketoacids, electrolyte disturbances, dehydration, and hyperglycemia) or hypoglycemic (low blood glucose) reactions requiring hospitalizations.  There was also no evidence of twice monthly visits to a diabetic care provider or diabetic complications.  The Abbreviated Medical Board Report that placed the CI on his second and final limited duty did not restrict activities.  

The 23 July 2008 VA Compensation and Pension (C&P) examination, performed 4 months before separation, reported that the CI was taking an oral hypoglycemic medication and insulin.  The CI reported abnormally high thirst and urination.  The examiner did not indicate that avoidance of strenuous occupational and recreational activities was medically necessary.  The physical examination revealed no evidence of diabetic peripheral neuropathy or peripheral vascular disease (diminution or absence of peripheral pulses).  An ophthalmology evaluation found no evidence of diabetic retinopathy.  The examiner indicated that no renal impairment was present.

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the diabetes mellitus condition 20% (coded 7913) citing no rationale for the rating.  The VA rated the diabetes mellitus condition 20% (coded 7913) citing hyperglycemia, oral hypoglycemic agent, insulin, tingling in fingers and toes, no loss of sensation, no renal problems, and no diabetic retinopathy.  The Board agreed that the requirement for treatment with insulin, and restricted diet justified a 20% rating.  Because there was no evidence of medically prescribed regulation of activities, the next higher 40% rating was not justified.  Furthermore, he did not require frequent visits to a diabetic care provider, nor were there episodes of ketoacidosis, hypoglycemic reactions, hospitalizations or diabetic complications that could support higher ratings.  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 type 2 diabetes mellitus.  

Contended PEB Conditions:  Hyperlipidemia.  The Board’s main charge is to assess the fairness of the PEB’s determination that the contended condition was not unfitting.  The contended condition was not profiled or implicated in the commander’s statement or judged to fail retention standards.  There was no performance-based evidence from the record that the condition significantly interfered with satisfactory duty performance at separation.  After due deliberation, the Board concluded that there was insufficient cause to recommend a change in the PEB fitness determination for the contended condition and so no additional disability rating is recommended.  

BOARD FINDINGS:  In the matter of the type 2 diabetes mellitus and IAW VASRD §4.71a, the Board unanimously or majority recommends no change in the PEB adjudication.  In the matter of the contended hyperlipidemia, the Board unanimously recommends no change from the PEB determination 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 20140819, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

MEMORANDUM FOR DIRECTOR, SECRETARY OF THE NAVY COUNCIL OF REVIEW
               BOARDS 

Subj:  PHYSICAL DISABILITY BOARD OF REVIEW (PDBR) RECOMMENDATIONS
 
Ref:   (a) DoDI 6040.44
       (b) CORB ltr dtd 21 Jun 16

      In accordance with reference (a), I have reviewed the cases forwarded by reference (b), and, for the reasons provided in their forwarding memorandums, approve the recommendations of the PDBR that the following individual’s records not be corrected to reflect a change in either characterization of separation or in the disability rating previously assigned by the Department of the Navy’s Physical Evaluation Board:

		- XXXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXXX, former USN

						  		 XXXXXXXXXXXXXXXXXXXX
	     				  			 Assistant General Counsel			  							(Manpower & Reserve Affairs)