RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXX	CASE:  PD-2014-03947
BRANCH OF SERVICE:  Navy	SEPARATION DATE:  20080430

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E5, Machine Accountant, medically separated for “insulin-dependent diabetes mellitus” with a disability rating of 20%.  

CONTENTION:  “Please consider all conditions.”  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 - 20080318	VARD - 20080922	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Insulin-Dependent Diabetes Mellitus	7913	20%	Type I Diabetes Mellitus	7913	20%	20080801	
Esophageal Reflux	Cat III	Gastroesophageal Reflux Disease	7346	30%		
Minimal Elevations of Hepatic Transaminases	Cat III	No VA Placement	
Hypertension	Cat III	Hypertension	7101	10%	20080801	
COMBINED RATING:  20%	COMBINED RATING OF ALL VA CONDITIONS:  70%	

ANALYSIS SUMMARY:

Insulin-Dependent Diabetes Mellitus.  According to service treatment records and the Medical Evaluation Board (MEB) narrative summary, the CI acquired adult-onset diabetes in 2007.  Despite medication treatment, the condition could not be adequately rehabilitated to meet the CI’s military specialty and he was referred to an MEB.  The MEB forwarded “diabetes mellitus without mention of complications, Type II or unspecified type, not stated as uncontrolled” and “long-term (current) use of insulin;” “essential hypertension, unspecified;” “esophageal reflux” and “nonspecific elevation of levels of transaminase or LDH” conditions for PEB adjudication.  
During a wellness clinic visit in March 2007, the CI attended a “Healthy Eating” class.  The objective was to provide the CI with instructions regarding:  healthy eating, healthy food choices, portion control, and incorporation of a moderate physical activity plan into daily life, with the goal of achieving a healthy weight and lifestyle.  The MEB NARUSM on 11 February 2008, 3 months before separation, the examination documented the CI using Humalog (insulin) three times daily and Levemir long-acting insulin at night.  A restriction of activities was not cited.  The CI required multiple visits to the endocrinology and metabolism clinic to treat his poorly controlled Type 2 diabetes.  The non-medical assessment performed by the CI’s commander signed in March 2008, 2 months before separation, implicated the CI’s diabetes condition and documented the CI’s ability to perform the physical fitness test.  

At the 1 August 2008 VA Compensation and Pension (C&P) evaluation, 3 months after separation, the CI reported a history of elevated blood sugar levels in 2003 with a diabetes diagnosis in 2007.  The CI was initially started on oral medication, then prescribed insulin followed by an insulin pump in April 2008.  The examination documented the CI had no episodes of hypoglycemic reactions or ketoacidosis, was not restricted from performing strenuous activities, no hospitalizations for diabetes and no change in his weight.  The CI reported some activities of daily living were moderately effected:  chores, shopping, exercise, sports, recreation, traveling, feeding and driving.  A diagnosis of Type I diabetes was rendered.  

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the diabetes 20%, coded 7913 (diabetes mellitus).  The VA also rated the diabetes 20% coded 7913, based on the VA C&P examination 3 months after separation, citing required insulin and a restricted diet to control diabetes.  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.  The CI did require frequent visits to a diabetic care provider; however, there were no 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 insulin-dependent diabetes mellitus condition.  

Contended PEB Conditions:  Esophageal Reflux, Minimal Elevations of Hepatic Transaminases, and Hypertension.  The Board’s main charge is to assess the fairness of the PEB’s determination that the contended conditions were not unfitting.  None of the conditions were profiled or implicated in the commander’s statement or 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 at separation.  After due deliberation, the Board concluded that there was insufficient cause to recommend a change in the PEB fitness determination for any of the contended conditions and so no additional disability ratings are recommended.  

BOARD FINDINGS:  In the matter of the insulin-dependent diabetes mellitus condition and IAW VASRD §4.119, the Board unanimously recommends no change in the PEB adjudication.  In the matter of the contended esophageal reflux, minimal elevations of hepatic transaminases, and hypertension 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 20140527, 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 8 Aug 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 USMC
		- XXXXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXXXX, former USMC

						  	XXXXXXXXXXXXXXXXXXXX
	     				  		Assistant General Counsel
						 	(Manpower & Reserve Affairs)