RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2015-00044
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20070816

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E7, Imaging Ground Specialist, medically separated for “diabetes” with a disability rating of 20%.  

CI CONTENTION:  The CI contends for a higher rating for his diabetes. 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 upon a 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 - 20070521	VARD - 20071001	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Diabetes Mellitus	7913	20%	Diabetes Mellitus Type I	7913	20%	20070410	
COMBINED RATING:  20%	COMBINED RATING OF ALL VA CONDITIONS:  20%	

ANALYSIS SUMMARY:  

Diabetes.  According to the service treatment records (STR) and medical Evaluation Board (MEB) narrative summary (NARSUM), the CI developed type I diabetes mellitus in the fall of 2006 which ultimately required treatment with insulin.  The CI was hospitalized in October2006 for blood sugar in excess of 500 mg/dL (normal < 118) prior to stateside return.  Despite treatment, the diabetes 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 mellitus type I, new onset, poorly controlled” for PEB adjudication.  

At the MEB examination dated 5 March 2007 (5 months pre-separation), the CI was taking insulin.  The examiner did not indicate that avoidance of strenuous occupational and recreational activities was medically necessary.  The MEB NARSUM examination on 1 May 2007 (3 months pre-separation), noted that the CI was on (short- and long- acting) insulin.  Other than being non-deployable, the CI did not report any functional limitations.  The examiner indicated restrict in the performance of the CI’s occupation secondary to his flight restrictions.  There was no evidence of retinopathy, neuropathy or other complications of diabetes.  Review of the STR showed no hospitalizations for treatment of ketoacidosis or hypoglycemia except for the initial hospitalization which led to the diagnosis of diabetes.  There was also no evidence of twice monthly visits to a diabetic care provider and diabetic complications.  The permanent profile did not restrict activities.  

At the 10 April 2007 VA Compensation and Pension (C&P) evaluation (4 months pre-separation), the CI reported taking insulin.  The examiner did not indicate that avoidance of strenuous occupational and recreational activities was medically necessary.  The physical examination was normal showing no evidence of complications due to diabetes.  

The Board directed attention to the rating recommendation based on the above evidence.  The PEB assigned a 20% rating under the 7913 code (Diabetes mellitus), citing a requirement for insulin and restricted diet.  The VA also assigned a 20% rating using the 7913 code based on the VA C&P examination 4 months pre-separation, citing a requirement for insulin and restricted diet.  

The Board agreed that the requirement for treatment with insulin and restricted diet justified a 20% rating.  As 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 diabetes condition.  

BOARD FINDINGS:  In the matter of the diabetes condition and IAW VASRD §4.71a, the Board unanimously recommends no change in the PEB adjudication.  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 20150115, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

SAMR-RB						

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

SUBJECT:  Department of Defense Physical Disability Board of Review Recommendation for 
XXXXXXXXXXXXXXXXXX, AR20160018801 (PD201500044)

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