RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX.	CASE:  PD-2015-00180
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20060111

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E4, Air and Missile Defense Crewmember, medically separated for “diabetes mellitus type 1…” rated 20%.

CI CONTENTION:  The CI contends he was denied service-connection for the loss of 18 teeth.  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 - 20050916	VARD - 20060718	
Condition	Code	Rating	Condition	Code	Rating	Exam	
DM Type 1…	7913	20%	DM Type 1 w/ ED & Early Nephropathy	7913	20%	20060503	
COMBINED RATING:  20%	COMBINED RATING OF ALL VA CONDITIONS:  40%	

ANALYSIS SUMMARY:  

Diabetes Mellitus Type 1 (DM-1).  The CI developed DM-1 (characterized by destruction of insulin [glucose regulating hormone] producing pancreatic beta cells) in 2004 which required treatment with restricted diet and insulin.  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 DM-1 for PEB adjudication.  The permanent profile dated 18 February 2005 did not restrict activities.  According to the MEB examination on 9 June 2005, 7 months prior to separation, the examiner noted that the CI was on insulin.  The examiner did not indicate that avoidance of strenuous occupational and recreational activities was medically necessary.  The MEB narrative summary (NARSUM) examination on 5 August 2005, 5 months prior to separation, noted that the CI was on insulin.  The physical examination revealed “no gross abnormalities” and the eye (funduscopic) examination revealed “no evidence of retinopathy [retinal blood vessel damage],” a complication of diabetes.  The examiner did not indicate that avoidance of strenuous occupational and recreational activities was medically necessary.  At the 3 May 2006 VA Compensation and Pension (C&P) examination, 2 months after separation, the examiner reported that the CI was taking basal (Lantus insulin 15 U/bedtime) and mealtime (Humalog insulin 6 U/meal) insulin.  The CI reported a history of erectile dysfunction (ED) that was successfully treated with Viagra.  He reported he was told that the ED was “was related to his DM1 by the VA clinic PCP.  He also lost 18 teeth and was told that it was related to DM1.”  The CI denied blurred vision or numbness or tingling of his feet.  He complained of paresthesias (abnormal sensation, tingling, burning, prickling) of his arms and legs when in cold weather.  The eye examination was grossly normal, with no comment on diabetic retinopathy.  The sensory examination documented no sensory loss, with no comment on diabetic peripheral neuropathy (vascular and metabolic nerve damage).  The examiner cited a February 2006 lab which showed evidence of microalbuminuria (subtle increase in urinary excretion of protein albumin), a possible manifestation of early diabetic nephropathy (kidney structural and functional damage).  The examiner did not indicate that avoidance of strenuous occupational and recreational activities was medically necessary. 

The Board directed attention to its rating recommendation based on the above evidence.  The PEB assigned a 20% rating under the 7913 code (diabetes mellitus) citing good control on insulin.  The VA assigned a 20% rating under the 7913 code (diabetes mellitus) based on the VA C&P examination 4 months after 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.  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 diabetic ketoacidosis (life threatening ketoacid elevation, glucose elevation, electrolyte disturbance, and dehydration), 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 mellitus type 1 condition.  

Contended PEB Condition: Tooth Loss.  The Board’s main charge is to assess the fairness of the PEB’s determination that the contended tooth loss 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 tooth loss condition and so no additional disability rating is recommended.  

BOARD FINDINGS:  In the matter of the diabetes mellitus type 1 and IAW VASRD §4.119, the Board unanimously recommends no change in the PEB adjudication.  In the matter of the contended tooth loss condition, the Board unanimously agrees that it cannot recommend it for additional disability rating.  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 20150224, 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, AR20160018511 (PD201500180)

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