RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2015-00948
BRANCH OF SERVICE:  Air Force 	SEPARATION DATE:  20070518

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E3, Security Forces, medically separated for “diabetes mellitus type I”, rated 20%, with a disability rating of 20%.  

CI CONTENTION:  “Awarded 50% from VA, in 2011, increased to 80%.”  The 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 - 20070302	VARD - 20070625	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Diabetes Mellitus Type I	7913	20%	Diabetes Mellitus Type I	7913	20%	20070611	
			Peripheral Neuropathy Right Upper Extremity associated with Diabetes Mellitus Type I	8515	10%	20070611	
			Peripheral Neuropathy Left Upper Extremity associated with Diabetes Mellitus Type I	8515	10%	20070611	
			Peripheral Neuropathy Right Lower Extremity associated with Diabetes Mellitus Type I	8520	10%	20070611	
			Peripheral Neuropathy Left Lower Extremity associated with Diabetes Mellitus Type I	8520	10%	20070611	
COMBINED RATING:  20%	COMBINED RATING OF ALL VA CONDITIONS:  50%	

ANALYSIS SUMMARY:

Diabetes Mellitus Type I.  The CI first presented with symptoms of diabetes mellitus in February 2006 and ultimately required treatment with oral hypoglycemic medication, dietary restriction and insulin.  The CI was hospitalized in December 2006 for an episode of ketoacidosis, which was the only hospitalization for the treatment of ketoacidosis or hypoglycemia evident in the service treatment record (STR).  There was no evidence of twice monthly visits to a diabetic care provider and diabetic complications.  Despite treatment, the diabetes condition could not be adequately rehabilitated to meet the physical requirements of the CI’s military specialty and he was referred for a Medical Evaluation Board (MEB).  The MEB forwarded “insulin dependent diabetes mellitus” for PEB adjudication.  

At an endocrinology follow-up evaluation on 6 September 2006 (8 months prior to separation) the CI reported paresthesias (abnormal sensations) although the location was not specified.  Physical examination of the extremities and feet was normal, and a neurologic exam was normal.  The temporary profile (P4) dated 27 December 2006 (5 months prior to separation) noted only that the CI was non-deployable, and otherwise specified “no restrictions.”  The MEB NARSUM examination on 16 January 2007, approximately 4 months prior to separation, noted complaints of tingling in the hands in the morning.  The physical examination was normal, including sensation in the feet and legs.   

At the 11 June 2007 VA evaluation (1 month after separation) the CI reported that he was hospitalized 3 times during the previous year, and that he visited his doctor 24 times per year for his diabetes.  He complained of numbness and tingling in his hands and feet with leg cramps.  There were no restrictions on his activities.  His eyes and kidneys were reportedly unaffected by diabetes.  The physical examination was remarkable for decreased light touch sensation in both the upper and lower extremities.  Pin-prick, vibration and pressure or 2-point discrimination testing was not reported.  Knee and ankle reflexes were normal.  The examiner diagnosed neuropathy of the upper and lower extremities as a complication of the diabetes.  

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the diabetes mellitus type I condition 20%, coded 7913 (diabetes mellitus).  The VA also rated the diabetes condition 20% coded 7913, citing the requirement for insulin and a restricted diet as a rationale.  The VA also assigned separate 10% ratings for peripheral neuropathy of each extremity.  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 Board noted the additional ratings assigned by the VA for peripheral neuropathy of each extremity, based on the VA examination one month after separation.  However, the examiner did not utilize testing recommended for detection of diabetic sensory neuropathy (pressure, vibration, temperature or pain); and the findings of diminished light touch were not consistent with other examinations, including that of an endocrinologist who did not conclude that peripheral neuropathy was present.  The Board therefore concluded that additional rating for peripheral neuropathy was not warranted.  Even conceding the presence of neuropathy however, a causality linkage of a neuropathy condition with the unfitting diabetes condition is not a basis in itself for disability rating.  The Board could find no evidence in the STR, profile or commander’s statement that suggested duty was impaired from neuropathy.  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 I condition. 

BOARD FINDINGS:  In the matter of the diabetes mellitus type I condition and IAW VASRD §4.119, 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 20150607, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

SAF/MRB

XXXXXXXXXXXXXXXXXX
XXXXXXXXXXXXXXXXXX
XXXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXXXXX

Reference your application submitted under the provisions of DoDI 6040.44 (Section 1554, 10 USC), PDBR Case Number PD-2015-00948.

After careful consideration of your application and treatment records, the Physical Disability Board of Review determined that the rating assigned at the time of final disposition of your disability evaluation system processing was appropriate.  Accordingly, the Board recommended no re-characterization or modification of your separation.

I have carefully reviewed the evidence of record and the recommendation of the Board.  I concur with that finding and their conclusion that re-characterization of your separation is not warranted.  Accordingly, I accept their recommendation that your application be denied.

Sincerely,