RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXXX	CASE:  PD-2015-00972
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20030210

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was a Reserve O3, Signal Officer, medically separated for “…type II diabetes mellitus,” with a disability rating of 10%.  

CI CONTENTION:  “Condition(s) has gotten worse”.  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 - 20021125	VARD - 20040513	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Type II Diabetes Mellitus	7913	10%	Diabetes Mellitus, Type II	7913	10%	20040416	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  10%	

ANALYSIS SUMMARY:  

Type II Diabetes Mellitus.  According to the service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM) documented an initial presentation to the emergency room in January 2000 (2 years prior to separation), at which time the CI was discovered to be critically hyperglycemic (glucose 400 range).  He was admitted for stabilization (not in diabetic ketoacidosis) and discharged with a diagnosis of Type II diabetes mellitus (DM II).  The initial treatment regimen was dietary management, an oral hypoglycemic agent (metformin), and sliding scale insulin.  Subsequent outpatient notes from the STR documented an uncomplicated course without further hospital admissions, ketoacidosis, hypoglycemic episodes, systemic diabetic complications, or requirement for frequent provider visits.  Insulin was discontinued, but two oral hypoglycemic agents (Glucotrol and Avandia) were added (metformin continued).  The medication profile confirmed ongoing use and compliance.  Dietary management was continued, but there was no STR entry indicating limitation of activities or a recommendation to that effect.  Neither the profile nor the commander’s statement indicated any activity or duty limitation other than constant access to care.  Satisfactory control of the DM II condition for accommodating unrestricted military service could not be achieved, however, and the CI was referred for an MEB which in turn forwarded “type II diabetes mellitus, poor control” to the PEB.

The NARSUM examination on 26 June 2002 (8 months before separation) documented suboptimal control (referencing increasing hemoglobin A1C levels), but more recent improvement with home glucose monitoring “less than 150 due to medication adjustments.”  The NARSUM corroborated dietary measures and treatment with the three oral hypoglycemic agents referenced above.  Other than monitoring of visual acuity by optometry (no retinopathy per STR examinations), no diabetic complications were documented.  The physical examination was normal, without evidence of neuropathy or other diabetic complications.  

A VA Compensation and Pension (C&P) examination on 16 April 2004 (14 months after separation) documented good control with dietary management and now only two oral hypoglycemic agents (metformin and Avandia).  The examiner specified “no restriction of activity,” and listed the absence of all common systemic complications of diabetes.  The examiner further noted that the CI only required semi-annual provider visits, and had not manifested any hypoglycemic, ketoacidosis or other episodic complications of diabetes.  The physical examination was normal and it detailed negative findings for all common systemic complications of diabetes.  

The Board directed attention to its rating recommendation based on the above evidence.  Both the PEB and the VA rated 10% under the solely applicable code 7913 (diabetes mellitus) per VASRD §4.119.  A 10% rating under 7913 is for “manageable by restricted diet only.”  The 20% criteria are “requiring insulin and restricted diet, or; oral hypoglycemic agent and restricted diet.”  Both the MEB and the C&P evidence definitively established continuing regulation of diet and use of oral hypoglycemic agents.  The 20% criteria were thus amply supported, and it was unclear why neither the Service nor the VA accounted for that evidence in their respective rating determinations.  Neither the use of insulin nor the requirement for activity restriction were present, as requisite for a 40% rating.  None of the requisite criteria for any higher ratings were supported as detailed in the above evidence; and, there were no evidence for systemic complications of diabetes to justify additional rating.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board recommended a disability rating of 20% for the DM II condition under code 7913.  

BOARD FINDINGS:  In the matter of the Type II diabetes mellitus condition, the Board unanimously recommends a disability rating of 20%, coded 7913 IAW VASRD §4.119.  There were no other conditions within the Board’s scope of review for consideration.  The Board recommends that the CI’s prior determination be modified as follows, effective as of the date of the prior medical separation:  

CONDITION	VASRD CODE	PERMANENT RATING	
Diabetes Mellitus, Type II	7913	20%	

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

 SAMR-RB	

MEMORANDUM FOR Commander

SUBJECT:  Department of Defense Physical Disability Board of Review Recommendation for XXXXXXXXXXXXXXXXXXXXX, AR20170000909 (PD201500972)

1.  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, accept the Board’s recommendation to modify the individual’s disability rating to 20% without re-characterization of the individual’s separation.  This decision is final.  

2.  I direct that all the Department of the Army records of the individual concerned be corrected accordingly no later than 120 days from the date of this memorandum.   

3.  I request that a copy of the corrections and any related correspondence be provided to the individual concerned, counsel (if any), any Members of Congress who have shown interest, and to the Army Review Boards Agency with a copy of this memorandum without enclosures.

 BY ORDER OF THE SECRETARY OF THE ARMY:

CF: 
(  ) DoD PDBR
(  ) DVA