RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXXX	CASE:  PD-2015-01035
BRANCH OF SERVICE:  Air Force 	SEPARATION DATE:  20050329

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E4, Vehicle Operations Journeyman, medically separated for “diabetes mellitus type I,” with a disability rating of 20%.

CI CONTENTION:  “Disability should be at least 40% if not more.  I was prescribed medication for hypertension. I currently have dizzy spells/vertigo & nerve damage in right leg.”  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 - 20041209	VARD - 20050926	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Diabetes Mellitus Type I, Requiring Insulin	7913	20%	Diabetes Mellitus, Type II	7913	20%	20050726	
COMBINED RATING:  20%	COMBINED RATING OF ALL VA CONDITIONS:  30%	

ANALYSIS SUMMARY:  

Diabetes.  The service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM) documented an initial presentation to the emergency room in June 2004 (9 months prior to separation), at which time the CI was discovered to be hyperglycemic (glucose 265).  He was admitted for hydration and stabilization (not in diabetic ketoacidosis), discharged with a diagnosis of new onset diabetes mellitus (DM), and prescribed a diabetic diet and insulin regimen.  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.  The insulin regimen was adjusted and the CI was not converted to oral therapy.  Dietary management was continued, but there was no STR entry indicating limitation of activities or a recommendation to that effect.  The profile permitted all events, only prohibiting deployment; and, the commander’s statement did not note any activity or duty limitation other than an inability to deploy.  Treatment notes proximate to separation from the VA file encouraged exercise and noted compliance with same.  Satisfactory control of the DM condition for accommodating unrestricted military service could not be achieved, however, and the CI was referred for an MEB.  The MEB forwarded “diabetes mellitus” for PEB adjudication.

The NARSUM examination on 24 August 2004 (7 months prior to separation) documented an improving course (recording serial laboratory findings of falling glucose and favorable hemoglobin A1C levels), listed the absence of systemic diabetic complications by consultations, and noted current treatment with dietary management and a regimen of long and short-acting insulin.  There was no documentation of limitation of activities.  The physical examination was normal, without evidence of neuropathy or other diabetic complications.  

A VA Compensation and Pension (C&P) examination on 26 July 2005 (4 months after separation) documented the above clinical course with continued good control on the same treatment regimen as that in the NARSUM.  Dietary management was not mentioned, nor was any limitation of activity.  The physical examination was normal, without evidence of neuropathy or other diabetic complications.  

The Board directed attention to its rating recommendation based on the above evidence.  Both the PEB and the VA (referencing VA treatment notes as well as the C&P evidence) rated 20% under the solely applicable code 7913 (diabetes mellitus); and, both the PEB and VA evidence satisfied the 20% criteria, “requiring insulin and restricted diet, or; oral hypoglycemic agent and restricted diet.”  A requirement for activity restriction, as requisite for a 40% rating, was not supported by the evidence.  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 concluded that there was insufficient cause to recommend a change in the PEB adjudication of the DM condition.  

BOARD FINDINGS:  In the matter of the diabetes mellitus 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 20150606, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

SAF/MRB
1500 West Perimeter Road, Suite 3700
Joint Base Andrews, MD  20762

XXXXXXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXXXXXXXX:

Reference your application submitted under the provisions of DoDI 6040.44 (Section 1554, 10 USC), PDBR Case Number PD-2015-01035.

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,

XXXXXXXXXXXXXXXXXXXXX

Attachment:
Record of Proceedings