RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXXX	CASE:  PD-2015-01154
BRANCH OF SERVICE:  Air Force 	SEPARATION DATE:  20030707

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

CI CONTENTION:  The CI contends his condition has worsened and submitted medical records from 2015.  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 - 20030602	VARD - 20031002	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Diabetes Mellitus, Insulin Dependent	7913	20%	Diabetes Mellitus	7913	20%	STR	
COMBINED RATING:  20%	COMBINED RATING OF ALL VA CONDITIONS:  30%	

ANALYSIS SUMMARY:  

Diabetes Mellitus, Insulin Dependent.  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI presented to the emergency room on 12 November 2002 after his headache symptoms worsened and was experiencing nausea, vomiting, blurry vison in association with headaches.  His blood glucose levels were high and he was admitted for ketoacidosis for several days and discharged with no prior history and regular insulin.  An ophthalmology evaluation in November 2002 found no evidence of diabetic retinopathy.  At the Endocrinology consult on 26 November 2002, the CI reported he was very physically active (lays pipes and does manual labor) and went to the gym and did power exercises for an hour.  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 MEB.  The MEB forwarded insulin dependent diabetes mellitus for PEB adjudication.  The MEB NARSUM examination on 17 December 2002, 7 months prior to separation, noted that the CI was on Lantus and Humalog insulins.  Physical examination noted consults with neurology, nutrition, and ophthalmology were normal showing no evidence of retinopathy, neuropathy or other complications of diabetes.  The examiner did not indicate that avoidance of strenuous occupational and recreational activities were medically necessary.  The examiner stated “No” to impairment for military occupation.  

There was no VA Compensation and Pension (C&P) evaluation performed.  The VA used the STRs to complete their assessment.  

The Board directed attention to its rating recommendation based on the above evidence.  The PEB (and Formal PEB with SAFPC concurrence) rated the diabetes mellitus condition 20%, coded 7913 (diabetes mellitus), citing no limitations in the activities of daily living and leads an active lifestyle and follows an ADA diet.  The VA also rated the diabetes mellitus condition 20% coded 7913, based on the STR, citing the requirement of insulin and diabetic diet with no restriction in activities.  Review of the STR showed no hospitalizations for treatment of ketoacidosis or hypoglycemia except for the initial hospitalization for ketoacidosis 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 profile did not restrict activities.  The January 2003 commander’s statement stated that the diabetes prevented the CI from wearing a respirator to perform duties when working with chemicals, but otherwise had no duty requirement restrictions.  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, the CI 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 mellitus condition.  

BOARD FINDINGS:  In the matter of the diabetes mellitus condition and IAW VASRD §4.120, 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 20150608, with attachments
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

SAF/MRB

XXXXXXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXXXXXXXX:

Reference your application submitted under the provisions of DoDI 6040.44 (Section 1554, 10 USC), PDBR Case Number PD-2015-01154.

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,

Attachment:
Record of Proceedings