RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2015-01235
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20021126

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E6, Motor Transport Operator, medically separated for “diabetes mellitus,” with a disability rating of 20%.

CI CONTENTION:  “Review all conditions.”  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 - 20020903	VARD - 20030107	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Diabetes Mellitus, Insulin Dependent	7913	20%	Diabetes Mellitus, Type 2 With Erectile Dysfunction	7913	20%	20021031	
COMBINED RATING:  20%	COMBINED RATING OF ALL VA CONDITIONS:  60%	

ANALYSIS SUMMARY:  

Diabetes Mellitus, Insulin Dependent.  The CI developed diabetes mellitus type II (DM Type II) in January 2001.  He was started on oral glycemics, but several days later was hospitalized for hyperglycemia with glucose levels in the 700’s (normal less than 100) and was started on insulin.  The CI received nutritional education for dietary regulation in February 2001.  An ophthalmology evaluation in June 2001 found no evidence of diabetic retinopathy.  The CI complained of paresthesia in his left hand and feet and those symptoms reportedly resolved once Metformin was prescribed.  Treatment did not result in improvement sufficient to allow unrestricted duty. The Medical Evaluation Board (MEB) forwarded “diabetes mellitus, insulin dependent” for PEB adjudication.

According to the MEB examination (recorded on DD Forms 2807 and 2808) dated 24 April 2002, 7 months prior to separation, the examiner noted that the CI was on oral hypoglycemic medications and insulin.  The CI reported some tingling in feet.  The examiner did not indicate that avoidance of strenuous occupational and recreational activities was medically necessary.  

The MEB narrative summary examination on 28 June 2002, 5 months prior to separation, noted that the CI was currently taking insulin and oral hypoglycemic medications.  The diabetes was noted to be poorly controlled with a hemoglobin A1C of 13 percent (normal less than 6.0).  Dietary restrictions included no MRE’s for greater than 3 days and following an ADA diet.  The examiner did not indicate that avoidance of strenuous occupational and recreational activities was medically necessary for DM Type II management.  The examiner noted the CI was on a P2 profile for degenerative joint disease of the right knee with limitations of no jumping, climbing, or prolonged standing and alternate aerobic walking event for his physical fitness test and stated “…otherwise, has no other limitation.” 

Review of the service treatment record showed no hospitalizations for treatment of ketoacidosis or hypoglycemia except for the initial hospitalization.  There was also no evidence of twice monthly visits to a diabetic care provider and diabetic complications

At the 31 October 2002 VA Compensation and Pension (C&P) evaluation, performed 1 month before separation, the examiner reported that the CI was taking oral hypoglycemic and insulin.  The CI reported being diagnosed with hypertension in March 2000 and erectile dysfunction in November 2000 due to decreased blood flow.  The CI had some numbness and blurred vision at the onset of his DM.  The numbness and blurred vision resolved after taking his diabetic medications.  The physical examination was 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 was medically necessary. 

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the diabetes mellitus condition 20%, coded 7913 (diabetes mellitus), citing requirement of insulin and restricted diet.  The VA rated the diabetes mellitus condition 20% coded 7913, based on the VA C&P examination 1 month before separation, citing the requirement of insulin and a 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 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 DM condition.   

BOARD FINDINGS:  In the matter of the diabetes mellitus condition and IAW VASRD §4.73, 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 20150615, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

SAMR-RB						

MEMORANDUM FOR Commander

08 MAR 2017

SUBJECT:  Department of Defense Physical Disability Board of Review Recommendation for 
XXXXXXXXXXXXXXXXXX, AR20170002452 (PD201501235)

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