RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME: XXXXXXXXXXXXXXXXXX	CASE:  PD-2015-01325
BRANCH OF SERVICE:  Air Force 	SEPARATION DATE:  20070422

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was a Reserve E6, Aircraft Structural Maintenance Craftsman, medically separated for “diabetes mellitus type II…,” with a disability rating of 20%.

CI CONTENTION:  The CI requests that all conditions be considered.  His 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 - 20070209	VARD – NA	
Condition	Code	Rating	Condition	Code	Rating	Exam	
DM Type II…	7913	20%	NA	
Hypertension	Cat II		
Hyperlipidemia	Cat III		
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  NA	

ANALYSIS SUMMARY:  

Diabetes Mellitus Type II.  The CI was first documented to have elevated lipids in December 1996 and treated with dietary counseling.  The records are silent for further evaluation until he is seen in October 2004 for elevated blood pressure during a routine dental evaluation.  An evaluation was undertaken and he was begun on medications the same day.  It was noted that his fasting blood sugar was elevated as was a measure of renal function.  The CI was then referred to cardiology and seen on 8 November 2004.  His sodium intake was thought to be excessive and his blood pressure remained elevated albeit reduced.  The physical examination was unremarkable and his ECG normal.  He was also noted to be overweight at 234 pounds, an increase of 87 pounds since accession (147 pounds).  His medications were adjusted and an echocardiogram recommended.  The CI reported that it showed “thickening of the heart.”  On 24 November 2004, his fasting blood sugar was normal at 99, but an HgbA1C was elevated at 6.9 (6.0 is the upper limit of normal) indicative of poor control the prior 4 months.  On 16 December 2004, his medications were again adjusted, a medication for elevated lipids added, and he was begun on a low salt, weight loss diet to help control the hypertension (increased blood pressure), increased lipids, and poor glucose tolerance.  There are no records then in evidence until the CI was admitted on 11 April 2005 for a 1 week history of blurred vision, weakness, increased thirst, and increased urination.  He also endorsed a weight loss of 30 pounds over the previous few weeks.  Laboratory findings showed a markedly elevated blood glucose level and elevated renal functions.  The latter were thought to reflect dehydration from the diabetes.  His blood sugar was normal and physical examination was unremarkable for diabetic sequelae (eye, nerve, kidney, or heart).  He was discharged on a diabetic diet and insulin.  His medications were adjusted over the next few months and good control was obtained for the diabetes, hypertension, and elevated lipids.  The final record in evidence was an internal medicine note dated 10 July 2006.  The diabetes was noted to be in good control on insulin.  The blood pressure was within normal limits, but slightly above the 130/80 goal for a diabetic.  The lipids were also under good control.  There was no evidence of end organ damage from the diabetes.  Renal insufficiency was noted, but attributed to excess diuretic intake and inadequate fluids.  The CI was advised to continue exercise.  Regulation of activities was not recorded.  Review of the service treatment record showed no hospitalizations for treatment of ketoacidosis or hypoglycemia.  There was also no evidence of twice monthly visits to a diabetic care provider and diabetic complications.  Rather than restricting activities, the profile instead indicated that the CI could participate in fitness training.  The CI did not file a VA claim for compensation so there was no VA Compensation and Pension evaluation or rating decision in evidence for comparison.  

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the diabetes condition 20%, coded 7913, citing the use of insulin.  The Board agreed that the requirement for treatment with insulin and restricted diet justified a 20% rating.  There was no evidence of medically prescribed regulation of activities to support a higher rating of 40%.  Furthermore, the CI did not require frequent visits to a diabetic care provider, nor were there episodes of ketoacidosis, hypoglycemic reactions, hospitalizations (other than the initial presentation) 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 type II condition.  

Contended PEB Conditions:  Hypertension & Hyperlipidemia.  The Board’s main charge is to assess the fairness of the PEB’s determination that the contended conditions were not unfitting.  There was no performance-based evidence from the record that either of these conditions significantly interfered with satisfactory duty performance.  After due deliberation, the Board concluded that there was insufficient cause to recommend a change in the PEB fitness determination for any of the contended conditions and so no additional disability ratings are recommended.  

BOARD FINDINGS:  In the matter of the diabetes mellitus type II and IAW VASRD §4.120, the Board unanimously recommends no change in the PEB adjudication.  In the matter of the contended hypertension and hyperlipidemia conditions, the Board unanimously recommends no change from the PEB determinations as not unfitting.  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 20150616, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

SAF/MR

Dear XXXXXXXXXX:

Reference your application submitted under the provisions of DoDI 6040.44 (Section 1554, 10 USC), PDBR Case Number PD-2015-01325.

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