RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2015-01529
BRANCH OF SERVICE:  Air Force 	SEPARATION DATE:  20050719

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

CI CONTENTION:  “Review of all conditions.”  The CI’s complete submission is at Exhibit A.  

SCOPE OF REVIEW:  The panel’s scope of review is defined in DoDI 6040.44.  It is limited to review of disability ratings assigned 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 or non-compensable.  Any conditions outside the panel’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 panel’s authority is limited to assessing the fairness and accuracy of PEB rating determinations and recommending corrections, where appropriate.  The panel’s assessment of the PEB rating determination 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(s) at the time of separation.  The panel 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 panel gives consideration to VA evidence, particularly within 12 months of separation, but only  

RATING COMPARISON:  

SERVICE PEB - 20050527	VARD - 20060329	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Diabetes Mellitus, Insulin Dependent	7319	20%	Type II Diabetes Mellitus with Proteinuria	7319	20%	20051128	
Inappropriate Sinus Tachycardia	7010	Cat II	Sinus Tachycardia	7011	60%		
Hypertension	7101		Hypertension	7101	10%		
Bilateral Carpal Tunnel Syndrome	8515-8599		Carpal Tunnel Syndrome, Right Wrist	8515	NSC		
			Carpal Tunnel Syndrome, Left Wrist	8515	NSC		
Polycystic Ovary Syndrome	7615-7699		Polycystic Ovary Syndrome	7615	0%	STR	
Overweight	Cat III	No VA Placement	
COMBINED RATING:  20%	COMBINED RATING OF ALL VA CONDITIONS:  90%	

ANALYSIS SUMMARY:  

Diabetes Mellitus, Insulin Dependent.  According to service treatment record (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s diabetes mellitus condition was diagnosed in December 2002, and ultimately required treatment with insulin.  Despite treatment, the diabetes condition could not be adequately rehabilitated to meet the physical requirements of the CI’s military specialty.

At the 29 April 2005 MEB examination dated, 3 months prior to separation, noted that the CI was started on oral hypoglycemic agent in 2002 and had demonstrated good diabetes control with HgbA1C below 7.  However, in 2004 her condition required the administration of insulin.  The CI continued to have HgbA1C level consistently below 7 on insulin, and she had no diabetes related complications.  The examiner did not indicate that avoidance of strenuous occupational and recreational activities was medically necessary.  Physical examination showed the eyes, heart, and lungs were normal, and there was normal muscle strength and normal sensation.  Recent lab results noted HgbA1C value of 6.9.  

The CI’s diabetes condition was treated by a civilian endocrinologist as of July 2004.  Endocrinologist letter dated 1 May 2005, 2 months prior to separation, noted that her HgbA1C were consistently below 7.  The examiner indicated a restrictive diet was necessary; however, there were no restrictions on activity.  The CI had an unremarkable physical examination with the exception of being overweight.  The physician stated, “It is my opinion that she is able to remain at her military duties in a satisfactory fashion despite the constraints of diabetes, and consideration should be given to her continuing her military career in the face of this diagnosis.”  

At the 14 June 2005 medical assessment (recorded on DD Form 2697), 1 month prior to separation, the CI reported that she was currently pregnant, and that the only condition which limited her ability to work in her military specialty was the diabetes for which she was being medically discharged for.  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 or diabetic complications.  There was no evidence of a permanent profile; however, temporary profile dated 9 May 2005 noted restrictions related to pregnancy.
	 
At the 28 November 2005 VA Compensation and Pension (C&P) evaluation, performed 4 months after separation, the CI denied episodes of hypoglycemia or ketoacidosis, as well as activity restrictions secondary to diabetes.  Physical examination was unremarkable.

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the diabetes mellitus condition 20%, coded 7319 (diabetes mellitus), citing insulin dependent.  The VA also rated the diabetes mellitus condition 20% coded 7319, citing controlled well with insulin.  The panel 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 panel concluded that there was insufficient cause to recommend a change in the PEB adjudication for the diabetes mellitus condition.   

Contended PEB Conditions:  Inappropriate Sinus Tachycardia, Hypertension, Bilateral Carpal Tunnel Syndrome, Polycystic Ovary Syndrome, and Overweight.  The panel’s main charge is to assess the fairness of the PEB’s determination that the contended conditions were not unfitting.  None of the conditions were profiled, implicated in the commander’s statement nor judged to fail retention standards.  There was no performance-based evidence from the record that any of the conditions significantly interfered with satisfactory duty performance at separation.  After due deliberation, the panel 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 condition and IAW VASRD §4.119, the panel recommends no change in the PEB adjudication.  In the matter of the contended inappropriate sinus tachycardia, hypertension, bilateral carpal tunnel syndrome, polycystic ovary syndrome, and overweight conditions, the panel recommends no change from the PEB determinations as not unfitting.  There were no other conditions within the panel’s scope of review for consideration.  The panel, therefore, recommends that there be no modification or re-characterization of the CI’s disability and separation determination.  

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20150621, w/attachments
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

XXXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXXXXX:

Reference your application submitted under the provisions of DoDI 6040.44 (Section 1554, 10 USC), PDBR Case Number PD-2015-01529.

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,

XXXXXXXXXXXXXXXXXX
Director
Air Force Review Boards Agency

Attachment:
Record of Proceedings