RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2015-01675
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20050115

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

CI CONTENTION:  “Diabetes Type 1 has been a hardship.  Starting to have eye problems.  Married with 2 children. Social anxiety.”  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 - 20040927	VARD - 20050224	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Diabetes Mellitus	7913	20%	Diabetes Mellitus, Type I	7913	20%	20041022	
COMBINED RATING:  20%	COMBINED RATING OF ALL VA CONDITIONS:  20%	

ANALYSIS SUMMARY:  

Diabetes Mellitus.  According to the Service Treatment Records (STR) and Medical Evaluation Board (MEB) narrative summary (NARSUM) the CI developed type I diabetes mellitus in 2004 which ultimately required treatment with dietary restriction and insulin.  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 an MEB.  The MEB forwarded “diabetes type I” for PEB adjudication.  

The MEB NARSUM examination on 10 August 2004, 5 months prior to separation, noted that the CI was on insulin.  The CI reported having low blood sugar.  The examiner did not indicate that avoidance of strenuous occupational and recreational activities was medically necessary. 

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 regular visits to a diabetic care provider or diabetic complications.  The permanent profile restricted unlimited walking, running, biking and swimming but allowed running, walking, biking and swimming at the CI’s own pace and distance, and upper and lower body weight training.  For the physical fitness test the CI was allowed to perform the push-ups, sit-ups; it restricted the 2-mile run but allowed the alternate walk, swim, and bike; and he was able to move with a fighting load at least 2 miles and was able to do 3-5 second rushes under direct and indirect fire.  

At the 22 October 2004 VA Compensation and Pension (C&P) evaluation, performed 3 months before separation, the examiner reported that the CI was taking insulin.  The CI reported he checked his blood sugars up to 4 times a day and that it is usually under good control.  He stated he was suffering from kidney damage as a result of high blood sugar for a prolonged period (before he was diagnosed and treated).  He had a thorough optometric examination without dilation, and he reported no visual disturbances.  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 condition 20%, coded 7913, citing it as being in fair control with insulin and diet, manifesting with hypoglycemic episodes, weakness and fatigue.  The VA also rated the diabetes condition 20%, coded 7913, citing the condition was fairly well controlled on subcutaneous insulin.  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 a higher 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 for the diabetes mellitus 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 20150604, w/attachments
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

SAMR-RB						

MEMORANDUM FOR Commander, US Army Physical Disability Agency 
(AHRC-DO), 2900 Crystal Drive, Suite 300, Arlington, VA  22202-3557

20 MAR 2017

SUBJECT:  Department of Defense Physical Disability Board of Review Recommendation for 
XXXXXXXXXXXXXXXXXX, AR20170001930 (PD201501675)

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