RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXXX	CASE:  PD-2015-02144
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20041231

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was a National Guard E6, Infantryman, medically separated for “Type 1 diabetes mellitus [DM]” with a disability rating of 20%.

CI CONTENTION:  The CI contended DM and feet conditions.  Additionally, the CI contended four conditions not identified by the Medical Evaluation Board (MEB) nor the Physical Evaluation Board (PEB).  The 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 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 - 20040929	VARD - 20050720	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Type 1 DM	7913	20%	DM, Type 1	7913	20%	STR	
Tinea Ungis	Not Unfitting 	Dermatophytosis of Both Feet with Tinea Pedis, Tinea Unguim and Onychomycosis	7813	0%		
Tinea Pedis						
COMBINED RATING:  20%	COMBINED RATING OF ALL VA CONDITIONS:  20%	

Type 1 DM.  According to service treatment records (STR) and the MEB narrative summary (NARSUM), the CI’s Type I DM condition began in March 2004 after the sudden onset of unquenchable thirst, frequent urination, nausea and vomiting, and physical weakness while deployed. He was hospitalized for ketoacidosis. Shortly after recovery, the CI was started on insulin and a restricted diet.  

According to the 28 April 2004 MEB examination (recorded on DD Forms 2807 and 2808), 8 months prior to separation, the examiner noted that the CI was on insulin and suffered from fatigue.  The CI reported he was in excellent health with no functional limitations listed.  

The 28 June 2004 MEB narrative summary (NARSUM) examination, 6 months prior to separation, noted the CI was prescribed insulin.  The examiner did not indicate that avoidance of strenuous occupational and recreational activities were medically necessary.  Review of the STR showed no hospitalizations for treatment of ketoacidosis or hypoglycemia after 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 nor diabetic complications.  The 10 August 2004 permanent profile did not restrict activities, but did specify assignment limitations.  The CI failed to report to a scheduled 16 March 2005 VA Compensation and Pension evaluation.  The VA utilized the CI’s STR to determine the rating percentage.  

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the diabetes condition 20%, coded 7913 (diabetes, mellitus), citing the requirement of insulin use and a restricted diet.  The VA also rated the diabetes condition 20%, coded 7913, citing the same rationale.  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.  Although the CI did experience an episode of ketoacidosis requiring a hospitalization, the lack of physician-directed regulation of activities precludes a 60% rating.  Furthermore, the CI did not require frequent visits to a diabetic care provider, nor were there episodes of 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.  

Contended PEB Conditions:  Tinea Unguis and Tinea Pedis.  The Board’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 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 Type 1 DM condition and IAW VASRD §4.120, the Board unanimously recommends no change in the PEB adjudication.  In the matter of the contended tinea unguis and tinea pedis 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 20150201, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

AR20170005397, XXXXXXXXXXXXXXXXXXXXX 

XXXXXXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXXXXXXXX:

	The Department of Defense Physical Disability Board of Review (DoD PDBR) reviewed your application and found your separation disability rating and your separation from the Army for disability with severance pay to be accurate.  I have reviewed the Board’s recommendation and record of proceedings (copy enclosed), and I accept its recommendation.  I regret to inform you that your application to the DoD PDBR is denied.  

	This decision is final.  Recourse within the Department of Defense or the Department of the Army is exhausted; however, you have the option to seek relief by filing suit in a court of appropriate jurisdiction.

Sincerely,					      
						      					
Enclosure