RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2015-02159
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20040310

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was a Reserve O3, Field Artillery Officer, medically separated for diabetes type II, with a disability rating of 20%.  

CI CONTENTION:  The CI’s condition continues to worsen.  Review all conditions.  The 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 to the extent that it reasonably reflects the severity of the disability at the time of separation.

RATING COMPARISON:  

SERVICE PEB - 20040109	VARD - 20040805	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Diabetes, Type 2, Requiring Oral Medication and Insulin for Control with Diet Restrictions	7913	20%	Diabetes Mellitus 	7913	0%	20040630	
Thoracic Back Pain	Not Unfitting	Back Strain	5299-5236	NSC	20040707	
Keloid Alopecia		Keloids, Scalp	7817	0%	20040630	
Hypercholesterolemia		No VA Placement	
COMBINED RATING:  20%	COMBINED RATING OF ALL VA CONDITIONS:  0%	

ANALYSIS SUMMARY:  

DIABETES, TYPE II.  The CI had a preexisting history of type II diabetes since February 1996.  Following mobilization in January 2003, he had increasing difficulty with glucose control and was started on insulin.  However, treatment did not result in improvement sufficient to allow unrestricted duty.  The 13 November 2003 MEB NARSUM examination, 4 months prior to separation, noted that the CI was on oral hypoglycemic medication and insulin.  The examiner stated that he required dietary restrictions but no exercise limitations, and there were no secondary complications.  Review of the service treatment record (STR) 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.  The permanent profile required insulin and refrigeration for glucose, but did not restrict activities.  

At the 30 June 2004 VA Compensation and Pension (C&P) evaluation, 4 months after separation, the CI reported he stopped running because of increased shortness of breath on exertion, and he engaged in regular activity doing things around the house, etc.  The examiner reported that the CI was taking oral hypoglycemic medication and insulin, and did not indicate that avoidance of strenuous occupational and recreational activities was medically necessary.  The physical examination was normal showing no evidence of retinopathy, neuropathy or other complications of diabetes.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the diabetes condition 20%, coded 7913, citing oral medication and insulin for control with diet restrictions.  The VA rated the diabetes condition 0%, coded 7913, citing inability to establish that his diabetes was aggravated to a compensable degree during his latest period of military service, and assigned a non-compensable disability evaluation.  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, 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 panel concluded that there was insufficient cause to recommend a change in the PEB adjudication for the diabetes mellitus condition.  

Contended PEB Conditions:  Thoracic Back Pain, Keloid Alopecia, and Hypercholesterolemia.  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 or implicated in the commander’s statement or 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 condition and IAW VASRD §4.120, the panel unanimously recommends no change in the PEB adjudication.  In the matter of the contended thoracic back pain, keloid alopecia, and hypercholesterolemia conditions, the panel unanimously recommends no change from the PEB determinations as not unfitting.  There are no other conditions within the panel’s scope of review for consideration.  The panel, 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 20150805, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

AR20170010055, XXXXXXXXXXXXXXXXXX 

XXXXXXXXXXXXXXXXXX
XXXXXXXXXXXXXXXXXX
XXXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXXXXX

	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,