RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2015-02205
BRANCH OF SERVICE:  Army	SEPARATION DATE:  20070611

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was a Reserve W2, UH-60 Pilot, medically separated for “diabetes mellitus, requiring oral hypoglycemic agent and restricted diet” with a disability rating of 20%.  

CI CONTENTION:  “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.  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 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 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 – 20070417	VARD - 20070815	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Diabetes Mellitus…	7913	20%	Diabetes Mellitus Type 2	7913	20%	20070801	
Chronic Low Back Pain	Not Unfitting	Lumbar Strain with Scoliosis	5237	10%		
COMBINED RATING:  20%	COMBINED RATING OF ALL VA CONDITIONS:  30%	

ANALYSIS SUMMARY:

Diabetes Mellitus.  According to the service treatment record (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s diabetes condition initially manifested as syncope before it was diagnosed in September 2006.  During a 10 October 2006 nutrition clinic visit, 6 months before separation, the CI discussed and was given written instructions on nutrition therapy and the effects of exercise, stress, and medications for diabetes, along with a sample meal pattern and meal journal, with the goals of improved blood glucose via healthy meals and lifestyle.  

The 21 March 2007 MEB NARSUM examination, 3 months before separation, documented the CI taking diabetes medication twice daily and having to check his blood sugar several times a day.  The CI felt his diabetes was under better control due to his medication regimen, diet and exercise routine.  A restriction of activities was not cited.  Oral hypoglycemic medication was documented and prescribed for control of diabetes.  The 22 March 2007 physical profile, 3 months before separation, allowed the CI to perform the alternate physical fitness test via walk, swim or bike.  The CI was also able to perform upper and lower body weight training.  The 2 March 2007 commander’s performance statement, 2 months before separation, implicated the CI’s diabetes condition and documented the CI’s inability to “lift objects due to degenerative disc disease and perform physical training.”  

At the 1 August 2007 VA Compensation and Pension (C&P) evaluation, 2 months after separation, the CI denied ketoacidosis or hypoglycemic reactions, but felt weak twice a week which was relieved by eating something and resting.  A restriction of activities was not cited.  The CI worked as an insurance agent and had not lost time from work.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the diabetes 20%, coded 7913 (diabetes mellitus).  The VA also rated the diabetes 20%, also coded 7913 based on the C&P examination 2 months after separation, citing diet and medication to control the diabetes.  The panel agreed the CI’s requirement for oral hypoglycemic agent 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.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel concluded there was insufficient cause to recommend a change in the PEB adjudication for the insulin-dependent diabetes mellitus condition.  

Contended PEB Condition:  Low Back Pain.  The panel’s main charge is to assess the fairness of the PEB’s determination that the contended condition was not unfitting.  The contended condition was L2 profiled in 2004 after flight school training when the CI was diagnosed with degenerative disk disease, and was profiled again proximate to separation.  The commander’s performance statement implicated the CI’s degenerative disk disease, stating the CI could not lift or perform physical training; however, the commander also stated the CI’s inability to fly aircraft, was due to his medical condition and medication, and lack of experience rendering the CI non-deployable.  During the MEB NARSUM examination 3 months before separation, the CI stated his “job [aviator] was not feasible, if I pass out what happens?”  Both the MEB NARSUM and MEB judged the contended condition did not fail retention standards.  There was no performance-based evidence from the record that the condition significantly interfered with satisfactory duty performance at or prior to separation.  After due deliberation, the panel concluded there was insufficient cause to recommend a change in the PEB fitness determination for the contended condition and so no additional disability rating is recommended.

BOARD FINDINGS:  In the matter of the diabetes mellitus condition and IAW VASRD §4.121, the panel unanimously recommends no change in the PEB adjudication.  In the matter of the contended chronic low back pain condition, the panel unanimously recommends no change from the PEB determination as not unfitting.  There are no other conditions within the panel’s scope of review for consideration.  The panel, therefore, recommends 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 20150813, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

AR20170010614, 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,