RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2015-02303
BRANCH OF SERVICE:  Air Force	SEPARATION DATE:  20070820

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E6, Electronic Signals Intelligence Exploitation Craftsman, medically for “diabetes mellitus type I,” 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 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 - 20070612	VARD - 20080319	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Diabetes Mellitus Type I	7913	20%	Diabetes Mellitus Type I	7913	20%	20080109	
COMBINED RATING:  20%	COMBINED RATING OF ALL VA CONDITIONS:  50%	

ANALYSIS SUMMARY:

Diabetes Mellitus Type I.  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI developed diabetes mellitus type I condition in April 2007, 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 MEB.  The MEB forwarded “diabetes mellitus type I” for PEB adjudication.  The MEB NARSUM on 10 May 2007, 3 months prior to separation, noted CI complaints of diabetes mellitus type I, insulin dependent.  History included weight loss, increased thirst and urination, dry mouth, and mild nausea.  The CI had high level of glucose in urine as well as ketones, a fasting glucose of 284 (normal 80-120), and elevated glycosolated hemoglobin level of 15.0 (normal 4-6).  The CI was started on insulin (Lantus) and testing confirmed type I diabetes with elevated levels of glutamic acid decarboxylase autoantibodies (GAD Ab).  The examiner indicated that the CI had attended diabetic education classes and learned how to control his disease with insulin.  Physical examination showed normal extremities that were neurovascularly intact with full sensation to monofilament testing.  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.  There was also no evidence of twice monthly visits to a diabetic care provider and diabetic complications.  The MEB profile restricted the CI to work day shifts for a period of 3 months for medication adjustment.  Laboratory results from 30 April 2007 showed a fasting glucose of 101 (normal) and a normal urinalysis.  Glycosolated hemoglobin from 17 May 2007 was 9.4 (normal 4-6).  At the 9 January 2008 VA Compensation and Pension (C&P) evaluation, performed 5 months after separation, the CI reported fatigue and progressive weight loss.  There was no past history of diabetic ketoacidosis or hypoglycemia requiring hospitalization.  The examiner reported that the CI was taking insulin (Lantus and NovoLog).  On physical examination, the eyes, heart, lungs, and sensation were normal.  There were no skin changes, blood pressure or kidney problems.  The examiner noted the diagnosis was diabetes mellitus type I and required daily insulin.  He had no complication of diabetes and had been avoiding strenuous activities to prevent hypoglycemic reactions.

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the diabetes mellitus type I condition 20%, coded 7913 (diabetes mellitus), citing insulin regimen requirement that restricted his ability to work shifts.  The VA also rated the diabetes mellitus type I condition 20% coded 7913 (diabetes mellitus), citing a “requirement for insulin and restricted diet, or oral hypoglycemic agent and restricted diet.”  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 (avoidance of strenuous occupational and recreational 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 type I condition.

BAORD FINDINGS:  In the matter of the diabetes mellitus type I condition and IAW VASRD §4.119, the panel unanimously recommends no change in the PEB adjudication.  There were 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 20150831, w/atchs
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-2015-02303.

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.  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.  I accept their recommendation that your application be denied.

Sincerely,

XXXXXXXXXXXXXXXXXX
Director
Air Force Review Boards Agency

Attachment:
Record of Proceedings