RECORD OF PROCEEDINGS
PHYSICAL DIPSABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2015-02484
BRANCH OF SERVICE:  Marine Corps 	SEPARATION DATE:  20090831

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E6, Combat Engineer, medically separated for “type 1 diabetes,” with a disability rating of 20%.

CI CONTENTION:  He requests review of 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 - 20090223	VARD - 20100702	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Type I Diabetes	7913	20%	Diabetes Mellitus Type II with Erectile Dysfunction	7913	20%	20091023	
COMBINED RATING:  20%	COMBINED RATING OF ALL VA CONDITIONS:  80%	

ANALYSIS SUMMARY:  

Type I Diabetes.  According to the service treatment record (STR), the CI developed type I diabetes mellitus in late 2007 which ultimately required treatment with oral hypoglycemic medication, dietary restriction and insulin.  Treatment did not result in improvement sufficient to allow unrestricted duty.  The 12 December 2007 MEB narrative summary (NARSUM) examination, 20 months prior to separation, noted that the CI was on oral hypoglycemic medication and insulin.  The CI did not report any functional limitations.  The examiner did not indicate that avoidance of strenuous occupational and recreational activities was medically necessary.  At the 23 October 2009 VA Compensation and Pension (C&P) evaluation, performed 2 months after separation, the examiner reported that the CI was taking prescribed oral hypoglycemic medication and insulin.  The CI reported loss of strength in both hands and arms, tingling and numbness in hands and feet, fainting, and blurry vision.  The examiner did not indicate that avoidance of strenuous occupational and recreational activities was medically necessary.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the diabetes condition 20%, coded 7913.  The VA also rated the diabetes condition 20%, coded 7913, 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, and carefully examined the evidence regarding the requirement for “regulation of activities” (avoidance of strenuous occupational and recreational activities) in this case, since this stipulation justifies the higher 40% rating.  However, there was no evidence that these restrictions fulfilled the “avoidance of strenuous activities” stipulation, nor were they prescribed by a medical professional as medically necessary.  The 9 October 2008 physician's statement for diabetes stated the CI needed to alter his physical training regimen, not altogether avoid physical training.  Panel members thus concluded that the “regulation of activities” stipulation was not met in this case, and therefore the next higher 40% rating was not justified.  Furthermore, there was no requirement for 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 condition.  

BOARD FINDINGS:  In the matter of the diabetes condition and IAW VASRD §4.121, the panel unanimously recommends no change in the PEB adjudication.  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 20150917, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

MEMORANDUM FOR DIRECTOR, SECRETARY OF THE NAVY COUNCIL OF REVIEW
               BOARDS 

Subj:  PHYSICAL DISABILITY BOARD OF REVIEW (PDBR) RECOMMENDATIONS
 
Ref:   (a) DoDI 6040.44

      In accordance with reference (a), I have reviewed the cases listed below and approve the recommendations of the PDBR that the following individual’s records not be corrected to reflect a change in either characterization of separation or in the disability rating previously assigned by the Department of the Navy’s Physical Evaluation Board:

		- XXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXX, former USN

		
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	     				  Acting