RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2016-00262
BRANCH OF SERVICE:  Air Force	SEPARATION DATE:  20030922

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E4, Vehicle Operator, medically separated for “Type I diabetes mellitus requiring insulin therapy” with a disability rating of 20%.

CI CONTENTION:  Diabetes should be rated higher.  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 – 20030708	VARD - 20040122	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Type I Diabetes Mellitus requiring Insulin Therapy	7913	20%	Diabetes Mellitus	7913	20%	20031108	
COMBINED RATING:  20%	COMBINED RATING OF ALL VA CONDITIONS:  0%	

ANALYSIS SUMMARY:  

Type I Diabetes.  According to the service treatment record (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s diabetes condition manifested as abdominal pain, polyuria (abnormal frequent urination), polydipsia (abnormal great thirst), polyphagia (excessive hunger) and an approximately 8-pound weight loss in April 2003.The P4 profile, 5 months before separation, restricted the CI from formal physical training when his blood glucose was greater than 250. 

The 14 May 2003 MEB NARSUM, 4 months before separation, revealed the CI received insulin therapy, was carbohydrate counting (restricted diet), and exercised at least three times per week.  A regulation of activities was not indicated. The commander’s performance statement noted the CI was a top squadron performer who continued to work a number of assignments requiring his presence beyond normal working duty hours. 

The 8 November 2003 VA Compensation and Pension (C&P) general evaluation, 2 months after separation, documented the CI received insulin three times per day and went to the gym to weight lift once a week.  The examiner noted the CI had never been hospitalized for control of ketoacidosis or hyperglycemic reactions, and the CI denied any evidence of peripheral neuropathy, diabetic neuropathy or nephropathy.  A regulation of activities was not indicated. 

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 rated the diabetes condition 20%, also coded 7913, based on the C&P examination 2 months after separation, citing a requirement for insulin and restricted diet.

The panel agreed the CI’s requirement for 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, the CI denied any 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 there was insufficient cause to recommend a change in the PEB adjudication for the Type I diabetes condition.

BOARD FINDINGS:  In the matter of the Type I diabetes condition and IAW VASRD §4.121, the panel 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 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 20160427, 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-2016-00262.

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 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