RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXX	CASE:  PD-2016-00311
BRANCH OF SERVICE:  Air Force 	SEPARATION DATE:  20080404

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E5, Communication Computer Specialist Operator Craftsman, medically separated for ”diabetes” with a disability rating of 20%.

CI CONTENTION:  Counsel's 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 at the time of separation.  The panel has neither the role nor the authority to compensate for progression or complications of service-connected conditions after separation.  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 FPEB - 20080212	VARD - 20090126	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Diabetes Mellitus	7913	20%	Diabetes Mellitus Type I	7913	20%	20081020	
COMBINED RATING:  20%	COMBINED RATING OF ALL VA CONDITIONS:  50%	

ANALYSIS SUMMARY:  

Diabetes Mellitus (DM).  According to the service treatment record (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s diabetic condition began in approximately January 2007.  The CI reported increased thirst and urination, with increased hunger and was initially diagnosed with DM by his primary care physician in July 2007 after two elevated blood sugar readings.  In August 2007 the CI was evaluated by endocrinology and thought likely to have type I DM.  The CI reported rare episodes of hypoglycemia which he self-treated.  Diabetic control was achieved with an insulin regimen with transition to an insulin pump was planned.  Ophthalmology and podiatry consults showed no evidence of diabetic complications.  At the 1 February 2008 endocrinology evaluation, the CI’s recent A1C (reflects blood sugar control over approximately 90 days) was 6.1 percent (normal below 5.7 percent).  The CI was transitioned to an insulin pump for life style flexibility and tight control.  The endocrinologist recommended continuation on a restricted low calorie diet and participation in regular exercise.  

The 20 October 2008 VA Compensation and Pension (C&P) evaluation, 6 months after separation, reported no evidence of diabetic complications, and no indication of restricted activities.  Blood work showed the CI’s blood sugar was 154 milligrams/deciliter and AIC of 6.1 percent

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the diabetic condition 20%, coded 7913 (DM) citing diabetic control was achieved with insulin.  The VA also rated the diabetes condition 20% coded 7913, based on the C&P examination 6 months after separation, citing requirement for insulin 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, the next higher 40% rating was not justified.  Furthermore, the CI 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 diabetic condition.  

BOARD FINDINGS:  In the matter of the diabetic mellitus condition and IAW VASRD §4.119, 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 modification or re-characterization of the CI’s disability and separation determination. 

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20160501, w/attachments
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

XXXXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXXXXXX:

Reference your application submitted under the provisions of DoDI 6040.44 (Section 1554, 10 USC), PDBR Case Number PD-2016-00311.

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,

Attachment:
Record of Proceedings