RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2016-00435
BRANCH OF SERVICE:  Army	SEPARATION DATE:  20040703

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E4, Infantryman, medically separated for “type 1 diabetes” with a disability rating of 20%.

CI CONTENTION:  His condition warrants a higher rating and continues to affect daily activities.  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 - 20040419	VARD - NA	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Type 1 Diabetes	7913	20%	No VA Examination Proximate to Separation in Evidence	
COMBINED RATING:  20%	COMBINED RATING OF ALL VA CONDITIONS:  20%	

ANALYSIS SUMMARY:

Type 1 Diabetes.  According to the service treatment record (STR) and Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s diabetes condition was identified in January 2003 after blood laboratory results were positive for fasting hyperglycemia (high blood glucose).  At a 9 June 2003 internal medicine encounter, the CI was initially diagnosed with diabetes mellitus type 2.  The CI was started on an oral hypoglycemic agent.

The 4 November 2003 ophthalmology encounter assessment listed diabetes mellitus with no diabetic retinopathy (diabetic complication of retinal blood vessel damage).  There were osmotic (lens bulging from high glucose) refractive error changes and the plan was to recheck vision when fasting serum glucose levels stabilized.  In the 22 January 2004 MEB NARSUM examination, 5 months prior to separation, the CI reported a history of “increased urination, polydipsia (excessive drinking) and polyphagia (excessive eating).  Additionally, he began to lose weight at a very dramatic rate.  He was initially placed on oral agents and sent for further evaluation.  The endocrinologist diagnosed type 1 diabetes, discontinued his oral agent, and prescribed 50 units of Lantus.  Since that time his sugars were under reasonably good control.  Ophthalmology evaluated the CI and found that he had no retinal changes consistent with diabetic retinopathy.  Additionally, the CI denied any emergency room visits for hyper or hypoglycemia and he did not have to alter his activities.  The physical examination revealed no evidence of the diabetic complications of retinopathy, peripheral neuropathy (vascular and metabolic nerve damage), or peripheral vascular disease (diminution or absence of peripheral pulses).  The examiner documented the CI’s diabetes condition as chronic and stable.  His type 1 diabetes required daily insulin with diet modification and no significant activity limitations.  The 9 February 2004 internal medicine encounter documented the CI had taken steps to improve his medical status by eating better, following nutrition recommendations and exercising three times per week.  There was no VA examination proximate to separation for the panel to review.

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the type 1 debates 20%, coded 7913 (diabetes mellitus), citing type 1 diabetes requiring insulin and restricted diet.  The panel agreed 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 STR showed no episodes of ketoacidosis or hypoglycemia requiring hospitalizations or frequent visits to a diabetic care provider (twice a month or more frequently), or 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 diabetes mellitus type 1.

BOARD FINDINGS:  In the matter of the diabetes mellitus type 1 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 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 20160603, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record 

	
AR20170015661, 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,					       
						      					
Enclosure