RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXX	CASE:  PD-2016-00681
BRANCH OF SERVICE:  army 	SEPARATION DATE:  20040827

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

CI CONTENTION:  His diabetes is uncontrollable and his right and left knees, right shoulder and lower back should have been rated.  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 - 20040517	VARD - 20041209	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Diabetes Mellitus Type II	7913	20%	Diabetes Mellitus	7913	20%	20040924	
COMBINED RATING:  20%	COMBINED RATING OF ALL VA CONDITIONS:  50% 	

ANALYSIS SUMMARY:  

Diabetes Mellitus (DM) Type II.  According to the service treatment record (STR) and Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI developed type II DM in January 2004 which ultimately required treatment with oral hypoglycemic medication. 

At the 25 April 2004 MEB NARSUM examination, 4 months prior to separation, the CI’s chief complaint included elevated blood sugar with symptoms of excessive thirst, excessive appetite, weakness, and dizziness.  His physical examination (PE) was normal.  The CI’s medication included oral metformin on a daily basis.  The examiner noted the CI’s profile proscribed extended consumption of military meals ready to eat and availability of meals three times a day.  The examiner did not indicate that avoidance of strenuous occupational and recreational activities was medically necessary.   

At the 24 September 2004 VA Compensation and Pension (C&P) evaluation, 1 month after separation, the CI remained taking oral hypoglycemic medication.  A brief and limited PE was normal.  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.  Both the PEB and VA rated the diabetes condition at 20%, coded 7913 (DM), each citing the requirement for a hypoglycemic agent and restricted (diabetic) diet. The VA decision was based on the C&P examination 1 month after separation.

All panel members agreed the required oral hypoglycemic agent (metformin) and restricted diet directly supported a 20% impairment rating.  Absent evidence of insulin use and or medically-prescribed regulation of activities, the next higher 40% rating was not supported.  Furthermore, following initiation of treatment at the time of diagnosis, the STR revealed 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 any of the 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’s adjudication for the DM condition.  

BOARD FINDINGS:  In the matter of the DM 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 20160916, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record 

AR20170016349, XXXXXXXXXXXXXXXXXXX

XXXXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXXXXXX:

	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