RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXX	CASE:  PD-2016-00705
BRANCH OF SERVICE:  ARMY 	SEPARATION DATE:  20040622

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E3, Generator Repairman, medically separated for “insulin dependent diabetes mellitus with an A1C of 8” with a disability rating of 20%.  

CI CONTENTION:  No specific contention made.  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 - 20040409	VARD - 20040525	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Insulin Dependent Diabetes Mellitus …	7913	20%	Diabetes Mellitus Type 1	7913	40%	STR	
COMBINED RATING:  20%	COMBINED RATING OF ALL VA CONDITIONS:  40%	

ANALYSIS SUMMARY:  

Insulin Dependent Diabetes Mellitus.  According to the service treatment record (STR) and Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI developed type I diabetes mellitus (DM) in December 2003 which required medical evacuation from a combat theater and immediate treatment with insulin.  

The 26 February 2004 MEB narrative summary (NARSUM) examination, 4 months prior to separation, noted the CI was on insulin.  The examiner stated, “currently this soldier cannot perform strenuous physical activity because of symptoms of hypoglycemia” and also indicated the CI was unable to perform basic soldiering activities or military occupation-specific tasks such as “heavy lifting requiring significant physical activity,” but did not specify the reasons for these limitations.  The NARSUM also indicated the CI had been seen by optometry for acute refractive error that was “probably secondary to his high blood sugars.”  

At the time of the 24 March 2005 VA primary care clinic visit, 9 months after separation, the CI complained of vomiting, malaise, and poorly controlled blood sugars in the 300-400 range; he was treated acutely with IV fluids and insulin.  He had hypoglycemic episodes once every 2-3 months prior to his medications being changed due to pharmacy protocols.  Following a medication change, his diabetes subsequently worsened with increased fatigue, nausea and polyuria.  At a subsequent 6 April 2005 VA appointment, the examiner noted the CI exercised by walking on a regular basis and that the DM was under poor control following a change of insulin and he appeared to have some degree of diabetic neuropathy.  

The CI underwent a consult with endocrinology on 27 June 2005 (1 year after separation) and was noted to be having one hypoglycemic event a week. He had two events in the past year that required third-person intervention with paramedics having been called; one required an overnight hospitalization.  The examiner stated he had no known complications from his diabetes, with no nephropathy or microvascular complications and no neuropathy substantiated on physical examination.  The specialist approved him for an insulin pump to get his insulin level in balance.  Subsequent VA records indicated the insulin pump was effective, although the CI was diagnosed with peripheral neuropathy in both feet.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the diabetes condition 20%, coded 7913 (DM), citing an A1C of 8 (test indicating blood glucose level; normal is below 5.7%).  In May 2004, 1 month prior to separation, the VA rated the diabetes condition 40%, coded 7913, (DM), based on the STR.  Following the October 2006 C&P examination, 28 months after separation, the VA continued the 40% rating for diabetes and added two 10% ratings under 8520 (sciatic nerve; mild) for the left and the right lower extremity peripheral neuropathies.  

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.  The NARSUM examiner indicated the CI could not perform strenuous activities due to hypoglycemia, and the physical profile also restricted all activities that could be described as strenuous.  The panel concluded that the “regulation of activities” (avoidance of strenuous occupational and recreational activities) stipulation was reasonably met in this case.  Furthermore, following initiation of treatment at the time of diagnosis, the STR showed additional post-separation episodes of hypoglycemia requiring additional hospitalization, but did not show frequent visits to a diabetic care provider (twice a month or more frequently), or complications that could support ratings higher than 40% proximate to separation.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel recommends a disability rating of 40% for the DM condition, coded 7913.  

BOARD FINDINGS:  In the matter of the DM condition, the panel unanimously recommends a disability rating of 40%, coded 7913 IAW VASRD §4.119.  There are no other conditions within the panel’s scope of review for consideration.  

The panel recommends the CI’s prior determination be modified as follows; and, that the discharge with severance pay be re-characterized to reflect permanent disability retirement, effective as of the date of the prior medical separation:  

CONDITION	VASRD CODE	PERMANENT RATING	
Insulin Dependent Diabetes Mellitus …	7913	40%	

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 

AR20170016921, XXXXXXXXXXXXXXXXXXX

XXXXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXXXXXX:

	I accept the recommendation of the Department of Defense Physical Disability Board of Review (DoD PDBR) to re-characterize your separation as a disability retirement with the combined disability rating of 40% effective the date of your medical separation for disability with severance pay.  Enclosed is a copy of the Board’s recommendation and record of proceedings for your information.

	The re-characterization of your separation as a disability retirement will result in an adjustment to your pay providing retirement pay from the date of your original medical separation minus the amount of severance pay you were previously paid at separation.
 
	The accepted DoD PDBR recommendation has been forwarded to the Army Physical Disability Agency for required correction of records and then to the U.S. Defense Finance and Accounting Service to make the necessary adjustment to your pay and allowances.  These agencies will provide you with official notification by mail as soon as the directed corrections have been made and will provide information on your retirement benefits.  Due to the large number of cases in process, please be advised that it may be several months before you receive notification that the corrections are completed and pay adjusted.  Inquiry concerning your correction of records should be addressed to the U.S. Army Physical Disability Agency, (AHRC-DO), XXXXXXXXXXXXXXXXXXX.

	A copy of this decision has also been provided to the Department of Veterans Affairs.

Sincerely,					      
Enclosure