RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2016-01131
BRANCH OF SERVICE:  ARMY 	SEPARATION DATE:  20040907

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E5, Explosive Ordnance Disposal Specialist, medically separated for “insulin dependent type II diabetes mellitus” with a  disability rating of 20%.  

CI CONTENTION:  Rating should be 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 Medical Evaluation Board (MEB), but determined by the PEB 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.  The panel’s authority is limited to assessing the fairness and accuracy of PEB rating determinations and recommending corrections when appropriate.  The panel’s assessment of the PEB rating determination is based on review of medical records and all available evidence relevant to application of the Veterans Affairs Schedule for Rating Disabilities (VASRD) standards for 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, which operates 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 disability at the time of separation.  

RATING COMPARISON:  

SERVICE PEB - 20040510	VARD - 20050228	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Insulin Dependent Type II Diabetes Mellitus	7913	20%	Diabetes Mellitus	7913	20%	20041129	
COMBINED RATING:  20%	COMBINED RATING OF ALL VA CONDITIONS:  50%	

ANALYSIS SUMMARY:  

Insulin Dependent Type II Diabetes Mellitus.  According to service treatment record (STR) and the MEB narrative summary (NARSUM), the CI’s diabetes condition was recognized during routine lab work for a physical when he was found to have significantly elevated fasting glucose in February 2003.  The CI had no symptoms of diabetes (no polyuria, polydipsia, proteinuria, etc.).  In addition to the elevated fasting glucose, further testing yielded hemoglobin A1c value of 7.3.  He was initially treated with oral hypoglycemic but later changed to insulin due to poor response to oral medication.  The profile performed 4 months before separation restricted the CI from the 2-mile run and unlimited running.  Additionally, his profile allowed for unlimited walking, biking and swimming.  Maximum physical exertion was limited to 15 minutes and moderate to 30 minutes.  

The 3 March 2004 MEB NARSUM, 6 months before separation, noted the CI reported no significant duty limitations secondary to his diabetes.  He was able to do a 12-mile road march without any problems.  It was noted he had no dietary restrictions, and he received insulin therapy.  A regulation of activities was not indicated.  Physical examination was unremarkable.  
The 2 April 2004 MEB NARSUM addendum, 5 months before separation, repeated the examiner’s previous report that the CI was able to eat MREs and field rations; however, recommended the ADA diet (restrictions).  The examiner stated that the CI had “over-estimated” his activity level in order to have a more favorable outcome in regards to being deployed, and was having difficulties with the 2-mile run.  Other statements reflected the language in the profile noted above.  The commander’s performance statement was written prior to his most recent profile, and stated the CI was able to perform fully the duties required of him based on grade and MOS.  It was noted his diabetes was under scrutiny in regards to his ability to deploy.

The 29 November 2004 VA Compensation and Pension (C&P) examination, performed 2 months after separation, documented the CI received insulin therapy, and indicated his daily activities were affected by his condition since he no longer ran or hike.  The CI had not gained nor lost any weight, and had no dietary restrictions.  The examiner noted the CI had never been hospitalized for control of ketoacidosis or hyper/hypoglycemic reactions, and the CI denied any evidence of peripheral neuropathy, diabetic neuropathy or nephropathy.  A required regulation of activities was not recorded.

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 also 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 that the CI’s requirement for insulin and restricted diet justified a 20% rating.  Because there was no evidence of significantly limiting medically prescribed regulation of activities to be considered regulations of activities, the next higher 40% rating was not justified.  The CI was able to engage in unlimited walking, biking and swimming and was able to run 1 mile, and perform maximum exertion for 15 minutes and moderately for 30 minutes.  Although the FPEB referenced a May 03 hospitalization secondary to hypoglycemia, the STR indicated the CI was seen the emergency room for hypoglycemia on 3 May 03, and was released to home without inpatient admission.  Furthermore, the CI denied any hospitalizations secondary to episodes of ketoacidosis, hypoglycemic reactions, 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 Type II diabetes condition.

BOARD FINDINGS:  In the matter of the insulin dependent type II diabetes mellitus condition and IAW VASRD §4.120, the panel unanimously recommends no change in the PEB adjudication.  There are no other conditions within the panel’s scope of review for consideration.  Therefore, the panel recommends 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 20160919, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record 

AR20180005832, 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