RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2016-01493
BRANCH OF SERVICE:  ARMY 	SEPARATION DATE:  20040312

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was a National Guard E5, Wheeled Vehicle Mechanic, medically separated for “chronic jaw pain” rated 10%.  “Diabetes mellitus” was determined as existed prior to service and not rated.  

CI CONTENTION:  “Review all conditions.”  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 (VA), 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 - 20040127	VARD - 20050302	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Jaw Pain	5099-5003	10%	Residual Fracture Right Mandible	9905	10%	STR	
Diabetes Mellitus 	7913	EPTS	Diabetes Mellitus	7913	NSC	STR	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  20%	

ANALYSIS SUMMARY:  

Chronic Jaw Pain.  According to the service treatment record (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s jaw condition began on 23 April 2003 after being hit in the jaw with a steel bar.  The CI underwent three surgeries, including open reduction and internal fixation; the last surgery, which included the removal of retained hardware, occurred on 10 July 2003.  The 5 September 2003 MEB NARSUM examination, 6 months prior to separation, noted complaints of 8-10/10 jaw pain that occurred 6-7 times per day, and lasted 30 to 90 seconds.  Physical examination showed right jaw defect with tenderness at the right temporomandibular joint (TMJ).  It was noted that the CI was unable to open his jaw completely.  Jaw range of motion was tender.  There was no VA examination in evidence proximate to separation. 

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the jaw condition 10%, coded 5009-5003 citing pain slight and frequent per US Army Physical Disability Agency Policy Guidance, not requiring daily narcotic therapy.  The VA rated the jaw condition 10%, coded 9905, (limited motion of temporomandibular articulation), based on review of the STR, citing slight displacement of the mandible with little loss of jaw motion or masticatory function.  

Although there was no documentation of lateral excursion or inter-incisal range of TMJ motion, the panel noted that there was tenderness of the right TMJ with painful motion and an inability to open the jaw completely, which warranted a 10% rating for painful motion IAW §4.59.  Likewise, there was no evidence of loss of masticatory function that would provide a higher rating under codes 9903 or 9904.  There was no evidence based alternative coding/rating scheme that would result in a rating greater than the 10% adjudicated by the PEB.  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 jaw condition.  

Diabetes Mellitus.  According to the STR and the MEB NARSUM, the CI’s diabetes condition began in September 2002.  Blood sugar was initially 300 but came down to 110 with medication.  The 5 September 2003 MEB NARSUM examination, 6 months prior to separation, noted complaints of diabetes with sugar usually stable at 120-140.  Symptoms of polyuria and polydipsia, blurred vision, shakiness and weakness had improved with treatment.  However, he still had blurred vision, weakness and dizziness with low sugars.  Most recent Hgb-A1c was 7.5 on 18 December 2003.  He was taking glyburide daily to treat the diabetes.  Physical examination was within normal limits with the exception of the jaw examination, which was as described above.  He was not working in his MOS but was working as a van driver.  On 7 January 2004, 2 months prior to separation, the CI stated that “a little over a year and a half ago I was found to have [diabetes], I got on medication and diet, and was found to be okay.  I got activated last Feb. 03.  Tour physical everything was ok was shipped overseas but hurt [and] next thing I [know] I’m a diabetic all over again.”

The panel directed attention to its rating recommendation based on the above evidence.  The PEB did not rate the diabetes condition, but instead found it to have existed prior to service with no service aggravation, coded 7913 (diabetes), citing requirement of oral hypoglycemic agent and restricted diet.  The VA likewise did not rate the condition, but instead found it to be not service connected, coded 7913.  The CI reported that his condition was first diagnosed in September 2002, which was before his activation and overseas deployment.  He was redeployed stateside due to an injury to his jaw and not for complications of his diabetes.  The CI stated that prior to his deployment, he was controlling his diabetes with diet and medications.  His HgbA1C of 7.5 in December 2003 indicated that his condition was fairly well controlled on oral medications and diet.  Since he was controlling his condition with medications and diet prior to activation, there was no evidence of worsening to establish service connection by aggravation or evidence the condition permanently worsened as a result of service.  Therefore, the condition is considered EPTS without service aggravation.  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 diabetes condition. 

BOARD FINDINGS:  In the matter of the jaw condition and IAW VASRD §4.71a and 4.150, the panel unanimously recommends no change in the PEB adjudication.  In the matter of the diabetes 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.  
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, received 20161018, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record 

AR20180001622, 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