RECORD OF PROCEEDINGS PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXXXX		CASE: PD-2017-00375 BRANCH OF SERVICE: MARINE CORPS	SEPARATION DATE: 20060715

SUMMARY OF CASE: Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E3, Machine Gunner, medically separated for “Type II diabetes mellitus (DM)” with a disability rating of 20%.

CI CONTENTION:  Review of all conditions requested.  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 - 20060515	VARD - 20070521	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Type II DM	7913	20%	Type I DM	7913	20%	20070514	
COMBINED RATING: 20%	COMBINED RATING OF ALL VA CONDITIONS: 40%	

ANALYSIS SUMMARY:

Type II DM. According to the service treatment record (STR) and MEB narrative summary (NARSUM), the CI developed Type II DM in 2003. Prior to his deployment to Iraq in 2005 his blood sugars were well controlled with diet. The internal medicine clinic examination, performed on 28 September 2005, noted complaints of some polyuria, polyphagia, and polydipsia with weakness and need to urinate frequently. The examiner noted the CI was on an oral medication (Glyburide and metformin combination) to help control high blood sugar levels which were in the 268-425 range (normal 80-120). He was then prescribed insulin (Lantus®) and instructed to follow up with blood glucose laboratory tests. One month later his blood sugars were down to the 150-175 range while on a Lantus dose of 24 units daily.

At the internal medicine clinic examination, performed on 24 February 2006, 5 months prior to separation, the CI complained of nausea after meals. The examiner noted his elevated levels of GAD antibody test points (immune system stopping insulin being produced, leading to diabetes). His HGB A1C (glycosylated hemoglobin) was 8.7 % (normal below 5.7%). The 16 March 2006 MEB NARSUM examination, 4 months prior to separation, noted the CI’s Type II diabetes was poorly controlled. The examiner noted the most likely reason was “noncompliance with tracking his blood sugar level as well as taking his insulin.” Physical examination showed normal strength, gross motor and sensation intact with normal gait. The primary care clinic examination, performed on 29 November 2006, 4 months after separation, noted he was taking insulin (Lantus) at bedtime and Humolog three times a day. The CI reported his HG A1C in October 2006 was 5.5% (normal).  The examiner found he was negative for polydipsia, polyphagia and polyuria.

The 14 May 2007 VA Compensation and Pension (C&P) examination, 10 months after separation, noted no hypoglycemic reactions, ketoacidosis, numbness, or pain of the upper and lower extremities. The examiner reported no doctor-prescribed bedrest or incapacitation in the last 12 months. He was independent in activities of daily living without impediment. The examiner found he was treated with insulin after meals three times a day and Lantus at bedtime. In November of 2006, his A1C was 8.5%. Physical examination was normal and the examiner noted there was no restricted diet and activities were not restricted.

The panel directed attention to its rating recommendation based on the above evidence. The PEB and the VA both rated the Type II DM condition 20%, coded 7913. The VA based the rating on the C&P examination citing symptoms controlled with insulin. The panel agreed that 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, following initiation of treatment at the time of diagnosis, 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 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 condition.

BOARD FINDINGS:   In the matter of the Type II diabetes mellitus condition and IAW VASRD
§4.119, the panel 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.

2	PD-2017-00375

DEPARTMENT OF THE NAVY
SECRETARY OF THE NAVY COUNCIL OF REVIEW BOARDS 720 KENNON STREET SE STE 309
WASHINGTON NAVY YARD, DC 20374-5023

IN   REPLY   REFER TO,
1850
CORB: 003 20May20

From: 

Director, Secretary of the Navy Council of Review Boards 

Subj:  PHYSICAL DISABILITY BOARD OF REVIEW  (PDBR)

Ref:	(a) DoDI 6040.44
(b) PDBR ltr dtd 29 Mar 19

1.	Pursuant to reference (a), the PDBR reviewed your case and forwarded its recommendation (reference (b)) to the Department of the Navy on 5 Mar 2020 for appropriate action.

2.	On 20 March 2020, the Assistant Secretary of the Navy (Manpower & Reserve Affairs) accepted the recommendation of the PDBR of no change to your characterization of separation or disability rating assigned by the Department of the Navy's Physical Evaluation  Board.

3.	The Secretary's decision on your PDBR application is final and is not subject to appeal or additional review by the Board for Correction of Naval Records.