RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-00998
BRANCH OF SERVICE:  ARMY 	SEPARATION DATE:  20080602

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E4, Health Care Specialist, medically separated for “diabetes mellitus, type I” with a disability rating of 20%.  A chest wall condition was determined to have existed prior to service (EPTS) and was 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 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 - 20080214	VARD - 20080724	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Diabetes Mellitus, Type I	7913	20%	Diabetes Mellitus- Type I	7913	60%	20080411	
Chest Wall Pain	5099-5003	EPTS	Costochondritis	5019-5297	0%		
Left Carpal Tunnel Syndrome	Not Unfitting	Carpal Tunnel Syndrome	8599-8515	0%		
COMBINED RATING:  20%	COMBINED RATING OF ALL VA CONDITIONS:  60% 	

ANALYSIS SUMMARY:  

Diabetes Mellitus, Type I.  According to the service treatment record (STR) and the MEB narrative summary (NARSUM), the CI developed type I diabetes mellitus in May 2007 which ultimately required treatment with dietary restriction and insulin.  The condition was discovered after the CI experienced blurred vision, polyuria and polydipsia and was admitted with elevated blood glucose levels without ketoacidosis.  Following initiation of treatment at the time of diagnosis, the STR showed no episodes of ketoacidosis or hypoglycemia requiring hospitalizations.  There was no evidence of diabetic complications.  The 29 August 2007 MEB NARSUM examination, 9 months prior to separation, noted that the CI was on insulin.  The CI reported no functional limitations.  The physical examination showed no complication from the CI’s diabetic condition.  The 25 September 2007 permanent profile did not restrict activities.  

At the 11 April 2008 VA Compensation and Pension (C&P) evaluation, 2 months before separation, the examiner reported the CI was taking insulin with the aid of an insulin pump.  The CI reported he had been hospitalized when diagnosed with diabetes for ketoacidosis and was seeing the doctor three times per month to control his disease.  The examiner did not indicate that avoidance of strenuous occupational and recreational activities was medically necessary.  The physical examination was normal, showing no evidence of retinopathy, neuropathy or other complications of diabetes.  

The panel directed attention to its rating recommendation based on the above evidence.  The panel noted the STR repeatedly documented that ketones were negative at the time of the CI’s hospitalization in May of 2007.  Furthermore, after his initial evaluation and stabilization, with the exception of visits related to his MEB, the CI was seeing a provider for the purpose of managing his diabetes approximately 1-1.5 times per month.  At no time was the CI advised to restrict his activities to gain control over his blood glucose levels.  The PEB rated the diabetes condition 20%, coded 7913, citing no complications and not requiring activity limitations.  The VA rated the diabetes condition 60%, coded 7913, citing insulin use, episodes of ketoacidosis and visits to the doctor 3 times per month for diabetes.  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, 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.  

Contended PEB Condition:  Chest Wall Pain.  According to the STR and the MEB NARSUM, the CI’s chest wall pain began prior to service in 1998 when he rolled an ATV causing a fracture to the sternum.  He initially entered service in June 1999, but was separated after three weeks due to sternum pain.  In 2006 he obtained a waiver for his history of sternum fracture and entered the service on 26 April 2006.  There was no report of chest wall pain until 11 October 2006 when the CI’s central sternum area became symptomatic after performing the fireman’s carry with a 150-200 pound dummy.  There were no treatment notes in the STR for chest wall pain from 21 October 2006 until the condition was profiled on 16 March 2007.  

During the 28 June 2007 MEB examination (recorded on DD Forms 2807-1 and 2808), 11 months prior to separation, the examiner noted decreased strength along the left side as a result of painful motion on the left sternal boarder.  The 29 August 2007 MEB NARSUM examination, 9 months prior to separation, noted complaints of chest wall pain. The examiner stated the condition was stable but likely to get worse if the CI remained in military service.  

At the 11 April 2008 VA C&P evaluation, 2 months before separation, the CI reported constant, localized pain in the upper left chest.  The pain was described as burning, aching and sharp and made worse with strenuous activities.  The examiner found no muscle weakness or wasting.  

The panel directed attention to its recommendation based on the above evidence.  The PEB did not rate the chest wall pain citing the condition was a residual of a sternal fracture that EPTS and was not permanently service aggravated.  The VA rated the chest wall pain 0%, coded 5019-5297 (bursitis - removal of ribs) based on the C&P examination 2 months before separation, citing no removal of a rib and no limitation in range of motion of any body part.  The panel noted that after the fireman’s carry in October 2006, the pain was located in the central sternum, but proximate to separation it was described as being in the upper left chest.  After due deliberation, considering all of the evidence, the panel concluded the chest wall pain was not permanently aggravated by service beyond the natural progression of the condition and therefore recommends no change in the PEB’s adjudication.  

BOARD FINDINGS:  In the matter of the diabetes mellitus, type I condition and IAW VASRD §4.120, the panel unanimously recommends no change in the PEB adjudication.  In the matter of the contended chest wall pain, the panel unanimously agrees that it cannot recommend it for additional disability rating.  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 20170120, w/attachments
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

AR20180005697, 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