RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX		CASE:  PD-2017-01027
BRANCH OF SERVICE:  army 	SEPARATION DATE:  20060105

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E3, Military Policeman, medically separated for “type I, insulin-dependent ketogenic diabetes” with a disability rating of 20%.  

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 - 20051122	VARD - 20060522	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Diabetes Mellitus, Type I	7913	20%	Diabetes Mellitus, Type I	7913	40%	20060306	
Shoulder Dislocation	Not Unfitting	Status Post Left Shoulder Dislocation	5299-5203	0%	20060306	
COMBINED RATING:  20%	COMBINED RATING OF ALL VA CONDITIONS:  40%	

ANALYSIS SUMMARY:  

Type I, Insulin-Dependent Ketogenic Diabetes.  The CI developed type I diabetes mellitus in January 2005, which required treatment with insulin.  According to the 7 June 2005 MEB examination (recorded on DD Form 2807-1), 7 months prior to separation, the examiner noted that the CI’s urinalysis showed no sugar and there was a normal endocrine evaluation.  The examiner did not indicate that avoidance of strenuous occupational and recreational activities was medically necessary.  The 29 August 2005 MEB narrative summary (NARSUM) examination, 4 months prior to separation, noted that the CI was taking NovoLog (insulin) before meals and Lantus (insulin) before bedtime.  It was noted the CI’s hemoglobin A1C was 6.4 on 11 May 2005 (indicative of well-controlled diabetes).  The CI reported he was able to do his garrison duties adequately, but had difficulties in field conditions because of diet issues.  The examiner noted that “several of [the CI’s] hypoglycemic episodes…occurred while in the field.”  The examiner did not indicate that avoidance of strenuous occupational and recreational activities was medically necessary.  Following initiation of treatment at the time of diagnosis, the STR showed one subsequent episode of hypoglycemia requiring hospitalization (3 February 2005).  There was another hospitalization on 2 March 2005, but it was for hyperglycemia.  Other than restricting the CI from field exercises, the permanent profile did not restrict activities; however, it limited deployment to areas with definitive medical care.  

At the 6 March 2006 VA Compensation and Pension (C&P) evaluation, 2 months after separation, the examiner reported that the CI was taking NovoLog three times a day and Lantus once a day.  The CI reported no functional limitations.  The examiner noted the CI had been hospitalized two times during the past year for hypoglycemia and visited the doctor once a month for his diabetes.  The examiner did not indicate that avoidance of strenuous occupational and recreational activities was medically necessary.  On physical examination, the eyes, heart, lungs, and sensation were normal.  The examiner did not indicate that any renal impairment was present.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the diabetes condition at 20%, coded 7913, citing insulin and dietary control requirements.  Utilizing the same code, the VA rated the diabetes condition at 40%, citing requirement for insulin, restricted diet and regulation of activities.  The panel agreed that the requirement for treatment with insulin and restricted diet justified a 20% rating.  Although there was evidence of one episode of hypoglycemia (after the initial diagnosis and initiation of treatment) requiring hospitalization, there was no medically-prescribed regulation of activities.  Therefore, the next higher 40% rating was not justified.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel concluded there was insufficient cause to recommend a change in the PEB’s adjudication for the diabetes mellitus condition.  

Contended PEB Condition:  Left Shoulder Dislocation.  The panel’s main charge is to assess the fairness of the PEB’s determination that the contended condition was not unfitting.  The contended condition was not profiled, implicated in the commander’s statement nor judged to fail retention standards.  There was no performance-based evidence from the record that the condition significantly interfered with satisfactory duty performance at separation.  After due deliberation, the panel concluded that there was insufficient cause to recommend a change in the PEB fitness determination for the contended condition and so no additional disability rating is recommended.  

BOARD FINDINGS:  In the matter of the diabetes condition and IAW VASRD §4.120, the panel unanimously recommends no change in the PEB adjudication.  In the matter of the contended left shoulder condition, the panel unanimously recommends no change from the PEB’s determination as not unfitting.  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 20170224, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record 

AR20180005505, 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