From: To:

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
12 Feb 20

Director, Secretary of the Navy Council of Review Boards 
PD-2017-01128

Subj:	PHYSICAL DISABILITY BOARD OF REVIEW (PDBR)

Ref:	(a) DoDI 6040.44
(b) PDBR ltr dtd 4 Feb 19

1.	Pursuant to reference (a), the PDBR reviewed your case and forwarded its recommendation (reference (b)) to the Department of the Navy of 15 October 2019 for appropriate  action.

2.	On 31 January 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.

RECORD OF PROCEEDINGS PHYSICAL DISABILITY BOARD OF REVIEW
NAME: XXXXXXXXXXXXXXXX	CASE: PD-2017-01128
BRANCH OF SERVICE: NAVY	SEPARATION DATE: 20080430

SUMMARY OF CASE: Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E5, Maintenance Technician, medically separated for “diabetes mellitus” 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 - 20080115	VARD - 20080529	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Diabetes Mellitus	7913	20%	Diabetes Mellitus	7913	20%	20080226	
Hypothyroidism	Cat III	Hypothyroidism	7903	10%	20080226	
Hyperlipidemia	Cat IV	No VA Placement	
COMBINED RATING: 20%	COMBINED RATING OF ALL VA CONDITIONS: 40%	

ANALYSIS SUMMARY:

Diabetes Mellitus (DM). According to the service treatment record (STR) and MEB narrative summary (NARSUM), the CI was diagnosed with DM in June 2007 and was ultimately diagnosed with DM type I, which required treatment with an insulin pump. The 14 August 2007 limited duty (LIMDU) form restricted the fitness test, prolonged physical activity and exposure to extreme temperatures during initiation of treatment with the insulin pump.

At the 10 December 2007 MEB NARSUM examination, 5 months prior to separation, the CI reported recently joining the YMCA and exercising 6 days per week performing 25 minutes of cardio exercise and three days a week lifting weights. 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.

During the 17 December 2007 MEB examination (recorded on DD Forms 2807-1 and 2808), 4 months prior to separation, the examiner noted the CI was treated with an insulin pump, insulin injections and an oral diabetes medication. The CI did not report any functional limitations. The examiner did not indicate that avoidance of strenuous occupational and recreational activities was medically necessary. The STR showed no episodes of diabetic ketoacidosis or hypoglycemia requiring hospitalizations or frequent visits to a diabetic care provider (twice a month or more frequently). There was no evidence of diabetic complications.

At the 26 February 2008 VA Compensation and Pension (C&P) examination, 2 months before separation, the examiner reported the CI was taking insulin with a pump along with oral diabetes medicine. The CI reported having no symptoms associated with the diabetes. The examiner indicated the CI was “able to do all activities.” 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 PEB rated the DM condition 20%, coded 7913 (DM), citing continuous subcutaneous insulin infusion. The VA also rated the DM condition 20%, coded 7913, based on the C&P examination, citing treatment with medication and restricted diet since May 2008.

The panel agreed that the requirement for treatment with insulin and restricted diet justified a 20% rating. Although the LIMDU in August 2007 noted physical activity limitations and the CI’s treating physician counseled her at that time to avoid exercise, once the insulin pump was regulated, the CI’s blood sugars were well controlled and she was counseled to exercise regularly as part of the management of her DM and weight. At the MEB NARSUM the CI reported she was exercising regularly without problems and at the VA examination, the CI reported no symptoms due to the DM. Panel members thus concluded that the “regulation of activities” stipulation was not met in this case, and therefore 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 diabetes 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 DM condition.

Contended PEB Conditions: Hypothyroidism and Hyperlipidemia. The panel’s main charge is to assess the fairness of the PEB determination that the contended conditions were not unfitting. Neither of the conditions were noted on LIMDU forms, implicated in the non-medical assessment or judged to fail retention standards. There was no performance-based evidence from the record that either of the conditions significantly interfered with satisfactory duty performance at separation. Additionally, the hyperlipidemia is a laboratory result and not a physical disability. After due deliberation, the panel concluded there was insufficient cause to recommend a change in the PEB adjudication for either of the contended conditions, so no additional disability ratings are recommended.

BOARD FINDINGS: In the matter of the DM condition and IAW VASRD §4.119, the panel recommends no change in the PEB adjudication. In the matter of the contended hypothyroidism and hyperlipidemia, the panel recommends no change to the PEB adjudications. 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.