RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-01169
BRANCH OF SERVICE:  Air Force	SEPARATION DATE:  20090527

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was a National Guard E6, Security Forces Craftsman, medically separated for “diabetes mellitus, insulin dependent,” with a disability rating of 20%.  

CI CONTENTION:  The CI requested that all conditions be reviewed.  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 - 20090413	VARD - 20100312	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Diabetes Mellitus, Insulin Dependent	7913	20%	Diabetes Mellitus, Type II, with Early Diabetic Nephropathy	7913	20%	20091102	
COMBINED RATING:  20%	COMBINED RATING OF ALL VA CONDITIONS:  20%	

ANALYSIS SUMMARY:  

Diabetes Mellitus, Insulin Dependent.  According to the service treatment record (STR) and MEB narrative summary (NARSUM), the CI developed type II diabetes mellitus in 2003 which ultimately required treatment with dietary restrictions and insulin.  The 29 December 2008 MEB NARSUM examination, 5 months prior to separation, noted that the CI was prescribed twice daily long acting insulin and 2 to 3 times daily sliding scale insulin.  The CI reported that he had no physical limitations and he exercised on a daily basis with no chest pain or shortness of breath.  The examiner did not indicate that avoidance of strenuous occupational and recreational activities was medically necessary.  The CI’s commander also reported in November 2008 that the CI was able to perform all in-garrison duties without restrictions, limitations, or work-arounds.  No physical profile was provided in the evidence of record, but a duty limiting condition report issued 14 October 2008 indicated the CI was not world-wide deployable due to undergoing a MEB, but no physical restrictions were listed.  

At the 2 November 2009 VA Compensation and Pension (C&P) evaluation, 5 months after separation, the examiner reported that the CI had dietary restrictions and was taking insulin.  The CI reported he was not having any symptoms from his diabetes.  The examiner stated the CI had not been hospitalized in the past year for his diabetes, was not having hypoglycemia, and had not been in ketoacidosis.  The CI’s physical activity was not restricted in order to control his blood sugar.  Physical examination showed early diabetic neuropathy with microalbuminuria, but normal renal function and no evidence of retinopathy.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the diabetes condition 20%, coded 7913 (diabetes mellitus).  The VA also rated the diabetes condition 20%, coded 7913, based on the C&P examination, citing clinical evidence that he required diet and insulin for control.  

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 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 adjudication for the diabetes condition.  

BOARD FINDINGS:  In the matter of the diabetes 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.  

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20170222, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Record

SAF/MRB
1500 West Perimeter Road, Suite 3700
Joint Base Andrews, MD  20762

XXXXXXXXXXXXXXXXXX

Dear Applicant:

Reference your application submitted under the provisions of DoDI 6040.44 (Section 1554, 10 USC), PDBR Case Number PD-2017-01169.

After careful consideration of your application and treatment records, the Physical Disability Board of Review determined that the rating assigned at the time of final disposition of your disability evaluation system processing was appropriate.  Accordingly, the Board recommended no re-characterization or modification of your separation.

I have carefully reviewed the evidence of record and the recommendation of the Board.  I concur with that finding and their conclusion that re-characterization of your separation is not warranted.  Accordingly, I accept their recommendation that your application be denied.

						Sincerely,

		

								XXXXXXXXXXXXXXXXXX
								Director
								Air Force Review Boards Agency

Attachment:
Record of Proceedings