RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-01665
BRANCH OF SERVICE:  Army	SEPARATION DATE:  20050810

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E6, Military Policeman, medically separated for “diabetes mellitus, type II, insulin requiring” 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 - 20050615	VARD - 20060208	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Diabetes Mellitus, Type II 	7913	20%	Type II Diabetes Mellitus	7913	20%	20051213	
Cyclothymic Disorder	Not Unfitting	Panic Disorder; Cyclothymic Disorder	9412	30%	20051213	
Panic Disorder	Not Unfitting					
Alcohol Abuse	Not Unfitting					
Recurrent Headaches	Not Unfitting	Cluster Headaches	8199-8100	30%	20051213	
Recurrent Low Back Pain	Not Unfitting	Lumbar Spine Strain	5237	10%	20051213	
Dyslipidemia	Not Unfitting	Dyslipidemia	7099-7000	NSC	20051213	
COMBINED RATING:  20%	COMBINED RATING OF ALL VA CONDITIONS:  70%	

ANALYSIS SUMMARY:  

Diabetes Mellitus, Type II.  According to the service treatment record and MEB narrative summary (NARSUM), the CI’s diabetes mellitus condition began in January 2005 during a routine physical which revealed an elevated fasting glucose of 256 (normal 80-100) without symptoms.  He was started on oral medications; however, the CI ultimately required treatment with dietary restriction and insulin.
The 11 May 2005 MEB NARSUM examination, 3 months prior to separation, noted complaints of diabetes.  His home blood sugars ranged from “180 to 257” (elevated).  He reported experiencing multiple hypoglycemic (low blood sugar) episodes for which he sought out a soft drink or something to eat.  He reported his exercise activities had been moderately limited and he stopped exercising due to hypoglycemic symptoms about 50% of the time.  He had no housework or family responsibility limitations due to his low blood sugar.  He stopped office work about 10% of the time due to his blood sugar level.  The CI indicated there were times when he tried to ignore his hypoglycemic episodes while busy at work.  He was instructed to pay close attention to hypoglycemia symptoms and treat them appropriately with a glucose source.  There were no diabetic related hospitalizations or emergency room visits.  Physical examination cited by the DD Form 2808 examination date 23 March 2005 documented a normal sensory examination.  The 27 January 2005 glycosylated hemoglobin level was 9.2 (elevated), and the 10 May 2005 level was 7.7 (slightly elevated).

At the 13 December 2005 VA Compensation and Pension (C&P) examination, 4 months after separation, the CI reported being on insulin for diabetes.  He denied any neuropathy, bowel, bladder or erectile dysfunction.  Mild intermittent blurred distance vision complaints were evaluated and determined not to be a diabetic complication.  His exercise consisted of:  hiking 3-4 times per week, approximately 2-3 miles each occasion; running 3 times per week, approximately 2 miles each session; and push-ups and sit-ups.  He denied a history of ketoacidosis.  He reported 8-10 episodes of hypoglycemia in the last year as insulin was being adjusted.  He reported hypoglycemia 1-2 times in the last few months manifested by tremors and agitation; blood glucose had been less than 70 with those episodes.  He reported one episode of syncope in the last 6 months secondary to hypoglycemia when his glucose was 20.  Physical examination showed no diabetic abnormalities.  The impression was diabetes mellitus type II, insulin-dependent, without sequelae.

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the diabetes mellitus condition 20%, coded 7913 (diabetes mellitus), citing use of insulin without diabetic sequelae, and no regulation of activities.  The VA also rated the diabetes mellitus condition 20%, also coded 7913, based on the C&P examination, citing the 20% rating criteria.  The panel agreed that the requirement for treatment of diabetes 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, there was no requirement for twice a month visits to a diabetic care provider, proximate to separation; nor were there episodes of ketoacidosis, hypoglycemic reactions, hospitalizations or diabetic 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 mellitus condition.

Contended PEB Conditions:  Cyclothymic Disorder, Panic Disorder, Alcohol Abuse, Recurrent Headaches, Recurrent Low Back Pain and Dyslipidemia.  The panel’s main charge is to assess the fairness of the PEB’s determination that the contended conditions were not unfitting.  None of the conditions were profiled, implicated in the commander’s statement or judged to fail retention standards.  There was no performance-based evidence from the record that any of the conditions significantly interfered with satisfactory duty performance at separation.  After due deliberation, the panel concluded there was insufficient cause to recommend a change in the PEB fitness determination for any of the contended conditions, so no additional disability ratings are recommended. 

BOARD FINDINGS:  In the matter of the diabetes mellitus condition and IAW VASRD §4.119, the panel recommends no change in the PEB adjudication.  In the matter of the contended cyclothymic disorder, panic disorder, alcohol abuse, recurrent headaches, recurrent low back pain and dyslipidemia, the panel recommends no change from the PEB determinations 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 20170306, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Record

AR20180008156, 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