RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-01848
BRANCH OF SERVICE:  Air Force 	SEPARATION DATE:  20090626

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E5, Security Forces Journeyman, medically separated for “diabetes mellitus type I” with a disability rating of 20%.  

CI CONTENTION:  His condition continues to worsen and negatively impact daily activities.  He also requested review of additional conditions not identified by the Medical Evaluation Board (MEB) and Physical Evaluation Board (PEB).  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 PEB to be unfitting for continued military service, and when specifically requested by the CI, those conditions identified by the 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 - 20090210	VARD - 20101217	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Diabetes Mellitus Type 1	7913	20%	Diabetes Mellitus	7913	20%	20101012	
COMBINED RATING:  20%	COMBINED RATING OF ALL VA CONDITIONS:  60% 	

ANALYSIS SUMMARY:  

Diabetes Mellitus Type 1.  The CI developed type I diabetes mellitus (DM) in 2008 which ultimately required treatment with dietary restrictions and insulin.  He was hospitalized in July 2008 for ketoacidosis.  Hospital discharge instructions included placement on a restricted diet and take insulin twice a day.  There was no comment regarding restriction of activities.  A 30 July 2008 ophthalmology evaluation found no evidence of diabetic retinopathy.  

At the 24 September 2008 MEB examination, 9 months prior to separation, the CI’s chief complaint was listed as “Diabetes follow-up”.  His physical examination (PE) was normal.  The CI’s medication included daily use of insulin.  The examiner did not indicate that avoidance of strenuous occupational and or recreational activities was medically necessary.   A 6 February 2009 duty limiting condition report exempted the CI from aerobic and muscular components of the physical fitness assessment but permitted walking, cycling, swimming, using the elliptical, underwater treadmill, and aqua jogger belt, and strength training with a weight limit of 45 pounds.  

At the 12 October 2010 VA Compensation and Pension (C&P) examination, 16 months after separation, the examiner reported that the CI was taking insulin and that he was not restricted in his ability to perform strenuous activities.  The PE 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 diabetes mellitus condition 20%, coded 7913 (diabetes mellitus), citing use of an insulin pump, no diabetic complications, and no regulation of physical activity secondary to the diabetes condition.  Utilizing the same code, the VA also rated the diabetes mellitus condition 20%, based on the remote C&P examination, citing use of insulin, a restricted diet, no hypoglycemic episodes or ketoacidosis, and no activity restrictions.  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 subsequent 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 mellitus condition.  

BOARD FINDINGS:  In the matter of the diabetes mellitus 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 20170329, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Record 

XXXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXXXXX

		Reference your application submitted under the provisions of DoDI 6040.44 (Section 1554, 10 USC), PDBR Case Number PD-2017-01848.

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