[AR Number], XXXXXXXXXX. 

XXXXXXXXXX
XXXXXXXXXX
XXXXXXXXXX

Dear XXXXXXXXXX:

	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

RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXX.	CASE:  PD-2017-02039
BRANCH OF SERVICE:  Army	SEPARATION DATE:  20091014

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E5, Motor Transport Operator, medically separated for “diabetes mellitus Type II” with a disability rating of 20%.

CI CONTENTION: An extensive contention requested review of tension headaches as well as the unfitting diabetes.  The CI 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 - 20090624	VARD - NA	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Diabetes Mellitus Type II	7913	20%	No VA Examination Proximate to Separation in Evidence	
Tension Headaches	Not Unfitting 		
COMBINED RATING:  20%	COMBINED RATING OF ALL VA CONDITIONS:  NA	

ANALYSIS SUMMARY:  

Diabetes Mellitus (DM) Type II.  According to the service treatment record (STR) and MEB narrative summary (NARSUM), the CI was diagnosed with Type II DM in 2006, which ultimately required treatment with Glucovance (metformin), an oral hypoglycemic medication.  The CI was referred to nutritional medicine for dietary regulation in October 2008.  According to the 9 January 2009 MEB examination (recorded on DD Forms 2807-1 and 2808), 9 months prior to separation, the examiner noted that the CI was on Glucovance and Actose (oral hypoglycemic medication).  The CI reported constantly urinating and high blood sugar since 2006.  Laboratory medicine examination showed urine 3+ glucose and 1+ ketones.  Hemoglobin A1C was 8.7%.  The examiner did not indicate that avoidance of strenuous occupational and recreational activities was medically necessary.  

The 14 January 2009 MEB NARSUM examination, 9 months prior to separation, noted that the CI was on Glucovance and Actose.  The CI reported no complications of diabetes but the addition of multiple oral medications in an attempt to get her diabetes under good control (without significant success).  Physical examination showed the diabetic and neurological examinations were normal with no ulcers, sores, or calluses.  Hemoglobin A1C was 9.1%.  The examiner noted that the CI was able to perform both the duties of her military occupational specialty and of a soldier and did not indicate that avoidance of strenuous occupational and recreational activities was medically necessary.  The examiner did note that the next step for the CI would be the addition of long-acting insulin, which was planned in the near future.  He also stated that she should not be assigned to units where she would have prolonged consumption of pre-packaged meals on a regular basis.  There was no VA examination proximate to separation in evidence. 

At the 15 April 2009 internal medicine clinic appointment, 6 months prior to separation, the CI reported not feeling tired or poorly, no blurry vision, polyphagia (excessive hunger) or nausea.  Physical examination showed no signs of diabetic complications. Laboratory medicine examination included:  hemoglobin A1C was 9.1% from April 2009, an increase from 8.7% January 2009 and from 6.8% in July 2008.  There were no hospitalizations or emergency room visits noted.  The CI’s condition was “uncomplicated and with poor control” with blood sugar tests higher than previous visits.  “Lantus (insulin) 10 units PM” was recommended.

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the DM Type II condition 20%, 7913, citing the requirement for insulin and restricted diet which the panel agreed 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 complications that could support higher ratings.  Although the CI had frequent visits to a diabetic care provider (twice a month or more frequently), there was no regulation of activities to support a higher rating.  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 diabetes condition.

Contended PEB Condition:  Tension Headaches.  The panel’s main charge is to assess the fairness of the PEB determination that the contended condition was not unfitting.  The contended condition was not profiled or implicated in the commander’s statement and did not 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 there was insufficient cause to recommend a change in the PEB fitness determination for the tension headaches, so no additional disability rating is recommended.  

BOARD FINDINGS:  In the matter of the Type II diabetes mellitus condition and IAW VASRD §4.120, the panel recommends no change in the PEB adjudication.  In the matter of the contended tension headaches, the panel recommends no change from the PEB 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 20170308, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Record