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

XXXXXXXXXX
XXXXXXXXXX
XXXXXXXXXX

Dear XXXXXXXXXX:

		Reference your application submitted under the provisions of DoDI 6040.44 (Section 1554, 10 USC), PDBR Case Number PD-2017-02122.

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,

								XXXXXXXXXX

Attachment:
Record of Proceedings 

RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXX	CASE:  PD-2017-02122
BRANCH OF SERVICE:  Air Force	SEPARATION DATE:  20071203

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E4, Aircrew Egress Systems Journeyman, medically separated for “diabetes mellitus type I” 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 - 20070926	VARD - 20080819	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Diabetes Mellitus Type I	7913	20%	Diabetes Mellitus Type I with Polydipsia and Polyurea	7913	20%	20080701	
COMBINED RATING:  20%	COMBINED RATING OF ALL VA CONDITIONS:  30%	

ANALYSIS SUMMARY:  

Diabetes Mellitus Type I.  According to the service treatment record (STR) and MEB narrative summary (NARSUM), the CI sought treatment in July 2007 due to complaints of polydipsia, polyuria and blurry vision.  His glucose levels were greater than 800mg/dL and he was hospitalized for 4 days for treatment of hyperglycemic state and new-onset of diabetes mellitus.  He was started on an initial insulin regimen which was adjusted prior to discharge.
 
During the 9 August 2007 MEB NARSUM examination, 4 months prior to separation, the CI was doing well without specific complaint, and taking Lantus (before bed) and Novalog (before meals) insulin; physical examination was unremarkable.  A 9 August 2007 profile did not restrict activities.

At the 1 July 2008 VA Compensation and Pension (C&P) examination, 7 months after separation, the CI reported that he had to regulate his eating and exercise, and experienced hypoglycemia 2 or 3 times per week, which he treated with regular soda.  He took Novolog and Lantus insulin, with blood sugar generally ranging from 80 and 240 mg/dl.  He reported good exercise levels, and denied kidney, bowel or bladder problems, neuropathy, or cardiovascular disease.  Polyuria and polydipsia had been present only with prolonged hyperglycemia.  Physical examination showed no objective cardiovascular, neurological, eye, skin, bowel, or bladder findings of diabetes mellitus complications.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the diabetes mellitus 20%, coded 7913 (diabetes mellitus), citing insulin to control diabetes.  The VA also rated the diabetes mellitus 20%, coded 7913, based on the STR and C&P examination, citing requirement for insulin or oral hypoglycemic agent and restricted diet.  Members agreed that while the requirement for insulin and a restricted diet justified a 20% rating, there was no evidence of medically-prescribed activity regulation to warrant a higher 40% rating.  Furthermore, following initial treatment, 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 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.  

BOARD FINDINGS:  In the matter of the diabetes mellitus and IAW VASRD §4.121, 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 20170212, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Record