RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-02410
BRANCH OF SERVICE:  Air Force 	SEPARATION DATE:  20050429

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E5, Supply Management, medically separated for “diabetes mellitus requiring insulin injections” with a disability rating of 20%.   

CI CONTENTION:  “The issues acquired during active duty were more severe than noted.  Because of the issues, I was not able to obtain employment.  The same issues worsened over the years.”  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 - 20050224	VARD - 20051116	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Diabetes Mellitus…	7913	20%	Diabetes Mellitus…	7913	20%	20050916	
COMBINED RATING:  20%	COMBINED RATING OF ALL VA CONDITIONS:  60%	

ANALYSIS SUMMARY:  

Diabetes Mellitus (DM).  According to the service treatment record and MEB narrative summary (NARSUM), the CI’s DM condition began in June 2004 after an evaluation for a burning sensation in the hip area led to a laboratory evaluation where his blood sugar level was found to be 313 and 362 with a recheck.  He was treated with oral hypoglycemic medication and insulin.  

At the 6 October 2004 MEB narrative summary (NARSUM) examination, 7 months prior to separation, the CI voiced no specific physical complaints and his current medications included Glucophage (oral hypoglycemic) and Lantus (insulin) on a daily basis.  His general physical examination was normal.  The examiner did not indicate that avoidance of strenuous occupational and or recreational activities was medically necessary.  “Overall [the DM condition] has not interfered with [the CI’s] duty at all and is actually improved [the CI’s] sense of wellness since being diagnosed and treated.” 

At the 16 September 2005 VA Compensation and Pension (C&P) examination, 5 months after separation, the CI reported symptoms of extreme fatigue, dizziness, and excessive sweating, thirst, and urination.  The CI indicated activity restriction, but without explanation and there was no report of cited medical restriction of activity.  His general examination did not reveal any specific DM-related abnormalities.  However, on 21 September 2005, a VA eye examination revealed mild non-proliferative diabetic retinopathy.  There was no report of additional medications used or activities restricted.

The panel directed attention to its rating recommendation based on the above evidence.  Both the PEB and VA utilized the same VASRD code of 7913 (DM) and rated the condition at 20% citing “insulin injections” and “medication use and restricted diet,” respectively.  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 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’s adjudication for the DM condition.  

BOARD FINDINGS:  In the matter of the DM 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 20170227, 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 XXXXXXXXXXXXXXXXXX:

		Reference your application submitted under the provisions of DoDI 6040.44 (Section 1554, 10 USC), PDBR Case Number PD-2017-02410.

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,

		

Attachment:
Record of Proceed