RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-02905
BRANCH OF SERVICE:  Army	SEPARATION DATE:  20050419

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

CI CONTENTION:  “The examination was done with a rushed and almost hostile attitude.  I was instructed to ignore any problems not related to the diabetes because this would force me to be held up for a year or more in med hold and possibly cause me to receive no benefits or compensation.  The evaluation ignored complaints of constant pain and symptoms of PTSD which I have since been diagnosed with to expedite the process and remove me from service.”  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 - 20050407	VARD - 20051221	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Type I Diabetes Mellitus	7913	20%	Diabetes Mellitus, Type I	7913	20%	20051207	
Cephalgia, Resolving	Not Unfitting	Headaches	8100	NSC	20051207	
Bilateral Shoulder Pain, Mild and Intermittent	Not Unfitting	Bilateral Shoulder Problems	5201	NSC	20051207	
Left Knee Pain, Retropatellar Pain Syndrome	Not Unfitting	Left Knee Pain	5257	NSC	20051207	
COMBINED RATING:  20%	COMBINED RATING OF ALL VA CONDITIONS:  20%	

ANALYSIS SUMMARY:  

Type I Diabetes Mellitus.  According to the service treatment record (STR) and MEB narrative summary (NARSUM), the CI’s diabetes condition began in November 2004 in Iraq, after Thanksgiving dinner, when he became sick, vomited, and passed out the following day on the way to seek medical care. The CI had an elevated blood sugar of 645 and was diagnosed with diabetic ketoacidosis.  Following hospitalization and stabilization on insulin, he was medically evacuated from theater.  

The 9 March 2005 MEB NARSUM examination, 1 month prior to separation, noted complaints of elevated blood sugar.  Civilian treatment with insulin adjustments was ongoing with reported fasting blood sugars averaged 140 (normal 74-100), with his last hemoglobin A1C of 7 (AEA goal is less than 7).  Physical examination showed a well-nourished, well developed male who appeared in good health.  Neurologic and ocular examinations demonstrated no evidence of diabetic complications.  The 17 February 2005 fasting blood sugar was 106 and hemoglobin A1C was 7.  The examiner noted the duty restrictions from the temporary profile dated 9 December 2004 of no running, jumping, or marching, no training for the Army Physical Fitness Test (APFT), and no working more than 8-hour shifts.  The permanent profile dated 1 March 2005 allowed unlimited activities and the full APFT, with restrictions on assignments and avoidance of duty where sudden loss of consciousness would be dangerous.  

At the 7 December 2005 VA Compensation and Pension (C&P) examination, 8 months after separation, the CI reported that, following his initial hospitalization at diagnosis, he had no additional hypo or hyperglycemic difficulties which required hospitalization.  He indicated his blood sugar was well controlled on his new insulin regimen, and there were no complaints of complications of diabetes.  Physical examination showed no evidence of ocular, cardiovascular, or neurologic complications of diabetes mellitus.  The examiner’s diagnosis was diabetes mellitus type 1 with current adequate control with multiple daily injections, and dietary restrictions.  

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 multi-dose insulin requirement and blood glucose monitoring which could not be managed outside of a home/garrison environment.  The VA also rated the diabetes mellitus condition 20%, coded 7913, based on the C&P examination, citing current adequate control with multiple daily injections and dietary 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 and stabilization on insulin, the STR and VA evaluations 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 condition.  

Contended PEB Conditions:  Cephalgia, Resolving; Bilateral Shoulder Pain, Mild and Intermittent; and Left Knee Pain, Retropatellar Pain Syndrome.  The panel’s main charge is to assess the fairness of the PEB determination that the contended conditions were not unfitting.  The panel noted that the PEB rendered a de facto “not unfitting” determination by not explicitly addressing the MEB’s submission of left knee pain and the CI contended this condition.  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 cephalgia, resolving; bilateral shoulder pain, mild and intermittent; and left knee pain, retropatellar pain syndrome conditions, 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 20170404, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Record

AR , 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